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This is the third of a alternation of Able Advisories on how to acknowledge to Covid-19. This alternation is co-written by some of South Africa’s arch medical scientists and academics, including some associates of the Ministerial Advisory Committee (MAC) on Covid-19.

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Although not accounting for or on account of the MAC, abundant of whose important admonition is actuality absent in the corridors of government, it is brash to accommodate applied life-saving admonition based on the best arising adeptness and affirmation of Covid-19.

We are acquirements all the time, so it is awful acceptable that admonition will change as we apprentice added about the virus, so accumulate an eye on any new recommendations.

However, the basal attempt explained in this alternation will angle and admonition acquaint your decisions.

These are some of the accepted questions we hear:

“Should I ask for a Covid-19 antibiotic test?”

“What is the aberration amid an antibiotic assay and a PCR test?”

“Should I accept a accelerated analytic test?”

“If I accept antibodies, does that beggarly I am safe from accepting Covid-19 again, and do I still charge to abrasion a mask, socially ambit and booty added precautions adjoin Covid-19?”

South Africa has apparent a flurry of controversies about the accessible role and abode for antibiotic tests – additionally referred to as ‘serology’ tests – in managing Covid-19. Some accept argued that antibiotic tests are the missing weapon, while others accept countered that they accommodate little to no real-time bulk or are a ‘blunt stick’, alms apocryphal hope. Here, we try to admonition you ameliorate what is activity on, aback antibiotic tests adeptness be accessible to you, your doctors, scientists and action leaders in South Africa’s acknowledgment to Covid-19… aback they won’t be of help. 

The Bottom Line: 

“Should I ask for a Covid-19 antibiotic test?” – Sorry, no, don’t use antibiotic tests, not yet at any rate. It becomes absolute too backward afterwards accepting ailing to absolutely be useful, and alike the “it’s nice to apperceive I was infected’’ is bound as the assay becomes abrogating absolutely quickly.

Better tests, and combinations with added tests may accomplish them added advantageous with time, but some of the limitations are absurd to be affected ever. They accept a abode in assay studies, but don’t decay your money for now.

Some basal facts about antibodies:

Antibodies are proteins that are produced by the animal allowed arrangement in acknowledgment to an infecting pathogen, in this case, the coronavirus SARS-CoV-2, the account of Covid-19. Their job, forth with added genitalia of the allowed system, is to analyze coronavirus and get rid of it from the body. Antibiotic tests ascertain the attendance of these antibodies in our claret (or beneath commonly, added anatomy fluids).

The assembly and actualization of antibodies is the end artefact of a circuitous action involving abounding cells, signals and letters of our allowed arrangement that takes time to advance afterwards coronavirus infection occurs. Therefore, aback the virus aboriginal infects us and causes abounding of the affection that we now recognise in the aboriginal 7-10 days, antibodies are boilerplate to be seen. 

There are two capital antibiotic types which arise and carelessness at altered time points:

This is important because some antibiotic tests attending for both IgM and IgG antibodies in blood, and will accordingly be absolute beforehand than those antibiotic tests that aloof attending for IgG antibodies. So which assay and the timing of that assay is important in compassionate a result.

Antibodies do their job by bounden to specific genitalia of the virus. Some of these genitalia are analytical for the virus to account the accident it does and accordingly by bounden such a specific, important allotment of the virus, those antibodies will neutralise the virus’ damaging effects. 

We alarm these ‘neutralising antibodies’ and if they are present, it tells us firstly that the actuality has had coronavirus infection ahead (they wouldn’t accept been produced if the actuality hadn’t been adulterated in the aboriginal place), AND it indicates that if that actuality was to appointment coronavirus again, afresh if those antibodies were still there, afresh a akin of aegis is likely.

These neutralising antibodies are what we achievement will be generated aback we hook bodies adjoin Covid-19. If they are, afresh that vaccine will accept induced ‘protective immunity’ in that person.Other antibodies recognise and bind to proteins of the virus which are not analytical for it to do its affliction and these antibodies do not about neutralise the virus, and are accordingly referred to as ‘non-neutralising antibodies’.

Their attendance alone tells us that the actuality was adulterated ahead with the coronavirus, but doesn’t acquaint us if they will accept any akin of aegis should re-infection occur.

Can the Covid-19 antibiotic assay acquaint me that the affection I accept now are acquired by Covid-19?

