John Iafrate, MD, PhD, and Edward Ryan, MD, break down the basics about antibodies, serology testing and the potential implications of a positive antibody presence in the case of COVID-19.
As the COVID-19 curve flattens in the United States, medical experts and policymakers discuss what to expect throughout the remainder of the year and what will be necessary to resume daily life. In a Massachusetts General Hospital COVID-19 Virtual Seminar Series, a panel of experts—including Timothy Ferris, MD, MPH, chair of the board and chief executive officer, Mass General Physicians Organization; Eric Rosenberg, MD, director of Microbiology Laboratories; and Rochelle Walensky, MD, MPH, chief of the Division of Infectious Diseases—discussed breakthroughs in testing and tracing as well as implications for the future.
What is the next step in testing?
Many experts believe that direct-to-consumer testing is the next step in mitigating further spread of the virus. Dr. Rosenberg explained that the challenges surrounding these tests are:
- Ensuring the specimen (i.e. saliva, nasal swab, etc.) is appropriately obtained
- The ease at which a positive or negative test result can be determined, as the results displayed on many at-home tests can be hard to read
Going forward, another challenge with testing is the implications for vulnerable populations, says Dr. Walensky.
“I have heard it said that isolation and quarantine is a privilege,” says Dr. Walensky. “Our testing plan must also take into account how we will treat vulnerable populations.” Many individuals may not come forward with symptoms if they believe they will lose their jobs, their homes and their livelihoods, if they have to quarantine for two weeks, she explains.
Does the presence of antibodies mean you are immune?
Antibodies are proteins in the blood produced quickly by the body to fight a pathogen (such as a virus) and often provide long-term protection, should the pathogen invade the body again.
There are currently not enough data on whether antibodies in COVID-19 patients provide protective immunity or how long that immunity lasts, as there has not been enough time to conduct the studies necessary to determine it.
“Antibodies may mean you are protected, but we simple don’t know yet,” says Dr. Rosenberg. There is not enough information to conclude if those individuals who develop antibodies in response to COVID-19 infection are immune or protected from re-infection. Therefore, we strongly recommend that even if a person tests positive for antibodies that does not mean you can go back to work or stop physical distancing, he says.
Is herd immunity likely?
“Herd immunity suggests that if enough people were immune to the disease, then people who are susceptible might be protected as well because the transmission cycles would stop,” says Dr. Walensky. However, as mentioned, whether or not immunity can be determined from a positive presence of COVID-19 antibody remains unclear.
According to Dr. Walensky, herd immunity requires 50-66% of the population to have protective antibodies. To date, she says that the United States is not yet close to meeting this number, as this is usually accomplished through large-scale vaccination strategies.
What is the role and expected timeline of a vaccine?
“Vaccines will help us get to herd immunity,” says Dr. Walensky. “And, if and when we have them, they will be a game-changer.”
Referencing a previous statement made by Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases and member of the White House's coronavirus task force, Dr. Walensky says that about 18 months is needed to develop a vaccine.
Until a vaccine is rolled out, she anticipates that we will need to continue many of our physical distancing measures in order to protect against infections in immunocompromised and vulnerable populations.
Are containment strategies like contact tracing viable?
Up until this point, many countries in the world have been implementing mitigation strategies to stop transmission of the virus through contact, which include tactics like increased handwashing, physical distancing measures and school closures.
Containment strategies are typically used when testing becomes so widely available that everyone can be tested, and health care systems can quickly identify those who are infected and treat them. From there, the next step in a containment strategy is to identify anyone that the individual in care has been in contact with. For COVID-19 a “contact” is someone who has been within a six-foot distance for longer than 10 minutes.
“If we can isolate people who have the disease and contact trace all of their contacts, then we could potentially quarantine them and stop the disease transmission,” says Dr. Walensky.
This strategy is routinely done with measles cases, since there are so few cases in the US. However, even with such few cases, contact tracing methods are enormously resource-intensive. In order to successfully implement these strategies, testing capabilities must be greatly improved and states must have the appropriate resources to implement them, says Dr. Walensky.
What will the new “normal” look like?
According to Dr. Ferris, a long-term normal will involve measures such as optimizing every social gathering to ensure there is physical space, wearing masks and being asked to report symptoms frequently.
“One of the most challenging areas will be schools and kids,” says Dr. Ferris. “How will parents go to work without congregate settings for kids? I think that is one of the major things that has yet to be resolved.” He anticipates that we will learn within the next four months which measures are necessary to bring society back to an environment with which it is more familiar.
For Dr. Walensky, she opts to envision a “better normal.”
“I do not think we will get back to the normal we once knew, but there are opportunities to get to a different normal—and some of it may be a better normal,” says Dr. Walensky. People have learned to connect in new ways through technology as well as better care for and communicate with the elderly and vulnerable populations.
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