The Washigtnon Post - 03.04.2020

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

the coronavirus pandemic

BY CAROLYN Y. JOHNSON

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

critical.”

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

status?

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

evolved.

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.”

[email protected]

Laurie mcGinley contributed to this

report.

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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