The rise of the coronavirus's delta variant has made it very hard to gauge the health risks of returning to everyday life.
It's even more difficult if you are immunocompromised.
That's the dilemma that faced Washington, D.C., attorney Samuel Shafner as he considered the safety of traveling for work or even attending a wedding. He is vaccinated, but Shafner's immune system is compromised. That caused him to be uncertain of his body's ability to fight off the coronavirus.
He wanted to know specifically how immune to COVID-19 that he was.
"Although my general reading seemed to reassure me that I was 'likely' safe from contracting COVID-19 after receiving my vaccination, I wasn’t willing to gamble on a 'likely' assumption. Would you want to get on a plane that was 'likely' to arrive at its destination?," wrote Shafner about the experience.
Some internet searching led him to research papers and Post Bulletin news articles about Rochester's Imanis Life Sciences and its Immuno-Cov test.
Compared to standard COVID-19 antibody tests, the $300 Immuno-Cov test provides much more precise information for patients and doctors to track immunity to the virus. While all antibodies can identify the virus, only neutralizing antibodies can actually block the virus from entering cells to prevent infection. Immuno-Cov identifies and tallies the number of a patient's neutralizing antibodies in a measurement called a titer.
Having dealt with health issues much of his life, Shafner pushed and advocated for himself until samples of his blood were eventually sent to Rochester for testing by Imanis at its lab in the Rochester Technology (former IBM) Campus.
“We feel people like Mr. Shafner can benefit greatly from knowing what their immunity levels are,” said Dr. Stephen Russell, a Mayo Clinic researcher and co-founder of Imanis and its sister company, Vyriad.
Imanis determined early in the pandemic that a titer level of at least 250 is necessary to have a basic immunity to COVID. Shafner's test results showed that despite being vaccinated, his weakened system did not have that level of active antibodies.
“While this wasn’t the news I wanted to hear, it was exactly what I needed to hear in order to make the most informed decisions surrounding my personal health and safety,” Shafner wrote in a letter about the experience. “Unfortunately, it was not a favorable answer, but it's a lot better to know you're in danger than to blindly go ahead thinking you’re safe. Before this, the doctors were guessing. The basic idea was ‘You are probably all right.’ And the answer was no, I'm not.”
While his experience happened earlier this summer before medical and governmental leaders started discussing the need for booster shots eight months after vaccination to bolster waning immunity levels, Shafner was able to get a booster shot. Then he had Imanis test his blood again.
The results showed that while still did not have the levels that a healthy person would have, he had a titer higher than 250.
In the end, having the Immuno-Cov test done helped Shafner make educated decisions about his safety.
“I normally do a fair amount of travel for my business. I was tempted to start again... I normally go to synagogue at least once a week… I go to an outdoor service... Even though around me a lot of people are going in now, I'm not and I'm taking certain precautions,” he said.
Knowing that he had some immunity also gave Shafner some confidence.
“On the other hand, knowing that the third dose has given me some protection has enabled me to hug my grandchildren,” he said “The more data you have, the more intelligent the decision you can make -- and the more confidence you can have in that decision.”
Russell and his team at Imanis say the key thing to remember is different people respond to vaccines differently. Even people who are not immunocompromised like Shafner might not get the full effect of a vaccine.
About 50 employees at Imamis have been using the test on themselves to judge their personal levels of immunity. Of those employees, two healthy vaccinated people discovered that their active antibody levels were below the immunity baseline. Knowing that allowed them to take steps to boost their immunity.
Imanis has also determined that a patient’s titer number needs to be even higher than the 250 level to be immune to the delta variant.
Russell said the firm expects to roll out a version of the test that specifically measures the titer of antibodies that neutralize the delta within about six weeks.
While Shafner was able to get the test, the process is still not as easy getting a strep test at your doctor's office.
Dr. Kah-Whye Peng explained for the typical patient to receive the Immuno-Cov test, their doctor needs to order it from Mayo Clinic. They are doing about 24 to 25 such tests a week.
The biggest hurdle in getting the test is having blood samples taken and shipped to Rochester. Immanis is working on a way to make that easier.
Imanis Principal Scientist Dr. Rianna Vandergaast said researchers are conducting trials to see if using a dried blood spot instead of a liquid blood sample is as effective for the Immuno-Cov test.
The blood spot process involves poking a patient’s finger, collecting drops of blood on a special piece of collection paper and then mailing the paper to Imanis. A hole punch could then take several samples from a blood card for testing.
“We want it to be widely available, because it is incredibly useful,” said Vandergaast of the test.
Imanis wants to help people have the information they need to understand their risks during a confusing time.
“The reality is there are protected individuals and there are unprotected individuals,” he said. “What matters is people using the information to live safely.”