Diary of a Doctor – Should You Trust Antibody Tests?

As you may have read from the About page, Dr. Alex Mentzer is an Infectious Disease Registrar at the John Radcliffe Hospital in Oxford. He’s also a Scientific Group Leader at the Wellcome Centre for Human Genetics where he specialises in researching genetic susceptibility to certain diseases. His focus right now is Covid-19.

I’ve been recording his day-to-day thought and feelings since we went into lockdown. The aim is to give insight into the wonderful work happening here in Oxford, not only by Alex, but by the amazing people working and researching at the hospital and university. Plus I hope to give you some idea of what’s it’s been like to be a ‘high risk’ frontline family.

This is the 6th Chapter since lockdown commenced. If you would like to read our full journey, you can do so here.

‘It’s been a strange couple of months in the hospital’, Alex says.

At the beginning (in March) the virus was a novelty, a rare finding. If detected, the patient was isolated and trial and error hospital treatments given to support them through the worst symptoms.

Then the WAVE CAME.

Suddenly, the hospital was full of Covid-19.

Everywhere you turned more and more patients.

Many wings were filled to capacity.

In ICU you could hear the buzz of ventilators, the beep of cardiac monitors and the busy footsteps of people running all over the place.

Research teams were employed to sign patient’s up to drug trials and take blood for antibody testing. Flurries of paperwork, thousands of samples, newly installed refrigerators.

Due to COVID-19 crisis restrictions, no one lingered in the hospital public spaces, like the café and main lobby.

And in the non-emergency wings it became eerily quiet. People were too frightened to come in. Some doctors were twiddling their thumbs.

Then in mid May the hospital began to see the return of its regular patients. Normal services resumed. Those that needed care, but had hid away, came flooding in again.

Covid-19 is still featuring.

But it’s become just one of the differentials to look out for.

For example, someone may come in with heart problems, and when tested they’re also carrying Covid-19 but this might not be the main problem, just something else to consider.

With this in mind, those working towards the Winter screening are now incorporating SARS COV-2 (Covid-19) into the standards tests for seasonal bugs like the flu, RSV and other respiratory illnesses.

In other words, Covid-19 is becoming a normal part of the hospital.

However, there is a general feeling of a false sense of security.

That this could simply be another lull before a storm in June and July as lockdown eases….but we’ll see.

For a few hospital workers, at least it may mean some respite from the crazy few months they’ve just endured.

A time to recharge batteries, get some sleep and some sunshine, focus on healthy living and taking extra measures to build resilience for the next potential wave (more on how we as a family do this here).

Covid-19 Research

The research world on the other hand is charging full steam ahead, so Alex is certainly still keeping busy.

‘It’s madness, I’m exhausted, can I get off this roller-coaster for just one second please?‘ Alex comments.

Mental Health Awareness Week 18th22nd May

At home I’m a lot better this week. The sun is out again, and I enjoy a long run and chat with a good friend.

Though sadly, the children are really struggling.

Our daughter is discussing Mental Health Awareness Week during online school chats. She becomes very teary and expresses that she’s missing her friends and wants to go back to school.

Unfortunately, she’s the year group that probably won’t return until September.

Our son, at four years old, is not so good at expressing himself. He’s simply causing trouble, desperate for some attention.

Despite this being very trying, I recognise that it’s important I show compassion for his feelings right now.

He’s certainly not doing it on purpose.

I take him out for long walks to burn off some pent up energy and emotion. It seems to help. He may be returning to nursery on the first of June.

Here’s an update after Alex worked this weekend on the wards…

‘We’re only just beginning to digest what has happened. Up until a few weeks ago, it was intense, heart-breaking, lonely, soul destroying. In fact, it was complete anarchy; a whirlwind through our usually organised hospital. Now it’s getting much more manageable and things are less crazy. There are fewer Covid patients than before. A combination of a trickle that are admitted most days, with some that have been in for a very very long time (77 days as the record) and are only just recovering’.

Can we trust PCR Tests?

Sometimes you need a few PCR tests to be certain if a patient has active coronavirus. Naturally, through the nature of the test (a nasal and throat swab), accuracy can be down to the skill of the person doing the swab and the amount of virus present.

Some patients you’re absolutely sure have it through symptoms, but only test positive on the second or third try.

So, there are definitely some false negatives – in fact, some sources quote up to 30%!

And what about Antibody Tests?

Staff are also frustrated; many are still waiting for antibody test results.

Four to six weeks after they’ve given blood for analysis, they still don’t know whether they’ve tested positive or not.

Testing facilities have been overwhelmed it seems.

Alex waits on tenterhooks for his Antibody Test outcome (results revealed below).

Weekend 30th May to 1st June – A lockdown birthday

On a positive note, my legend of a husband, Dr Alex Menzter, is 40 this weekend.

We’ve known each other for over 25 years!

