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Avera Talks “Antibody Testing“

Jackie Hendry: A direct to consumer blood test available through Avera Quick Lab locations and various Avera clinics may detect whether someone has been exposed to COVID-19. What exactly does this mean and what might the benefits be? Well, Dr. David Basel is a physician and vice president for clinical quality with Avera Medical Group and he's here today to explain. Dr. Basel, welcome back to In The Moment.

Dr. David Basel: Yeah, thanks for having me back.

Jackie Hendry: So let's get down to real basics with this story first, what are antibodies, and why might we want to test for them in a situation like this?

Dr. David Basel: So when you are exposed to a virus or a bacteria, one of the major tools in the immune system to fight that off are antibodies which are small proteins that white blood cells make, and they attached to the virus or the bacteria and inactivate it. And so usually there's two or three different types. There's IgM IgG, then there's IgA. But the big one that we usually pay attention to is IgG, which is a permanent immunity. And so you want to be able to see that you've developed that antibody response that gives you an idea that your immune system has been working to fight that off. The problem with antibodies is that they react differently with different viruses. And so if you think measles or polio, it's lifelong immunity. And so you're going to have antibodies that protect you for the rest of your life. You've got some things like tetanus after 10 years, it comes down. Others, it might only last a few months and then the immune response goes away. And there's some like HIV that we never develop an antibody response to. And so that's where a lot of the unknown with coronavirus comes in.

Jackie Hendry: Interesting. Oh, when I first started hearing about this antibody test, I imagined you get one of two results. You either have the antibodies or you don't, but in reading the press release from Avera, there's three possible results for this test. Can you kind of explain what those look like?

Dr. David Basel: Yeah. I would say it's still by and large, it's either going to be reactive or positive or nonreactive, which is negative. There's just a couple percent that are in determinant in between there, but it's still part of the problem with it is that we don't know if you're reactive, if we find antibodies, how protective those are and how long they're protective. And so the test is most useful for a couple of different reasons. The best use case for the test is for epidemiology to figure out how much COVID do we have circulating in the community at any given time. But what we can't tell you is if you're positive, well, you're safe, you're protected. We don't know that for sure yet, but it can tell you if you're positive that you know, that cold you had back in April probably was a COVID type of thing. And so it's almost more satisfying curiosity at this point, which is why we're kind of making it direct access to the consumers. You don't need a physician order, you can just go up and get it.

Jackie Hendry: Interesting. If someone's test comes back saying, yes, you have antibodies, you were exposed at some point, would that mean that they are still able to spread the virus?

Dr. David Basel: We think it is less likely at least in the short term. So if you've got antibodies, you've probably gotten over it and at least in the short term, you're a lot less likely to get sick from it, but we don't know how long that's going to last. And there's also, like you said, positive or negative, there's barely positive, which we don't separate out, which means you just have a few antibodies versus you got a whole bunch of antibodies. And so we aren't able to distinguish that. And so some of the people with positives are going to be more protected than others, which is why you have to be very careful interpreting these.

Jackie Hendry: Interesting. It is a blood test. What should be the practical expectation for the test? Is it a finger prick or a larger blood draw?

Dr. David Basel: It is about three or four CC. So it's a regular blood draw more so than just a finger prick. Correct. So it's a regular blood draw. I actually had it done as part of just the testing of it myself. So it's pretty quick, comes back in about 24, 48 hours. Costs $80. Insurance does not cover it when we're doing this direct to consumer type of testing. So you can use your [inaudible 00:04:44] plan, your flex dollars, those sorts of things for it.

Jackie Hendry: Okay. I don't know if you would feel comfortable with this or not, but I'm curious what your result was and how you interpreted that for yourself.

Dr. David Basel: So interestingly, so I mainly got it to kind of help them test out the process and everything and putting this together, but my wife is actually a pulmonary and critical care physician who cares for pretty sick COVID patients on a pretty much a daily basis. And so I figured if anybody had been exposed, it might be me as a practicing physician with a wife who is certainly being exposed all the time. And I actually had a febrile illness earlier a month or so ago, but sure enough, we came back negative. And probably that's the most interesting thing as part of this, we did a study where we looked at our ED frontline staff, anybody that's seen patients in our McKennan ED. And we figured if anybody was going to be being exposed to this, it would be those people who are seeing kind of less than ideal controlled situations, a patient coming in off the street and things, and out of 180 tests, we ran as part of the quality project, we only had two positives, which was very, very low.

