Covid-19 ’immunity certificates’: practical and ethical conundrums - STAT
The media’s understandable focus is now on the number of people hospitalized with and dying from Covid-19. Yet most Americans who develop this disease will recover from it on their own after experiencing flu-like symptoms. Some experts see them as a resource for restarting the economy and want to make their status official with the papers to prove it.
We need to think them through first.
German researchers have proposed testing 100,000 people for antibodies to SARS-CoV-2, the virus that causes Covid-19, and giving “immunity certificates” to those who have these antibodies, which presumably make them resistant to reinfection. The United Kingdom has floated the idea of “Covid passports,” Italy is discussing the idea, and it is being raised in the U.S. as well.
Immunity certificates offer the enticing promise that an increasing number of people can stop sheltering in place and instead help the world revive. They could play an important role in the period before we have excellent treatments or an effective vaccine. But they raise issues about the science of Covid-19 immunity, about how such certificates would be provided and policed and, most important, about a country split between the free and the confined.
But no test is perfect. Some detect antibodies that do not exist (false positives), others miss antibodies that do exist (false negatives). False positives may be a particular problem here, as a test might signal positive for SARS-CoV-2 antibodies when it is really detecting antibodies to cold-causing coronaviruses.
In normal times, a test is not used until its accuracy and rates of false positives and false negatives have been carefully tested and optimized. But these are not normal times. Such optimization has not yet been done yet for any of the tests under development, and it is not clear how long such a process will take.
Antibody tests are not the only way to decide that an individual is immune to SARS-CoV-2. We could assume that those who have had the disease are now immune and issue them immunity certificates. But how will we know they had Covid-19? Will an applicant need to show a positive virus test to justify a certificate? Without such testing, it can be difficult to know for sure if someone truly had Covid-19 or if they had something else, like the flu, with similar symptoms. But many people with Covid-19 symptoms have been unable to get coronavirus tests and have even been told not to try.
Employers or governments might require that only people with immunity certificates be allowed to work in jobs involving substantial human contact, like health care, food, service, retail, transportation, and more. Restaurants, bars, sporting events, concerts, or other so-called public accommodations might admit only those with immunity certificates. Travel by public transportation or the privilege to attend classes in person might be limited to individuals with immunity certificates. But should they be so restricted?
These certificates have appeal — unless you are one of the many people who end up locked out of the world due to no fault of your own. For you, it is discrimination: some people can work, play, or travel while you cannot.