A waste of money: why COVID-19 antibody tests don't make sense

There is no point in doing tests for antibodies to COVID-19, experts say. Their results are extremely unreliable and do not allow convincing conclusions to be drawn, especially regarding the level of human immune protection. The publication spoke about this in more detail. with the BBC.

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In fact, this is a waste of money, although this is not the main reason.

The danger is that such a test can give a person the illusion of protection, as a result of which many allow themselves to violate restrictive measures and put themselves and others at risk.

The fact is that the accuracy of such testing leaves much to be desired, and scientific studies consistently and quite convincingly show that the concentration of antibodies to COVID-19 in the blood of those who have been ill and vaccinated has a very indirect relationship to the level of protection against COVID-19.

“The presence of antibodies is only half the picture,” says molecular biologist Konstantin Andreev, an employee of the Institute of Medicine at Northwestern University in the United States. “There is also a cellular immune response that lasts longer, and the antibody test will not see it.”

In other words, you may have low levels of antibodies, but at the same time a good defense against the virus due to cellular immunity, the expert explains. And maybe vice versa. For example, the first injection of a vaccine can provoke a sharp surge in the level of antibodies, but the immune system will be weak and will only get stronger when other protective mechanisms come into play.

“Almost no one does an antibody test in the United States,” says Andreev. “Insurance does not cover it, unlike testing for the virus itself or vaccination.”

No insurance company, he said, "will pay for something that doesn't make sense." An antibody test is more important to scientists working on research than it is to a specific person.

For example, this is how the proportion of asymptomatic COVID-19 patients in the Italian city of Vo Euganeo was established in the spring of last year: they checked all its residents for the presence of specific antibodies and realized which of them had already met the virus and who had not. The antibody test also played a huge role in the story of the Diamond Princess cruise ship: this is how scientists learned that COVID-19 had suffered a lot on board the ship without any symptoms without even noticing the disease.

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If judged from the point of view of one person, then the value of the results of such an analysis seems very doubtful. An antibody test is not suitable for diagnosing an infection, treating it or preventing it.

Doctors recommend periodically checking the level of antibodies. And if he began to fall, be vaccinated again, but the scientist urges not to listen to such advice.

“This is complete nonsense. It is clear that someone wants us all to be tested and vaccinated every six months, or better yet, monthly. But there is no such data. It’s just business,” the expert assures.

At one's own risk

In many countries of the world, individual antibody tests are not encouraged: the authorities are actively convincing people of the uselessness of such tests and refuses to spend money on them.

In particular, the website of the Centers for Disease Control and Prevention (CDC) states that these tests are not suitable for diagnosing infection, because the body needs almost 3 weeks after infection to produce antibodies. Therefore, a negative test does not necessarily mean that a person is healthy, and a positive test, in turn, does not at all guarantee that he is sick.

Antibody tests are also not suitable for determining the level of immune defense. If, for some reason, you still decide to do such a test, the CDC strongly discourages making decisions based on the results obtained.

Separately, they warn against conclusions about the need for vaccination or re-vaccination after an illness.

Other disadvantages of this method are cited as an additional argument against individual testing. For example, some tests can only detect antibodies left over from an infection but not after vaccination, which only adds confusion and increases the risk of misinterpretation of results.

There is also a possibility that the test will erroneously give a positive result due to the so-called cross-reaction, mistaking for immunity to COVID-19 slightly similar antibodies left after a common cold.

Taking into account all these factors, it becomes obvious that the question of determining the level of immune protection using such a test is not even worth it. Determining the concentration of antibodies in the blood using special equipment is quite simple. It is much more difficult to draw at least some meaningful conclusions from the figures obtained.

Guessing on the coffee grounds

The fact that the virus continues to mutate only adds to the uncertainty.

Scientists cannot yet confirm that the antibodies produced by the body in response to infection or vaccinations against COVID-19 will be as effective against new variants of the virus, or how long it will last.

Sooner or later (with a high probability) the virus will evolve and learn to bypass our immune defenses. Some studies suggest that this process has already begun.

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Recently, the journal Science published an article, the authors of which were convinced that the blood plasma of patients who recovered from COVID-19 copes with new variants of the virus much worse.

It becomes even more difficult to predict the degree of immune defense based on the level of antibodies alone, and an individual test more and more resembles a fortune-telling on coffee grounds.

“If specific antibodies to COVID-19 can be detected in the blood serum, this indicates that the person has already been ill or has been vaccinated. However, this says very little about the protective nature of the immune response, the authors of the article write. “Neutralizing antibodies that can recognize the spike protein provide more information in this sense. But to measure them, it is necessary to build cell-viral systems. But this process is expensive, time-consuming, not flexible enough and has risks of infection.”

Cheap and angry

According to the professor of the Russian Higher School of Economics, epidemiologist Vasily Vlasov, to carry out full-fledged research that can determine the various components of the immune response and give a more accurate forecast, specially equipped laboratories with a high level of biochemical protection are needed.

Determining the concentration of antibodies in blood plasma, of course, is much easier and cheaper, experts agree. But why? After all, there are three types of antibodies, and only one of them needs to be counted.

“The potential of immune protection can only be determined by the level of neutralizing antibodies,” explains Didier Trono, professor at the School of Biological Sciences in Lausanne and author of the Science article. “And a conventional serological test is not even able to distinguish whether they are neutralizing or not.” It captures all the antibodies without going through them.”

When asked whether it is possible to draw any conclusions on the basis of such an analysis, Professor Trona throws up his hands: "The result of such a test only testifies to the fact of a disease or vaccination suffered in the past."

“Although, if the antibody titers are very high... then it is likely that the neutralizing activity will be at a good level,” the expert suggests.

However, this is just a theory for now. Scientists still do not know what level of antibodies is needed for effective protection against the virus. Moreover, they are not even sure that this question can be answered in principle.

Even now, we still know quite a bit about the new virus, and recommendations are changing so quickly that many people around the world are simply tired of the uncertainty, according to Visha Viswanath, professor at the Harvard University School of Public Health. Yes, an antibody test is not able to determine the level of immune defense. But he can add confidence to someone and create an illusion of control in a person, and in times of a global crisis, this is also not bad.

“People are trying to cope with the huge flow of information in one way or another, in particular taking measures of different levels of comprehension, just to feel that they are doing at least something to avoid infection,” explains Professor Viswanath. “At such moments you simply don’t pay attention to official recommendations.”

“Today, the only thing that, from a scientific point of view, makes sense to do at all is to go and quickly get vaccinated against the virus,” the expert sums up.

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