Ubel: Antibody Tests Could Offer A False Sense of Security

Statistics show even small error rates could have big consequences

May 6, 2020
Health Care, Innovation


A lot of hope on reopening businesses and returning to work in the U.S. hinges on COVID-19 testing and the development of treatments and a vaccine. 

But as the country ramps up antibody testing – analyzing blood samples for signs someone has been exposed to or infected with the coronavirus that causes COVID-19 – physician and economist Peter Ubel of Duke University’s Fuqua School of Business warned about the potential consequences of imperfect tests. 

“Right now, there have been a lot of tests that have been approved by the FDA, but some are not so great,” he said.

Many tests boast what may sound like low error rates, he said. Yet even seemingly small rates of false-positive and false-negative results could lead to people unwittingly spreading the virus, either thinking they are not infected and safe to socialize, or falsely believing they have already been exposed to the virus and can’t be infected again. Therefore, the idea that people could use testing to determine who’s immune and can return to a non-socially-distant life may not be realistic, he said.

“I think this idea of an ‘immunity passport’ is not ready for prime time, because I don’t think any test could be accurate enough to give us anything but a false sense of security,” Ubel said recently on a live broadcast for Fuqua followers on LinkedIn (see videos). He also co-authored an opinion piece in The Washington Post on the topic.

Assuming the test is 96% accurate, you could test 1,000 random Americans and end up with 80 people who think they’re immune, and “only half of them are correct, and we don’t know which half,” Ubel said. “So it's a real challenge to know, as people are pushing to have home antibody testing, whether people are going to misinterpret the results of their own tests.”

Ubel urged the FDA to consider strict regulation on antibody tests – perhaps even stricter than guidelines as they test drugs that could treat COVID-19.

“We're feeling the urgency of this epidemic and we're trying to move faster than normal,” Ubel said. “But we shouldn't lower the standards for that kind of testing because it can be so misleading, and then have the bad consequences of making people feel safer than they really are, and therefore more worsening the epidemic.”

Ubel also discussed how governments and businesses may need to suspend a basic rule of business in order to be more prepared for the next pandemic. 

“What we learn about in business school about how to run efficient, on-demand delivery and production of goods and services makes a ton of sense -- until you need twice as much stuff as you thought you needed, and you're in the middle of a pandemic,” he said. “This is going to have to come as a social goal that needs government support – we’re going to have to invest in resources we don't use necessarily -- that we hope to never use. And that looks inefficient from the strict standpoint of how a business runs, but is incredibly important.”

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