Dr. Roach: Reader bemoans lack of precise immunity test
Dear Dr. Roach: Can you comment on the lack of a test that truly demonstrates the effective level of immunity an individual has from receiving the COVID vaccine? My wife has lupus and rheumatoid arthritis, and had both doses of the Pfizer vaccine over a month ago. Now we learn that her immune system may not have created any antibodies against COVID-19! There is no test to give her peace of mind that she is protected. The one test mentioned (SARS-CoV-2 Semi-Quantitative Total Antibody, Spike) shows only that you have some antibodies from the vaccine, but doesn’t reveal the true level of protection. It’s frustrating!
Dear B.W.: I completely agree that the lack of a blood test that can reliably identify people who are at risk for developing COVID-19 — or alternatively, those who have reliable protection — is extremely frustrating. For many vaccines, we do have such a test for effectiveness. For measles or rubella, for example, a person can get the blood test, and if the antibody isn’t present at a high-enough level, we know they are at risk and recommend booster shots. Unfortunately, we do not have that test for COVID-19 at the time of this writing.
There are many different kinds of antibody tests a physician can order, but it is unknown whether the absence of antibodies indicates a person is at risk, nor whether their presence is reliable proof of immunity. The Centers for Disease Control and Prevention notes: “none of the currently authorized tests have been authorized to assess individuals that have received a vaccine” and “antibody testing is not currently recommended to assess for immunity to COVID-19 following COVID-19 vaccination or to assess the need for vaccination in an unvaccinated person.” I sincerely hope that by the time this column is published or shortly thereafter, we will have a reliable test. This would be very useful, especially for people such as your wife, who are at higher risk for complications of COVID-19 and who have a reduced response to the vaccine due to medications she might be taking for her lupus and rheumatoid arthritis.
Dear Dr. Roach: Nine years ago, I had two surgeries related to spinal stenosis, fusing C4-C7 and L5-S1. I’m concerned about two relatively new issues: extreme muscle cramping in my neck and, more concerning, a sciatic-type pain that starts developing after about an hour of driving, a pain that significantly increases over the next hour. Stopping and walking for a few minutes alleviates the pain and allows me to continue driving. Any suggestions to correct these issues? I’m 70 years old.
Dear D.H.: Fusion is commonly performed in surgical treatment for spinal stenosis, a condition where the spinal cord or one of the nerve roots is compressed by the hard structures in and around the spine. Unfortunately, fusion at one (or more) levels of the spine tends to put more pressure on the remaining areas, and people who develop spinal stenosis in one part of the spine may do so in another part of the spine. I think it is worth a re-evaluation (which may include imaging studies) to look for any areas of nerve compression. The major symptoms of spinal stenosis are pain, numbness and weakness. Cramping is not a common symptom, so I would be concerned there may be something else going on. Your regular doctor is probably the best place to start.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.