President Donald Trump wants to start reopening the country for business. Health officials and state governors are skeptical but are still weighing the option of opening parts of the country, depending on how susceptible a region is to a public health and/or economic crisis.
One idea that has been gaining attention is testing people and giving "immunity cards" or "immunity passports" to those proven to have COVID-19 antibodies. What this means is that people who have already contracted the disease are presumed to be immune (at least for the time being). An ID card would allow them to leave their homes and tend to their families and jobs. This idea has already been raised in other countries, such as Germany, Italy, the United Kingdom and here in the U.S.
As the World Health Organization recently warned, there is still no empirical evidence that once a person contracts COVID-19, he or she is then actually immune and can walk around without fear of getting the virus again. However, all other respiratory viruses, including other coronaviruses, produce at least short-term immunity, making it likely that SARS-CoV-2 (which causes COVID-19) works the same way. This immunity mechanism is also how vaccines for all other viruses work. As such, no evidence of immunity is not the same as there being evidence of no immunity. But COVID-19 may be different.
Nevertheless, if immunity cards, or any other proposal to open up the economy, are to be successful and safe, we must ensure that the assumptions that we are making as a country are correct. Yet, there are logistical hurdles that we can overcome now as we verify our assumptions.
The drawbacks
Assuming that people who contracted COVID-19 are in fact immune for some time, the idea of immunity cards still has medical, moral and economic drawbacks, but it may be the best of the many bad alternatives available. The idea necessitates more widespread testing, something that has been a struggle to implement. We would also have to account for the possibility of false positives and false negatives, and what that would mean for spread of disease. There is still uncertainty about the extent to which antibodies confer immunity and what levels are necessary to be protected. This will hopefully become clear as research continues.
Immunity cards may also motivate people to contract COVID-19 in order to leave their homes. This could do the very opposite of "flattening the curve." However, people are already motivated to leave their houses, with or without contracting COVID-19, in order to find work or respite in sociality.
Access to testing and immunity cards might also increase socio-economic and racial disparity. Since people of lower socio-economic status are getting hit harder medically and economically by the disease, immunity cards may give this a governmental stamp of approval. Immunity cards may become the new ID cards that are used by enforcement agencies to keep "certain populations" off the street.
However, these potential detriments must be understood considering that this is only a short-term solution and in light of the alternatives. It will no longer be required once an effective vaccine is developed. Even for those who would not be able to get vaccinated, herd immunity will mitigate (though not eradicate) the risks to the vulnerable few. If the alternatives are simply staying at home indefinitely, letting people leave their homes in phases without identifying who is immune and who is vulnerable, or just "storming the Bastille," this idea would certainly be the best option.
Potential benefits
Despite concerns, there are potential benefits to implementing a plan to issue immunity cards. This system creates a way for the public to feel at ease when interacting with those who are immune. It will create a population that can hold the hands of the dying and care for loved ones who are ill without fear of making anyone worse. People can go to work in industries that are short on staff, go back to their prior jobs, or work in hospitals and other health settings, since they can fill gaps left by sick or quarantined hospital workers. If immunity cards were accepted globally, it may even allow for international travel, which is essential for the global economy.
Immunization cards also allow for mass enforcement, either on the national or local level. Whether the federal government or state and local governments adopt this idea, there is a way for police to identify those who can and those who shouldn't be out. In Canada and elsewhere, this is already happening in a different form: People who gather in crowds have their ID cards checked. If they are too far from their homes they receive tickets or fines. Immunity cards could work in a similar manner but would expand a person's liberty to be outside.
There will be detriments that would arise as a result of this system. We do not deny that. However, the detriments are not intrinsic to the idea; they are based on how it is implemented. These concerns will need to be mitigated, but the potential damage of other alternatives can cause even greater public health and economic damage.
