Israel Recognizes ‘anti-N’ Serology Test for COVID Green Pass Eligibility

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A coronavirus test in Jerusalem
A coronavirus test in JerusalemCredit: Emil Salman

The Health Ministry announced that those who have received only one or two doses of the COVID-19 vaccine will be eligible, as of Monday, for the Green Passport, if they present a designated serology test called anti-N, which will show they have previously contracted the virus. Until now, Israelis who contracted COVID-19 before being vaccinated, but had no medical proof to that effect, were ineligible for the Recovery Certificate and Green Pass.

The Health Ministry published an update to the COVID-19 recovery definition protocol, according to which a positive result in an anti-N serology test will render the person tested eligible for the Green Pass upon completion of at least one dose of the vaccine, regardless of the order of test and vaccination. The pass in such cases will be in effect until March 22, 2022. According to the update, extension of the pass’ expiration time “shall be considered from time to time.”

The anti-N test is designed to locate IgG antibodies that work against the virus’s N protein. The level of these antibodies rises after exposure to the virus itself. The test was recently recognized by the Health Ministry and put into use. The test can be taken at any hospital at the patient’s cost, and does not require a doctor’s referral. Until now, those who had received one or two doses of the vaccine were ineligible for a Recovery Certificate with an anti-S serology test, as that test locates IgG antibodies which work against the S protein of the virus, and these antibodies appear following both infection and the vaccine.

The S and N proteins are the two antigens that were used to develop serology tests to identify the coronavirus’ antibodies. The S protein, known as the Spike, is the virus’s capsid protein which it uses to bind with cells. The N protein, which stands for Nucleocapsid protein, is an intracellular protein involved in the virus’ creation and replication processes. The antibodies that neutralize the virus are those that target the S protein and that is why the COVID-19 vaccines target it. Therefore, antibodies targeting the N protein will appear only following infection and not in uninfected vaccinated people.

The Health Ministry’s updated protocol include additional changes in the recognition of recovering COVID-19 patients and issuing of Recovery Certificates. One of the changes is that a person will be defined as recovering if they received a borderline result in an antigen test done at a station recognized by the ministry, or if they get borderline positive results in PCR tests done within 72 hours later. The protocol also allows the Kupat Holim sick funds to recognize a person as recovering in undefined, exceptional cases.

Furthermore, the Health Ministry is abolishing the requirement for a serology test to authenticate a vaccination certificate from abroad. It also recognizes a statement-based recovery certificate issued abroad along with relevant documentation, without the need to show a serology test.

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