Tale of the Titers: Serologic Testing for SARS-CoV-2-Yes, No, and Maybe, With Clinical Examples From the IDSA...

Area of Science:

• Infectious Diseases
• Immunology
• Clinical Diagnostics

Background:

• Current SARS-CoV-2 diagnosis primarily uses viral antigen or nucleic acid detection.
• Serologic testing is crucial for epidemiological studies but has limited routine clinical application.
• Misapplication of SARS-CoV-2 serology occurs in contexts like vaccination need determination.

Purpose of the Study:

• To delineate the clinical utility of SARS-CoV-2 serologic testing.
• To provide guidance on appropriate and inappropriate uses of serologic tests.
• To clarify clinical decision-making regarding antibody testing in the context of COVID-19.

Main Methods:

• Review of available SARS-CoV-2 serologic testing methodologies.
• Presentation of clinical vignettes illustrating appropriate and inappropriate test applications.
• Analysis of scenarios where serologic data offers clinical value versus where it does not.

Main Results:

• Serology is generally not indicated for diagnosing acute SARS-CoV-2 infection.
• Antibody testing can be valuable for assessing persistent symptoms in undiagnosed individuals.
• Serologic tests are inappropriately requested for decisions like vaccination necessity.

Conclusions:

• Understanding the specific applications of SARS-CoV-2 serology is essential for effective clinical practice.
• Serologic testing should be judiciously employed, primarily for specific diagnostic dilemmas and epidemiological insights.
• Clearer guidelines are needed to prevent misuse of SARS-CoV-2 antibody tests.