Test to determine COVID immunity could reshape US politics

Two years into the COVID pandemic, and we still have no way of knowing for sure whether the immunity you get from infection or the vaccine is enough to protect you from reinfection or a serious illness. We call this a correlate of protection. We can still only guess.

Don’t get me wrong, the biotechnology of detection has come a long way in two years, the PCR test we developed in early 2020 has remained a very valuable tool even against emerging highly mutated variants, and repeated rapid tests are accurate. especially when you have COVID-like symptoms.

But what’s still missing is a simple test to determine which antibodies work against COVID-19, including the current omicron variant. This is especially important now that we know that many hospitalized patients are not only unvaccinated, but have previous infections with delta, alpha, or the original SARS-COV-2 strains.

Consider that according to the Centers for Disease Control and Prevention and seroprevalence data, about 145 million Americans had been infected by October with about 125 million additional infections since. Most estimates suggest that we are officially diagnosing about 1 in 4 infections. Officially there have been over 77 million cases, but the true number is probably closer to 270 million, which means re-infection plays an important role .

With omicron prevalent, we had averaged over 500,000 daily cases since early January, with numbers eventually dropping dramatically to less than a third of that. The numbers have clearly been slowed down by existing immunity even though we cannot measure it.

We have not yet crossed the powerful omicron wave. Nearly 85,000 COVID patients are still filling our hospitals. Several studies conducted in the UK, Kaiser Permanente and CDC have shown that vaccinated and recently boosted patients are around 90% less likely to be hospitalized. Unfortunately, according to recent CDC data, only 42% of all eligible adults nationwide have received a booster shot, an insufficient number.

It’s clear that our hospitals are full of people who have already had COVID as well as people who are not sufficiently protected by the vaccine – due to immune evasion or decline. This is in addition to the core group who have had neither vaccine nor previous infection.

It is also clear that prior COVID infection provides a valuable source of immunity against reinfection, but this protection does not last forever and does not always protect us against the immune-evasive omicron variant. A new study from Qatar just published in the New England Journal of Medicine shows that a previous infection provided 60% protection against omicron with substantial protection against hospitalization, but we haven’t seen the same pattern here in the United States.

As a country, our approach has been too narrow and rigid. On the one hand, we don’t recognize that a recent infection offers protection, as Israel does. On the other hand, we stick tightly to the idea that the vaccine offers complete protection when it does no such thing, especially against omicron.

Israel, on the other hand, recognizes the protective quality of recent infection and accepts positive antibody titer tests to document this for traveler entry. We have seen this policy successfully applied to our patients traveling to Israel for several months, and its absence here in the United States has deepened the divide, as those recovering from infection are marginalized despite some degree of immunity.

We need a titer test to measure antibodies instead of more political rhetoric. We need to develop an endpoint for antibodies, however you got them, whether by infection or vaccination, that we can all agree to rely on as a marker of immunity. In the meantime, we can tell you that a low nuclear capsid antibody level after being sick with COVID means that you probably did not retain sufficient immunity against your infection and that a low antibody protein pic means you probably need an extra booster. But what number is enough to say that you are protected against an omicron infection? We don’t know, but we have the technology we need to establish that.

It is time to prioritize the conduct of clinical studies to validate the level of immunity to COVID-19 correlated with protection. CDC Director Rochelle Walensky mentioned in an interview on Doctor Radio Reports last week that work is being done on this, but we believe progress is too slow.

An example that we propose is the realization of a prospective study on the crew members of cruise ships. Currently, most crew members are tested for COVID-19 infection twice a week. Our plan would be to couple this with monthly blood and saliva samples which would be stored and then evaluated after infections are diagnosed by comparing those who have been infected with those who have not. In this way, we could determine a threshold number of antibodies above which you are probably protected, whether against vaccination or a recent infection.

We have a good idea of ​​the prevalence of the virus. The omicron variant is clearly down. We need to focus on better understanding how we are protected from it and what other variations may emerge.

Marc Siegel, MD, is Professor of Medicine and Medical Director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book “COVID; the politics of fear and the power of science.

Robert Redfield, MD, is an American virologist and senior public health adviser to Governor Hogan and the state of Maryland. Redfield served as director of the Centers for Disease Control and Prevention and administrator of the Agency for Toxic Substances and Disease Registry from 2018 to 2021.

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