COVID 19 ANTIBODY TESTING- WHAT YOU NEED TO KNOW

Since March 1st, we have evolved—
 
-First there was no test available for Covid 19.
– Then came the nasal PCR swab PCR to show us evidence of the live virus.
-And now, antibody testing has arrived. 
 
Depending on your age, you can hear Roseanne Roseannadanna in the distance.
 I know a lot of you are asking, what is an antibody test? Do I need one? Where do I get this test? Do I have to pay for it or is it free? Do I come to you or do you come to me? Can you do it from my car curbside or do I have to go into the office? Do I see a doctor first? If I have had Covid 19 do I get one? If I haven’t do I get one?   
 
Well dear patients; you sure ask a lot of stupid questions! God bless Gilda Radner looking down with a smile…
 
Of course these are not stupid questions at all.  Let’s answer succinctly.
 
This is a perfect time to bring up the old adage LET THE BUYER BEWARE…
 
The WHO has put out many cautions that the antibody test may not actually predict your immunity. Many experts are also cautioning that the antibody test may not actually predict immunity since COVID-19 is such a new virus; it would be dangerous to rely on a test that has no track record.
 
At Caduceus, we completely agree. On the other hand, it’s “the best we got.” It appears clear that if you need a high degree of assurance of your immunity, you should pass on the antibody test for now.
 
However only by doing antibody tests on a large population of people will we be able to find out if it’s accurate. A true catch 22.
 
Covid 19 is a virus and when it is in your body acts as an antigen. Your body forms antibodies to fight off the virus.  You need a test to find out if you’ve had Covid 19 and to check for immunity.
 
Some health plans are paying for it; others will not tell us yet. You may be asked to pay $75 if it’s unclear your health plan will reimburse for it. We are also offering a cash price for those uninsured of $99 which includes the video visit screening and curbside antibody test from your car. 
 
Caduceus is only doing testing curbside. The staff will be bundled up well in PPE. We advise against having the test inside a medical office or hospital. At Caduceus, a physician’s order is required, and the doctor will help you interpret the test. It is NOT a simple positive/negative as with the PCR nasal swab.
 
You SHOULD consider having one no matter if you’ve had Covid 19 or not. 
 
Two cautionary tales…
 1.  In our opinion, antibody tests available prior to April 20th are very suspect. Distributors were frankly “shady” and prices were all over the map, there were high false negative rates, and no FDA emergency blessing. We searched high and low to find one that we are comfortable with recommending for our patients and the community at large.   All antibody tests are NOT the same. Before having one vetted, stay away from sites that charge over $125, do not require a doctor’s order, give you results in two minutes, require you to enter a lobby with other possibly sick patients, or in general appears sketchy. This is one test you may want to avoid the “Motel 6 variety.” Hold out for the “Four Seasons” version. 2.  Studies are showing it may take up to 90 days for the antibody to “show up” on the tests. If you were exposed in early March that means ideally you’d be tested in June. Realizing most patients will not want to wait, be prepared to be re-tested in the summer if you test negative now.

 
Let’s have a little fun….and play doctor….NO not that game!  Instead I’ll give you FOUR short cases and you guess which is the right test; nasal PCR swab or blood antibody?
 
Case 1-
Suzy is 44 and has a fever, cough, and loss of taste for the last week. Two weeks ago she went to the grocery without a mask and the deli worker did sneeze a couple of times near her. What test should she have?  ANSWER- Nasal swab. It will show active Covid 19 virus accurately. The antibody test will be negative for weeks more. 
 
Case 2–
Sam is 55 and went to a New Year’s Eve party where a couple were coughing and saying they were “getting over a flu bug.”  A week later, he spiked a high temperature, started coughing, and had chills and body aches. He went to an urgent care where they diagnosed the flu and gave him Tamiflu. It took two weeks to recover, and Sam now believes he may have actually had Covid 19 since the couple at the party was hosting a Chinese exchange student over holiday break.  What test for Sam?  ANSWER – antibody test.  The virus is most likely out of his body but the antibody test will reveal if he has antibodies against Covid 19, thus confirming that was his proper diagnosis in January. 
 
Case 3–
Tammy is 26 with an active social life and who also cares for her frail 79 year old grandfather. A month ago, a close friend tested positive for Covid 19. A week later, Tammy had a mild sore throat and low grade fever for two days. She did not get tested. She wants to be sure she is not a carrier so she does not spread Covid 19 to her friends or grandfather. Which test to order?  ANSWER- A PCR nasal swab will rule out her being contagious. An antibody test does not test for active virus but would tell Tammy if she indeed had Covid 19 but NOT if she’s a contagious carrier. 
 
Case 4-
Joe is 50 and has been furloughed from his job for a month now. He has been well, with no symptoms or known exposure. His boss has announced his intent to reopen the office and resume operations sometime in May, but he is requiring all staff to show whether they have had Covid 19 and if they are immune.  What test does Joe ask for?  Answer- An antibody test will actually give Joe TWO results on antibodies; IgM will tell us if he has had Covid 19 recently. IgG will confirm immunity. A PCR nasal swab fails on these criteria. 
 
Did you have a perfect score at FOUR for FOUR? If so we may want to deputize you! I mean every Sheriff Taylor needs his Barney right?

Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group
 

Please follow these directions to request an antibody test:

• Email videovisits@caduceusmedicalgroup.com and include your full name, date of birth, cell phone, and if you are not an existing patient any insurance information or if you will be paying cash. 
• A staff member will email you back same day between the hours of 8-5 M-F.
• You will be scheduled for a video visit antibody screening (just like a Facetime call) from the comfort of your home on your cell phone or other mobile device.  If you do  not have a cell phone you can also use a laptop or desktop and to guarantee the best connection we do recommend using a mobile device.
• The medical provider will review with you on the video call the four possible readings and then direct you to one of our two curbside testing sites in Yorba Linda or Laguna Beach.
• You will receive a call back from a staff member or provider the same day to review your results.