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New York Gov. Andrew Cuomo sees antibody testing as the state’s next biggest hurdle in the fight against the coronavirus and has asked the U.S. Food and Drug Administration for expedited approval of an antibody finger prick test that could be used on up to 100,000 New Yorkers a day.
“The more testing, the more open the economy,” he said in his daily news conference on Wednesday. “But there’s not enough national capacity.”
These tests can detect antibodies—proteins in the blood produced in response to the virus—via a finger prick test. If a patient has the specific antibodies the test measures, it means he or she has had the virus and is no longer a risk to transmit and, presumably, immune to catching the disease again.
If approved, the new test would dramatically increase the state’s ability to determine how many people have been affected.
“That’s 500,000 a week, if you don’t work weekends,” he explained. About half a million people in the state have been tested for the disease since the outbreak began in early March, he added, “so you get a sense of how powerful that could be.”
Performing widespread tests have been touted as a key component to restarting the economy.
New York has been “on pause” since mid-March as the state tries to slow the spread of COVID-19. The state has been the epicenter of the pandemic in the U.S., with more than 213,000 cases reported. New York City accounts for more than 111,000 cases, with more than 11,000 fatalities.
Up to 2,000 patients a day could receive the test, developed by the state Department of Health, as of this week, the governor said. New York has also created a regional testing partnership with Connecticut and New Jersey to help develop tests, he announced on Friday.
Priority for these tests would be given to health-care workers, first responders and essential employees across the state, Cuomo added.
“We’ve all been saying ‘thank you,’ to the health-care workers, and that’s nice, but…[they] need support,” he said. “They need the tests to make sure they’re not getting infected or, if they are infected, what is their status?”
Testing key to reopening businesses
Along with the testing, Cuomo stressed restarting of the economy would be done in phases, with the most essential businesses opening first. Public health will remain the priority, as not to risk another outbreak.
Antibody testing can help there, too, however.
Data compiled from the tests could show what percentage of New Yorkers have the antibodies and are thought to be immune from the virus, according to Dr. Vincent Racaniello, the Higgins Professor at the Department of Microbiology and Immunology at Columbia University.
“We know that if you get a certain percentage of the population immune to this virus, they won’t be reinfected,” he said. “That will give us what we call herd immunity, where everyone’s protected because most of the population can’t be infected.”
When the majority of the population is immune, the likelihood of transmission becomes very low. But to develop herd immunity to coronavirus, it estimated that between 50% to 70% of the population has to be immune, Racaniello said.
Knowing what percentage of the population is immune will also help predict future waves of the virus, he noted.
Read: Coronavirus likely to cost New York City up to $10 billion in lost revenue
“The data from those antibody tests is really important,” Racaniello said. “Not just for telling people to go back to work, but assessing whether population immunity is high enough to prevent another serious outbreak.”
Until the tests are available, there’s no way of knowing just how many New Yorkers have had the virus, Racaniello said. He estimates it could be 10 times more than the official tally, due to lack of early testing and the potentially large number of asymptomatic carriers.
Unlike the swab tests used to determine whether a patient is currently positive for the virus, these tests use a drop of blood to look for antibodies created only after the illness has passed. Those are called immunoglobulin G antibodies, as opposed to another kind of antibody called immunoglobulin M, which can exist while a patient is still sick and can also cross react with other seasonal coronaviruses that cause colds, but not serious disease.
“You want to get people far enough away from their initial infection that they’re just making IgG,” Racaniello said. In addition, it will be more specific to this strain of the virus.
The antibody tests were approved by the U.S. Food and Drug Administration on April 2, and private sector companies have been racing to meet demand for them. But many do not have all the materials and equipment to scale up to the level of production currently needed, Cuomo pointed out on Wednesday.
On-the-ground testing
Testing has already become a part of life for some essential workers, according to Henry Garrido, the executive director of District Council 37, New York City’s largest municipal employees union with 150,000 members and nearly 100,000 retirees.
About 100,000 of his members are considered essential employees, which includes health-care and EMS workers, employees of city relief agencies, school employees serving lunches to New York families and myriad other workers crucial to keeping the city running.
Among members of the union, there have been at least 520 cases of the virus and more than 50 deaths as of Tuesday, Garrido said. There are also hundreds of workers currently ill, and quarantined.
To get back to work, employees must have had no fever for 72 hours without the aid of medicine and, in some cases, need a doctor’s clearance, Garrido explained.
Also see: These 21 companies are working on coronavirus treatments or vaccines — here’s where things stand
The union has set up some sites to test members who may have recovered from the virus, with first responders given priority. Porters and drivers have second priority, Garrido noted, adding that a system has been devised to get the most essential workers tested.
A path forward beyond New York
Antibody testing will be key to getting economies around the country moving again.
“We have these estimates that it could be millions of people” in the U.S. who will qualify to go back to work once an antibody test is deployed, said Joshua M. Epstein, a professor of epidemiology at the New York University School of Global Public Health.
He said he believes that antibody testing, combined with continued physical distancing and an eventual vaccine, are the way back to health. But there also has to be a way to register, confirm and keep track of the data from those tests, he added.
See: The U.S. could be looking at social distancing measures into 2022, Harvard researchers warn
“There needs to be ways of verifying all this,” Epstein said. “If for no other reason, people can misinterpret the test. But under the circumstances of economic privation, you can imagine other abuses of the system.”
Epstein cited a system in Germany that uses an I.D. card to register and verify immunity, but said he had not heard of such a system being developed yet in the U.S. The New York State Health Department did not immediately respond to requests for comment on how they will track the data.
The real end of the COVID-19 crisis will only come when a vaccine is developed, Cuomo said Wednesday, which could be 12 to 18 months away.
