Do you want to know if you have been infected with SARS-CoV-2 the coronavirus strain that causes COVID-19? With 25-50% of infections being asymptomatic or very mild you will need an antibody test to find out.
If you are found to have antibodies to SARS-CoV-2 would you not want to know the titre or amount of antibody in your blood? And whether or not these antibodies are so-called neutralizing and capable of preventing reinfection with SARS-CoV-2?
Answering these questions is critical and underpins the strategy of allowing people to receive a so-called “COVID-19 passports”. The passport will state that you have immunity to the virus and hence you can rejoin the herd and get on with your life.
As an MS researcher, I am also interested to know what happens to the antibody response to SARS-CoV-2 in pwMS on different DMTs. For example, are people on rituximab and ocrelizumab less likely to develop an antibody response after COVID-19 and if they do is the antibody response good quality, i.e. capable of neutralizing the virus and preventing reinfection? What about the antibody responses in people on natalizumab? On fingolimod? Post-cladribine or post-alemtuzumab?
My predictions are that the IRTs (cladribine and alemtuzumab) and possibly natalizumab will come out on top both in term of qualitatively (neutralizing antibodies) and quantitatively (overall titre) in terms of anti-SARS-CoV-2 antibody responses. Anti-CD20s (rituximab, ocrelizumab and ofatumumab) and the S1P-modulators (fingolimod, siponimod and ozanimod) will come out on the bottom. Please note this is a hypothesis and as with all hypotheses they need to be tested in well-designed and appropriately powered studies.
Barts-MS has therefore proposed doing an antibody study of this kind, but it looks like pharma is chicken to collaborate with us. I suspect they don’t want to know the answer to the questions above. I call this the “ostrich syndrome”; you can put our head in the sand for as long as you like, but eventually, a rabid dog will come and “bite your arse”.
As the MS community gears up for ensuring their patients are “vaccine ready”, who if they are SARS-CoV-2 antibody-negative (no previous infection) will want to be on a DMT that blunts or prevents an adequate vaccine response. Why take a chance if you don’t have to particularly as there are several suitable alternative DMTs? However, if the above hypotheses are disproved then most of us will be happy with the status quo.
All these arguments above are predicated on the assumption that we will get an effective SARS-CoV-2 vaccine or vaccines. Please note there is no guarantee that this will happen. I would estimate the chances of getting an effective vaccine in the next 18-24 months as being close to 80%. Optimistic? Yes, but at the same time, I am trying to be realistic.