One potential use of COVID antibody tests is to measure the extent of the pandemic at the population level. Our understanding of the disease and its projected impact in the US is weakened by our inability to monitor its spread among people with either mild symptoms or none at all.
Another use is to measure the progress of individual infection. Antibody tests quantify the number of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies in the blood. The presence of more IgM antibodies, which are the first to appear and mobilize against an invading organism, indicates more recent exposure to the virus. It is through this result that an asymptomatic carrier of the virus could be identified—a feature of no small importance, since “silent carriers” have played a major role in transmission.
More IgG antibodies, which are virus specific and produced in later stages of infection, would lead a person to test positive for immunity, implying recovery. This unfortunately doesn’t guarantee full protection. The test won’t reveal how neutralizing, or how potent, these IgG antibodies are; nor can it determine how long they will last. With certain families of coronaviruses, including the beta coronavirus family that includes SARS-CoV-2, reinfection has been found to occur, and for now it remains a possibility.
Successful deployment of antibody tests depends on their “sensitivity and specificity.” Sensitivity prevents false negatives, since a more sensitive test is more likely to actually detect it. Specificity, on the other hand, prevents false positives, since a less specific test may pick up on antibodies against a virus other than SARs-CoV-2.
It would take a concerted effort, but in the United States we have the infrastructure and manpower it takes to conduct rapid antibody tests quickly, cheaply, and at a massive scale. The small European country of Andorra has plans to give antibody tests to its entire population. Compared to other resource rich nations, we’ve failed to answer the WHO director general’s call to “test, test, test.” That can change—but only if we act now, and act fast.