The Health 202: Immunity certificates could help people return to work. But huge questions remain.

with Paulina Firozi

Giving people who already had the novel coronavirus a certificate of immunity could be a way to get the United States back to normal. It would also land policymakers in uncharted and fraught waters. 

Authorities have hailed the arrival of antibody tests as a potential path to slowly restarting parts of the crippled economy in the not-too-distant future. But there’s been little discussion so far of some key questions about the idea of allowing people with immunity to the highly contagious disease back to work, including: Who would issue the certificates, and how would people get them? What would they allow people to do? And are there even reliable tests to measure whether someone is truly immune? 

“It looks like the train is getting ready to leave the station and nobody has checked to see what the track ahead is like,” Henry Greely, director of the Stanford Center for Law and the Biosciences, told me. 

Many more of these antibody tests will become available over the next week.

That’s according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who told CNN once testing is more widespread, “that’s possible” people might eventually carry some form of identification showing they’re immune from the virus.

“It’s one of those things that we talk about when we want to make sure that we know who the vulnerable people are and not,” Fauci said. “This is something that’s being discussed. I think it might actually have some merit, under certain circumstances.”

The Trump administration issued guidance over the weekend on how insurers must provide free antibody testing for patients, something required under the third economic rescue bill passed by Congress since the start of the pandemic.  

The idea (as we’ve written about here and here) is that by measuring blood for immune proteins — indicating someone’s body previously fought off a coronavirus infection and is therefore protected from future infections — at least some Americans could ease off from social distancing. It’s more than likely this will be a topic of discussion at the White House today, as Trump is scheduled to meet today with recovered covid-19 patients in the Cabinet Room later this morning. 

U.S. government officials would surely run up against enormous obstacles compared to other countries. 

Some are already adopting immunity passports. Chinese citizens in some places must display a colored code on their smartphone indicating their infection risk. In Germany, a group of researchers are planning to test around 100,000 people at a time for antibodies and give immunity certificates to those who test positive.

The goal is the same: restarting the economy without also endangering public health and risking a second large wave of coronavirus casualties. That’s easier said than done in a country far less centralized. There are 50 state governments and a patchworked, largely private health-care system. And the Trump administration has struggled to mount a coordinated response to the pandemic, regarded by many as teetering from one crisis moment to the next with little advance planning. 

Even leaders in Britain, which has a highly regarded national health-care program, have said their country isn’t ready for immunity certificates.

Peter Mills, assistant director at the United Kingdom’s Nuffield Council on Bioethics:

Officials are first faced with the question of whether there are even reliable antibody tests to use. 

The science could be the biggest obstacle of all. It’s far too early in the research on the virus to fully understand how the body reacts after an infection. 

Scientists don’t know how long the antibodies last after someone has had the disease — estimates are between a few months to a few years. Nor are they certain the antibodies protect against reinfection. A study by Chinese researchers found some recovered covid-19 patients had few or no antibodies.

It’s also likely that the protection the antibodies offer from covid-19 might decline over time. That’s what scientists studying SARS and MERS have found.

“Designing valid epidemiologic studies to figure all of this out is not easy,” Marc Lipsitch, a professor in the Departments of Epidemiology and Immunology and Infectious Diseases at Harvard, wrote in the New York Times.

And then there’s this: It’s easy to get a false negative on an antibody test if it’s conducted too soon after someone first contracted the virus. The body doesn’t start showing antibodies until 10 to 12 days after the first onset of symptoms.

“For serology, timing is everything,” said Elitza Theel, a serologic researcher at Mayo Clinic in Rochester, Minn. “If you collect the sample from the patient too soon, it will be negative.” 

There are also thorny logistical questions about how to issue certificates en masse. 

States could issue them. But that could lead to differing standards around which tests could be used and whether they’d be accepted across state borders. For example: Could a Virginia resident present an immunity certificate to go to their job in Maryland?

It seems clear that states would have varying standards of verification as well. Would people have to get tested at a particular lab to apply for a certificate? How recently?  

The privacy concerns would also need to be addressed. 

Would the certificates include information like what’s on a driver’s license: a photo, perhaps, or other identifying physical information? 

Having to show one’s certificate to gain admission to public spaces – potentially from work to the gym, sports games and conferences – would raise serious privacy questions. 

