The predictive value of serological testing during the COVID-19 pandemic

updated: 4 June 2020     original published date: 30 April 2020

This rapid research brief synthesises the evidence on the predictive value of serological antibody tests and the comparability of point-of-care (POC) tests to laboratory tests.

Key findings:

  • Point-of-care (POC) and laboratory-based serological tests can be used to detect antibodies against SARS-CoV-2. Globally, health authorities are evaluating their use to determine individual immunity, the prevalence of infection in the population, to aid in diagnosis, to aid in contact tracing, and to inform when restrictions can be eased.
  • Laboratory-based tests are both quantitative and qualitative. POC tests deliver only a positive or negative result; or a semi-quantitative result at best.
  • Neither type of serological test is currently ready for widespread deployment. However rapid advances can be expected.
  • With respect to immunity, the interpretation of serological antibody tests relies on a clear understanding of the immune response to SARS-CoV-2, which currently remains undefined.
  • For as long as the prevalence of COVID-19 is low in Australia and available serological tests are not approaching 100% specificity, serological testing to measure the prevalence of COVID-19 will not be meaningful. However, if highly accurate serological techniques operating in some academic labs are validated against national standards, they could offer a means for predicting prevalence at the population level.
  • Laboratory-based serological testing is being used to identify donors of convalescent plasma that could be used to treat critically ill COVID-19 patients.

Contributing authors
Image of Dr Melinda Dean
Dr Melinda Dean School of Health and Sport Science, University of the Sunshine Coast
Image of Professor Emily Hilder FTSE
Professor Emily Hilder FTSE Director Future Industries Institute, University of South Australia
Image of Professor William Rawlinson AM FAHMS
Professor William Rawlinson AM FAHMS NSW Health Pathology Randwick and University of New South Wales
Image of Professor Carola Vinuesa
Professor Carola Vinuesa FAA Australian National University
Image of Dr James Watson
Dr James Watson Group Leader, Australian Centre for Disease Preparedness, CSIRO
Peer reviewers
Image of Professor Brendan Crabb AC
Professor Brendan Crabb AC Director and CEO Burnet Institute
Image of Professor Dominic Dwyer
Professor Dominic Dwyer Director, Serology group, Westmead Clinical School Institute for Clinical Pathology and Medical Research, University Technology Sydney
Image of Professor Caroline Miller
Professor Caroline Miller Director, Health Policy Centre, South Australian Health and Medical Research Institute
Image of Ms Suellen Nicholson
Ms Suellen Nicholson Section Head, Infectious Diseases Serology, The Peter Doherty Institute for Infection and Immunity
Image of Dr Jenny Robson FRACP FRCPA FACTM
Dr Jenny Robson FRACP FRCPA FACTM Serology Advisory Chair for the Royal College of Pathologists in Australasia
Image of Professor John Shine AC PresAA
Professor John Shine AC PresAA President of the Australian Academy of Science
Image of Professor James Vickers
Professor James Vickers Head of Tasmanian School of Medicine, University of Tasmania

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