{"id":171,"date":"2020-05-15T12:00:00","date_gmt":"2020-05-15T16:00:00","guid":{"rendered":"http:\/\/anyonecanscience.com\/?p=171"},"modified":"2020-05-14T19:59:44","modified_gmt":"2020-05-14T23:59:44","slug":"knowing-the-score-antibody-testing-and-immunity","status":"publish","type":"post","link":"https:\/\/anyonecanscience.com\/index.php\/2020\/05\/15\/knowing-the-score-antibody-testing-and-immunity\/","title":{"rendered":"Knowing the Score: Antibody Testing and Immunity"},"content":{"rendered":"\n

         A few weeks ago, we talked about antibodies and how they can convey immunity after an infection or a vaccine. Recently, there has been a lot of talk about antibody tests and whether they could be used to allow \u201cimmune\u201d individuals to return to work. But there are a lot of misconceptions about these tests, what they actually tell us, and how they should be implemented. There is a persistent misconception that if an individual has antibodies, they are completely immune to reinfection. It is completely possible, even likely, that if you got the coronavirus and barely had any symptoms, then you may not have enough antibodies to prevent reinfection. Even as some tests can calculate an exact number of antibodies a person has, doctors don\u2019t yet have an understanding of just how many antibodies are required to convey immunity. And no one is sure how long that immunity will last.<\/p>\n\n\n\n

         Antibody tests<\/a> (also known as serological tests) identify the presence of antibodies in the blood, which may be indicative of a past infection. This can be helpful for epidemiologists trying to determine the course of a disease (especially in the case of Covid-19 where the majority of infected may have had little to no symptoms). Additionally, blood from people identified to have antibodies (convalescent plasma<\/a>) may be a helpful treatment<\/a> for severe cases of Covid-19. A transfusion of convalescent plasma could help a struggling patient\u2019s immune system identify and eliminate the threat faster.   <\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0In some cases, antibody tests are positive indicators of immunity. Both measles and chickenpox create strong lifelong immunity through antibodies and memory B-cells that remember the virus and prevent reinfection. Other infections provide more temporary immunity, weaker immunity, or even no immunity at all.\u00a0HIV<\/a>\u00a0is an extreme example of a virus that doesn\u2019t convey any immunity\u2014infected individuals produce a large amount of HIV antibodies, but these antibodies are completely ineffective at neutralizing a secondary infection.<\/p>\n\n\n\n

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Plasma cells (B-cells) segregate specific antibodies to mark an subsequently destroy viruses (influenza viruses).3D rendering.<\/figcaption><\/figure>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0But what about SARS-CoV-2? How effective are Covid-19 antibodies at providing immunity? The answer is that we don\u2019t really know yet.\u00a0Preliminary<\/a>\u00a0studies<\/a>\u00a0have indicated that individuals infected with SARS-CoV-2 develop some level of neutralizing antibodies (the specific antibodies that confer protective immunity). But it is unknown how long this immunity will last. It is also unclear how many useful antibodies the initial infection generates. The majority of people infected with Covid-19 have mild symptoms or even no symptoms at all, which could mean fewer antibodies created.\u00a0Initial<\/a>\u00a0reports<\/a>\u00a0indicate that individuals with mild symptoms may still generate enough antibodies for immunity, but more studies are needed to determine the strength and length of immunity.\u00a0<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0The first coronavirus\u00a0antibody test<\/a>\u00a0was given emergency approval by the FDA on April 1st<\/sup>. Since then,\u00a0eleven<\/a>more antibody tests have been given emergency approval. The quality and reliability of these tests can vary\u2014as can the usefulness of their results. There are three main\u00a0types<\/a>\u00a0of antibody tests: rapid diagnostic tests (RDT), enzyme-linked immunosorbent assays (ELISAs), and neutralization assays.<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0RDTs are the fastest form of antibody test, taking around 10-30 minutes to yield results. Blood is dropped on a test strip and moves up the strip, encountering specific Covid-19 antigens (protein on the outside of virus that antibodies recognize), as well as tagged control antibodies. Further up the strip, a test line containing the antibody of interest catches antigens that have been pulled up with the antibodies in the blood. The blood continues even further up the strip where a control line catches the tagged control antibodies verifying that the test worked normally. If both the control line and the test line show color, then the test is considered positive for Covid-19 antibodies. If only the control line shows color, then the test is negative for antibodies. Any result where the control line shows no color is considered inconclusive.<\/p>\n\n\n\n

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Example of a Covid-19 RDT<\/figcaption><\/figure>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0RDTs can only verify whether a person has antibodies or not. These tests don\u2019t give any quantitative results concerning the number of antibodies in the blood, and they don\u2019t give any indication as to whether those antibodies are able to neutralize a Covid-19 infection. However, false positives can be a big issue with RDTs. While most of these tests have about a 5% chance of providing false positives, this error inflates when the number of infected individuals in a population is small.\u00a0<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Consider a small-town of 1000 people. 150 people in the town have been exposed to Covid-19. Everyone in the town takes the antibody test to figure out if they are immune. Our test correctly gives positive results to 95% of people with antibodies and correctly gives negative results to 95% of people with negative antibodies. So, of the 150 people with antibodies, 7.5 people (7 or 8 people since you can\u2019t have \u00beths<\/sup>\u00a0of a human) get a negative result. That\u2019s not so bad, and maybe the worst thing that happens is that a few people who are \u201cimmune\u201d can\u2019t get a haircut. On the other end of the spectrum, of the 850 people who do not have antibodies, 42.5 people (42 or 43) get a positive result. A total of 185 people in the town are told that they can go back to work, get haircuts, and attend gatherings, but 23% of those people\u00a0are<\/strong>\u00a0actually vulnerable to reinfection. These tests may be accurate enough in places like New York, where the percentage of infected citizens is high enough to limit the effect of false positives, but in other areas of the country they may be far too unreliable.\u00a0\u00a0\u00a0<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Alternatively, ELISA tests take 2-5 hours to perform and are performed by trained lab technicians. A patient\u2019s blood is incubated in tray wells containing the specific Covid-19 antigen. Another tagged antibody is deposited into the well where it binds to any antibody-antigen complexes in the blood. The degree of color change can be measured precisely with a device called a spectrophotometer. The specific amount of color change is linked directly to the concentration of antibodies in the blood sample.<\/p>\n\n\n\n