“The major privacy concern” comes from “other people, companies, employers etc. having access individuals’ personal information,” Mills wrote in a blog post.

Pushback to the idea of limiting people’s freedom of movement is already brewing on both the political right and left. 

From Rep. Justin Amash (I-Mich.):

From Alex Gladstein, chief strategy officer for the Human Rights Foundation:

Health experts are also raising serious questions of strategy. 

While antibody testing could allow a minority of people return to work, many others could be faced with the prospect of having to remain at home because they hadn’t yet been infected.

And being required to present proof of immunity in order to return to daily life would almost certainly incentivize healthy, younger people at lower risk of serious illness to try to contract the virus. It could also lead to an extensive black market, where people pay phony laboratories to produce fake tests they could use to get a certificate. 

This could have the opposite effect by worsening the pandemic. “The stakes are high,” Greely wrote in a recent op-ed published by Stat News. If a person who is not immune has an immunity certificate — because of error, fraud, or other reason — that person might contract the disease, with or without symptoms, and pass it on to others.

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Ahh, oof and ouch

AHH: Bernie Sanders has endorsed Joe Biden. 

The independent senator from Vermont announced his endorsement on a live stream with the former vice president about the nation’s coronavirus response, five days after ending his bid for the White House. 

“We have got to make Trump a one-term president, and we need you in the White House,” Sanders said. “I will do all that I can to see that that happens.”

Biden stressed similarities with Sanders – even on health-care, a major issue the two had argued over. 

“I think people are going to be surprised that we are apart on some issues, but we’re awfully close to on a whole bunch of others,” Biden told Sanders. “I’m going to need you not just to win the campaign but to govern.” 

Biden vowed to “make sure health care, and this is your signature issue, is made affordable and accessible to every American and build a public health system that can prevent future pandemics.” 

Days ahead of Sanders’s endorsement, Biden sought to appeal to the party’s left flank. 

He released a pair of proposals, including one to expand access to health care by lowering the eligibility age of Medicare coverage from 65 to 60. The proposals followed private conversations between the two teams, our Post colleague Sean Sullivan reports

“While they do not put Biden in line with Sanders on two pillars of the democratic socialist’s sweeping agenda, they represent concessions that bring the two sides closer together,” Sullivan adds, underlining that Biden has not edged much closer to the Medicare-for-all system Sanders has long championed. 

The former vice president did say his new health-care proposal was in part a response to the pandemic. “It reflects the reality that, even after the current crisis ends, older Americans are likely to find it difficult to secure jobs,” he wrote.

HuffPost’s Tara Golshan:

OOF: The White House denies Trump is considering firing Fauci. 

Trump retweeted a message over the weekend that included the hashtag #FireFauci, a move that prompted widespread alarm about his relationship with the nation’s top infectious-disease specialist, who has become one of the faces of the federal government’s coronavirus response, as our colleagues Katie Shepherd, John Wagner and Felicia Sonmez report. 

During yesterday’s coronavirus briefing, Trump sought to tamp down speculation. “Today I walk in and I hear I’m going to fire him,” Trump said. “I’m not firing. I think he’s a wonderful guy.”

White House spokesman Hogan Gidley said in a statement, “This media chatter is ridiculous — President Trump is not firing Dr. Fauci. … Dr. Fauci has been and remains a trusted advisor to President Trump.”

“Trump said Monday that the retweet was just ‘somebody’s opinion’ and ‘a person’s view’ that did not align with his own,” our colleagues Toluse Olorunnipa, Seung Min Kim and Josh Dawsey report. “ … But the retweet set off a rush to defend Fauci that included Republican and Democratic lawmakers, while also unleashing a fresh round of attacks by some of Trump’s most ardent backers on social media.” 

OUCH: Governors are coordinating reopening plans.

New York Gov. Andrew M. Cuomo (D) announced he and the governors of New Jersey, Connecticut, Pennsylvania, Rhode Island and Delaware discussed a cooperative plan to reopen the region’s economy. He later said Massachusetts would join the coalition. 

The Northeastern governors did not indicate a specific date for reopening, though Cuomo said the timetable was “weeks.”

