The Washigtnon Post - 03.04.2020

(Joyce) #1

friday, april 3 , 2020. the washington post eZ re A

the coronavirus pandemic


At the root of almost every plan
to restart society is a new kind of
coronavirus test that searches not
for the virus itself, but the rem-
nants floating in people’s blood of
the battle between their immune
system and the infection.
These “serology tests” aren’t
aimed primarily at p eople who cur-
rently have the disease caused by
the novel coronavirus, but anyone
who has ever had it — those who
were very sick and got better, those
who had mild symptoms they mis-
took for something else and those
who never felt sick at all. Those
people, whether they know it or
not, may have disease-fighting an-
tibodies that give them some im-
munity to the coronavirus.
Serology testing is becoming a
new pandemic buzzword, at the
center of many of the most ambi-
tious and reputable recovery
plans. A report by Scott Gottlieb,
former Food and Drug Adminis-
tration commissioner under Pres-
ident Trump, highlights the
blood-based tests as an important
way to reopen society. So does a
plan from Ezekiel Emanuel, one
of the architects of the Affordable
Care Act under President Barack
Obama. In late January, Tom In-
glesby of the Johns Hopkins Cen-
ter for Health Security called for
“urgent serology development
programs” in case the coronavirus
could not be contained.
The theory is that such testing
could be used to divide the world
into people who’ve had it and
aren’t at risk anymore — and
those who are. Health-care work-
ers with immunity could return to
the front lines. Large employers
could test their workers to find
out who could return to work first.
Health insurers might use the
tests to tell members whether it is
risky to go out into the world.
People who know they have a level
of immunity could help others. In
the Ebola outbreak in Congo, sur-
vivors played a special role in
providing care — and much-need-
ed human contact — to people
who were sick.
“This is going to be a very valu-
able portion of the population,”
said Gigi Gronvall, a senior schol-
ar at t he Center for Health Securi-

ty. “They are people who are pre-
sumably protected, and can vol-
unteer. They can have important
roles if they have jobs that are
Figuring out how much of the
population has fought off the vi-
rus and whether they truly are
immune — and for how long —
will be essential for informing
sweeping, long-term decisions
about when to lift stay-at-home
orders, reopen schools and re-
sume business as usual. And it
could also be a targeted way to
safely restart normal life sooner.
Germany has said it will start
looking for disease-fighting anti-
bodies in a study of 100,000 peo-
ple, and could issue certificates
that indicate someone has immu-
nity. Gronvall said she has been
considering several ideas, p erhaps
armbands that declare immunity
or something like the “Carte
Jaune,” the yellow slip of paper
that people carried in their pass-
ports to assure countries they had
received key vaccinations.
But experts on testing warn
that these new serology tests
come with logistical and scientific
challenges just as big, if not big-
ger, than the ones that made the
scale-up of diagnostic testing for
active infections so difficult. The
mass deployment of blood-based
testing will require m any millions
of accurate tests, a system to take
reliable samples and a slew of
decisions that may have to be
made based on incomplete
knowledge. Will a certain level of
antibodies be necessary to declare
someone likely to be immune?
How lasting and complete will
that immunity be? When is the
best time to start doing such tests,
given that many who are tested
today and have no evidence of
exposure to the virus may be in-
fected tomorrow? And how will
people declare their immunity
Companies have already begun
to jump in, offering these anti-
body blood tests while diagnostic
tests based on deep nasal swabs
for acutely ill people are still in
short supply — almost guarantee-
ing confusion about how the se-
rology tests should be used.
Elitza Theel, an associate pro-
fessor of laboratory medicine and

pathology at the Mayo Clinic in
Rochester, Minn., said that serolo-
gy tests should not be used for
people who have symptoms now.
That’s because the tests don’t de-
tect the virus directly, but an im-
mune response that may take
eight to 14 days to develop. A
person who is a few days into the
illness may test negative and be
falsely reassured.
Kelly Wroblewski, director of
infectious diseases at t he Associa-
tion of Public Health Laborato-
ries, said that one of the biggest
concerns about the serology tests
that will be offered in the coming
weeks and months i s the possibili-
ty that they haven’t been vetted
well enough to know whether
they are triggered by antibodies
for other illnesses, leading to
“false p ositive” r esults.
The FDA announced that it
“does not intend to object” t o the
distribution of such tests, so long
as they carry warning statements
that they have not been reviewed
by the FDA and can’t be used as
the sole basis to make a diagnosis.
The evidence about what to tell
people about their immunity is

