Why immunity passports are a bad idea
nature.com
nature.com
As of 3 days ago there is:
https://science.sciencemag.org/content/early/2020/05/19/scie...
It certainly points to it working, but it's not conclusive.
The only conclusive test will be a challenge test, where you purposely infect people, or waiting a year after a vaccine to check for reinfection rates.
A more fair summary is that they tested on monkeys and the results looks good, in their words:
""" We developed a rhesus macaque model of SARS-CoV-2 infection that recapitulates many aspects of human SARS-CoV-2 infection, including high levels of viral replication in the upper and lower respiratory tract (Fig. 1) and clear pathologic evidence of viral pneumonia [...] data suggest the utility of rhesus macaques as a model for SARS-CoV-2 infection for testing vaccines and therapeutics and for studying immunopathogenesis [...] However, neither nonhuman primate model led to respiratory failure or mortality, and thus further research will be required to develop a nonhuman primate model of severe COVID-19 disease.
Given the near-complete protection in all animals following SARS-CoV-2 rechallenge, we were unable to determine immune correlates of protection in this study. [...] Moreover, additional research will be required to define the durability of natural immunity. """
I think this is scientist talk for meaning "likely" but "not exhaustively proven" yet. The article explains the situation very well and I suggest a thorough read. It would be very upending if a virus such as this one did not confer immunity.
edit: from the referenced article:
> To date, no human reinfections with SARS-CoV-2 have been confirmed.
That's the thing about "immunity passport", it implies here you have someone you can expose to the virus all day long. I suspect no one can survive unlimited expose to whatever deadly disease without getting sick.
I mean, as I understand it, for most diseases, the purpose of vaccines is to get the (over-used) "herd immunity", meaning people are immune enough on average to stop the spread of the disease. Situation were a substantial portion of people refuse vaccines (thanx, antivaxer) can result in outbreaks where vaccinated people also get sick.
You mean dose?
The current vaccine research is measuring antibody titres (how much) is being generated by an inoculated individual in reference to a recovered patient. The next step is to determine if those antibodies are actually sufficient as they are different.
My googling also turns up herpes, Epstein-Barr, measles(!), HPV, Hep-B [1]...
It looks like there are many diseases which can find a host reservoir in our body to hide out for a while.
The crux of this is that immunity doesn't last forever but does last for awhile. In measles it looks like 15 years after your two standard MMR vaccines you get from a kid. We have to recognize too that vaccines aren't perfect. Your immune system might not make as strong of an antibody response as another person. You may lose immunity sooner than others. Etc. But the whole premise of the vaccine is that you can get immunity. And if we look at this study, this worked out for most people. Not many people got measles, and of those that did only 9% were vaccinated, which shows that there is a substantial bias for those that weren't vaccinated.
So when I'm saying that people get get immunity I don't mean forever and to every strain, but that they generally get some protection. In fact, this is an essential component to vaccine theory. If you gain __NO__ immunity (for any period of time) from covid, then a vaccine isn't going to do anything because you can't build an immunity. If you get immunity for a year (like with the flu), I think that's a pretty acceptable risk for many and shows that we could build substantial herd immunity just with the younger populations (like with the flu, which the vaccine there isn't even that great, but better than nothing).
And as another note on Shingles, I don't know about you, but chickenpox parties (because it is A LOT worse when you're older) were a thing when I was a kid (I'm not even 30!) and less than 1% of people get shingles. The main factors are being old, immunocompromised, and getting chickenpox before you're 18 months old. Saying you can get reinfected and will get reinfected are different statements with different risk values.
With COVID-19, clearly people get well.
This isn't to say it will protect you forever, and isn't to say there can't be variants that can infect you. But still...
It happens very much for the same reason: it's good for business. Can you imagine the local cops and especially the local judges get serious on DUI's and hand out real prison sentences (5 or 10 years for first offense) for drunk driving? I can't. The local restaurateurs would be dead set against it.
Isn't blood clots a side effect from lying in hospital beds all day, rather than the disease itself?
Family, friends, grandparents, colleagues at work. And those will undoubtedly spread it further, until it eventually reaches people that it actually kills. There simply is no way to safely perform a deliberate "self-infection" in order to get antibodies other than by committing to a radical externally-enforced quarantine for the duration of the infection. And I personally wouldn't trust most of the prime candidates for such a self-infection (young adults fed up with the lack of parties and entertainment) to be responsible enough for that, which is why I confront any ideas that might incentivize such behavior, like immunity passports, with extreme doubt and caution.
