Benjamin E. Mays, an American civil rights leader, once said, “The tragedy of life is not found in failure but complacency”. In the context of the COVID-19 pandemic complacency could be just around the corner, if not already here?
In early November 2021, Germany’s Health minister said COVID-19 is “far from over” as vaccination rates plateau across the German population and clinics report rising COVID-19 cases.1 By the end of November Germany went into a 4th wave2 with football games being played behind closed doors.3
Hans Kluge, regional head of the World Health Organization, was quoted saying, “the pace of transmission across Europe was a grave concern adding that the region was moving back to the epicentre of the health crisis”. 4 Why is this happening when vaccination has been successful across many European countries?
Testing, PPE, and vaccine rollout strategies have undoubtedly been successful. But are parts of world now being lulled into a false sense of security? Also, vaccine supply seems to be slowing5 and swathes of the world’s population are being left behind as they remain unvaccinated.6
It is important to distinguish between the different types of antibody tests. Therefore, for this article the term ‘antibody test’ refers to tests that detect IgG antibodies that target the SARS-CoV-2 spike protein including neutralising antibodies.,. By determining the presence of neutralising antibodies, it helps to provide a correlation of protection.
Modify behaviour based on evidence
Some people have been using antigen tests twice a week to confirm infection, whether they are vaccinated or not: teachers in the UK are an example of this. Almost doing so autonomously under government-led, one-dimensional testing policies. Some people will not question the policy, some may not care, and some may not understand.
But solely focusing on confirming infection leaves a big gap in knowledge for individuals, professionals, and policymakers. What about determining immune response to vaccination and infection? When are antibody levels dropping and potentially putting people at risk?
Surely everyone needs to know their antibody levels and therefore be able to take precautions and modify behaviour based on whether they have an immune response or not.
Who should be monitoring COVID-19 IgG antibody levels?
The following statistics, announced on 16th October 2021, by Prof Tim Spector, Professor of Genetic Epidemiology at King’s College London, UK, and principal investigator for the ZOE Study, paints a clear picture as to why IgG antibody testing is valuable.
“We’re seeing approximately 80,000 new [COVID-19] cases per day in the UK…with 22,500 of those being double vaccinated individuals and who probably thought they were safe…not everyone develops antibodies, and we think about 20% (1 in 5) don’t seem to get that initial antibody response”.7
The 1 in 5 people highlighted in the ZOE came from a cohort of 10,000 people. If that 20% translates into a population the size of UK, Germany, or the USA, for example, then millions of people could potentially be at risk. If the 1 in 5 people had regular access to IgG antibody tests at work or via a simple pharmacy walk in service, for example, it would probably lead to people:
- modifying behaviour and limiting contact with colleagues, friends, or family
- seeking medical advice because of their low or zero antibody levels
The ZOE study is not alone in concluding the production of antibodies varies. Recent research highlighted:
- immuno-compromised generate lower antibody levels compared with healthier people after two vaccine doses8
- there are variations in vaccine-response between males and females9
- there are different responses in patient cohorts when comparing the Moderna and Pfizer-BioNTech vaccines10
- antibody levels start to reduce at around 2-3 months11
For the people who fall into these categories above, testing antibody levels would help them have insights into risk of infection or enable them to seek medical advice. Otherwise, people are unwittingly going about their business without knowing if or when protection will wane.
Where should we monitor COVID-19 IgG antibody levels?
We’ve established people respond differently to COVID-19 infection and vaccination and antibodies wane over time. It is important therefore to reduce the guesswork in determining who and when people need to be cautious.
Border Control or Large Events
- Many countries accept vaccine certificates, proof of recovery or a negative antigen test result. This approach doesn’t help identify risk of infection. Vaccine certificates are only proof someone has been vaccinated. They don’t confirm if someone has produced a protective immune response.
- A negative test only confirms if someone doesn’t have the live virus at the time of testing and no insight into protection.
- For some occupations, people must go to the workplace. These people are currently unaware if they have an on-going immune response at all, let alone know at what level.
- If employers could understand who and when people are at risk, this would help shape health and safety policies. Meaning employers could mitigate risk for their workforce and help avoid people having to isolate or be sent home unnecessarily following a confirmed case.
- For employees anxious about returning to the workplace, regular monitoring of antibody levels would help alleviate concerns.
- Pharmacies have the power to give individuals and communities an insight into their level of protection. Offering a simple walk-in service puts control in the hands of individuals to make their own health choices.
- Evidence of low antibody levels via the pharmacy would allow people to inform employers, friends, and family why they shouldn’t go into the workplace or avoid the next gathering. In addition, it’s possible peer pressure about being over-cautious is creeping in. Confirming low protection levels would put doubters in their place!
- Introducing mass antibody testing would mean governments can make more informed decisions about vaccine roll out and booster policies and priorities. The guesswork would be removed and therefore people with low protection levels could be fast tracked for the next jab and those with adequate antibody levels could be left to be monitored.
- With everything that has been explained throughout this article, there is a strong case for governments and health agencies to recommend antibody testing protocols in the 3 areas above. It is obvious that knowing antibody levels is a powerful part of interpreting and managing risk; all with aim of avoiding blanket lockdowns and putting people in harms-way unnecessarily.
The UK government website states the NHS COVID Pass can be used to demonstrate “coronavirus (COVID-19) status”13. This is true for proving someone has been vaccinated or whether they currently have a negative COVID-19 antigen test. But it doesn’t provide a possible ‘risk status’.
IgG antibody testing aids the provision of understanding the ‘full picture’ for individuals, professionals, and policymakers. In no way is there a one size fits all solution and antigen testing, PCR, PPE, and vaccines need to remain. But without understanding a population’s antibody levels there is an information gap and therefore the margin for error could possibly be higher than it needs to be.
Therefore, is it finally time to increase antibody testing?
The mission of this article is to make more people and organisations aware of the benefits of COVID-19 IgG antibody testing [to the SARS-CoV-2 spike protein]. The process of determining antibody status and levels is straightforward, requiring infrequent testing and no swabbing. People and organisations don’t need to wait for governments to offer guidance and can immediately start to understand risk.