Coronavirus (COVID-19) Information
A Message from our Chief Medical Officer
Dear Colleague,
Given its prevalence in the news, you will likely receive questions from your patients about antibody/serology testing. These discussions can be challenging as patients are looking for a “test” that provides the security of immunity. It is important to be able to share current fact-based information with them.
The tests will not indicate whether an individual has an active infection of COVID-19. Additionally, as recently stated in the CDC Guidelines, the following remains uncertain:
- Whether individuals with antibodies are protected against reinfection with SARS-CoV-2;
- What level of antibodies is needed to confer protection; and,
- The duration of any protection that might exist.
There is a range of accuracy, even among the tests that have been authorized by the FDA and listed on the FDA Emergency Use Authorization (EUA) website. There is also the issue of cross reactivity with the benign cold-producing coronaviruses creating false positive tests. Having said that, it is important to understand that even the most accurate test antibody/serologic tests should not be used to determine immune status in an individual patient.
It is noteworthy that the CDC states that “there should be no change in clinical practice or use of personal protective equipment by health care workers and first responders who test positive for the SARS-CoV-2 antibody.” Additionally, for individuals who have antibodies the recommendation is to continue practicing social distancing and handwashing guidelines to prevent transmission.
In accordance with the Families First Coronavirus Response Act, CareFirst will be covering the antibody test for SARs-CoV-2. The test should:
- Be on the EUA list
- Be ordered by a physician, nurse practitioner, or other authorized provider
- Be medically necessary
- Have a high likelihood of impacting clinical decision making
There are limited clinical scenarios mentioned in the CDC guidelines where serology testing could have a role: 1) to support diagnosis in persons who present to care 9 to 14 days after illness onset and 2) to help establish the diagnosis of multisystem inflammatory syndrome in children.
In short, serology is not designed to be a diagnostic test and has very limited clinical utility in the assessment and care of an individual patient. Additionally, the CDC guidance states serology testing should not be used to make decisions about returning to the workplace, nor to make decisions about grouping persons residing in schools, dormitories or correctional facilities.
Serologic testing is an active area of research and plays a valuable public health role in the surveillance of communities to track where the virus has been and where it is heading. We anticipate further clarification and direction as to how to use these tests and newer tests in the future.
CareFirst will continue to monitor the CDC’s antibody/serology testing guidance and will communicate any coverage changes on our Coronavirus Resource Center. Please continue to regularly check our website, and the CDC, as guidance is ever evolving.
Thank you for all you are doing to care for our members during this public health emergency.
Sincerely,
Daniel J. Winn, M.D.
Vice President and Chief Medical Officer