The novel Coronavirus (COVID 19) has now infected more than 2 million people across the globe, a groundbreaking number reached in just a few months after the disease broke out in the Chinese city of Wuhan.

This pandemic caused unprecedented challenges impacting and aggravating all age groups and all social circles across continents. Many borders are at the moment closed, lockdowns have been implemented, health care systems are dangerously overwhelmed, while economies are draining, unemployment rate is increasing and major industries have been hit hard. The conundrum, describing the current situation, is the spread of a global pandemic triggering a world-wide economic recession, is forcing policy-makers to grapple with a trade-off between the economic growth and health.

Attempting to find a pathway out of this debacle, several states are considering the solution of ‘immunity testing’ to facilitate the way out of crisis. The aim of so-called ‘immunity certificates’ in Germany, ‘immunity passports in Britain or colour-coded QR code applications in China, is to indicate the individuals who have immunity to the virus, enabling a smooth transition into post-corona life.

Testing anti-bodies

One of the most agreed upon ways out of this health crisis, is for governments to increase the number of testing to be able to contain the virus and therefore to break the transmission chain, isolating new outbreaks emerging. This should also alleviate the burden on the healthcare systems preparing them for the huge influx of numbers due to projections that the coronavirus might continue to spread-with a slight slower pace- till 2021 or until a vaccine has been developed. Therefore, some states such as Kuwait prompted thinking about the coping mechanisms and measures to live under such conditions.

Consequently, according to Der Spiegel, the German weekly news magazine, researchers are aiming to conduct large-scale coronavirus-antibody tests over the coming weeks in mid-April.[i] Gerard Krause, an epidemiologist in Brunswick's Helmholtz Institute for Infectious Disease Research has stated: “You could give immune people something similar to a vaccination certificate that could allow them exceptions from limits on their activities.” [ii]   The aim of such tests is to show the number of people infected and hence who have developed anti-bodies against the virus and are immune. This could lead quarantined individuals to re-enter society and enabling a smooth yet proper transition into post-lockdown life.  While the German study has been given wide attention from international media outlets, the government has not officially provided its observation regarding the  study for such a certificate proposed by the researchers.

The idea of immunity certificate has also been suggested in the UK.  Health Secretary Matt Hancock suggested that Britons who have had the virus could be given an immunity passport  or wristbands.[iii] The Food and Drug Administration in the US has also approved Cellex Inc. of Research Triangle Park in North Carolina to be the first to measure antibodies to the SARS-CoV-2 virus that causes COVID-19.[iv] This reveals that the US is also considering immunity testing as a tool out of the lockdown.

Germany, UK and US were not the only states that aim to end the lockdown and transition back to normal life. China, for example, has also implemented a smart phone technology, run on the ubiquitous platforms Alipay and WeChat, which provide residents colour-coded designations, depending on their health status and travel history, and a QR code that can be scanned by authorities.

Individuals, who have been confirmed as symptomatic or asymptomatic Covid-19 patients, have a fever or are suspected to have contracted the virus are given a red code.  A yellow code is assigned to people with a close contact to individuals with a red code. The rest will get a green code and hence are able to travel freely, while still respecting the required measures such as wearing masks, gloves, washing hands etc.[v] Therefore, the aim for such system is to avoid the resurgence of the virus and to contain the spread.

Benefits of immunity testing

Der Spiegel has affirmed that the German government’s public health organization as well as a significant number of research groups and hospitals are conducting the above-mentioned mass study, which will include testing blood samples from 100,000 individuals for coronavirus antibodies.  The availability of antibodies in the blood -positive results of the test- indicates that the body is able to fight the virus and may show whether a subject was once a carrier  (given that the virus can be asymptomatic),  and hence is now immune. This would also mean that s/he is not infectious to others. The researchers plan to repeat test at regular intervals on an accumulatively bigger sample of the population, facilitiaing the tracking of the pandemic’s progress. The study, which is hoped to start soon, will also help to determine a more accurate mortality rate from the virus.

