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As the COVID threat becomes less urgent is it time we started adopting new approaches?
One idea being explored is to use lateral flow antibody testing to provide an alternative form of COVID pass for admitting people into countries, sporting events or other large gatherings.
Some countries have already introduced antibody certificates as vaccine equivalents to allow more people who have been exposed to the virus to participate in society. In the US state of Kentucky, the legislature recently passed a symbolic resolution declaring that a positive antibody test would be considered equivalent to being vaccinated. The thinking is that most people will by now have had some exposure to COVID, and so their immune systems will be more familiar with the disease.
The latest evidence shows that natural infection with COVID-19 does provide some protection against reinfection, and in some cases equal to that given by vaccinations. The more antibodies a person has, the more protection they have from the virus over time. Therefore, doing a lateral flow test that shows antibody count will show how likely a person is to catch COVID-19 and then spread it to other people.
If the Kentucky resolution is approved, people would be considered equivalent to being fully vaccinated if their lateral flow antibody test result showed a high enough level of neutralizing antibodies – above the 20th percentile of the immunized population.
A recent example is the row over tennis player Novak Djokovic’s vaccine status and his entry into Australia. Some scientists have argued that if Djokovic did have COVID-19 in December, as he claims, an antibody test could have established if he had sufficient antibodies to provide resistance to the virus and prevent him transmitting it during the Australian Open. This could be a policy to consider implementing at large sporting events in the future.
More than just a COVID pass
Antibody testing has benefits beyond simply being an alternative form of COVID pass. Its supporters in Kentucky say it could also increase uptake of booster vaccinations in the state if people find out they don’t have high enough levels of COVID antibodies.
Even among the vaccinated, the tests could be useful. People with weaker immune systems, whether through age, medical condition, or medication, will be particularly keen to check if their immune system has responded to the vaccine. And, as vaccine effectiveness wanes over time, people might want to know how much protection they have, especially if it’s been a while since they had the jab.
On a larger scale, antibody testing could have public health implications, allowing authorities to track the percentage of the population that has been exposed to the virus. This would be especially useful when the effect of vaccines starts to wane, which could be in as little as four months after a third or “booster” dose. This could then help authorities decide whether certain protective measures should be introduced.
Data capture will be key
For lateral flow antibody testing to be effective, whether on an individual scale or in a larger cohort, the test results must be recorded and stored. The easiest way to do this is with a mobile phone app that captures an image of the test result along with associated patient data (age, gender etc.) and vaccination data (date of vaccination, name of vaccine etc.). All data can be encrypted and anonymized and stored securely in the cloud.
Proof of a test result with antibody values can be emailed to the patient immediately after the test, with test history kept in the app where it can be accessed by clinicians, pharmacists, or, if in a workplace testing environment, the test operator.
For individuals, the data could be used to demonstrate that they have a sufficiently high level of antibodies to give them protection against COVID-19 infection and to prevent the spread of the virus.
On a larger scale, the data could be anonymized and used by public health agencies to monitor the spread of the pandemic and allow them to implement measures only where necessary, limiting the impact on people’s lives and the economy. This would also give scientists valuable new insight into the virus and our immunity to it, increasing our understanding of COVID-19 and shaping our approach to future disease outbreaks.
Let’s reassess and use the new tools we have
Many scientists and public health experts suggest we are heading towards the endemic phase of the disease, where COVID becomes one of the viruses regularly circulating in societies, alongside cold viruses and the flu.
Measures such as masks and vaccine passes are being phased out in some countries, but in many situations – such as for international travel and certain large events – they are likely to remain for the foreseeable future. Yet, despite the successful rollout there will still be many people who for various reasons won’t get vaccinated.
Thanks to huge investment and hard work, a lot of new and innovative diagnostic testing technology has been developed over the last two years. Instead of relying on vaccines, movement restrictions and lockdowns, we should be using these diagnostics and other alternative tools we now have at our disposal to keep us safe and let life continue.