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Infection Prevention

UPMC Hopes To Answer Antibody Research Questions

The University of Pittsburgh Medical Center hopes to help answer questions of whether the presence of COVID-19 antibodies protects someone from a future COVID-19 infection.

There is currently no medical consensus whether or not the presence of antibodies prevents a COVID-19 reinfection in the future. South Korean studies intimate antibodies could protect against COVID-19, but the World Health Organization warned in a scientific brief last week that not enough evidence exists to prove that a majority of those with antibodies are protected from further infection. Dr. Donald Yealey, chair of emergency medicine at UPMC, said during a news conference Thursday that current antibody testing is useful at showing the actual spread of COVID-19 in a community, but doesn’t provide enough answers about what type of antibodies a person has. UPMC could have its own test available within two to four weeks, Yealey said, that helps answer those questions.

“The current tests tell us in general about was there a previous exposure,” Yealey said. “They do that reasonably well but they don’t tell us if they’re the kind of antibodies that kill the virus and come back later on should you be re-exposed to the virus. That’s the activity that we hope over the next few weeks that we can develop that type of testing either on our own platform or together with commercial platforms to help answer that question.”

“No one can tell you that right now. The best they can tell you is a certain number of people have had some circulating antibody around, but whether or not it actually is protective in the future we simply don’t know yet.”

The hospital system, which includes UPMC Chautauqua in Jamestown, has begun rescheduling previously delayed health care procedures. Those who come in for a scheduled procedure, which could be surgical or non-surgical, will get a COVID-19 test. There will soon be expanded testing so that anyone who comes to a UPMC facility for any type of care are tested for COVID-19. Eventually antibody testing will become part of the hospital system’s regular routine.

Antibodies are proteins produced by the immune system of higher life-forms that help defend the host against foreign invasion. They can help fight an initial infection and can also help protect people who are exposed to the same infection in the future. While there are commercial antibody tests available, their reliability varies. Yealey said the UPMC clinical lab team is assessing available antibody testing options, including developing its own tests. The antibody tests are important because they can provide policy makers and those in the health care system with much-needed data about how COVID-19 behaves and what type of risk people face from the virus. Antibody studies in California and New York have shown much greater spread of COVID-19 than had previously been confirmed, giving medical professionals a greater understanding of COVID-19’s potency.

Yealey used Allegany County in Pennsylvania as an example. The county has a total of 1,289 positive COVID-19 cases and 94 total deaths for a mortality rate of 7.2%. Yealey said the facts change greatly if the rate of asymptomatic antibodies in Allegany County holds true to the New York and California antibody testing results, there would be 36,000 people in Allegany County who had COVID-19 and never knew. The mortality rate, then, drops to about 0.25%.

“This is why we want to do broader testing, to try to understand more about the prevalence of this disease,” Yealey said. “COVID-19 can infect almost anyone. The biggest challenge is in our most vulnerable populations. That’s particularly true in the elderly and those who are immunocompromised. Sadly the majority of deaths in our regions, whether it’s Central Pennsylvania, New York, Maryland or even Allegany County and Northern and Northwestern Pennsylvania, are associated with the elderly and particularly those in nursing homes and people with an average age of 80 or above.”

Expanding the antibody testing will work in concert with UPMC’s previously discussed REMAP program. UPMC-REMAP-COVID19 is open across UPMC’s 40-hospital system and began with multiple treatments tested simultaneously in different combinations — including hydroxychloroquine, steroids and medications called immunomodulators that alter the responsiveness of the immune system. The REMAP system conducts clinical trials in real-time, which means the treatments that perform the best are used more often while poor-performing therapies are discarded.

“So what is UPMC going to do about this?” Yealey asked. “Anyone who is symptomatic we will test, as we have been doing for months. Now, with the addition of testing in asymptomatic patients and planning antibody testing, we will continue to study what novel treatments might help those who are infected using our novel and international REMAP trial that Dr. (Derek) Angus told you about weeks ago. UPMC is also going to focus on the most vulnerable population, that is seniors. Wherever they live, particularly those that are in a nursing home or a congregate facility, we are developing innovative ways to diminish the effect of COVID-19 with targeted treatments, even before a vaccine becomes available. This will include reliable antibody approaches and other treatments you’ve heard of, like convalescent plasma. By taking this highly targeted approach on identifying who has the illness, both with symptoms and without, and focusing on how we protect the most vulnerable, especially the elderly, those in nursing homes even more importantly, we can inform policy makers and public health officials with respect to opening up society, opening up the economy and protecting as many citizens as possible.”

A sign stating “Heroes Work Here” is pictured outside UPMC chautauqua. P-J file photo

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