Will there be risks and accidents? Of course, nothing is perfect. But some control sounds like a much better environment than just letting it happen completely uncontrolled.
(Answer: you'd need proper testing, paid sick leave and especially paid quarantine, but that kind of public health measures is politically unthinkable. My institution "recommends" quarantine for potentially exposed workers, and that isn't enough.)
The Chinese have that problem with their porous border with Russia and North Korea, where the pestilence is uncontrolled. It's a continuous source of new cases, but I expect that these will not spread far.
You can go through life right now, until we get a vaccine and/or better treatments, doing your damndest to neither catch, nor spread it.
Granted, there are still very serious ethical issues, in the sense that we don't know if there are any long-term damages caused by the virus. But at least it will be an option for those who oppose the current isolation rules, it requires skin in the game from everyone involved and it could work almost as a damage-reduction policy (as the infected ones would not go back home until they are cleared)
Set up a hotel in Vegas with 3000 rooms, 450 ICU beds. Start with people under 30 years old. Have people get infected with a weakened version of the virus.
In the first 1 or 2 iterations of people, measure the antibodies in each person, and do a test for how long people are contagious for. We STILL don’t know this for a fact. Also measure how long it takes for people to become immune. Do tests like figure out which people are more susceptible to severe symptoms or which people are more likely to have asymptomatic symptoms. Again, we STILL don’t know this.
Cycle the asymptomatic and non-contagious people out first and keep doing it until the ICU beds are full. As an ICU bed becomes empty add the appropriate number of people into the test to get them infected. This seems ethical to me.
I bet a lot of younger people would be willing to do this especially if their chance of death is 0.1% or lower and they can go back to work sooner.
Once we gather valuable data from this, then move up in terms of risk and keep going until we have herd immunity.
I’m almost 50, with a few comorbidities but if I knew I would get a weakened version of the virus with dedicated bed and top health care, not only would I volunteer but I would also pay for it out of my own pocket. I’m sick of being afraid and part of the fear is the lack of understanding and misinformation that is being spread. We need science To answer a lot of questions but they aren’t very helpful right now, or at least they aren’t answering the questions we need. We need volunteers to get themselves infected so that we understand what is going on with this virus. if we can do this in a predictable and safe way and allow science to learn from it it’s a win win. We need to stop worrying about ethics especially if people are willing to volunteer themselves.
Trust me, you don't want to belong to that group. The reason you are in hospital is that you have serious pneumonia for weeks and may walk out with permanently reduced lung function. Have you seen Boris Johnson before and after?
I would only seriously propose such a thing for those that really want to get out of the isolation measures and for those business owners that worry more about their pockets than human life. For instance, in my proposal people really would not leave the hotel until cleared. If hospitalization were needed, it would be to the hotel owner to provide a section of the rooms to be equipped, and bear the costs of it. Voluntarily infected => No hospital bed for you.
There may be less well-informed people who would be down for something like this, but it’s not a decision that would be driven by a realistic appraisal of what we know and what we know we don’t know.
- People don't seem to be getting this disease twice in three months, even if exposed again. So there's clearly some level of immunity. In a month, we'll know if it's good for four months. It doesn't have to be lifetime. A year or two would be enough. By then there will be either a vaccine or herd immunity.
- The first batch of rushed antibody tests were not very good, but there are reliable antibody tests now. Above 99%, anyway. That's good enough.
- If huge numbers of tests will fix the problem, that just takes money. Far cheaper than a 3 trillion dollar "stimulus". Cost goes down with volume, too.
- Too few survivors - right now, yes; over time, no. New York City is somewhere in the 15% - 20% range now. By the time the plan is in place, there will be more.
- As for "marginalized groups", this seems to hit Asians and blacks worse. So those groups will have more survivors, more immunity passports, and better access to jobs.
the rate of infection (and immunity development) is going down everywhere. it seems high immunity level will take too many months to arrive even in the most affected cities. By that time the virus will have mutated, like other coronaviruses
No, it's not.[1] Some places it's up, some places it's down. The US as a whole is flat right now.
[1] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&are...
What you're describing is a perfectly fair system, but that is not how marginalization works in practice.
I can't see the future, but I imagine that groups who strongly associated with corona virus would face much greater scrutiny when obtaining documentation. Historical examples of this kind of effect can be seen in civil war pension discrimination[0] and in the general belief in racial stereotypes[1]. There's every reason to believe that the factors that make a group vulnerable would be redoubled in through a certification process.
[0] https://news.byu.edu/news/racial-discrimination-union-army-p...
[1] https://www.aamc.org/news-insights/how-we-fail-black-patient...