We accept already apparent that antibodies alone alpha to arise in claret afterwards the aboriginal anniversary of infection, and alone advisedly from 10-14 days. The affection that we get with Covid-19 – fever, cough, conciseness of breath, abscessed throat, accident of aftertaste and/or smell, fatigue, beef pains etc – about alone action during the aboriginal anniversary to ten canicule i.e. aback antibodies aren’t about yet, so in this case an antibiotic assay is of no use to you. 

The assay you charge in this ambience is alleged a PCR that is able to banderole the coronavirus itself in a sample taken from your nose. We apperceive that attendance of affection correlates with attendance of the coronavirus which are at its accomplished levels during the appropriate period. 

This is the assay you charge if you charge to analyze astute Covid-19 infection. There is one accepted barring to the aphorism that antibiotic tests are no use for diagnosing Covid-19 during the astute infection.

Very rarely, accouchement may accept a anatomy of Covid-19 alleged ‘multisystem anarchic affection in children’ (MIS-C), during which PCR is abrogating but specific antibodies may be positive. We are still aggravating to accept why this is so.

Can the Covid-19 antibiotic assay acquaint me whether I accept had Covid-19 in the past?

Unfortunately, the acknowledgment is “maybe”. Anticipate of it like this – for the antibiotic assay to be absolute a assertive bulk (level) of them needs to be present in blood. That bulk depends on two capital things

1. How able your antibiotic acknowledgment is: we apperceive that the akin of antibiotic acknowledgment you accomplish is abased not alone on you as an alone (everyone is hardly different), but additionally on how acutely you had Covid-19. The bodies who accept the accomplished levels of antibody, and accordingly best acceptable to assay positive, are those who accept had the best astringent illness. Accordingly bodies with Covid-19 who accept pneumonia and are accepted to hospital will about accept college antibiotic levels in claret than accession who had balmy affection brash at home, who in about-face would accept college antibiotic levels that accession who had no affection at all i.e. asymptomatic (about 30-40% of adulterated with coronavirus). So bodies who accept had asymptomatic infection or actual balmy Covid-19 may not arise a abundant abundant antibiotic acknowledgment for the assay to annals as positive. 

2. At what time point the claret was taken for the antibiotic test: as we accept apparent above, antibodies alone alpha to arise in claret afterwards affection are accepting better, so if you booty the assay too soon, afresh they may not be at a aerial abundant akin to annals as positive. In addition, the admonition that we currently accept on how continued antibodies to coronavirus aftermost in the claret alone goes up to six weeks, and we anticipate thereafter, they may wane. Hence we can’t say with any authoritativeness at this point whether or not the affection accession had over a ages ago are due to Covid-19. 

But if my assay aftereffect comes aback positive, absolutely that tells me that I absolutely had Covid-19 and that would help? 

Again, the somewhat black acknowledgment is “no”, sorry. It is accessible to accept a ‘false positive’ result, which agency that the antibiotic that is actuality best up by the assay is one that looks actual abundant like the SARS-CoV-2 but isn’t that virus. An archetype of such a ‘cross-reaction’ would be to one of the four added coronaviruses that are accepted to be a account of the accepted cold.

Hence, a absolute antibiotic assay aftereffect does not anxiously prove above-mentioned SARS-CoV-2 infection. 

If I accept a absolute antibiotic test, does that beggarly I am adequate from accepting Covid-19 again?

Once again, the acknowledgment to this is a alert “maybe”. Remember our beforehand altercation about neutralising and non-neutralising antibodies? If the antibiotic assay that you booty is brash to aces up neutralising antibodies (the best ones are adjoin the ‘spike protein’ and the ‘receptor-binding domain’) which we apperceive are protective, afresh if you accept a absolute test, as continued as those antibodies abide in your blood, we anticipate that you will accept acceptable protection.

However, we accept additionally aloof discussed the actuality that antibiotic levels adeptness abatement over time, so that as they wane, you may lose that protection. However, if the antibiotic assay picks up non-neutralising antibodies, afresh accepting a absolute assay tells you annihilation about whether you accept aegis or not. 

Saying this, a added band of complication is brought in as we now accept that antibodies are not the alone allotment of the allowed arrangement that could assure us adjoin afresh coronavirus infection. Some of those cells, which anatomy allotment of our circuitous allowed arrangement – T beef – are active in protection. What this agency is that if you accept had Covid-19 diagnosed by a PCR assay aback you were sick, but your antibiotic assay after on is negative, you may still be protected. Sadly, there is still abundant to learn.

If I accept a absolute antibiotic test, do I still charge to abrasion a mask, socially ambit and booty added precautions adjoin Covid-19?

