Updated: Jul 11, 2020
I am a provider in Portland, Oregon, a Naturopathic physician who works in private practice. I have seen zero cases of COVID19 to date. PCNM is offering testing; although, most of our visits are via Telemedicine. We are triaging over the phone. Testing has been scarce in Oregon as well as PPE. We’ve recently spoke to a rep at Vibrant America about their COVID19 antibody test.
Antibody tests can tell us if someone has been exposed to the virus; whereas the PCR test (what we’ve been using thus far in the US) tells us if someone currently has the virus. The antibody test is useful to determine “immunity” of a person, but more research and more time are required to determine exactly what the means. Other countries have been using antibody tests. We are late to the game.
Right now, the amount of testing is increasing due to the availability of antibody tests created by lab companies. The only test approved by the FDA to my knowledge is one by Cellex, about two weeks ago under “emergency use authorization.” There are many PCR tests that are authorized due to emergency.
The recent increase of availability of testing and pop-up clinics around town will result in an increase in number of positive cases. Don’t let this alarm you. As the numbers of positive cases climb, this is due to availability of testing and does not equal more deaths. It’s great that there are more tests available. This means those of us who are asymptomatic can get tested. This is already happening in Bolinas, California. Their small town of about 1,600 people have decided to test everyone with both PCR and antibody test. It’s an experiment that will be interesting to watch closely.
“CAN I GET TESTED,” YOU ASK?
Well, I’ve talked to Care Oregon, our medicaid, to get answers, but it’s unclear if the test will be covered especially if you have no symptoms and test negative. Under medicaid, testing with PCR should be covered if you test positive or negative and have symptoms under medicaid. I am not sure about antibody testing. The test from Vibrant America, which is more comprehensive, costs $150 plus fees for collection, processing and interpretation. We collect a blood sample in a test tube and send it off for testing using 4 different antigens of the virus. The tests checks for levels of IgM, IgA and IgG antibodies in the blood. At this point, it’s unclear if the patient OR insurance OR the government will be paying for antibody tests. The hope and current understanding is that patients can later request reimbursement from their health insurance for any specialty lab testing.
HOW ACCURATE IS THE ANTIBODY TEST?
Well, one thing that concerns me regarding these tests is their accuracy. The accuracy is based on sensitivity and specificity. Since all these tests are new, there hasn’t been much testing of the tests. Just because someone tells you a test has a high sensitivity and specificity, the next question to them is, “how many people have you tested?” If N=1, meaning they only tested 1 person, then would you trust them? I am also concerned that some tests may come back positive, but to a different strain of coronavirus. The most common coronavirus strain causes the common cold. It’s up to the lab companies to make sure they are picking the right part of COVID19, specific only to this strain of virus, when creating the test.
Testing from Vibrant America has an overall sensitivity of over 97% and specificity over 98% for the combination of all 4 COVID19 proteins and the associated three antibodies being measured. This is based off about 340 tests, and is the most comprehensive testing available that we've been able to find.
WHAT HAPPENS IF THE ANTIBODY TEST IS POSITIVE?
There are no recommendations from the OHA at this time. I am probably missing something here, so if you know, drop a comment. In South Korea, if you test positive even if you are asymptomatic, you quarantine for two weeks. They even provide an app on your phone to track you so you don’t leave your home.
Some strains of virus keep shedding even after symptoms disappear meaning a person can continue to be contagious. Worse yet, a person could relapse. This means they never fully kicked the virus and their symptoms came back. It looks like this can happen with COVID19, but I’d like to emphasize the importance of the individual’s immune system’s influence on the timeline and progression of a disease.
I’m assuming if someone tests positive using the antibody test, the recommendation is to quarantine for two weeks.
If you are symptomatic, ideally you’d have both the PCR test and antibody test done. And then get tested after symptoms resolve to see if the virus is still present and if you’ve formed antibodies.
Lastly, it’s unclear which testing companies are reporting their data to local government. I’m assuming data is being sent and processed to the right organizations. One can only hope.
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