The Long Now of Covid-19

15 December, 2022: Covid-19 vaccination has been of immense value and saved millions of lives. Vaccines have not however guaranteed complete societal, nor individual, protection. It is estimated millions worldwide have not mounted an effective immune response to vaccination. Some do not generate enough protective antibodies. But, no one knows exactly who is more vulnerable to infection, least of all the individuals themselves.?

Vaccines then provide essential but not sufficient protection. After the first wave of vaccination, Attomarker tested three NHS nurses for antibodies to SARS-CoV-2. Only one had antibody levels above a pre-pandemic threshold (consistent with the efficacy of 18 vaccines).??The other two thought they were well-protected, and, without the test and the information it provided, could have been a potential risk to patients.??

The reopening of society after lockdown(s) revealed and accentuated these weaknesses in public protection. Even high antibody levels drop over time. From the outset of the pandemic, Attomarker research has suggested it is desirable, if not essential, to use tools to look at?individual?antibody levels, especially for those interacting with the public and caring for the vulnerable, to establish thresholds of protection and to manage the consequences of levels dropping below the line.

Understanding risk and protection against Long Covid (LC) is also becoming increasingly important. Scientists have now revealed that repeat infection increases the chance of LC; this is where the fundamental conceit of "returning to normal" lies.??An economy cannot go back to normal if the population is still encountering a pestilence.??This is a strong term, but accurately describes the consequences of the “twindemic” combination of acute and Long Covid.??

Rather than being viewed as the highway out of the pandemic, vaccination should perhaps be seen as a way to buy time to bring additional systems of control alongside to manage a pernicious two-pronged disease and its consequences.??

Antibody half-life matters. A measure of a successful response to vaccination at three months, does not guarantee protection after six months: antibody testing by Attomarker on cohorts of medical professionals and teachers has shown their antibody levels dropping below the proposed protective threshold.?Unlike Ebola, SARS-CoV-2 renders its hosts infectious prior to the onset of symptoms, or can leave them symptomless yet infectious. The possibility of asymptomatic mass spreading remains; when combined with the danger of new variants, the likelihood that not 100% will have been vaccinated, alongside the dangers of Long Covid, the hard-won success of vaccination programmes could be lessened or even lost

A key question then is whether an antibody immunity threshold could be internationally agreed to provide an indicator of protection against severe disease and, possibly, Long Covid? Sufficient levels of antibodies in the blood imply a positive, adaptive immune response which includes the T and B cell response.? If a threshold could be established, and possibly in conjunction with T-Cell testing, this would suggest immunity testing could provide an immunity health "score"; enabling individuals to manage their own risk and protect others.

Growing numbers are presenting with Long Covid with symptoms lasting months, even years. It is currently estimated that, in the UK, over 2 million?people have LC, up from 1 million last year; many more may be undiagnosed.? The societal and health costs of this condition have yet to be fully realized; this potentially undermines any strategy of “living with Covid-19” as the relationship between the severity of Covid-19 and the contraction of Long Covid is not uniform. Attomarker tested an employee reporting LC symptoms but with no recollection of past infection; the research team was able to discern immune markers for past, in this case asymptomatic, CV-19 infection.

Employers are expected to take all "reasonable steps" to mitigate risk at work.?The?failure rate of vaccines, antibody decay and the risk of Long Covid are key emerging issues in this context. It is being reported that a significant number of people, including doctors, have lost their livelihoods due to LC.?Attomarker estimates that for any one individual there is a 5% to 30% chance that their booster has not induced antibodies above a protective threshold; can employers in the UK reasonably require all employees to return to work on this basis? Or just those who have a better immunity risk profile? Is ignorance a reasonable defence over the long-term? The question must be asked whether it is?reasonable for Government to mandate a mass return to work without mitigating this risk for employees and?employers?

Many Governments worldwide are continung to handle this outbreak as if it was a flu pandemic. It is not. The R number for the 1918-20 flu has been estimated?at 1.8; the R number for the latest Omicron variant makes it the second most contagious disease in the world.?Attomarker is advocating the merits of an immunity threshold, measuring immunity and identifying who should be prioritised for a booster, not just by age, but by immunity. Because the test is quantitative, it can provide an immunity score, which can be expressed as a percentage.?

At the time of writing, masks have just been re-mandated at our local hospital. Emerging evidence suggests the better use of antigen/antibody testing to protect schools, hospitals and enhance vaccination efficacy.??It is?imperative to research the protective threshold for antibody levels, to test on the basis of an established threshold and for us to understand as individuals our immunity risk profile and how we should act when we fall below that threshold.

Note: This article has emerged from discussions with the Attomarker research team. All errors of fact or interpretation are the author's own. Research publications can be found by searching for "Attomarker" here: https://scholar.google.com/