New Guide: American College of Physicians Discusses the Antibody Response to COVID-19 Immunity


Due to the mutation of the coronavirus induced by COVID-19, there is insufficient evidence to determine whether antibodies produced after exposure are protective against infiltration as well. As such, the American College of Physicians (ACP) publishes quick, evidence -based living practices in Annals of Internal Medicine discussing the role of antibodies in, tests for diagnosis, and tests for estimating the prevalence of COVID-19.

Exercise Point 1: Antibody Tests for COVID-19 Diagnosis

The ACP does not recommend the use of SARS-CoV-2 antibody tests to detect COVID-19. This recommendation is based on limited evidence suggesting that not all patients with COVID-19 develop antibodies early in the course of their infection, because the presence and levels of antibodies may vary among patients and be dictated. of specific disease characteristics.


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The pageant adds that clinicians and patients should be aware that some SARS-CoV-2 antibody tests may yield adverse outcomes, caused by cross-reactivity of antibodies to other coronaviruses.

The research also suggests that the sensitivity, specificity, and accuracy of currently available antibody tests are more diverse, further complicating their use as reliable diagnostic tools. The variability in sensitivity and specificity of these tests can also give both false negative and false positive outcomes, leading to incorrect conclusions about infection and possibly inappropriate or inadequate treatment.

Exercise Point 2: Antibody Tests for Estimated Community Outreach

Studies have suggested that patients develop resistance responses after exposure to the novel coronavirus. Evidence has been shown that immunoglobulin (Ig) A and IgM antibodies are detectable in most patients infected with the SARS-CoV-2 virus. Almost all patients also showed detectable IgG and neutralizing antibodies.

Over time, the prevalence and levels of these antibodies can vary with different patient characteristics, disease symptoms, and disease severity. On average, the level of each antibody class is between 20 to 31 days following symptomatic diagnosis or diagnosis of polymerase chain reaction. Studies have also shown that IgM antibodies can persist for up to 115 days and neutralization of antibodies can persist for up to 152 days. Consequently, the ACP recognizes that antibody tests may be an option for estimating the community prevalence of COVID-19.

Exercise Point 3: The Protective Effect of SARS-CoV-2 Antibodies Against Reinfection

There is a lack of evidence suggesting that natural resistance is conferred by SARS-CoV-2 antibodies. There is no evidence to suggest that SARS-CoV-2 antibodies can predict the presence, level, or strength of any given natural strength, especially with respect to protection against onset. also.

Since most patients exhibit detectable antibodies at least 100 days after infection, it can be trusted that natural resistance can occur. However, the panel reiterated that there was no direct evidence to answer the question of whether these antibodies could protect against recurrence of comprehension.

Some literature has shown that both asymptomatic and symptomatic patients may produce an antibody response that characterizes natural resistance following COVID-19, but variables such as disease severity, cause patient, class and number of antibodies, as well as the longevity of antibodies, play. an important role.

The instructional panel cited a small study of patients hospitalized with COVID-19 who reported a possible case of reinfection in the consolidation phase. This patient did not detect IgM or IgG antibodies at the 4-week follow-up period.

Limitations of Training Points

Consistent with the authors of the standard, points of practice have been shown to concern only the response of natural antibody resistance to COVID-19 and not specifically address the involvement of other natural antibodies, including cell -mediated resistance or acquired vaccine resistance.

Currently, the only evidence-based recommendation for increasing SARS-CoV-2 virus resistance and infection prevention is to receive an approved COVID-19 vaccine. Additional prevention strategies recommended in the standard include social isolation, wearing a mask in public, quarantine, and regular hand washing.

“Because of the limited knowledge about the association between antibody levels and natural resistance,” the authors of the standard, “patients with SARS-CoV-2 infection and those with a history of SARS infection -CoV-2 should follow recommended infection prevention and control measures to slow and minimize the transmission of SARS-CoV-2. ”

Please note:

Qaseem A, Yost J, Etxeandia-Ikobaltzeta I, et al; for the Scientific Medical Policy Committee of the American College of Physicians. What is the antibody response and role in conferring natural resistance after SARS-CoV-2 infection? Fast, live practice practice from the American College of Physicians (version 1). Ann Intern Med. Published online March 16, 2021. doi: 10.7326 / M20-7569

This article originally appeared Infectious Disease Counselor



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