Antibody testing’s chicken and egg problem

Good afternoon, readers.

Here in New York City, a free COVID-19 antibody testing program could reach up to 140,000 residents between now and June. That doubles the figure of tests to be conducted in the coronavirus pandemic’s epicenter: Another 140,000 are allocated for frontline and essential workers.

But COVID antibody testing is, to put it lightly, complicated. It comes with a series of contradictions and balancing acts for ensuring access to these tests—which will be critical for reopening the economy and understanding the novel coronavirus’ underlying nature—and making sure the ones people are taking aren’t giving us bogus information.

I spoke with senior government officials, pharmaceutical experts, and academics who specialize in biostatistics to parse exactly what the state of antibody testing is and the challenges which lie ahead.

As you might guess—it’s complicated. Such testing is important because it can tell us more about who has already contracted the coronavirus but recovered, even if they were asymptomatic for COVID-19. But that process will take time since health care institutions will need to learn through experience how accurate the dozen antibody tests which have been granted emergency authorization are, and what they tell us about how long someone may be immune to COVID-19.

Originally, the Food and Drug Administration (FDA) was willing to give companies developing antibody tests a bit more leeway since access to such diagnostics is important. The agency has since revised guidance to ensure quality control. It amounts to a chicken and egg dilemma of ensuring widespread testing while simultaneously boosting the most effective products.

Companies like Roche and Abbott Laboratories have made bold claims about their own antibody blood tests’ accuracy (Roche, for instance, says its test has a 100% rate of correctly identifying people who have antibodies and a more than 99.8% rate of correctly identifying people who don’t.) Previous tests, including ones that were being hawked even without emergency authorization, have had decidedly mixed results, according to a slew of researchers from UC Berkeley, UCSF, and others.

The science itself is complicated enough. The effects on society at large? Even more so.

“Antibody tests give us a bigger picture of the range of disease,” says Natalie Dean, a professor and biostatistician at the University of Florida. “They’re especially useful for identifying high-risk groups. [They] let us see at the highest-risk occupations such as factories where people are in close quarters. But you have to piece these things together from a bunch of different sources.”

How well we can “piece these things together” may take months or even years to determine, and likely require an all-hands data-sharing approach between traditional corporate rivals and government agencies.

Read on for the day’s news, and we’ll see you again next week.

Sy Mukherjee

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