aAfter nearly a year of pandemic panic, the end is in sight. But you still have to squint.
The FDA has allowed the Emergency Use Authority for two safe and effective vaccines, which science has distributed at record speeds. Now the question is: how do we best distribute them?
The Center for Advisory Committee on Disease Control and Prevention Practice (ACIP) has published guidance that vaccination should begin with health care personnel and residents of long-term care facilities, followed by other essential frontline workers and people over the age of 75. Only one sub-denomination mentioned how a history of Kovid-19 infection should affect one’s location in the line: “The end of HCP90 with documented acute SARS-CoV-2 infection in the first 90 days. May choose to delay vaccination. The duration of the day to facilitate vaccination of those HCPs who remain susceptible. “
Given the low risk for reinfection and the limited supply of vaccine doses, it would be a mistake not to make previous infections a more central consideration in our vaccine priority. An estimated 75 million Americans were already infected with SARS-CoV-2, but only 24 million know it, using a broad-scale Kovid-19 antibody test can help better vaccine allocation to those at highest risk . Doing so can save lives and return us to normalcy soon.
This strategy constitutes the two largest discoveries made in attempts against the virus. The first is that after infection, there appears to be lasting and strong immunity for more than six months, including mild and asymptomatic infection. The fact that about 100 million cases of Kovid-19 have been confirmed worldwide and only a handful of documents have strong evidence of permanent immunity. And even among rare reinfectas, their course will likely be thanks to the immune system’s memory.
The second breakthrough is the grand success of the Kovid-19 vaccine development.
This combination of permanent immunity and effective vaccines has been the cornerstone of almost all previous successes against the virus (HIV, to date, being the major exception). How it causes havoc of smallpox, polio, measles, mumps, and other infectious diseases. And this is how we will defeat Kovid-19.
But even in the best case scenario, it will be months before enough vaccine doses have been made to treat everyone. Epidemiologists estimate that two-thirds of the population needed to be protected from the epidemic must be immune to herd protection, an antibody-assisted approach would allow us to reach that limit faster.
Here is another reason why an antibody-assisted approach is needed for vaccination: due to a combination of insufficient testing and asymptomatic infection, most people infected with Kovid-19 are never diagnosed. This is especially true in virus-prone states. For example, in New York State, it is estimated that 30% of the population has recovered from Kovid-19, while only 7% have been diagnosed with the virus. Underdiagnosis is not limited to places like New York, which had an early boom. More than 36% of North dacoits are estimated to be infected, while only 13% have been diagnosed. Given these discrepancies, in states such as North Dakota, without the aid of antibody testing, I estimate that any of the 1 to 4 vaccines that are currently immune to Kovid-19 may be given.
While the presence of antibodies is not a true measurement of immunity, thanks to the rarity of reassignment and the accuracy of current antibody testing (with false positive rates of around 1% or less), people with antibodies are safely at low risk. Can be considered a group. This reality was further confirmed in Oxford University’s New England Journal of Medicine report, which followed 12,000 health care workers over six months and found no symptomatic infection in people with antibodies to SARS-CoV-2.
But there are two different things in theory and practice. Attempts to test the public’s swath for antibodies may seem unwise, with the US increasing difficulty in testing PCR, and with initial vaccine delivery sputtering. It is not.
With respect to scaling antibody testing, this procedure is completely different from the PCR-based test used to detect acute infection. Antibody tests are similar to traditional bloodwork and are processed as automated immunoassays. This means that they can be run in large batches on machines that are already in almost all functional medical laboratories and can use the existing laboratory collection infrastructure for collection and processing. Benjamin Meiser, a pathologist at Johns Hopkins Hospital, told me, “The delays we’ve encountered in PCR testing shouldn’t stop people from doing antibody tests if they are necessary. Antibody testing is very simple to perform and can be rotated in hours rather than days. “
An easy place to start would be to test for antibodies in people already in need of lab tests for other reasons, such as when they are hospitalized, in the emergency department, or in an clinic appointment. Standing orders with canceled copyrights may further extend access to others in clinical and commercial laboratories. School- and employer-based batch testing may inform their future vaccination campaigns.
To be clear, it is safe and beneficial for people previously infected with SARS-CoV-2 (just like adults who needed a booster to prevent chickenpox). It is a reasonable investment to support both tests And Vaccination. These efforts should be competitive, not competitive. And if access to antibody testing is not easily accessible, vaccination should never be delayed. Finally, once we have sufficient supplies to meet public demand, everyone should be vaccinated, regardless of antibody status.
I can close with an argument about how an antibody-assisted approach would allow the US to have faster access to herd immunity. Or will accelerate our economy. Or protect more frontline workers – nurses, teachers, grocers, delivery drivers, firefighters and others – soon.
But for me, and I suspect for you too, it is far less abstract than that. For every vaccine we save using antibody testing, there will be one more we can give to a high-risk person who is eagerly waiting for his or her turn in the line. And we all have loved ones standing in line: an elderly grandparents, an immunized mother, or a cousin fighting cancer.
Given that we have done so far to keep them safe – postponed meals, canceled holidays, and missed hugs – we must employ every weapon in our armaments against this plague. This includes antibody testing.
Michael Rose is a resident physician in internal medicine and pediatrics at Johns Hopkins University School of Medicine.