To be immune or not to be immune? (“that is the question”)…. This is the great question that SARS-CoV-2 has raised, the world over. However, the real question is: How can we ensure that we’re immune from the coronavirus?

Recently published data suggest that the majority of hospitalized patients produce antibodies against SARS-CoV-2. However, it’s not yet known whether the antibodies produced are sufficient to provide long-term protection. The experience we have with SARS and MERS suggests to us that immunity should be two years, but if SARS-CoV-2 were to behave like a common coronavirus that causes the common cold, then immunity would be much shorter.

Out of this uncertainty, the “COVID-19 Serology Project” has begun: a collaborative study involving 48 Italian Laboratories coordinated by the European Institute of Oncology (IEO) and the University of Pavia (Italy). The objective is to assess whether the presence of antibodies and SARS-CoV-2 protects against reinfection and for how long.

So what makes the “COVID-19 Serology Project’s Serology Test” different?

  • It’s an open test (i.e. non-commercial and accessible to all Laboratories and does not require additional investment in equipment and materials).
  • It detects various types of antibodies that characterize the entire spectrum of the immune response to the viral infection.
  • It has a very high sensitivity (i.e. it detects the presence of antibodies, even at relatively low levels) and specificity (that is, it excludes antibodies directed against other viruses of the same family of SARS-CoV-2), and it costs significantly less than commercial tests.

In addition, the data collected during the study will be available in a centralized database, open and searchable by all centers participating in the project. Specific population groups with an elevated risk of infection such as cancer patients will be studied. The main objective is to assess the immunity bestowed by antibodies and the frequency of re-infection of health-care workers and cancer patients who are both at high risk.

The “COVID-19 Serology Project” is also a response to some practical needs (i.e. the fact that the serological tests currently available on the market are not sufficiently reliable and they’re not sensitive and specific enough). Let’s consider an example: if the serological test is not specific enough (i.e. it detects the presence of antibodies against other coronaviruses, such as those that cause the common cold), then we may be led to conclude that we’re immune to SARS-CoV-2 and this would therefore provide us with a false sense of security.

Feasibility, cost and “immunity certificates”

Another important subject that this project addresses is the feasibility of potentially testing millions of people. The cost of commercial testing represents a rather important limit, especially in countries with comparatively weaker economies, so having a test available that can use the equipment normally found in Laboratories, is no doubt an advantage.

A final consideration must be made about the consequences of the availability of a reliable serological test, linked to a “license of immunity” that’s talked about so much:

  • The “license” (or certificate) should be renewed very frequently, especially in the winter of the year when the virus is most active. Not having antibodies today doesn’t mean that you can’t develop them tomorrow. This means performing lots of tests, with the logistical and financial consequences that you can imagine:
  • It could open up the issue of discrimination, since some portions of the population may not have access to tests, unless provided by a National Health System.
  • Could insurance companies grant policies only to “licensees”, and how should we regulate access to the data?
  • If having an “immunity license” would allow you to fully enjoy your freedom, could you be induced into thinking that the infection will develop antibodies?

Perhaps a futuristic scenario, but certainly possible, and for which we must prepare ourselves, keep ourselves informed and have an opinion on it, should the Government call on us to decide.

This post is also available in: Italiano

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