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Antibody-assisted vaccination will speed up the road to protection



A kindAfter nearly a year of pandemic horror, the sight is coming. But you still have to squint.

The FDA has approved emergency use authorizations for two safe and effective vaccines, and science has provided this vaccine at a record rate. The question now is: how do we best allocate them?

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has issued guidelines that vaccination should start with health care workers and residents of long-term care facilities, followed by other important front-line staff and those over 75. The only secondary consideration is how the history of Covid-1

9 infection should affect people’s position: “HCPs with acute SARS-CoV-2 acute infections recorded in the past 90 days can choose to postpone vaccination to one day in the late 1990s. In order to vaccinate HCPs that are still susceptible.”

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Given the low risk of reinfection and limited vaccine doses, it would be a mistake not to consider previous infections as a more important consideration in our vaccine prioritization. An estimated 75 million Americans have been infected with SARS-CoV-2, but only 24 million Americans know that the use of large-scale Covid-19 antibody testing can help target the vaccine to high-risk groups better. This can save lives and return us to normal sooner.

This strategy is based on the two biggest discoveries against viruses. The first is that after infection, including mild and asymptomatic infections, it seems that immunity can be sustained for more than six months. Nearly 100 million Covid-19 cases have been confirmed worldwide, and the fact that there are only a few documented re-infections provides convincing evidence for long-lasting immunity. Even in rare reinfections, their course may be more moderate due to the memory of the immune system.

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The second breakthrough is the great success of the Covid-19 vaccine development.

The combination of durable immunity and effective vaccines has become the cornerstone of almost all successes against viruses in the past (to date, HIV is the main exception). This is how to defeat the scourge of smallpox, polio, measles, mumps and other infectious diseases. This is how we are going to defeat Covid-19.

But even under the best circumstances, it can take months to produce enough vaccine doses to treat everyone. Epidemiologists estimate that two-thirds of the population must be immune to the herd protection needed to quell the epidemic, so antibody-assisted methods will enable us to reach this threshold faster.

This is another reason for the need for antibody-assisted vaccination methods: due to the combination of insufficient testing and asymptomatic infection, most people who have never been infected with Covid-19 have not been diagnosed with the vaccine. This is especially true in the states hardest hit by the virus. For example, in New York State, it is estimated that 30% of the population has recovered from Covid-19, while only 7% have been diagnosed with the virus. The phenomenon of underdiagnosis is not limited to areas like New York, which have long been developing. It is estimated that more than 36% of people in North Dakota have been infected, while only 13% have been diagnosed with infection. In view of these differences, in North Dakota and other states, without the help of antibody testing, I estimate that people currently immunized against Covid-19 can use up to a quarter of the vaccine.

Although the presence of antibodies is not a perfect immune indicator, due to the rarity of reinfection and the accuracy of current antibody tests (the false positive rate is about 1% or lower), the use of these antibodies can be safely considered low risk Group. A recent report published by the University of Oxford in the New England Journal of Medicine further confirmed this reality. The report tracked 12,000 health care workers within six months and found no anti-SARS-CoV-2 antibodies. Symptoms of infection.

But theory and practice are two different things. Due to the difficulty of large-scale PCR testing in the United States, and due to early vaccine distribution sputtering technology, efforts to test antibodies in the public population sound difficult. It’s not.

Regarding scale antibody testing, the process is completely different from PCR-based tests used to detect acute infections. The antibody test is more like a traditional blood test and is processed as an automatic immunoassay. This means that they can be run in large quantities on machines already owned by almost all functional medical laboratories, and can use the existing laboratory collection infrastructure for collection and processing. As Benjamin Mazer, a pathologist at Johns Hopkins Hospital, told me, “The delay in PCR testing should not prevent people from getting antibody testing when they need it. Antibody testing is very simple , Can be completed in a few hours instead of days.

A simple starting point is to perform antibody testing on people who already need laboratory testing for other reasons, such as when they are admitted to the hospital, when they are in the emergency room or when they make an appointment at a clinic. Regular orders plus out-of-pocket expenses cancelled by clinical and commercial laboratories for others can further expand the scope of visits. Batch testing based on schools and employers can provide information for their future vaccination activities.

What needs to be clear is that vaccinating people who have previously been infected with SARS-CoV-2 is safe and beneficial (just like adults with chickenpox need to be boosted to prevent shingles).Appropriate investment to support these two tests is critical with Vaccination. These efforts must be complementary, not competitors. Moreover, if the opportunity for antibody testing is not readily available, vaccination should not be delayed. Finally, once we have enough supplies to meet public demand, everyone should be vaccinated regardless of antibody status.

I can summarize the argument about how antibody adjuvant therapy can enable the United States to achieve cattle immunity faster. Or revitalize our economy faster. Or protect more frontline workers faster-nurses, teachers, grocery stores, delivery drivers, firefighters, etc.

But for me, I also doubt you, it is not that abstract. For each vaccine saved through the use of antibody testing, we can provide another vaccine for high-risk groups who are eager to wait for their turn. And the people we all have loved stand together: elderly grandparents, immunocompromised mothers or cousins ​​fighting cancer.

Given all the work we have done so far to ensure their safety-postpone meals, cancel holidays and missed hugs-we must use all weapons in our arsenal to deal with this plague. This includes antibody testing.

Michael Rose is a resident of internal medicine and pediatrics at Johns Hopkins University School of Medicine.




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