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A proposed COVID-19 management solution
How to take and record test results
In the days leading up to the lifting of social restrictions on the 19th July 2021, Prime Minister Boris Johnson urged caution, commenting that “this pandemic is not over”, and that it “continues to carry risks. We cannot simply revert…to life as it was before COVID”.1
In light of this, and the ongoing safety measures being implored by the government, in this article we look at the proposed COVID-19 guidance for Higher Education (HE) providers after the 19th of July and address the challenges for keeping students and staff safe. And we’ll go into detail on how adding the right antibody tests to proposed COVID strategies can offer insights following a negative antigen test, or give colleges and universities continuity-assurance with a practical tool to help interpret immunity.
The solution suggested in this article focuses on HE, but it is quite possible boarding schools could also consider this model for older pupils.
Dr Jenny Harries, Chief Executive of the UK Health Security Agency, gave feedback during the UK Government’s Public Accounts Committee and discussed the importance of antibody testing in the near future, commenting that “antibody testing is likely to come back” as “it’s important that we understand who has had a good response”.2 Dr Harries’ comments shed light on the importance of the presence of antibodies in determining a successful immune response post-vaccination and/or post-infection, something which is not currently a consideration.
In the Department for Education’s (DfE) Higher education COVID-19 operational guidance (applies from Step 4), it states that HE providers “have a legal responsibility to protect workers and others from risk to their health and safety, including from the risks of COVID-19”.3 An unequivocal statement that COVID safety responsibilities lie with institutes. But are the government guidelines fit for purpose?
Face to face teaching will be available after 19th July, with twice weekly asymptomatic testing and the use of the ‘self-administered’ Track and Trace App available for all students and staff throughout the summer break for settings that remain open or closed. There are several potential concerns surrounding this approach.
It is well documented across global media outlets that COVID-19 vaccines have different efficacy ratings. Also, many factors can contribute to substantial variations in immune response.4 If antigen testing occurs outside of the ‘live virus’ detection window and someone records a negative test, have they had the virus already? If so, is the body producing the right immune response with the presence of IgG antibodies to the SAR-CoV-2 spike protein including neutralising antibodies (antibodies produced post-infection or vaccination that neutralise the virus’ ability to penetrate and infect human cells)? Without information on individuals’ immune responses, we aren’t well equipped to know who is protected. Furthermore, it is possible that those with asymptomatic infections, around 1 in 3,5 will continue to use antigen tests unnecessarily: a significant drain on resources.
The government’s model for HE focuses on antigen testing and depends on the continued rollout of the vaccination program. However, this reliance raises issues. For example, the prevalence of COVID-19 infections and those with IgG antibodies will fluctuate as will the number of vaccinated and unvaccinated students, staff members, visitors, and suppliers visiting campuses.
There are also questions about how many young people are eager to be vaccinated. NHS England boss Sir Simon Stevens said that only “…about three fifths of people aged 18 to 24 have had their first vaccination…”, prompting calls for England football stars to contribute to increasing vaccine uptake6– an possible indication as to this age group’s relative hesitancy over visiting vaccination centres, which might give pause to relying on vaccination efforts for opening HE.
There are many complexities associated with managing the spread of COVID-19, and current strategies are neglecting some eventualities. Abingdon Health believes testing for SARS-CoV-2 IgG antibodies post infection or vaccination is a powerful tool for interpreting an individual’s and an institute population’s immunity status, and therefore a tool for identifying those who may be safe to remain on campus following a reported case of COVID-19.
A proposed COVID-19 management solution for Higher education
Neutralising IgG antibody testing should play a more prominent role alongside antigen tests and vaccines as part of an integrated approach. All with the sole aim of determining who is most at risk by confirming who has produced the desired immune response following infection or vaccination.
Taking Leeds University as one example, and should social restrictions not be in place later this year, 50,700 students and staff members 7 could potentially visit its campuses. This will inevitably put some people at risk.
For example, assuming that 80% of Leeds University’s population are double vaccinated with the AstraZeneca (82% efficacy8) or Pfizer (95% efficacy9) vaccines, 10,140 unvaccinated people will not know their antibody status, whether they have had the virus or not, and potentially a good proportion of vaccinated individuals will not have developed the right immune response.
Knowing the variation in vaccine uptake, immune response and asymptomatic people, without the provision to confirm IgG antibody status more people than necessary could be asked to isolate following the next reported COVID case?
The proposed model
Therefore, test everyone for SARS-CoV-2 IgG antibodies leading up to the start of the academic year, record the results, provide students and staff members with an antibody certificate for displaying at lectures, seminars, social events and leisure venues. For those who have not displayed antibodies, antigen testing and NHS track and Trace is there to fall back on. This way institutes can start the academic year with basis to interpret antibody status and make informed decisions.
In addition, it has been reported that IgG antibodies are persistent for several months10, helping to justify the need for less frequent testing.