Before Juhi Singh, 46, who owns a high-end wellness center on the Upper East Side, jetted off to the Amalfi Coast last month, she packed her bathing suits and left her 10-year-old son with his grandmother.
Her personal driver also took her to Sollis Healthcare, a concierge medical service in Manhattan, to measure her antibodies for the coronavirus. She received the Johnson & Johnson vaccine in February, and wanted to see if her immunity was still robust before joining friends at a five-star resort overlooking the Tyrrhenian Sea.
“I wouldn’t go on a trip without my antibodies,” Ms. Singh said. “It’s nerve-racking, but my numbers have been good.”
An email arrived 24 hours later with her results: 14.8 arbitrary units per milliliter. Although medical experts warn that an antibody count cannot tell if somebody is protected against the virus, patients have been reading into the numbers anyway. “Mine have dipped a little bit, but I know my vaccine is still working, and I am still protected,” Ms. Singh said.
Antibody testing on a monthly or regular basis has become a common practice among certain members of the nervous affluent class. “A lot of my patients and some of my friends are counting their antibodies,” Ms. Singh said. “It’s the Upper East Side, the Hamptons circles. It’s like dinner conversation at this point. It almost feels like counting calories.”
Medical concierge services, including Sollis, have started offering antibody tests as a perk to clients. “I check them for people daily,” said Dr. Scott Braunstein, the medical director of Sollis’s office in Los Angeles.
My Concierge MD, an upscale health care practice in Beverly Hills, Calif., has set up a drive-through where clients, including celebrities and Hollywood executives, can get tested without getting out of their G-Wagons and Teslas. “We do it with a finger prick,” said Dr. David Nazarian, who runs the practice. “Let’s just say with Delta, the test sites are busy right now.”
But Arthur Caplan, a professor of bioethics at New York University’s Grossman School of Medicine, is concerned about the overuse of antibody tests. “The doctors who are promoting them are not promoting good science,” Dr. Caplan said. “I think they are putting their patient at risk, because there are no agreed upon antibody levels.”
Some people check their antibodies because they are immunocompromised or are living with high-risk individuals. (Ms. Singh is the caretaker for her 91-year-old grandmother.) Others do it for peace of mind before taking an international flight or attending a gala.
Others just want to be armed with more information about their medical status, something that has become normalized in the era of health monitoring apps. “Our patients are very analytical,” said Dr. Alan Viglione who runs Montecito Concierge Medicine, a private health care provider in Montecito, Calif. “We have a lot of patients who want to know their numbers. It’s become a new trend to know what your antibodies are.”
Patients who get a low antibody count may decide to change their behaviors or “life choices,” Dr. Braunstein said. “They might decide to skip that wedding. They might take extra precautions.”
Some may opt to get a booster shot. Although the Food and Drug Administration has only authorized booster shots for those who are immunocompromised, there is some evidence that more than 1 million Americans have already received unauthorized third doses.
One medical concierge service was even encouraging high-risk patients to check their antibody levels before getting a booster — something that no public health agency has recommended.
To Test or Not to Test
Getting an antibody test (also known as a serology test) is a relatively easy procedure. Blood, drawn through a finger prick or through a vein, is screened for antibody proteins created by the immune system to fight infection or after vaccination. Antibody tests do not check for the virus itself and cannot be used to diagnose whether someone has Covid.
“It’s a simple blood test, and we see the results the next day because there are a number of large labs across the country doing it,” Dr. Braunstein said. “It isn’t overly expensive. Most insurances will cover it, but if they don’t it’s about $100 to 200.”
But the results offer limited information. Current tests only look for antibodies for SARS-CoV-2, the virus that causes Covid-19, and not for T cells, which plays an important role in the body’s immune response.
It is also not clear what the antibody count means. For starters, different tests measure the strength of the antibodies differently. A person who gets tested by Sollis, for example, may get a count of 20 or higher, while a different lab may give a result of 270 or higher. (A person without antibodies would get a negative result.)
A higher number may not necessarily confer great immunity. “We don’t have exact data on what a 4 means versus a 15,” Dr. Braunstein said. “You can’t specifically say that you are a 9, and I am a 8, so you are more protected than me.”
Indeed, the F.D.A. does not recommend that people use antibody tests to gauge immunity and, in fact, warns of its potential risk. People who receive a high antibody count may take fewer precautions, such as mask wearing, that could result in infection or spread. (Dr. Braunstein said that “all of our patients are informed of this recommendation and advised to follow all C.D.C. recommended safety measures, regardless of the test result.”)
“ “It can give you a false sense of security,” said Dr. Caplan, who leads N.Y.U.’s division of medical ethics. “They might say, ‘I got my antibody test, so I am not going to wear a mask or I am going to that concert, because I know I’m immune,’ which in fact they don’t know.”
Dr. Caplan is also concerned that people might use their antibody count as an excuse to skip a booster vaccination when the time comes. “Even if you have antibodies, it doesn’t mean you have them sufficient enough to fight off new variants,” he said.
‘Why Wouldn’t I?’
Still, antibody counting has become a practice among the wealthy who regard their health as a full-time undertaking, where no medical test is too insignificant and no medical resource too expensive.
“People read articles and get on the internet and do research and want to do tests,” Dr. Caplan said. “But it is up to the doctor to filter that and calm me down so I don’t spend money on useless or harmful things.”
Medical concierge services, he argues, often do the opposite — that is, cater to their patients’ wishes. “The problem is when you are a concierge practice, you have to honor what they want because they are paying you money to do what they want,” Dr. Caplan said.
The poor, he said, often avoid medical tests because they are scared they will lose their health insurance or job if they get a bad result. “If it turns out you have low antibodies, all of a sudden you might think, ‘I can’t tell anybody about this, because my boss won’t let me come into work,’” Dr. Caplan said. “The penalties for knowing more about bad health are not problems the rich face.”
That is certainly the case with affluent people who are counting their antibodies.
“With this Delta variant, I want to know where I stand,” said Terry Cohen, 62, a real estate agent in the Hamptons who works with high-end properties. “I want to understand what is happening in my body.”
Ms. Cohen, who lives in Sagaponack, N.Y., received two doses of the AstraZeneca vaccine while in Anguilla last winter. She felt protected until the Delta variant surged in July. She also wondered why people her age in Israel were getting booster shots if the vaccines were still effective, and why she was hearing of so many breakthrough cases in her social circle.
News about how much protection the vaccines offer also kept changing. “Whatever one says on Monday the following Monday needs updating,” she said.”
So she began checking her antibodies about once a month. “Why wouldn’t I?” Ms. Cohen said. “We have the ability to check them, and it’s good data for me to know. I had plenty last time and it makes me feel better, at least for this moment, knowing I am protected.”
As fears mount, concierge doctors are offering other ways to gauge immunity.
Sollis now offers a commercially available test for $200 that checks for T cells. “The test is much more difficult because there are only a few labs in the country doing this,” Dr. Braunstein said. “There is a seven-day turnaround with results, but we think it’s worth it.”
“I have had two or three clients ask for T cell tests,” added Dr. Viglione of Montecito. “Right now only specialty labs will do it, but in a month or so I think it will be much more common. It’s trendy to have a lot of personal data.”
