Bubble bursts on Cuomo’s hope of 'immunity' testing

Andrew Cuomo | Getty — Andrew Cuomo. | Stefani Reynolds/Getty Images

ALBANY — As his state was being ravaged by the worst coronavirus outbreak in the country in early April, Gov. Andrew Cuomo offered a glimpse of hope to those looking for a quick restart of New York’s economy: An antibody test, developed in a state laboratory, may be able to confirm immunity for a vast number of New Yorkers.

By last week, Cuomo and other officials had retreated from the approach, pointing instead to other metrics that may indicate the best way to avoid future waves of the virus. Cuomo is now describing the immunity idea as little more than a “theory.”

“Maybe you’re immune,“ Cuomo mused last week. “Maybe you’re not immune.”

Hanging hope on an idea that just a few weeks later doesn’t seem possible shows how states are struggling with how to reopen. As President Donald Trump has veered from promising scientific research to promising technology as he presses to unshutter the nation, state officials such as Cuomo are also eager to promote optimism as they search for a path forward.

At the time Cuomo talked up antibody testing, using the procedure to establish immunity was widely perceived as a possibility. But that ambition quickly turned to disappointment as the World Health Organization came out against such strategies, saying there is no evidence that antibodies give immunity. Something that seemed to have been a silver bullet was too good to be true.

Cuomo stepped back.

“We follow the science, the standards of the CDC and what the experts say,” Cuomo senior adviser Rich Azzopardi said on Monday, explaining the change in approach.

In early April, Cuomo‘s administration began talking about using the test — once it became widely available — as a central piece of the state’s strategy for rebooting commerce in the nation’s largest city and the surrounding region. People found to have antibodies, including some who never showed symptoms or tested positive for the virus itself, might get permission to go about their lives as if the virus had been eradicated. Or so the thinking went.

“That would mean that you’re no longer contagious and you can’t catch the virus because you have the antibodies in your system, which means you can get to work, you can go back to school, you can do whatever you want,” the governor said four weeks ago.

New York, which has recorded more than a quarter of all known coronvirus cases in the U.S., would have been the nation’s first proving ground for the concept. After more than a month of hard-charging toward its development, New York’s test earned federal approval and was used to test 15,000 New Yorkers at grocery stores and community centers statewide over the past two weeks.

The day the survey began, on April 19, Cuomo said the antibody testing would indicate both infection rates and immunity — at least in the short term. Five days later, both Cuomo and Health Commissioner Howard Zucker said they were confident in the state test’s accuracy.

That’s when the WHO issued its guidance. By the next week, Cuomo was backing off, saying he would move the state based on science and data rather than opinion, and pointing to contact tracing rather than antibody testing as the ticket to reopening

“It has really become entangled with the tracing movement, which is what we really need. Knowing where there have been high infection rates allow us to allocate resources much better,” Azzopardi said. “We do have a higher degree of confidence in our test. It is part of the reopening strategy.

“The science says the jury’s out on whether you can re-infect, but does not diminish the value of the test,” he added.

It was, for a while, an attractive thought for the state, the rest of the nation and countries across the globe that have faced economic devastation on top of still mounting death tolls from the virus. Even the U.S.‘ top infection disease expert, Anthony Fauci, said last month that the idea could “actually have some merit, under certain circumstances,” and that the Trump administration was looking at creating some type of immunity certificate. Germany and the Britain have considered similar moves.

Now, officials the world over who once thought antibodies might provide a shortcut to vaccination are suddenly realizing they‘ve hit another dead end. With little evidence that antibodies prevent a second round of infection or even transmission to the virus, Cuomo and others who were hoping for a quick fix are now switching gears to say that the tests may only be useful in showing where the virus has been.

If antibodies can show immunity, experts say, it’s too early to use that as the basis for a public health strategy.

“Those studies are beginning now. But they are going to take some time,” Michael Mina, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health, said on Monday. “They are exceedingly difficult studies to do quickly, because we have to wait for natural exposures to happen.”

The data from New York’s antibody test will no doubt be useful in finding out how widespread New York’s outbreak has been. But it’s not quite clear how much the results — suggesting that 12.3 percent of residents statewide and about one in five of those in New York City have antibodies to the coronavirus — will influence the state’s emergence from the pandemic.

Cuomo has pivoted to metrics for reopening more in line with CDC recommendations and Trump’s plan to reopen America: a regional approach that takes into account a 14-day decline in hospitalization rates and whether individual businesses have the capacity to ensure employees and customers can keep appropriate social distancing measures. He’s also focusing on employing an “army” of contact tracers, backed with former New York City Mayor Mike Bloomberg’s bucks.

It’s unclear how much money and resources the state spent developing its test, though there have been seemingly few limits as officials pounced on state solutions when hospitalizations and deaths began to balloon. New York budget director Robert Mujica said last month the state had spent at least $2.8 billion combating the coronavirus over two months.

The findings reflected the results of the 15,000 antibody tests already conducted and can be used to establish what officials are calling a „baseline infection rate.“

The state has targeted health care workers and first responders for the tests, and will soon expand antibody testing to determine how many transit workers have antibodies, Cuomo said.

In contrast to the state, New York City officials have avoided making any claims about whether antibodies can confer immunity. On April 23, a day before the WHO guidance was released, New York City Health Commissioner Oxiris Barbot said in a virtual town hall that antibody test results shouldn’t change the behavior of New Yorkers. Some antibody tests can’t distinguish between Covid-19 and other coronaviruses that cause the common cold, she said.

“That’s why, when people get tested for this antibody, and they may come out positive, or they may come out negative, the underlying guidance doesn’t change,” she said. “You need to stay indoors, you need to wear a face covering when you go outside, and we need you to keep that six-foot difference when you do go outside.”

Researchers are working worldwide to refine antibody tests that can dictate clearer actions for individuals and officials, said Danielle Scheurer, chief quality and safety officer for Medical University of South Carolina Health in Charleston, S.C., which has developed antibody testing in partnership with New York’s Mount Sinai Health System to understand how many health care workers have had Covid-19.

Medical experts say the best place to judge seroprotection will first be among cohorts of health care workers who have likely had the same levels of exposure to the virus.

“I do think the tests are going to improve as they have over the past two months,” Scheurer said. “The more we do, the more we learn. Eventually we will cross that finish line, to say, ‘Yes, we feel very confident that this exact type of antibody in this exact amount does confirm immunity,‘ we’re just not quite there yet.”

Marc Lipsitch, professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard’s public health school, said “almost everyone“ he knows in the field is working out how to find that evidence of immunity.

“I don’t think it’s a permanent state of ignorance, it’s a current state of ignorance because this is a new disease,” Lipsitch said.

With thousands still dying nationwide, it’s attractive for officials and policymakers to offer the day’s latest good news about experimental wins to give Americans hope, but ultimately there’s not going to be one quick fix, Scheurer said.

“Every win is a win, and I don’t want to take away from it, but until we have a really good vaccine — and even then there are all these caveats about how quickly that could be administered — I think we certainly are stuck with some semblance of these social precautions for a while.”

Amanda Eisenberg and Dan Goldberg in New York contributed reporting.