While it might be impossible to figure out who is going to become sick with novel coronavirus, some public health experts believe the more critical question may be who has already been exposed.
In Telluride, Colorado, last week, one biotech company put that idea to work.
United Biomedical is now working with San Miguel County, which includes the famous Rocky Mountain ski destination, to test all 8,000 residents for COVID-19 antibodies -- making it the first community in the country to do widespread antibody testing. The idea, officials said, is to learn from an individual’s blood whether there is evidence the person has already been exposed. With that information, officials can then make decisions about whether quarantines and restrictions would need to continue and whether they need to be as widespread as they are in states and cities across the country right now.
"The goal of this is to show you can predictably get an entire county back to its new normal as quickly as possible by using testing," said Lou Reese, co-CEO of United Biomedical and its COVAXX subsidiary.
Reese stressed that, if successful, the testing program could be expanded, "starting at the hot-spot areas right now to solve this problem, stop the panic and get people to their lives and back to work."
The science behind the testing concept is not complicated. Every person who contracts the coronavirus will develop antibodies in their blood, usually within 10 days, even if the individual has such a mild case that there are no symptoms. Antibodies are proteins that help the body fight off an intruding virus -- but they’re also unmistakable forensic evidence of where the virus has been.
Because it is generally believed that someone who’s had an infection has at least a temporary immunity, a person who already had COVID-19 may not need to remain locked down the way millions of Americans -- in New York, California, Washington state and other places around the country -- are this weekend. What remains unknown is whether the immunity is long-lasting or whether someone who has coronavirus antibodies can continue carrying the virus, potentially posing a threat to others. For instance, people with a MERS infection -- a virus from the same family -- are unlikely to be reinfected shortly after recovery, but according to the CDC, "It is not yet known whether similar immune protection will be observed for patients with COVID-19."
As the coronavirus pandemic rages, killing thousands of its victims and tearing apart families, some political and health care leaders view antibody testing as a way to start reopening cities and allow people to return to work and play.
"This could be a big breakthrough," New York Gov. Andrew Cuomo said of antibody testing during a briefing Saturday.
Reese said it could be a silver bullet.
"Antibody testing specifically is the fastest path of scientifically and mathematically getting to a new normal," Reese said.
Since the Food and Drug Administration announced an Emergency Use Authorization policy for antibody testing last week, laboratories across the U.S. have been rushing to develop their own antibody tests.
United Biomedical initially validated the accuracy of its COVID-19 antibody diagnostic test in China, where the coronavirus pandemic originated late last year.
"We found it was a very clean profile, there was no cross reactivity," said United Biomedical co-CEO Mei Mei Hu. "So when we saw COVID-19, it was COVID-19, and could differentiate between other coronaviruses circulating in the U.S."
Having developed diagnostic tools and vaccines for SARS, another type of coronavirus, Reese and Hu said their team was ready to move fast on coronavirus. They said their company has already deployed approximately 100,000 tests globally, mostly to China and Taiwan.
"Now we are on the front lines," Reese said.
Reese and Hu said they decided to pilot the program in Telluride because it’s home. But they insist that the test can be just as useful in places like New York City, New Orleans and Los Angeles, where officials fear hospitals could be overrun with COVID-19 patients.
San Miguel County, currently under a shelter-at-home order, is not the usual site for a drug trial. But it is the type of place that could be hit extremely hard in a viral outbreak.
"We are a rural community in southwest Colorado with no hospital of our own," said county spokeswoman Susan Lilly. The largest local medical facility, Telluride Medical Center, is not an overnight hospital and would be unable to treat a surge of COVID-19 patients. And, with the county sitting 9,000 feet above sea level, any respiratory contagion could have even more deadly results among residents because humans have a harder time breathing in higher altitudes.
United Biomedical’s testing program began last week, starting with first responders, health care workers, teachers, essential workers and their families. So far, no one has tested positive. Records show one San Miguel resident, who has not yet taken the new antibody test, was confirmed to have COVID-19 by a test that looks for the virus' genetic material, not bloodborne antibodies.
What to know about coronavirus:
- How it started and how to protect yourself: Coronavirus explained
- What to do if you have symptoms: Coronavirus symptoms
- Tracking the spread in the US and Worldwide: Coronavirus map
From Telluride, United Biomedical plans to work with officials to expand testing to as many as five states with virus hot spots, like New York and California, on the priority list.
"These are the places that are most likely to have the community spread so it's important to detect, know what the actual outbreak prevalence is and then to categorize the people that have developed some immunity back out," Hu said, adding that the company expects to be producing 1 million tests a day by the end of April.
Officials said they’re optimistic, but caution that an antibody test is only one piece of an overall strategy of dealing with a disease as resilient as COVID-19.
"This blood test is a tool that alone won’t work," Lilly said. "It is a tool that will only work in combination with the stay-at-home model and the social distancing. One without the other doesn’t give us the full capacity to employ a strategy that we think will work."