Antibody Tests Now Available Statewide

Josh Green. PC: State of Hawaii.

UPDATE: This article has been updated from its original version to include more information on the effectiveness of current antibody tests being used in the United States. 

Coronavirus antibody tests are available at clinics across Hawai‘i, meaning the state now has the capability to tell residents whether or not they’ve been exposed to the virus and likely have at least relative immunity to it.

The tests, approved by the US Food and Drug Administration, went live Wednesday, and Lieutenant Governor Josh Green said they can be performed at any lab. The tests will be useful in several ways, including developing a general idea of how many people have been exposed to the virus in Hawai‘i and how many are still at risk, which will be the best indicator of how close the state is to achieving herd immunity.

Those with antibodies have “likely immunity” when it comes to illnesses like coronavirus, said Green, adding “that’s what happens most of the time.” Everyone in the state is eligible for the antibody test whether they are symptomatic or not.

It is widely thought that the disease was circulating in the US for weeks before the first official case was confirmed, and people who had flu-like or cold-like symptoms earlier this year will be able to discern whether those were related to a COVID-19 infection, Green said.

And finally, the tests could be crucial in allowing tourism to return meaningfully and safely to Hawai‘i sooner than later. The antibody test is administered by way of a blood draw, in particular a finger prick, and is easily conducted.

“I’m going to be recommending something sane,” Green said, “that people, within three days of coming to Hawai‘i, they get a test.”

The tests take seven days to turnaround before antibodies begin showing up in the blood. The first type of antibody that appears signifies an active infection. The second type, which the test in Hawai‘i will measure, indicate a developing immunity.

However, most of those who take the test will be asymptomatic, meaning they’re less likely to have the virus and less likely to spread it easily if they do, Green continued.

Widespread antibody testing could allow tourism to start reopening in a meaningful way sometime in June, which is when Green said he believes it will begin to ramp up. Pairing that with a travel quarantine until results of antibody tests are returned could be an effective way to reintroduce the state’s largest industry.

However, disease experts have disagreed about whether these tests should be used based on questions of effectiveness.

“The antibody tests that are out there now, which are the ones that are most amenable to becoming take-home tests, are bad — for a lack of any other word,” said Dr. Tim Brown, Senior Fellow at UNAIDS Collaborating Center at the East-West Center.

Brown added the antibody tests cross-react with common cold coronaviruses, which means someone may test positive for a cold they had a month ago.

“The FDA is basically approving tests that have extremely high false-positive rates, so they are overestimating the prevalence (of the disease in areas like Los Angeles) … and badly overestimating it,” he continued. “They give a lot of people the impression that they’re not effective when they are, and vice versa, that they are effective when they’re not.”

That could cause serious health risks for those who believe they were exposed based on a bad test and head out into the community with a false sense of security due to a phantom immunity that doesn’t actually exist, Brown said.

Based on current projections, he believes it will be four or five months before reliable, antibody home tests are available.

Highly accurate tests would be an economic boon for the state, as roughly 100,000 jobs, or around 45% of Hawai‘i’s currently unemployed workers, are directly tied to tourism. While the economy desperately needs visitors to return, Green said he fears anger and altercations between locals and tourists will be inevitable if visitors can’t do so with a high degree of safety.

The month of May will be more about reestablishing local business, as Gov. David Ige announced Wednesday that several Hawai‘i businesses will be able to reopen over the next few days.

Businesses that will be allowed to open in the initial phase include auto dealerships, real estate, tutoring and music lessons, golfing, service for pets and animals, and car washes, among others. Floral businesses will also be allowed to open May 1.

These were chosen, the governor said, because they allow for social distancing with relative ease, don’t pool customers in large numbers and confine them to one area, and don’t need to significantly alter best-business practices.

Situations like indoor dining, bars, movie theaters and night clubs will be more logistically difficult to deal with and will pose more risks. All restaurants have been allowed throughout the COVID-19 pandemic to offer carryout and delivery services.

Green said at a virtual town hall meeting with West Hawai‘i politicians Wednesday night that he’s hopeful the state will “get everything open in May.” Every week, the governor will provide a new list of businesses that can start operating again, along with guidelines on what those operations need to look like.

The number of unemployed individuals in Hawai‘i tied to exclusively kama‘aina businesses is around 120,000.

State officials do expect a second wave of coronavirus to hit Hawai‘i, and Ige warned at a press conference Wednesday that if a surge of new COVID-19 cases does arrive, now reversed lockdown mandates may go back into effect.

A new experimental drug, remdesivir, may prove helpful in stemming any future surge. Developed by Gilead, a study by the National Institute of Allergy and Infectious Diseases indicates the drug is the most effective yet against coronavirus.

It was endorsed Wednesday by Dr. Anthony Fauci, Director of NIAID and the nation’s leading expert on infectious diseases.

“The data shows that remdesivir has a clear-cut, significant positive effect in diminishing the time to recover,” Fauci said.

The FDA is expediting public administration of the drug by issuing an emergency-use authorization. The way it blocks the virus and helps patients recover would limit the impact on Hawai‘i hospitals were hundreds of cases of COVID-19 to show up in a matter of days or a few weeks.

As for current testing levels across the state, roughly 2% of those tested have come back positive. Nearly 30,000 tests had been administered as of noon Wednesday. It’s also home to the lowest virus death rate in the country.

Hawai‘i has the capacity to test nearly 3,000 people daily with the traditional nostril-swab method and return those results within a day if they’re conducted before 11:30 a.m.

Currently, demand is for about 1,000 tests daily, leaving a leftover capacity Green said could be used in the development of a contact-tracing system, which is one of the key requirements to reopening all economic sectors and the entirety of society.

Ige said that conditions aren’t likely to return completely to what they were pre-pandemic until a vaccine or a highly effective treatment for coronavirus is developed.

Another condition of reopening will be consistently low positive tests reported over a two-week period. Hawai‘i has not reported more than six new cases of COVID-19 in a single day in nearly a week and a half, according to numbers provided by the state Department of Health Wednesday.