I've heard about antibody testing for COVID-19. What is antibody testing? Is it the same as testing to diagnose COVID-19?
Answer From William F. Marshall, III M.D.
With all the talk about coronavirus disease 2019 (COVID-19) testing in the news, it's not surprising that there's confusion about tests and how they differ. Antibody testing determines whether you had COVID-19 in the past and now have antibodies against the virus. A test to diagnose COVID-19 determines if you currently have the disease. Here's what you need to know about testing.
When is antibody testing done and why is it important?
Antibody testing, also known as serology testing, is usually done after full recovery from COVID-19. Eligibility may vary, depending on the availability of tests. A health care professional takes a blood sample, usually by a finger prick or by drawing blood from a vein in the arm. Then the sample is tested to determine whether you've developed antibodies against the virus. The immune system produces these antibodies — proteins that are critical for fighting and clearing out the virus.
If test results show that you have antibodies, it indicates that you were likely infected with COVID-19 at some time in the past. It may also mean that you have some immunity. But there's a lack of evidence on whether having antibodies means you're protected against reinfection with COVID-19. The level of immunity and how long immunity lasts are not yet known. Ongoing studies will eventually reveal more data on this.
The timing and type of antibody test affects accuracy. If you have testing too early in the course of infection, when the immune response is still building up in your body, the test may not detect antibodies. So antibody testing is not recommended until at least 14 days after the onset of symptoms. The U.S. Food and Drug Administration (FDA) authorized and verified certain antibody tests, but tests with questionable accuracy are still on the market.
Another benefit of accurate antibody testing is that people who've recovered from COVID-19 may be eligible to donate plasma, a part of their blood. This plasma could be used to treat others with severe disease and boost the ability to fight the virus. Doctors call this convalescent plasma. In the U.S., the COVID-19 expanded access program is recruiting participants for this promising treatment study, already used in some severe cases on an experimental basis.
What tests are used to diagnose COVID-19?
The FDA approved these types of tests for diagnosing a COVID-19 infection:
- PCR test. This COVID-19 test detects genetic material of the virus using a lab technique called polymerase chain reaction (PCR). Also called a molecular test, a health care worker collects fluid from a nasal or throat swab or from saliva. Results may be available in minutes if analyzed onsite or a few days — or longer in locations with test processing delays — if sent to an outside lab. PCR tests are very accurate when properly performed by a health care professional, but the rapid test can miss some cases.
- Antigen test. This COVID-19 test detects certain proteins in the virus. Using a nasal or throat swab to get a fluid sample, antigen tests can produce results in minutes. Because these tests are faster and less expensive than PCR tests, antigen tests may be more practical to use for large numbers of people. A positive antigen test result is considered very accurate, but there's an increased chance of false-negative results — meaning it's possible to be infected with the virus but have a negative result. Depending on the situation, the doctor may recommend a PCR test to confirm a negative antigen test result.
The FDA authorized certain diagnostic at-home test kits that require doctor approval and lab analysis. While the FDA hopes to authorize tests that can be done entirely at home or elsewhere, the agency warns consumers against buying unauthorized COVID-19 home tests because of concerns about accuracy.
What do I do if I'm interested in a COVID-19 diagnostic test or an antibody test?
Contact your doctor or other health care professional to discuss your situation and whether he or she thinks you need a COVID-19 diagnostic test or an antibody test. Before seeking a COVID-19 test in person, contact your doctor to discuss your situation and describe any symptoms.
Typically at this time, most doctors only suggest a test to diagnose COVID-19 if you have symptoms or you've had exposure to someone with COVID-19. To get antibody testing, you have to be fully recovered from COVID-19. But in some communities, people who never had symptoms of COVID-19 may be able to get tested. Some have positive results, meaning they likely were infected by the COVID-19 virus at some time.
Access to either test depends on where you live, test availability and whether you're viewed as eligible. In the U.S., collaborative efforts to make more tests available are ongoing. The nationwide goal is to test more people as more tests become available.
How can diagnostic and antibody testing help reduce the spread of COVID-19?
With COVID-19 diagnostic testing, people who test positive and have symptoms can get care earlier. Contacts can be traced and self-isolation or quarantine started sooner to help stop the spread of the virus.
But no COVID-19 test is 100% accurate. It's possible to test negative yet actually be infected (false-negative result). So it's vital to continue to follow COVID-19 guidelines from the Centers for Disease Control and Prevention, such as social distancing, until further notice.
Results of antibody tests indicate how many people had COVID-19 and recovered, including those who didn't have symptoms. This aids in determining who might have immunity, though to what extent and for how long is not yet known.
Aug. 19, 2020
William F. Marshall, III M.D.
See more Expert Answers
- AskMayoExpert. COVID-19: Diagnostic PCR testing and serologic antibody testing. Mayo Clinic; 2020.
- Patel R, et al. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of diagnostic testing for SARS-CoV-2/COVID-19. MBio. 2020; doi:10.1128/mBio.00722-20.
- Evaluating and testing persons for Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html. Accessed April 29, 2020.
- EUA authorized serology test performance. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance. Accessed Aug. 10, 2020.
- Coronavirus (COVID-19) Update: FDA alerts consumers about unauthorized fraudulent COVID-19 test kits. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-alerts-consumers-about-unauthorized-fraudulent-covid-19-test-kits. Accessed April 16, 2020.
- West CP, et al. COVID-19 testing: The threat of false-negative results. Mayo Clinic Proceedings. 2020; doi: 10.1016/j.mayocp.2020.04.004.
- Coronavirus (COVID-19) update: Serological tests. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-tests. Accessed April 16, 2020.
- Mayo Clinic. Expanded access to convalescent plasma for the treatment of patients with COVID-19. https://www.uscovidplasma.org. Accessed April 16, 2020.
- Abbasi J. The promise and peril of antibody testing for COVID-19. JAMA. 2020; doi:10.1001/jama.2020.6170.
- Coronavirus (COVID-19) update: Serological test validation and education efforts. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-test-validation-and-education-efforts. Accessed April 28, 2020.
- "Immunity passports" in the context of COVID-19. World Health Organization. https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19. Accessed April 29, 2020.
- IDSA COVID-19 antibody testing primer. Infectious Diseases Society of America. https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf. Accessed April 29, 2020.
- Coronavirus (COVID-19) update: FDA authorizes first test for patient at-home sample collection. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-test-patient-home-sample-collection. Accessed April 29, 2020.
- Coronavirus testing basics. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics?utm_campaign. Accessed May 18, 2020.
- Coronavirus Disease 2019 (COVID-19): Testing for COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/testing/index.html. Accessed August 7, 2020.
- Coronavirus (COVID-19) update: FDA authorizes first diagnostic test using at-home collection of saliva specimens. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-diagnostic-test-using-home-collection-saliva. Accessed May 12, 2020.
- Coronavirus (COVID-19) update: FAQs on Testing for SARS-CoV-2. What is the difference between the types of tests available for SARS-CoV-2? U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-testing-sars-cov-2#5eb3418a8c19f. Accessed May 12, 2020.
- Coronavirus (COVID-19) update: FDA authorizes first antigen test to help in the rapid detection of the virus that causes COVID-19 in patients. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-antigen-test-help-rapid-detection-virus-causes. Accessed May 14, 2020.
- Marshall, WF III (expert opinion). Mayo Clinic. Aug. 15, 2020.
- Coronavirus (COVID-19) update: FDA posts new template for at-home and over-the-counter diagnostic tests for use in non-lab settings, such as homes, offices or schools. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-posts-new-template-home-and-over-counter-diagnostic-tests-use-non. Accessed Aug. 11, 2020.