Immunity testing will eventually enable authorities to issue passes or certificates to individuals, who are immune and can go back to their work-force, excluding them from restrictive measures presently taking place. Therefore, through immunity testing could facilitate the following:

a)    Identification of frontline workers

To be able to resume some economy activity and gradually start to end the lockdown, the study aims to define ‘lists’ of the individuals, who can go back to their workforce, even at a lower rate initially, without risking the health and lives of the general public. In particular, such a policy would be beneficial for health workers, who are the most vulnerable to be infected. The immunity test could expedite the identification of crews, who have already been infected, to be allocated to areas of high risk, as stated by Health protection expert Paul Hunter. It will allow for the redistribution of personal protective equipment such as facial masks, which has been in short supply, to those who need it the most.

b)   Eliminating the possibility of a trade-off

 If immunity testing has been proven as a success in transitioning back to normal living conditions, states might achieve a sort of balance between health and economy, meaning without risking lives and simultaneously reopening the economy. 

Therefore, governments could start to ease the restrictive quarantine measures implemented, while regaining control over the economy.

For example, basic sectors such food and corps could resume economic activity.

Consequently, such a policy could give governments some mechanism and maneuvers that may enable them to get out of the unknown circle in which a world has fallen since the outbreak of the epidemic.

c)   Facilitating plasma (CP) transfusion treatment

Studies of numerous antiviral treatments and potential vaccines for the Coronavirus are already underway.  Currently, Chloroquine (malaria treatment) hydrochloroquine, Remdesivir and other viral analogues have been used, but one of the promising treatments showing successful results is the infusion of blood plasma. “Two teams of medics working at separate hospitals in China gave antibody-rich plasma to 15 severely ill patients and recorded striking improvements in many of them.” [vi]

Kuwait currently, has called for blood donations from those who recovered for plasma transfusion. Therefore, immunity certificates could facilitate such a treatment by identifying large numbers of recovered patients who were asymptomatic, and thus to obtain a greater amount of blood samples containing antibodies.

Potential challenges

Immunity certificates have received a wide media attention as such a policy may seem to facilitate the transition to post-lockdown life, however some experts have doubts about its feasibility, challenges and social outcomes.  There might be some hindrances to implement such a policy:

a)   Technical challenges

Because of the novelty of the virus, its genetics and the immunity against it are still unknown. According to Eleanor Riley, a professor of immunology and infectious disease at the University of Edinburgh: “it is not yet clear whether people who have recovered from coronavirus were immune from reinfection.” ^[vii] Moreover, in some countries, such as South Korea, some recovered coronavirus patients tested positive again. Dr. Maria Van Kerkhove, WHO’s lead scientist on Covid-19 affirmed that “a preliminary study of patients in Shanghai found that some patients had no detectable antibody response, while others had a very high response.” [viii]  Patients with SARS (another type of coronavirus) did not have long-term immunity, with potentially only up to a year after the infection.

b)   The creation of a "black market"

Relying on immunity testing to end the lockdowns could lead some to forge  the certificate, and the emergence of a black market for such a document. Especially with the length of restrictive measures, young people who believe that they are not vulnerable for infection, might resort to falsifications of such certificate. They can also try to deliberately get infected so they could return to work, which will eventually defeat the purpose of the social distancing measures.

c)   Fears of societal division and patient stigmatization

 There is also the fear of the emergence of social division, discrimination, and stigmatization of patients or groups that have not obtained immunity certificate to be able to end their isolation. Consequently, society would be divided into groups of people who are resuming their life and isolated groups. This may cause some social unrest, if this crisis lasted for a long time.

To conclude, due to the impact of the current health crisis on all states, governments are resorting to novel and innovative measures to start ending the lockdown caused by the pandemic. To be able to balance between economic growth and health protection, a policy of immunity certificates is being considered, establishing a new framework to be able to transition into ‘normal’ life conditions. Whether it will be effective is still in question, yet it might offer an apparatus to survive the pandemic circumstances.