still uncertain.
“The ideal situation is maybe
we test everyone and those people
that have developed immunity, w e
assume have protective immunity
and can go b ack out into the work-
force,” Theel said. “I think that’s a
possibility, but one of the ques-
tions that remains is: Just b ecause
you have antibodies, doesn’t nec-
essarily mean they’re at a protec-
tive level. That’s something we
need to look at a nd evaluate — and
what that protective level is, I
don’t t hink we know that either.”
Florian Krammer, a professor
of microbiology at the Icahn
School of Medicine at M ount Sinai
in New York, created a serology
test and is working to supply oth-
er labs with a necessary compo-
nent to stand up to such testing at
other laboratories. He said that
based on other coronavirus infec-
tions — including with coronavi-
ruses that cause common cold
symptoms — people who have had
it are likely to be protected.
One small study of a common
cold-causing coronavirus in 1990
found that people could b e reinfect-
ed after a year, but did not develop

symptoms. Other studies have doc-
umented that antibodies for severe
acute respiratory syndrome
(SARS), another type of coronavi-
rus, persisted for two years and
then d eclined by three years.
“That doesn’t mean you’re not
immune anymore, it means anti-
body levels are going down,” s aid
Krammer, who added that look-
ing at other coronaviruses, he
thinks people could be immune to
the new coronavirus for about one
to three years.
One model for how the screen-
ing could b e used is being tested in
Te lluride, Colo., where United
Biomedical is offering serology
tests to all 8,000 residents of San
Miguel County. Positive results
will be treated as presumptive
active infections and health offi-
cials will recommend self-isola-
tion for 14 days and a nasal swab
test that is being used widely
across the United States to con-
firm infection.
Te lluride is home to Mei Mei
Hu and Lou Reese, the married
co-chief executives of UBI, a pri-
vately held New York-based biop-
harmaceutical company that de-

velops immunotherapeutics and
vaccines for chronic and infec-
tious diseases.
“Our goal is to test the whole
county and see the prevalence,
who is infected, who has already
been exposed to it,” s aid Hu, who
said she thinks it is the first com-
munity-wide testing effort. The
company is offering the test free,
and screening is voluntary. It
plans to offer the test to other “hot
spots,” s he said.
Everyone who is tested will be
asked to return in two weeks to
take a second test that will show
how their immune response has
Logistical questions remain
about who would scale up testing
— which could be federal or state
governments, insurers or even
employers eager to get employees
back to work.
“I think a lot of groups are try-
ing to figure that out right now,”
Marc Lipsitch, an epidemiologist
at t he Harvard T.H. C han S chool of
Public Health, said at a news con-
ference last week. “We’ve never
had quite this situation.”
Wroblewski said she was aware
of a few state public h ealth labs in
hard-hit areas, such as New York,
beginning to develop their own
serology tests. She added that the
idea of using such testing to re-
open society in an organized way
was intriguing and might work in
theory, but one of the problems is
that testing isn’t a magic bullet. It
provides information that can in-
form decisions about how to re-
spond in a coordinated way —
which will be the job of those
leading the response.
“The reality is, and what’s been
somewhat frustrating throughout
the whole response, is the idea
that more testing is going to solve
problems, solve the outbreak,”
Wroblewski said. “Testing really
provides information, and that’s
all it does — it doesn’t s top viruses
from transmitting. You still have
to enforce the same public health
measures, the stay-at-home or-
ders and everything else, and peo-
ple have to follow them for lab
data to do anything effective.”

Laurie mcGinley contributed to this

Experts say testing survivors’ blood for immunity may help restart society

massimo Percossi/ePa-eFe/shutterstock
Health personnel in Italy perform blood tests on Tuesday. Experts say such tests on survivors of the
novel coronavirus could identify possible immunities to the disease, allowing some to reenter society.





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