• 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.

    #Coronavirus #Carte_immunité #Segregation_sociale

    https://seenthis.net/messages/843384 via Articles repérés par Hervé Le Crosnier

  • Opinion | The Dangerous History of Immunoprivilege - The New York Times

    The Dangerous History of Immunoprivilege

    We’ve seen what happens when people with immunity to a deadly disease are given special treatment. It isn’t pretty.

    By Kathryn Olivarius

    Ms. Olivarius is an assistant professor of history at Stanford University.

    April 12, 2020

    The article was widely discredited by public health experts and economists, as both logically dubious and ethically specious, but such thinking has already metastasized. The likes of Glenn Beck and Lt. Gov. Dan Patrick of Texas have fashioned the willingness to endure a bout with coronavirus as a patriotic, pro-economy act; Germany, Italy, and Britain are all toying with notions of “immunity passports” — proof that a person has beaten Covid-19 — that would allow people with antibodies to go back to work faster.

    That people could wield their hard-earned “immunocapital” to save the economy sounds like science fiction. But as we wait months or years for a viable vaccine, leveraging peoples’ antibodies may well be part of our economic strategy. If so, we should heed lessons from the past and beware of the potential social perils. As a historian, my research has focused on a time and place — the 19th-century Deep South — that once operated by a very similar logic, only with a far more lethal and fearsome virus: yellow fever. Immunity on a case-by-case basis did permit the economy to expand, but it did so unevenly: to the benefit of those already atop the social ladder, and at the expense of everyone else. When a raging virus collided with the forces of capitalism, immunological discrimination became just one more form of bias in a region already premised on racial, ethnic, gender and financial inequality.

    We know that epidemics and pandemics exacerbate existing inequalities. In the last three weeks, more than 16 million Americans — many of them waiters, Uber drivers, cleaners, cooks, caretakers — have filed for unemployment insurance. Meanwhile, tech executives, lawyers, and university professors like myself can sequester at home, work online, and still take home a paycheck and retain health insurance. Already, richer and poorer Americans are experiencing corona-capitalism differently.

    Once again, American politicians are arguing that viral immunity could be mobilized for economic benefit. While some version of this strategy seems possible, perhaps even likely, we should not allow an official stamp of immunity to Covid-19, or personal willingness to risk the disease, to become a prerequisite for employment. Nor should immunity be used to double down on our pre-existing social inequalities. There is already racial and geographic inequality in exposure to and testing for this virus. The most vulnerable people in our society cannot be punished twice over: first by their circumstance and then by the disease. We have been here before and we do not want to go back.

    #Coronavirus #Carte_immunité #Segregation_sociale

    https://seenthis.net/messages/843386 via Articles repérés par Hervé Le Crosnier