Immunity passports deserve consideration

Immunity passports based on positive antibodies to the novel coronavirus have been discussed as a way to allow people with natural immunity to return to work, and reopen the economy. The World Health Organization discouraged their implementation due to uncertainty around the evidence of immunity after infection, although most people cleared COVID-19 without antiviral medications or vaccines. In people who recovered from COVID19, no confirmed reinfections have been reported around the world and this fact strongly supports the theory that SARSCoV-2, the virus that causes COVID-19, leaves protective immunity. Protective immunity has been shown in rhesus monkeys, and scientists could replicate these studies in previously infected humans within 2 weeks.

Articles in major medical journals advanced ethical concerns that the distribution of immunity passports could be discriminatory. This argument neglects significant evidence that COVID-19 predominantly sickens and further impoverishes the poor, who would need such passports the most.

This theoretical ethical dilemma actually represents a way to address this existential threat for many families, who can no longer afford their bills, rent, or enough food. Many individuals cannot afford the luxury of social distancing since they are service industry workers, day laborers, or have to use public transportation. Many parents depend on daily wages to support their families and losing one paycheck may translate into homelessness or irreparable breaks in relationships from the stress of economic uncertainty.

The discriminatory potential of immunity passports seems less significant when compared to the discrimination that many groups already experience. Given the increasing unemployment and growing social inequities among the poor, but mainly African Americans, Hispanics and Native Americans, substantial disparities will only increase over time as the lock-down continues. Recently, more than 500 physicians sent a letter to President Trump comparing the ongoing lock-down to a “mass casualty incident” threatening significant consequences to millions of individuals with diseases other than COVID-19. The letter points out that the suicide hotline calls increased 600% and liquor sales are up 300-600%. The lock-down will continue to boost alcoholism, drug addiction, homelessness, suicide, unemployment, despair, poverty, and abuse. It will contribute to the neglect of heart attacks, strokes, and delayed cancer diagnoses.

Besides the fear of discrimination, immunity passport skeptics also worry that people may purposely expose themselves to SARS-CoV-2 just to acquire these passports. It is improbable that many would hazardously take this route. As long as people are well informed regarding social distancing and isolation of the sick, the vast majority of such individuals would have a mild illness and contribute to the herd immunity of their community.

Once protective immunity to SARS-CoV-2 is confirmed and displayed in immunity passports, there is no justifiable reason to hold immune people back from returning to their active lives. A simple cheap blood test showing prior exposure would allow people to return to work, or start looking for work if they lost their job while taking care of an ill-relative or while ill with COVID-19 themselves. Instead of feeling discriminated against, even the partners, children, and other family members of the “lucky” ones will surely enjoy the benefit of at least one regained income.

Unnecessarily preventing people from providing for their families after suffering through COVID-19 adds further economic and psychological injury to the physical one. These misplaced ethical and egalitarian issues lead to exaggerated restrictions and regulations and they do not matter to folks whose livelihoods have evaporated over these last few months.

Appropriate response requires quick adaptations, including proper distinction between the immune and not immune. Many of our brethren in academia, concerned about misuse of privilege, do exactly that – misuse their privilege, when they slow down necessary measures with unsubstantiated fears. As long as medical authorities and respected journals continue to prefer ideological buzzwords over sober analysis, we as medical professionals will not regain trust.