The specificity of serological tools detecting antibodies against SARS CoV-2 might be hampered by the presence of antibodies against other circulating coronaviruses in the population, and thus testing for cross reactivity is crucial. The likelihood of predicting protective antibody responses will thus increase when using either S1 antigens or RBD in the assay. We recently showed that antibodies directed against the S1 subunit of the SARS-CoV-2 spike protein and specifically to the receptor binding domain (RBD) within the S1 subunit strongly correlate with virus neutralization 3. The required performance of a serological assay will depend on the specific aim of testing, which may be either population screening (in the general population or at-risk populations) or diagnostic support. To assess the extent of virus circulation in the community, and the likelihood of protection against a re-infection, there is a crucial need to add serology to the testing algorithms. A key knowledge gap is the level and duration of protective immunity in the population at large and in specific groups, including persons with different clinical severity 1, 2. The gradual lifting of control measures will require active surveillance to allow early detection of new cases or clusters, coupled with contact tracing and quarantine, most likely combined with continued physical distancing recommendations and enhanced protection of those at-risk from most severe disease. The so-called exit strategy is defined as the transition from the current approach, which focuses entirely on flattening the peak of the COVID-19 emergence curve, to the transition phase in which restrictions are gradually lifted. There is wide agreement that, in the latter situation, rapid resurgence would be very likely, with modeled epidemic peaks potentially exceeding the current healthcare capacity 1. At present, given the global circulation of SARS-CoV-2, the consensus is that elimination of the virus is no longer feasible, and that longer-term strategies are needed that strike a balance between the economically and socially damaging (near) lockdown approaches and full release of any control measures. Since the initial notification of an outbreak on December 31st, the global response has transitioned from the initial policy of active case finding and containment to an increasingly complex package of confinement measures including closures of schools, implementation of travel restrictions, and physical distancing measures. The rapid global spread and exponential growth of the pandemic wave have stretched the limits of the available healthcare and intensive care unit capacity. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in late 2019 to cause coronavirus disease (COVID-19).
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