My soul mate, true friend, confidant, top dad, awesome compassionate beautiful soul of a man.

Hugely proud. I don’t often gush.

But he’s really the best!

This is a giant landmark, but we can’t celebrate…properly….yet.

But we’ve done a good job of having an awesome lockdown birthday – BBQ, Zoom dance party with some long time friends. Plenty of bubbles and cake. Really good fun and a chance to unwind.

1st – 5th June

Alex got his antibody test result this week.

To our surprise he was NEGATIVE.

This negative test result has come after seeing infected patients most days for the past 11 weeks, from walking around a hospital without adequate PPE, as well as exhibiting clear symptoms of Covid-19 in early April.

This is not an unfamiliar story.

Many staff members are testing negative despite having worked on the frontline from the beginning and having clear symptoms.

Furthermore, a large number of people are calling in saying that they’ve had a positive PCR test during active infection, but are testing NEGATIVE to antibody tests.

Alex is very suspicious and concludes that these antibody tests aren’t as accurate as we’d hoped.

In Sweden, where fewer lockdown precautions were taken, and ‘herd immunity’ was the goal, antibody tests are only measuring 7.3% infected (as of mid April).

It’s clear that the figures don’t add up.

Why might this be?

Well, the immune system is a complex set up that we don’t yet fully understand.

These are a few of my theories;

1. Sometimes it can take years to identify the correct antibody to test. So basically, a test may not be specific enough to target the right antigen (detect the correct antibody).

2. People with larger immune responses – e.g. those that suffer the worst symptoms, may produce more antibodies. Therefore, those with mild symptoms may not produce enough antibodies to be detected by a test. In other words, the test isn’t sensitive enough to measure small amounts of antibody.

3. We don’t know how long Covid-19 antibodies linger in the body. Scientists theorize around two years, but because it’s a novel virus nobody knows for sure. It could be two years, two months or two weeks for all we know! Meaning that antibodies may have disappeared before testing occurred.

Furthermore, different antibody tests, developed in different labs around the world, may be testing for different antigens (target antibodies).

Again, this confuses the statistics.

Basically – if you have a positive antibody test – you have antibodies, YEAH! If it’s negative, you might as well be tossing a coin.

HEADS OR TAILS? POSITIVE OR NEGATIVE?

This is in no way belittles scientists. After all, my husband is one of them.

This is a very hard job to achieve. It can take months to years, not weeks as the government and people expect.

I can personally vouch for the fact that Scientists are working flat out. Will any of them get a well deserved holiday this year? It’s looking unlikely.

However, it does pose the important questions

How is track and trace going to work if we don’t have accurate PCR testing?

How will the effectiveness of a vaccine be measured if we can’t guarantee antibody testing?

Most importantly, how will we EVER know if it’s safe to resume normal life, work and travel?

Second wave

Furthermore, everyone in the hospital is still frightened of a second wave.

It’s such an unknown.

A second wave could be more fatal than the first, and if it returns during the coming Winter it could risk the most vulnerable at the same time as Flu tends to rear its ugly head.

This combination could certainly overwhelm NHS resources once again.

So here’s my personal advice as a Nutritional Therapist married to an Infectious Disease Doctor: focus on looking after yourself, please.

We all have the power to improve and support our immune systems.

Seek out that knowledge. Don’t wait to be told.

Now is the time to eat healthy food, sleep, exercise, get some sunshine and take your vitamins to boost your immune system.

Before long, Summer will be closing and Autumn could potentially lead us into an explosion of seasonal bugs.

A fireman wouldn’t jump into a fire without the appropriate fire suit.

This virus is not behaving like experts thought it would.

Waiting for a vaccine?

As I wrote in a previous post, a vaccine is still a long way off, and its safety and efficacy may not be fully known until this time next year.

What we do know however, is that young healthy people tend to respond better to a vaccine. This could be due to their good immune systems.

All of the above are important reasons to take care of yourself and loved ones in these coming months.

What could this mean for the future of the NHS?

So, at present, everything is very uncertain.

We’re all in LIMBO.

As the public are slowly easing back to normal life, regular patients, that previously waited it out, are returning for their usual hospital appointments.

The news reported this morning that NHS waiting lists are likely to double as a result of a back log of other patients now returning. And a second wave could make this even longer.

It’s clear we’re going to be in this for the long haul.

Covid-19 isn’t going to vanish.

Alex says, ‘It’s prevalence is definitely reduced in the community, but it will remain with us for the foreseeable future’.

How are you feeling about coming out of lockdown? Are you taking measures to protect yourself and your family?

Published by carolinementzer

Caroline Mentzer is a Nutritional Therapist, Herbalist and Writer from Oxford, UK. Married to and Infectious Disease doctor, her blog discusses the benefits of combining holistic and conventional approaches to find unique solutions to many health and parenting challenges.

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