It has been announced that rapid, point-of-care “antibody immune status” testing for the SARS-CoV-2 virus (which causes COVID-19) is now becoming generally available. This information has been promoted on various national news programs as a way to accelerate getting the population back to work and back to “normal,” and on-screen pundits are advocating rapid start-up of broad-scale national testing. This possibility has even been recently discussed by Anthony Fauci, MD, of the National Institute of Allergy and Infectious Diseases and the White House coronavirus committee.
Explore This IssueACEP Now: Vol 39 – No 05 – May 2020
The need to return society to a more normal situation and to return people to work is critical and becoming more pressing with each day. However, beyond questions surrounding the accuracy of such antibody testing in identifying those who truly present no transmission risk lies another, possibly yet unrecognized issue. I suggest that there may arise unintended consequences to rapid activation of programs utilizing antibody testing as a pathway to attempt to return society back to normal.
Since there are no vaccines available now or in the near future, the only way that one can currently achieve some level of immunity from COVID-19 is by contracting the disease. This fact could lead, with national “immune” testing, to a division within our society of “haves” and “have-nots.” The haves with their “document of immunity test” and purported lack of ability to transmit disease would be allowed to resume their normal lives, including no social distancing, return to work environments, etc. Those who are not tested by this pathway, or are tested and found to have not yet acquired COVID-19 (negative antibody/immunity test), could find themselves within the limbo of still being home-isolated, socially distanced, and, more important, not allowed to resume their normal lives, such as return to work, or severely limited in such options with all the financial ramifications.
If antibody/immune testing proves to be acceptably accurate, if it can be determined that most recovered persons will not suffer reactivated disease or become reinfected, and if test kits can be provided in the large quantities needed to perform blanket testing by states and locales, there are pressing motivations for such testing to be deployed by states and other large segments of society in the attempt to get people back to work, stabilize the economy, and attempt to reestablish normal life.
However, we see in the news and political discussions that there is steadily mounting pressure on and by federal, state, and local governmental decision-making bodies to move immediately forward on such antibody/immune testing even prior to fully understanding accuracy, length and breadth of immunity, and potential reinfection risk related to such testing. I want to bring an awareness to the fact that, beyond other questions and controversies surrounding antibody testing, there may be negative economic and social downstream consequences to large groups in our society with any rapid rush to blanket application of such testing as a pathway for reactivation of economy and society that need to be considered and addressed.
Dr. Severance is adjunct assistant professor in the department of medicine at Duke University School of Medicine in Durham, North Carolina, and attending physician in the division of hyperbaric medicine, department of emergency medicine at Erlanger Baroness Medical Center/Erlanger Health System and UT College of Medicine/UT Health Science Center in Chattanooga, Tennessee.