You know that if you have a 3% prevalence of the virus in the population, and test 100 people with a test that has 99% specificity and sensitivity, then 3 will be positive, and most likely test positive, but 1 will test positive despite being negative.
Thus, of the 4 people testing positive, only 3 will have antibodies and immunity.
Not sure that's good enough.
(Note that this problem diminishes not only as the tests get better, but as the virus spreads more.)
Focus should be on improving test quality, understanding joe immunity works and increasing availability.
This article reads as a perfect is the enemy of the good piece. Limiting something potentially beneficial because not everyone can have it is a nice thought, but it backfires.
Not recommending this, it would still create some of the same problems, but I'm surprised it just hasn't naturally emerged from individual incentives.
If you're legally required to make people wear masks when they enter your store you can't just say "oh, but there are these peeps who said that they already had the virus, they said they could be identified by their green wristbands, I will let those in without a mask". Local law enforcement will first laugh at you, then threaten to close your store if you don't comply with the law which does not exactly include a paragraph about exempting people due to whatever kind of self-chosen fancy "survivor IDs".
The article presents neat, philosophical arguments.
But the real reason we can't have 'immunity passports' is that large swaths of young people will be swarming to get infected on purpose.
Massive numbers of people will either think 'there is no risk' or 'are willing to take the risk' or 'feel the need to take the risk' (i.e. for income).
Bragging about their 'freedom passports' on Instagram, egging others on.
I can see low-grade Instagram celebs doing 'team infections' on social media, going into a house together and getting infected.
I can see poorly raised teens making pacts. Semi lawless young people just going out and getting it.
Other young people taking bad cues for influencers.
Think of the problems FB and YouTube will have. Will they have to censor anyone promoting 'getting infected'?
The mere thought of 'immunity passports' is DOA for that reason alone, and of all the articles I've seen on the subject, they've never bothered to address this most obvious issue.
First, it's nothing like eugenics at all.
It's not the policy that is degrading your situations, it's the disease.
The policy is just an official recognition of the situation.
If you have a disease like AIDS, you cannot go around knowingly affecting people.
We already have public policy in place for similar such things.
'COVID Passports' are just a mechanical effectuation of policies we already put in place.
Yes, it comes along with ethnical questions, but if it were not for people racing to get themselves infected, it would be pragmatic.
Consider your 'concern for your rights' for a moment wherein the entire world on 'lockdown'. People literally locked in their homes working out 'prisoner's dilemmas'. 30 Million people have been rendered unemployed, many businesses have been shut down and people are bankrupt. What about their rights? Or forget 'rights' - what about their livelihoods and the destruction of their savings, homes etc.? It's more of a pragmatic concern than a moral issue.
It's not the disease, as in the suggested solutions will actually restrict the rights of people who haven't got the disease. Not that people who are sick deserve to have their rights curtailed, see below.
> If you have a disease like AIDS, you cannot go around knowingly affecting people.
This sounds so, so wrong. I believe that thinking similar to this generated the terrible situation and ostracisation that people who got AIDS in the late '80s had to face.
> rights' for a moment wherein the entire world on 'lockdown'.
The entire world is not on "lockdown" anymore. I live in a country who is slowly exiting one (after 2+ months), as does most of Europe, and even though we have never been the bastion of democracy we have managed to do it without resorting to the ostracisation of people.
But yes, to me it's weird that it's not the first. People dislike following lockdown rules already, imagine if we start rewarding their lack of caution with never having to follow the rules again.
This is actually an argument for giant 3-week rave parties in isolated areas. Everybody gets tested on the way out. Ones with antibodies and no virus get a passport. Then they get job offers. Extreme, but better than the current "open, stay open, and keep dying" plan.
Wow - absolutely not - the notion of people - anyone - purposely infecting themselves with a deadly disease that actually does kill quite a number of people - is absurd.
The notion that the government may indirectly encourage it is very irresponsible.
This is aside from even the fact that quite a lot of those people will still need hospitalization, and of course, they become carriers and will infect others.
A 'wave of young people getting infected' would cause the hospitals to spike again, get more healthcare workers and 'all the other people' in the hospitals infected as well.
We're going to have to aggressively socially distance and change a lot of our habits for the next 18 months or so as vaccines, cures, therapies etc. are developed - all of these things combine to bring R0R/R1 the numbers down.
It kills almost nobody under 25. It's an extremely low risk for that group.
On the other hand, we already have this in California. You can't attend school without your vaccinations. Although the state will provide the vaccinations for free if you can't afford them.
The problem is it actually is a good idea right now to operate under the assumption that antibodies provide immunity, but in the future it may not be.
