I never thought that I'd echo the raucous and impatient cries of our overly demanding Peace Now, crowd, but the time is overdue for Covid-19 antibody testing of the entire population of Israel. Now.
Basic biology shows that every human being who gets infected by any virus and survives, makes an immune response to that virus. That response includes two populations of lymphocytes (which are white cells of the blood, as opposed to red cells), T cells and B cells. The virus has a chemical fingerprint, called antigens, to which some of the T cells respond. These T cells are imprinted forever to start an immune reaction against those viral antigens. Among other mechanisms of defense, the T lymphocytes activate B lymphocytes to produce antibodies against the virus.
This antibody is what has gained so much fame in the current Covid-19 epidemic. Its presence in recovered Covid patients is what makes the plasma of those patients an active treatment against the disease; many critically ill patients were helped to recovery using plasma containing those antibodies. In short, they work- hopefully burying the baloney in the lay press that no one knows if Corona antibodies provide protection against Covid-19 disease.
In fact, the plasma of recovered patients is exactly the state that those developing vaccines are aiming for. The vaccine, unlike a live virus infection, contains dead viral antigens, which are injected into patients with the intent of provoking the aforementioned immune, antibody response.
Why in Heaven's name would the world be spending so much energy in a mad-rush to produce a vaccine, if the resultant antibodies were not protective?
Another point is that vaccines and immune systems are tricky. No vaccine and no antibody provides 100% immunity. We've all heard people say:" I got the flu shot this year, and I still got the flu, so it's worthless". Not true. It is far from worthless. Take last year's influenza season. The vaccine was overall only 45% effective (although in the vulnerable age group of kids up to age 17, effectiveness was 55%). That means that the incidence of infected patients was 45% of those who would have been infected in a totally unvaccinated US population; but 55% still got infected. However, the vaccination WAS worth it. Anyone who got the shot and still got infected, usually had a much less severe case. The person who might have died of influenza might have been hospitalized, but he/she by and large, survived- maybe even with only a simple fever and cough, staying at home.
Another point: T cells, as I said above, remember. Even if a lab were to measure antibody levels some time later after recovery, and the lab can find NO antibody in the patient's blood- if the virus attacks again, the T cells remember the viral antigens, will activate the B cells to produce antibody, and the patient will have protection.
To quote my friend Dr. Ben Katz, infectious disease specialist, Northwestern University: "The respiratory virus does not exist from which one can get a repeat infection". The only problem is: there are hundreds of viruses that can cause influenza-like illnesses (ILI's), with symptomatology ranging from a simple cold (URI, just a cough) to pneumonia to respiratory failure on a ventilator. Over a lifetime, one is exposed to many of these viruses, and gets sick again and again, but each time from a different virus.
One caveat to that last sentence: it assumes that the patient's immune system remains intact. For example, if the patient has emphysema and is given a steroid for his breathing, his immune system is much less functional. Ditto if his diabetes is out of control, or his kidney function is chronically bad, etc.
That is also why infants and toddlers can get bronchiolitis over and over again, even in the same winter. The infection is caused by, usually, respiratory syncytial virus (RSV), usually causing wheezing, but even cessation of breathing. Only kids aged birth to 2 years get bronchiolitis, and that is because their immune systems are immature. By age 2 years, they have more mature immunity, and bronchiolitis does not recur.
That leads us to these reports of patients getting second infections with Covid-19. Outliers, every one of them. As of this writing, there have been 67,000 cases of Covid in Israel, with the media reporting four repeaters. It is obvious that these patients must have something wrong with their immune systems. Years from now, some researcher will find some factor missing in these people which doesn't allow them a good immune response to Coronavirus. These outliers, however, are no reason to panic and think that 99.999% of the Israelis do not have an immune system capable of protecting them from a repeat bout Corona. They do. As I said above, if they did not, there is no point in producing a vaccine.
The point: the Israeli government needs to procure 9 million kits to test the entire population for antibody in their blood (and not test only for virus in their noses). Those who test positive for antibody are already "vaccinated"; these people need not wait for a vaccine to be invented and delivered, some 6-12 months from now.
Right now these people could be returned to work, school and leisure. Businesses and industries that are now closed could be opened, their workers employed. The tourist industry could be rapidly opened to those with an antibody passport- a flight of all antibody positive (Ab pos) travelers poses no risk to anyone. Add a requirement that these Ab pos workers and travelers have two recent nasal swabs negative for virus (i.e. they are not asymptomatic carriers who are presently fighting off a reinfection attempt by virus), and anyone antibody negative (Ab neg) who is willing to assume the risk to work and travel alongside the Ab pos people, can join them at work and travel. That risk is near zero. This means the vital tourist industry could be quickly opened- with relief for airlines, taxi drivers, hotels, restaurants, etc.
We are now six months into the Covid-19 pandemic. Here I guess, but it is a good presumption - that a sizable percentage of the population is antibody positive - possibly 50% or more. Universal antibody testing would get these people back to work, and the economy toward normal- quicker than the present "no light at the end of the tunnel" policy of false starts at opening up the economy, and then backtracking.
Also, there is no time to waste. There is no way to test everyone's T cells, those cells with a good immune memory. All we have is antibody. Last week, a New England Journal communication, with very few patients, found that the half life of serum antibody to Covid is 36 days, on average. For any serum drug or antibody, when five half-lives go by, the amount of that entity in the blood is near zero (half, 50%, is gone in one half-life; half of that, or 25%, remains after two half-lives; then 12.5%, then 6%, then 3%, etc.).
That means that in six months( five times 36 days), if you measure the antibody to Corona in a patient who recovered today, you probably won't find it- despite the fact that his T cells remember and he is protected- but a lab would not know it.
Bottom line: the government must act fast, procure the test kits, and get on the ball and test all Israelis.
Our health, and our economy, depend on it.
Postscript: Hadassah Ein Kerem Hospital is testing for serum antibody, for a fee.
Rabbi Dr. Hirsch is a physician residing in Beit El who works at Hadassah Hospital. He recently completed Rabbinical ordination of the Chief Rabbinate of Israel through a study
program at Yeshivat Merkaz Harav