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An example of ELISA
“File:ELISA TMB.jpg”<\/a>\u00a0by\u00a0Ajpolino<\/a>\u00a0is licensed under\u00a0CC0 1.0<\/a><\/figcaption><\/figure>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0ELISA tests give more information about the number of antibodies a person has. If this was a disease that we had a lot of experience with, doctors would have a known immunity threshold (the number of antibodies needed to make a patient immune to reinfection). There is no known immunity threshold for Covid-19 yet, so the results from ELISA tests don\u2019t actually give us enough information to establish immunity. It\u2019s a bit like knowing the points your favorite football team scored at the Superbowl, but not knowing how many the other team scored. You still have no idea if your team won or lost.\u00a0<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Neutralization assays are the gold standard for verifying immunity, but they take up to five days to perform and require extensive training and safety measures. In this test, dilutions of the patient\u2019s serum are mixed with live SARS-CoV-2 virus. The samples are spread on a plate containing host cells and monitored. Uninhibited virus activity will cause several plaques (areas with no cell growth). The presence of antibodies at different concentrations inhibits the formation of plaques by preventing the virus from replicating.<\/p>\n\n\n\n

\"\"
An example of what plaques look like on a petri dish
“Bacteria on petri dish”<\/a>\u00a0by\u00a0uonottingham<\/a>\u00a0is licensed under\u00a0CC BY-NC-SA 2.0<\/a><\/figcaption><\/figure>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Neutralization assays give us definitive reassurance that the antibodies a patient has actually inhibit viral replication\u2014a key function of immunity. But because they utilize live virus particles, they require labs and technicians with high levels of biological safety certification. That, combined with the time each test takes, mean these tests are not viable for efficient wide-spread use. However, they may be ideal for understanding how a person\u2019s immunity to Covid-19 changes over time.<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0I hope this answered a lot of your questions about antibody tests. These tests are fundamental to our understanding of where and how Covid-19 has spread, but they have limited capability on an individual level. Feel free to get an antibody test, especially in the context of a study trying to get information about Covid-19. Just don\u2019t expect a positive result to mean that you are completely immune. Continue to practice social distancing and good hygiene as much as you can.<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Comment below or email me at\u00a0contact@anyonecanscience.com<\/a>\u00a0to let me know what you think about this week\u2019s blog post and tell me what sorts of topics you want me to cover in the future. And subscribe below for weekly science posts sent straight to your email!\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n\n\n\n\n\n

<\/div>\n","protected":false},"excerpt":{"rendered":"

         A few weeks ago, we talked about antibodies and how they can convey immunity after an infection or a vaccine. Recently, there has been a lot of talk about antibody tests and whether they could be used to allow \u201cimmune\u201d individuals to return to work. But there are a lot of misconceptions about these tests, what they actually tell us, and how they should be implemented. There is a persistent misconception that if an individual has antibodies, they are completely immune to reinfection. It is completely possible, even likely, that if you got the coronavirus and barely had any symptoms,…<\/p>\n

Continue readingKnowing the Score: Antibody Testing and Immunity<\/span><\/a><\/div>\n","protected":false},"author":1,"featured_media":172,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[4],"tags":[22,28,5,32,30,33,21,31,29,6],"class_list":["post-171","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-viruses","tag-antibodies","tag-antibody-tests","tag-covid-19","tag-diagnostic-testing","tag-elisa","tag-immunity","tag-immunology","tag-neutralization-assay","tag-rdt","tag-sars-cov-2","entry"],"yoast_head":"\nKnowing the Score: Antibody Testing and Immunity<\/title>\n<meta name=\"description\" content=\"A few weeks ago, we talked about antibodies and how they can convey immunity after an infection or a vaccine. 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Recently, there has been a lot of talk about antibody tests and whether they could be used to allow \u201cimmune\u201d individuals to return to work. But there are a lot of misconceptions about these tests, what they actually tell us, and how they should be implemented. There is a persistent misconception that if an individual has antibodies, they are completely immune to reinfection. It is completely possible, even likely, that if you got the coronavirus and barely had any symptoms, then you may not have enough antibodies to prevent reinfection. Even as some tests can calculate an exact number of antibodies a person has, doctors don\u2019t yet have an understanding of just how many antibodies are required to convey immunity. 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Recently, there has been a lot of talk about antibody tests and whether they could be used to allow \u201cimmune\u201d individuals to return to work. But there are a lot of misconceptions about these tests, what they actually tell us, and how they should be implemented. There is a persistent misconception that if an individual has antibodies, they are completely immune to reinfection. It is completely possible, even likely, that if you got the coronavirus and barely had any symptoms, then you may not have enough antibodies to prevent reinfection. Even as some tests can calculate an exact number of antibodies a person has, doctors don\u2019t yet have an understanding of just how many antibodies are required to convey immunity. 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