And that's what we're finding now with the community, is that the numbers, the people that are positive are much lower. So many people think they've they, "Oh, I had this cold. I bet you that was COVID," but by and large, no, you've done it. And you're still susceptible. That's what we're finding.

Jackie Hendry: I've fallen into the same trap. I think back, this was back in January, I got the sickest I'd gotten in years and I thought maybe I had it. So who knows, maybe I'll have to take the test for myself just to see. Does this, when you, when you almost expected to have those antibodies and that comes back negative, does that it encourage you as far as our use of PPE and other protective measures?

Dr. David Basel: Yeah. That's been, you know, we were really wondering of ... That's been a big fear with the healthcare workers of how good is the protection being? Are we putting our workers in harm's way? And this has been very validating that the gowns, the gloves, the mask, the face shields have been doing their job. And we really haven't been seeing the workers come down with it, which has been wonderful.

Jackie Hendry: If folks decided to get this test, you mentioned it's for the individual, it may be as much about satisfying curiosity as anything else, but from an epidemiologist's perspective, why might it be important to the medical field to understand how many folks have these antibodies?

Dr. David Basel: How much are we still at risk, is one of the biggest questions. And then over time is it starting to come back into our community? It seems the way I've been describing COVID overall, when anybody asks me about it right now is we've got all these smoldering area of COVID pretty much, that seems pretty constant low level right now. And we're having flare ups here and a flare up there and trying to catch those flares and starting to see if we're starting to pick back up again. And so monitoring for that, especially as we go on into the fall, the weather starts to get a little bit cooler again, then rates may pick back up again, the serology or the antibody tests are really going to be a key part of keeping a monitor on that.

Jackie Hendry: Interesting. I happened to hear on OnPoint earlier this morning, someone talking about how we're still kind of not entirely sure, as you said, if you have these antibodies, like how long, or how much of an immunity that translates to for the coronavirus. And that as we think about developing a vaccine or other sort of preventative measure for the coronavirus, how those two things kind of intersect. Are you any more up to date on what the preliminary research is telling us how these two things come together?

Dr. David Basel: Well, it does seem like the antibodies are at least protective in the short term. And so they're to the right parts of the virus and they seem to what's called neutralize the virus. And so it does seem like that's good hope for being able to have a vaccine, cause that's different than say HIV, where the antibodies you develop aren't to the right parts and aren't protective even in the short term type of thing. So it does seem like we've got a pretty good chance of developing a vaccine that will be able to give immunity. But what we don't know is how long that immunity lasts, will it be three months, a year or 10 years? And that'll be what we'll have to find out.

Jackie Hendry: Right? How do you find out something like that? This is probably a silly question, but I'm curious what that research looks like.

Dr. David Basel: There's no shortcut for time for that one. There's really no way to say.

Jackie Hendry: Right?. Oh, for folks who are interested in this test, walk us through one more time. You don't need a doctor's order necessarily to get it. How can folks pursue this test for themselves?

Dr. David Basel: Probably the easiest way is either go to or a Google Avera Quick Labs and get the number of locations that offer this service so that you can get it drawn. And most of the locations, you don't need an appointment. You don't need a doctor's order. You just go in and get it drawn and they will contact you with the results in a day or two.

Jackie Hendry: And we're going to circle back again. We've talked in the past about testing for an active COVID infection. So antibodies is after the fact, you don't necessarily have symptoms or you've recovered from lighter symptoms. Talk us through the process of getting tested for an active infection.

Dr. David Basel: Yeah. So that's an important point to make, is the antibody test, the serology does not diagnose an active infection. And, and when you're looking at the active infection, you're looking for actual viral RNA particles telling you that you've got the virus in you at that point of time. And so that is a different type of a test. That's the swab, as opposed to a blood test. And so the swab is still, you can either call your local clinic or you can call the main Avera COVIT hotline, which is 877 AT AVERA, A-T A-V-E-R-A. And we can get you set up. We are, one of the things from the beginning of this we had been somewhat limited on the number of test kits that were available to us, and that's really loosened up over time. And so at the current time we are testing anybody that's symptomatic. So if you've got fevers, chills, muscle aches, cough, shortness of breath, vomiting, diarrhea, any of the usual COVID symptoms, we will test pretty much all comers at this point if they've got symptoms.

Jackie Hendry: My guest has been Dr. David Basel. He's a physician and vice president for clinical quality with Avera Medical Group. Dr. Basel, thanks as always for your time. Always enlightening.

Dr. David Basel: All right. Thank you.