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

It makes no sense to do tests for antibodies to COVID-19, experts say. Their results are extremely unreliable and do not allow one to draw convincing conclusions - especially regarding the level of human immune defense. The publication told about this in more detail. with the BBC.

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In fact, this is a waste of money, although it 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 of the picture,” says molecular biologist Konstantin Andreev of the Northwestern University Medical Institute. "There is also a cellular immune response that lasts longer, and an antibody test won't 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 nobody does an antibody test in the United States,” Andreev says. "Insurance does not cover it - unlike testing for the virus itself or vaccinations."

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, and preferably 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) indicates that these tests are not suitable for diagnosing an infection, because in order to develop antibodies, the body needs almost 3 weeks after infection. 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 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 in order to measure them, it is necessary to build cellular-viral systems. And this process is expensive, time-consuming, not flexible enough and carries 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 for immune defense can only be determined by the level of neutralizing antibodies," explains professor at the School of Biological Sciences in Lausanne and author of the Science article Didier Trono. “And a conventional serological test is not even able to distinguish whether they are neutralizing or not. It fixes all antibodies without going through. "

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 there will be at a good level," the expert suggests.

However, so far this is only a theory. What level of antibodies is needed to effectively protect against the virus, scientists still do not know. 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 try in one way or another to cope with the huge flow of information, in particular, they take 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 do not pay attention to the official recommendations."

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

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