The Benefits of Determining Covid-19 Immunity in The Physician’s Office

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 On August 28, 2021, I published on these pages, Waiting for a Sensible Approach to the SARS-CoV-2 Pandemic: How Long Will it Take (Ref.1)? The thesis was that trying to stop the spread of the virus was futile. Instead, we needed an office-based approach to evaluate an individual’s immunity, the key to controlling the pandemic, and importantly, re-affirm the patient–physician relationship that had so far been ignored. This is especially important for those who for whatever reason are unsure of their immunity. An improvement would be a simple in-office antibody test so that physicians could then use their judgment to advise their patients as to their immune status, and the chances of a serious complication should they become infected. I was unaware that the FDA had also thought this was a good idea and had authorized point-of-care antibody tests as early as September 4, 2020 (Ref.2).
    Patients should be informed that these in-office tests are qualitative, detect the spike protein antigen on the virus and measure two classes of antibodies, IgG and IgM. These antibodies are specific; they become positive only after either a SARS-CoV-2 infection or vaccination.  They measure both binding and neutralizing antibodies which are protective, neutralizing more so.  Antibody testing does NOT measure cell-based mechanisms which are critical when considering overall immunity.  Patients need to understand that presently these tests are not definitive and need to be interpreted with the help of a physician (Ref.3,4,5).
  There are now many point-of-care SARS-CoV-2 antibody tests with FDA emergency use authorization (EUA). I am personally acquainted with one produced by Now Diagnostics called ADRXUSDX which I found helpful and easy to use (Ref.6). Most insurances cover the cost of the test.
   There has been reluctance by the FDA in proposing antibody testing for the general-public (Ref.7). I wholeheartedly agree; this test like any other must be interpreted by a physician with the ability to integrate the general and patient specific factors to help create the best plan of action. In that light, the NIH published in their “At A Glance” series, March 2, 2021, that, “people with SARS-CoV-2 antibodies, a sign of prior infection, were much less likely to test positive for Covis-19 in the following months”. And “the findings suggest that commercial antibody tests could be used to help access COVID-19 risk and inform public health decisions” (Ref.8). This publication was based on a paper in JAMA Internal Medicine (Ref.9).
    SARS-CoV-2 with its variants is with us for the foreseeable future. Stopping its spread throughout the world has proven unsuccessful even despite the harshest lockdowns. The answer like in all previous pandemics is individual immunity. Fortunately, unlike in the past, that immunity can be obtained with vaccination. We can now test for humoral immunity (antibodies) in a physician’s office which can then be used for an in-depth conversation with the patient about the need for additional vaccination.
  It seems reasonable not to test the general population for the presence of the virus, especially in asymptomatic individuals, as it is ubiquitous. It is even found in many animal species (Ref.10). It would be much more effective to assess each individual’s SARS-CoV-2 immunity with a physician who would then advise the patient as to the best course forward.

  1. Ken Fisher, M.D., Waiting for a Sensible Approach to the SARS-CoV-2 Pandemic: How Long Will It Take?, Authentic Medicine, August 28, 2021, available at:    https://authenticmedicine.com/2021/08/waiting-for-a-sensible-approach-to-the-sars-cov-2-pandemic-how-long-will-it-take/  (accessed August 28, 2021)
  2. Kevin Kunzman, FDA Authorizers Point-of-Care SARS-CoV-2 antibody test, ContagionLive, September 24, 2020, available at: https://www.contagionlive.com/view/fda-authorizes-point-of-care-sars-cov-2-antibody-test (Accessed April, 3, 2022)
  3. How protected are we against COVID-19? Scientists search for a test to measure immunity, CNN, March 22, 2022. Available at: https://whdh.com/news/how-protected-are-we-against-covid-19-scientists-search-for-a-test-to-measure-immunity/ (accessed March 28, 2022)
  4. Dr. Samanthi, What is the Difference Between Neutralizing and Binding Antibodies, DifferenceBetween.com, September 17, 2021, available at: https://www.differencebetween.com/what-is-the-difference-between-neutralizing-and-binding-antibodies/ (accessed March 28, 2022)
  5. Marty Makary, FDA Shuts Out Its Own Experts in Authorizing Another Booster, WSJ, April 4, 2022, available at: https://www.wsj.com/articles/fda-shuts-out-its-own-experts-in-authorizing-another-booster-covid-vaccine-pandemic-science-11649016728 (accessed April 4, 2022)
  6. Faster, More Efficient Diagnostic Tests. Introducing the ADEXUSDX COVID-19 Test, available at: https://nowdx.com/ (accessed March 25, 2022)
  7. Antibody Testing Is Not Currently Recommended to Asses Immunity After COVID-19 Vaccination: FDA Safety Communication, FDA, February 24, 2022, available at: https://www.fda.gov/medical-devices/safety-communications/antibody-testing-not-currently-recommended-assess-immunity-after-covid-19-vaccination-fda-safety (accessed March 25, 2022)
  8. SARS-CoV-2 antibodies protect from reinfection, NIH, March 2, 2021, available at: https://www.nih.gov/news-events/nih-research-matters/sars-cov-2-antibodies-protect-reinfection (accessed March 25, 2022)
  9. Raymond A. Harvey, MPH, Jeremy A. Rassen, ScD, Carty A. Kabelac, BS, et al, Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection, JAMA Intern Med. 2021; 18 (5): 672-679, February 24, 2021, available at: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2776810 (accessed March 25, 2022)  
  10. Laura Ungar, Into the Wild: Animals the latest frontier in COVID fight, AP News, March 30,2022, available at: https://apnews.com/article/into-wild-animals-latest-frontier-covid-03ffc4fd156de891652e902ca884234f (accessed March 31,2022)

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