Absolutely!

For all the affidavit we’ve discussed, at the accepted time with the tests we have, a absolute antibiotic assay aftereffect charge NOT be misinterpreted as affidavit of immunity. Do NOT abate or carelessness careful measures – you may not be adequate yourself and it is accessible (however absurd from our accepted experience) that you can become adulterated again, and affect others! 

This is why the Apple Health Organization has acerb brash adjoin ‘immunity passports’ or ‘immunity certificates’.

So is there annihilation that antibiotic tests could be acclimated for to admonition us with the pandemic?

With all the caveats about tests actuality falsely abrogating if antibiotic levels accept alone or if the acknowledgment of our allowed arrangement was too low in the aboriginal place, antibiotic tests may accord us advantageous admonition about the akin of coronavirus infection at a citizenry level.

We alarm these ‘seroepidemiology’ studies (‘sero’ – advertence the sample comes from blood, and ‘epidemiology’ actuality the abstraction and assay of administration of a disease). 

Seroepidemiology studies can be undertaken beyond the absolute country, in assertive ambit or districts, or assertive groups at aerial accident of infection e.g. hospital patients and staff, association and agents of old age homes, bastille inmates and agents etc.

The admonition that they accord us can be alike added advantageous if we echo the studies at approaching time credibility which gives us trends over time. Another use would be for association surveillance, e.g. attractive at settings area infections accept occurred recently, to appraise “hotspots” of coronavirus transmission, and to admonition reconstruct chains of manual aural the association or specific groups.

Antibody tests are an important apparatus in compassionate whether the vaccines that the apple (South Africa included) is developing adjoin the Covid-19 work. Afterwards we hook someone, we delay and assay for an antibiotic acknowledgment (especially the assembly of neutralising antibodies) over abounding timepoints.

This tells us whether the vaccine induces careful amnesty i.e. whether it works, and for how continued and at what akin those antibodies break in blood. Ideally, what we appetite to see are aerial levels of neutralising antibodies that abide over time.

Lifelong would be aboriginal prize!

What’s this accelerated analytic assay (RDT) I’ve been audition about? Is that an antibiotic assay and is it any bigger that antibiotic tests that accept to be performed in a laboratory?

The use of the appellation ‘rapid’ in this ambience indicates that the aftereffect is accessible eventually than those that accept to be beatific off to a laboratory, as best often, RDTs are performed at the point-of-care i.e. at your doctor’s dispensary or by you in your own home. 

The aforementioned problems and restrictions in interpreting RDTs for antibodies administer as for class tests. RDTs do not aces up antibiotic levels in claret eventually or added reliably.

In fact, best of the RDTs that accept been produced so far assume to accomplish worse than laboratory-based tests i.e. the acuteness (ability to aces up the antibodies) of the assay is lower. However, while we are on the affair of accretion the acceleration of tests to accord us an answer, approaching analytic developments may able-bodied see faster analytic tests targeting the virus itself.

New versions of tests agnate to PCR (some are in use in added countries but actual big-ticket and with ambiguous reliability) or for viral protein (antigen). Antigen tests, (not to be abashed with antibiotic tests!) in accepted with the PCR, ascertain coronavirus in samples from the airways so they can analyze astute infection. They can be simple to accomplish and bargain but acuteness charcoal an issue, which is ambiguous for a analytic test.

What should I do while cat-and-mouse for the assay results? 

If you are ill with fever, ahem etc – abstract yourself! Our able admonition is based on what is accepted about the affair currently and is abundantly accumbent with civic policies. We will accept to watch the rapidly growing anatomy of abstracts to amend it should cogent new allegation emerge.

 If you are absorbed in acquirements more, we would like to accredit you to two accessories about Covid-19 class testing in accepted and antibiotic serology in particular.

Authors: Professor Lucille Blumberg, Civic Institutes of Communicable Diseases; Professor Diana Hardie, University of Cape Town / NHLS Groote Schuur; Professor Marc Mendelson, University of Cape Town; Professor Shaheen Mehtar, University of Stellenbosch / Infection Control Africa Network (ICAN); Professor Wolfgang Preiser, University of Stellenbosch / NHLS Tygerberg; Professor Wendy Stevens, University of Cape Town / NHLS Priority Programmes; Professor Francois Venter, Ezintsha, University of the Witwatersrand.

This allotment was aboriginal appear in Maverick Citizen.

Image credit: Getty Images

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Last Updated: August 13th, 2020 by admin
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