As medical experts and epidemiologists learn more about COVID-19, a question remains: How do antibodies fit into the response to the pandemic?
The answer is still unclear, said Dr. Clay Marsh, the state’s coronavirus czar.
“The antibody tests have really not found their home yet, I don’t think,” Marsh said. “In targeted populations, it can be very useful. There’s been work recently following people who have had COVID-19 to see what their response is as far as antibodies go, but in places with low incidence — like in West Virginia, despite the recent rise in cases — I don’t think antibody testing has really found its place.”
Antibodies are large proteins in the body used by the immune system to identify and neutralize viruses. Through blood samples from patients, antibody tests can be used to see whether someone had, at some point, been infected with the virus.
But antibodies differ depending on the virus from which they spawn, according to Dr. Sally Hodder, associate vice president for clinical and translational science at WVU Health Sciences. The infancy of COVID-19 — it was first detected in December — means there is less research and science on how its antibodies work compared to other viruses.
“For diseases that have been around for thousands and thousands of years, and that medical science has known about for decades, we know more about how antibodies can be used and react,” Hodder said. “Measles, for instance: once you develop antibodies, part of that antibody is generated by having the infection or [vaccine]. We can do the antibody testing then and say you’re immune. We do not have that knowledge for the coronavirus. It’s too new.”
With many illnesses, not just measles, antibodies can be used to build up immunity and prevent future reinfection. But with COVID-19, that is not guaranteed, Hodder said.
Marsh and Hodder both gave the example of Sweden, a country of 10 million people that, early in the global pandemic, decided against shutting down businesses and instead allowed citizens to spread the disease in an attempt to gain herd immunity.
The experiment didn’t work, Hodder said. The coronavirus reproduction value, or the average number of people who are infected by one person, is estimated to be about 2.5. In order to get herd immunity, Marsh said, 70% of the population would have to be infected.
By recent counts, only about 7% were infected, and to date, more than 5,500 Swedes have died from COVID-19, more than any other Scandinavian country, according to the World Health Organization.
“Now, people are saying herd immunity is not possible,” Marsh said.
Research suggests antibodies from the virus can stay in the body for roughly three months — not very long, according to Marsh.
Antibody tests in West Virginia and throughout the country provide limited information, Marsh said. In short, they can tell you whether the antibodies are present, but not how concentrated they are.
This is an improvement from early COVID-19 antibody tests, which sometimes had a 50/50 chance of being accurate, Hodder said. Now, those tests recommended by the Food and Drug Administration register accuracy rates at 90% or higher.
But not knowing how many antibodies are present limits their utility in fighting the virus. With many diseases, antibodies in plasma or a serum can be injected into people with the same blood type who currently have the virus to help them fight and overcome it, Hodder said. Because antibodies from COVID-19 are so temporary, there’s no guarantee introducing them into another body would do any good, especially in the long term.
“I think, frankly, we’re not really going to be looking at that until we get an effective vaccine, then going to be figuring out more about this virus, and how antibodies can help,” Hodder said.
Marsh said there is a chance those carrying antibodies could be less likely to immediately contract the virus again, but that’s not guaranteed. There’s also no way to know whether their body would react the same to subsequent infections, Hodder said.
“At this point, I think the best thing we can do is make no assumptions,” Hodder said.
Today, antibody tests are being offered at different places throughout the state. Some health departments — such as Kanawha-Charleston Health Department — are the tests by appointment and request. Private lab companies, like LabCorps, are also offering them, as well as several hospitals.
At Beckley ARH, however, CEO Rocky Massey said his team has not yet determined where antibody testing would come into their pandemic response.
“The verdict is still out on antibody testing, I think,” Massey said. “At first, there were some false negatives and false positives. It’s better now, yes, but I’m not sure how it fits, what the role would be right now.”
Despite doubts and early challenges, many in the state have opted for the tests. At first, Marsh said, the rush came from people who believed they could have been sick in the early days of the pandemic but were unable to access tests at the time because of limited testing capacity.
Now, Hodder said, testing requests are understandably being driven by curiosity and people seeking a sense of comfort from the unknowns of the virus. But people should still be careful in drawing conclusions from antibody tests, Hodder warned.
“I think if I had had a similar illness I’d be curious, and I really get that — we want to know things, who can blame us,” Hodder said. “But I think the danger here is that folks will start to make conclusions on what we should do and not do, based on a small yes or no, telling them if they’ve had the virus.”
For Susan Small, of Charleston, who underwent an antibody test in June, it was a way to put her mind at ease about a previous illness.
Small, who also works at the West Virginia Public Service Commission, said that a few months before her test, she became sicker than she’d been in her life.
“I was too sick to get out of the bed and go to the doctor’s to get the flu test. I could not move, my head was paralyzed. It ended up turning into pneumonia, but I had a lot of the same symptoms of COVID-19,” Small said.
In June, she was planning to visit her sister in New Jersey, who years before had cancer.
“If I had the antibodies, I’d feel a little better about going and seeing her — and we went anyway; but we were very safe,” Small said. “It was also a bit of curiosity — I never get sick, and this was the worst, the absolute worst.”
Small paid $10 for her test through LabCorps, in South Charleston. The results were negative.
“I was — frankly I was disappointed at the results,” Small said. “I hoped the awful thing I went through was the worst I could get. Now, I don’t know if that’s true.”
Emily Porter, who also lives in Charleston and works as a wedding photographer, underwent the antibody test to give herself peace of mind as weddings start up again and her workload — and person-to-person interaction — increases.
“I just thought it may be useful to know if I’ve had it, even though I’m not sure how accurate the antibody [tests] are,” Porter said.
Porter said she had symptoms similar to those of COVID-19 in January. For her, the test was a comfort.
“I feel like knowing for sure — or even with more certainty than just assuming — is useful. Now I know I haven’t had it, so it’s even more incentive to keep masks on and stay distanced from people, especially considering we’re still learning about the long term effects on people who recover.”
With West Virginia’s cases hitting new highs this week, Marsh and Hodder both were adamant that — regardless of antibody tests — everyone should take all precautions to limit the spread of COVID-19, just like Porter.
“The only thing we have right now to prevent this virus is really human behavior: wearing masks, washing hands, not touching your face, keeping distance. It’s hard to change, but we know it works until we have a vaccine,” Hodder said. “No matter what an antibody test says, this is uncharted territory for all of us and continuing these behaviors — things we know work — can limit the risk of spread. We need to continue our focus on that.”