‘Immunity Passports’ for SARS-CoV-2: an online experimental study of the impact of antibody test terminology on perceived risk and behaviour

Waller, Jo; Rubin, G James; Potts, Henry W W; Mottershaw, Abigail; Marteau, Theresa M.

doi:10.1136/bmjopen-2020-040448

Cited by 19 publications

(26 citation statements)

References 14 publications

(11 reference statements)

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“…Immunity Certi cation: from antibody testing An online experiment carried out in the UK in April 2020 (n=1204) found that 85% would de nitely (56%) or probably (29%) have an antibody test if offered [47].…”

Section: Uptake Of Tests and Vaccinationmentioning

confidence: 99%

Behavioural responses to Covid-19 health certification: A rapid review

Drury

Mao

John

et al. 2021

Preprint

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Background Covid-status certification – certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 – has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime.Method A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. Results Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing.Conclusions The limited evidence suggests that health certification in relation to COVID-19 – outside of the context of international travel – has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.

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Section: Uptake Of Tests and Vaccinationmentioning

confidence: 99%

Behavioural responses to Covid-19 health certification: A rapid review

Drury

Mao

John

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

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“…As more tests move towards FDA approval of home use, clear scienti c communication about the result interpretation becomes more crucial (23,39). A positive serological result does not necessarily mean active infection (23,31,49). Although combined use of molecular and seroconversion results can be used to con rm the diagnosis of symptomatic and hospitalized individuals (35), a positive serological test in the absence of symptoms dissociates the presence of the antibodies from the time of infection (44).…”

Section: Discussionmentioning

confidence: 99%

“…A false positive serological test result may prematurely instill con dence that one has immunity against SARS-CoV-2 infection, thus resulting in behavioral changes that increase risk of transmission (50). Hence, the probability that a person without antibodies will test negative on a serological test is more important than test sensitivity (48)(49)(50).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2

Trombetta

Kandigian

Kitchen

et al. 2021

Preprint

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Background: COVID-19 has resulted in significant morbidity and mortality worldwide. Lateral flow assays can detect anti-Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies to monitor transmission. However, standardized evaluation of their accuracy and tools to aid in interpreting results are needed.Methods: We evaluated 20 IgG and IgM assays selected from available tests in April 2020. We evaluated the assays’ performance using 56 pre-pandemic negative and 56 SARS-CoV-2-positive plasma samples, collected 10-40 days after symptom onset, confirmed by a molecular test and analyzed by an ultra-sensitive immunoassay. Finally, we developed a user-friendly web app to extrapolate the positive predictive values based on their accuracy and local prevalence.Results: Combined IgG+IgM sensitivities ranged from 33.9% to 94.6%, while combined specificities ranged from 92.6% to 100%. The highest sensitivities were detected in Lumiquick for IgG (98.2%), BioHit for both IgM (96.4%), and combined IgG+IgM sensitivity (94.6%). Furthermore, 11 LFAs and 8 LFAs showed perfect specificity for IgG and IgM, respectively, with 15 LFAs showing perfect combined IgG+IgM specificity. Lumiquick had the lowest estimated limit-of-detection (LOD) (0.1 mg/mL), followed by a similar LOD of 1.5 mg/mL for CareHealth, Cellex, KHB, and Vivachek.Conclusion: We provide a public resource of the accuracy of select lateral flow assays with potential for home testing. The cost-effectiveness, scalable manufacturing process, and suitability for self-testing makes LFAs an attractive option for monitoring disease prevalence and assessing vaccine responsiveness. Our web tool provides an easy-to-use interface to demonstrate the impact of prevalence and test accuracy on the positive predictive values.

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“…As more tests move towards FDA clearance for home use, clear scientific communication about the result interpretation becomes more crucial 31, 49. A positive serological result does not necessarily mean active infection 31, 41, 60 . Although combined use of molecular and seroconversion results can be used to confirm the diagnosis of symptomatic and hospitalized individuals 45 , a positive serological test in the absence of symptoms dissociates the presence of the antibodies from the time of infection 54 .…”

Section: Discussionmentioning

confidence: 99%

“…A false positive serological test result may prematurely instill confidence that one has immunity against SARS-CoV-2 infection, thus resulting in behavioral changes that increase risk of transmission 61 . Hence, the probability that a person without antibodies will test negative on a serological test is more important than test sensitivity 59, 60, 61 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2

Trombetta¹,

Kandigian²,

Kitchen³

et al. 2021

Preprint

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BackgroundCOVID-19 has resulted in significant morbidity and mortality worldwide. Lateral flow assays can detect anti-Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies to monitor transmission. However, standardized evaluation of their accuracy and tools to aid in interpreting results are needed.MethodsWe evaluated 20 IgG and IgM assays selected from available tests in April 2020. We evaluated the assays’ performance using 56 pre-pandemic negative and 56 SARS-CoV-2-positive plasma samples, collected 10-40 days after symptom onset, confirmed by a molecular test and analyzed by an ultra-sensitive immunoassay. Finally, we developed a user-friendly web app to extrapolate the positive predictive values based on their accuracy and local prevalence.ResultsCombined IgG+IgM sensitivities ranged from 33.9% to 94.6%, while combined specificities ranged from 92.6% to 100%. The highest sensitivities were detected in Lumiquick for IgG (98.2%), BioHit for both IgM (96.4%), and combined IgG+IgM sensitivity (94.6%). Furthermore, 11 LFAs and 8 LFAs showed perfect specificity for IgG and IgM, respectively, with 15 LFAs showing perfect combined IgG+IgM specificity. Lumiquick had the lowest estimated limit-of-detection (LOD) (0.1 μg/mL), followed by a similar LOD of 1.5 μg/mL for CareHealth, Cellex, KHB, and Vivachek.ConclusionWe provide a public resource of the accuracy of select lateral flow assays with potential for home testing. The cost-effectiveness, scalable manufacturing process, and suitability for self-testing makes LFAs an attractive option for monitoring disease prevalence and assessing vaccine responsiveness. Our web tool provides an easy-to-use interface to demonstrate the impact of prevalence and test accuracy on the positive predictive values.

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‘Immunity Passports’ for SARS-CoV-2: an online experimental study of the impact of antibody test terminology on perceived risk and behaviour

Cited by 19 publications

References 14 publications

Behavioural responses to Covid-19 health certification: A rapid review

Behavioural responses to Covid-19 health certification: A rapid review

Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2

Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2

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