A Note From Dr. House

Dr. House – Contributed photo

Antibody testing – this is the phrase on everyone’s mind right now. We’re getting high numbers of requests daily regarding this as these types of new tests are becoming available.

We are in the middle stages of evaluating these tests and have been looking at United Biomedical (who initially reserved a large number of tests for us), Cellex (who has shipped us a very limited quantity which will likely be used only to test against known positive patients initially) and UW (who we talked with this morning about their newly released serum antibody test). LabCorp also just updated us this morning that their serum antibody tests will be available next Monday.

According to the IDSA (Infectious Disease Society of America) there are a number of concerns and facts that one should know before the conversation can proceed:

• Antibody response in infected patients remains LARGELY UNKNOWN
• Clinical value of antibody testing has not been fully demonstrated
• Positive tests are difficult to interpret because performance of these new tests isn’t well established (yet). Specificity (vs sensitivity) of these tests may result in false positives if prevalance or pretest probability is less than 5%.

Based on those facts why would we want to do antibody testing?

• Some antigen testing (the dreaded nasopharyngeal swab) can sometimes be subject to low viral load and the RT-PCR may not detect it (false negative). This doesn’t mean that antibody testing should replace antigen testing. Antigen testing is, and will remain the gold standard for acute illness or for working to find asymptomatic positives among essential workers as we’ve been doing.
• Epidemiological studies: these data can help to go towards therapy and possibly vaccine.
• Verification of vaccine response (eventually).

Based on these ideas antibody testing may help us get steps closer to reopening communities and states. We all want normacly back. The process is slower than any of us would like, but because lives can and do potentially hang in the balance we owe it to ourselves and to our loved ones to work carefully and methodically.

Where does this leave us, then? Antibody testing is here. We have the ability to begin today, but caution and methodology should be our guiding factors. As such, we will begin calling in very specific patients for antibody testing. Please don’t overwhelm our phone system or messaging system with requests. Exercise patience; we’re having to do the same.

Where are we with overall testing? We continue to test SYMPTOMATIC patients and in particular those who are high risk. That’s not stopped, but is slowing. We’re wrapping our sample of 200 ASYMPTOMATIC essential workers today. Our intention in doing this has been simply to look for potential positive results among this demographic to prevent a POTENTIAL surge or spread in the community from people that may not know they even had the virus. Our results are still coming back, but to date we have found no positives. This is exceptionally great news which means the community has done an excellent job in distancing, sheltering, masking and stiffling the spread of the virus that we know has been here for weeks. Is this type of testing “a waste of time?” That sort of thinking is both highly dangerous and short-sighted. If we had found a positive we would have been able to quarantine that person and hopefully stop the spread within the community. Our attitude is that it is better to test and know than to remain in willful ignorance and endanger the community. There are still some asymptomatic essential workers being tested. If positives are found the community will know quickly just as they have with all previous testing for symptomatic individuals. These are difficult times that require difficult decisions.

We are working with Dr. James and the county to do Ring Containment testing for those indivdiuals who have been in contact with known or suspected positives.

We want to sincerely thank Dr. Frank James for supporting and helping to guide this effort. His expertise has always been readily at hand, whether multiple calls or messaging at literally all hours of the day (3 AM is our record). We want to thank the local healthcare providers who have reached out to help in these testing efforts with various forms of support. We want to thank the local businesses and restaurants for supporting and feeding us. Thank you cards have been going out for the past few weeks. Once this is all over we’ll say many very specific thanks.

Recap:

1. Continued antigen testing mainly for high risk symptomatic, but also for essential worker asymptomatic individuals.
2. No asymptomatic essential worker positives have been identified
3. Ring containment testing and tracing
4. Antibody testing is here, but please allow us to contact those who have the highest utility right now.

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