But if you allow a program that gives certificates for having antibodies, it will be really hard to put that genie back in the bottle.
a more pertinent question is how to monitor the quarantine of infected people for the following months. asian countries used quite harsh measures for that
> COVID-19 immunity is a mystery
No. It's not. Recovered people are almost certainly immune. There's evidence that's come out recently to actually empirically confirm this, but it's also how almost all diseases work, and so it's a super reasonable prior in the absence of evidence. This whole "we haven't positively proved it, therefore we have no idea" position that's being taken in some corners of the healthcare community is ridiculous, dangerous, and wrong.
> Serological tests are unreliable. The volume of testing needed is unfeasible. Tens to hundreds of millions of serological tests would be needed for a national immunity certification programme.
Some serological tests are unreliable. So use the reliable ones, problem solved. The US is doing hundreds of thousands of tests a day. That's enough for this program to work.
> Too few survivors to boost the economy.
This may be true in some areas, but it's certainly not true in NYC, where 20% of the population has been infected already. Even if it doesn't boost the economy, it'd allow freedom of movement to people who have recovered - that seems like a valuable thing to me on its own.
> Monitoring erodes privacy.
No it doesn't. Give someone an immunity certificate. If they get stopped outside when they're not supposed to be, they present it to the police and go on their way. Just like a drivers license or any form of identification now.
> Marginalized groups will face more scrutiny.
No. We do not need any extra monitoring to do this. Just take the current system with its current restrictions, and lift the restrictions for people with a certificate of immunity.
> Unfair access. With a shortage of testing, many will not have access.
First of all, unfair access is a choice. Design the system so it's fair, if you're worried about that. Second of all, unfair access is not a reason to deny access to everyone.
> Societal stratification.
This is literally the point. To stratify by recovered/immune. If you actually want to get into this, traditionally marginalized groups have been disproportionately infected by this virus, which means they will be disproportionately granted immunity certificates. If anything, this will stratify in the opposite way from 'traditional' stratification, and that seems like a fine thing to me.
> New forms of discrimination
This is just a restatement of the last two points.
> Threats to public health. Immunity passports could create perverse incentives. If access to certain social and economic liberties is given only to people who have recovered from COVID-19, then immunity passports could incentivize healthy, non-immune individuals to wilfully seek out infection — putting themselves and others at risk
Driver's licenses create perverse incentives. That's not a reason not to issue them. If someone infects themselves with covid to get an immunity passport, that's fine, we'll just get to herd immunity that much faster.
Remember, immunity passports aren't putting more restrictions on anyone. They're just lifting extant restrictions on those who have recovered. This idea that it's going to erode privacy or rights is such a crazy false choice I don't even know where to begin. The reasoning in this article is just so, so bad.
This is quite the claim. Unfortunately, it's not really backed up by much. Not to mention that the idea of an "immunity passport" is pretty anti-libertarian to begin with, so it just seems like odd shade-throwing.
> because of structural inequities, people of colour are dying from COVID-19 at much higher rates than are white people..
I was under the impression that people of color are more impacted by COVID-19 due to certain health profiles (e.g. diabetes being more common in black communities than, say, Asian communities). I'm not really sure how the jump is made here to "structural inequities." COVID-19 is just one co-morbidity and claiming otherwise is just agenda-waving.
That's one factor, but there are many. Hospitals in low income areas are not as well funded and supplied. Access to primary care may be more limited. Heavier concentrations of jobs with less ability to work from home. etc.
[Citation needed]
Which was poor US areas are really poor and so are their hospitals.
In sweden there are no really poor areas and no underpayed hospitals.
(they are also not perfect, though)
Immunity passport (or any other pandemic-prevention tools) focus on the population, not an individual. (It is not if you can or cannot get infected, it is if you are likely to infect others!)
I am disappointed by the populistic vibe of this article, endorsed by Nature. Sure, there are problems with the idea of the immunity passport. But the question is - what are the alternatives?
They gave much less scrutiny to the idea of a vaccine (that no-one knows if and when it is going to be available) and tracking (which works in Singapore, Taiwan and South Korea, but in other countries it fails miserably). They both suffer from many similar issues as the passport (tracking: regarding privacy, vaccine: access to less privileged groups, etc).
Population level solutions of this type would universally grant rights to (at least) entire blocks of a city.
If we can make the whole population immune - it is the best. If there are some people immune - it makes no sense restricting their traveling rights if they are not increasing risk of infecting others.
Decreasing fear is what is going to save this economy otherwise we are looking at another 2-3 years of economic paralysis.