United Kingdom to Begin Offering Home-Finger-Prick Tests for Covid-19 Antibodies

Yesterday, I wrote here about what I'm hearing about use of antibody testing in some long-term care facilities in Pennsylvania.  The more I read about antibody testing for COVID-19, the more I'm surprised by the state of the science and the level of apparent uncertainty about appropriate uses for such tests. 

I've read published articles suggesting multiple explanations for why such tests have not been widely used as part of the response to COVID-19 and variant infections including:

• Lack of availability of commercially-based testing products 
• Lack of reliable testing products
• Lack of FDA protocols to establish reliable tests
• Disagreements (or lack of clarity) over what level of antibodies should be considered "protective"
• Concern that any test results could be misused 
• Lack of easily administered tests, especially tests that would not require medically-trained persons for blood draws

See, for example, these two articles by John Hopkins Center researchers:  Rachel M. West et al, Antibody (Serology) Tests for COVID-19: A Case Study (May 2021); Rachel West, et al, COVID-19 Antibody Tests: A Valuable Public Health Tool with Limited Relevance to Individuals (November 2020). 

As a non-scientist I can understand some of these concerns for the first half of this pandemic, where the issue was whether and to what extent actual infection would provide protection against reinfection. But, with almost 9 months of publicly administered vaccines, it is troubling to think that there could still be concerns about reliability of antibody testing following those vaccinations. Can an illness be called a "breakthrough" infection if the level of immunity wasn't being tested?  Or rather, if the immunity status couldn't be reliably detected?  

In any event, as I dig deeper, it seems that the U.K. is moving forward this month (August 2021) to "begin offering COVID-19 antibody testing to the general public...for the first time" via a home-administered finger-prick test.  From a Reuters report that leans on other media sources:

The government's new programme is intended to produce data on antibody protections for people following infection by different coronavirus variants, according to details of the programme published by multiple media outlets, including Sky News and BBC.

 

From Tuesday, anyone aged 18 or over in England, Wales, Northern Ireland and Scotland, will be able to opt in to the programme when receiving a PCR test, Sky News reported.

 

Participants, on testing positive for COVID-19, will be sent two finger-prick tests to complete at home to inform the UK Health Security Agency of the antibody response to different coronavirus variants, BBC reported.

Again, I find it odd that the U.K. goal -- at least so far as this report -- is to determine level of antibody protections following "infections" rather than "immunizations." Why not both? Why not especially the latter?   I'd still like to think that the U.S. can better prioritize the need for any and all protective actions, including booster shots, through intelligent use of antibody testing. 

 

One of my new (and exciting) colleagues, Penn State Dickinson Law Assistant Professor Sara Gerke, is the lead author on an article discussing appropriate safeguards for implementation of employment-based antibody testing.  See Covid-19 Antibody Testing as a Precondition for Employment: Ethical and Legal Considerations, published Summer 2021 in The Journal of Law, Medicine & Ethics. The analysis begins with a series of important research-assumptions.  The authors "assume that there is an antibody test for COVID-19 on the market that is accurate and reliable with high specificity and sensitivity." They acknowledge "FDA authorized tests meeting a reasonable threshold of accuracy and reliability" are essential to establish an ethical basis for their use.  

 

So much of COVID-19 testing is happening in an unusually public context, with new information generated every day. The intensity of a pandemic response certainly affects research and treatment priorities.  Nonetheless, the fact that some facilities are using antibody tests to facilitate care decisions seems significant.  Could certain residential institutions offer -- encourage? -- voluntary testing for COVID-19 antibodies, especially after the administration of the first doses, and  both before and after any booster doses?  Could colleges and universities, assisted living centers and nursing homes, all places where people are likely to live, work, and play together in close quarters around the clock, be uniquely good platforms for important data generation?   Could these locations be making better priority-based decisions about protective measures that both help their customers stay safe and provide better information for the public at large?