“The seven states together have recorded over 325,000 confirmed virus cases, more than half of the U.S. total, and nearly 14,400 deaths, around 63 percent of the country’s total,” the New York Times reports. “The governors, speaking on a conference call, emphasized the importance of acting in concert so that the actions of one state did not inadvertently hurt another, or cause the outbreak to flare again.”

The governors of California, Oregon and Washington announced a similar pact. “Health outcomes and science — not politics — will guide these decisions,” reads an announcement from California Gov. Gavin Newsom’s (D) office. “Modifications to our states’ stay at home orders must be made based off our understanding of the total health impacts of COVID-19.” 

Ohio Gov. Mike DeWine (R) said the country is “not going to be coming back like some people think.” 

He thinks it won’t happen until there’s a vaccine. “We’re really not going to be all the way back until we have a vaccine that is available to everyone in the state and we know — we’re told at least — that is going to be in 12 to 18 months,” DeWine told our colleague Robert Costa.

White House coronavirus response

Yet Trump insists it’s actually his call whether to reopen the nation. 

Experts say the president has less authority than he claims. The national guidelines are voluntary, and he cannot override state and local orders. 

The president cannot command governors to “ease restrictions they imposed because of the virus outbreak. The Constitution largely gives states the authority to regulate their own affairs,” the Associated Press’s Mark Sherman reports. 

Governors on both sides of the aisle have acknowledged both the economic and health considerations to weigh in the reopening of the country. But state leaders have largely said health issues and the availability of widespread rapid coronavirus testing will drive any determination. 

The president is facing mounting pressure from some conservative activists to restart the economy, warning about the negative consequences of a sustained economic downturn and arguing there are safe ways to reopen the nation, as our colleagues Jeff Stein and Robert Costa report.

Trump floated a May 1 reopen date, but administration officials caution that may be unrealistic. 

The date is 17 days away. Food and Drug Administration Commissioner Stephen Hahn called it “a target” but said it was “too early for us to say whether May 1 is that date.” Fauci argued for a “rolling reentry” of normal life depending on the state of the pandemic in different U.S. regions, rather than a sudden reopening nationwide. 

“The transition could ‘probably start, at least in some ways, maybe next month,’  Fauci said. But he noted that there is also a possibility that the virus will make a resurgence later in the year,” Felicia, Taylor Telford and Elise Viebeck report.

Coronavirus around the globe

A reopening effort is unfolding in China. 

Businesses in China have long followed a five-step plan called a “hierarchy of controls” that’s aimed a reducing workplace risks, and companies are implementing that hierarchy for restarting production now. But the process has been expensive and slow, our colleague Eva Dou reports.

“That’s because many of the standard tools for workplace safety are ineffective against a risk like the novel coronavirus,” she writes. “Distributing masks and nagging employees to wash their hands count among the more uncertain methods for ensuring employee safety, experts say. But these are largely the methods that Chinese companies have been relying on as they have restarted production — and American businesses may not have many better options.” 

Trump could soon announce restrictions on WHO funding.

The announcement to halt U.S. funding, which could come this week, is a response to the World Health Organization’s handling of the coronavirus pandemic and comes as Trump’s administration and conservative allies ramp up criticism of the U.N. agency, our colleague Anne Gearan reports. 

“Secretary of State Mike Pompeo and other U.S. officials are expected to recommend to Trump ways to dock or condition payments to the agency as Republicans in Congress seek documentation of WHO dealings with China,” she writes. “Republicans in Congress are seeking documents from the WHO and calling for investigations of contacts between WHO officials and Chinese government officials. The White House backs those efforts but could hold up funding before results are in.” 

A senior administration official told The Post, “The money is not guaranteed if WHO does not do its mission.” 

Congress on coronavirus

Sen. Elizabeth Warren wants extra protections for front-line workers. 

Warren (D-Mass.) and Rep. Ro Khanna (D-Calif.) unveiled a workers’ “bill of rights” that’s meant to provide job security, higher wages and universal paid sick leave for all essential workers, including medical, grocery, janitorial and child-care workers, and independent contractors and gig workers. 

“Essential workers are the backbone of our response to the coronavirus,” Warren told our colleague Abha Bhattarai. “They are putting their health and the health of their loved ones on the line to keep our country running — and we need to have their backs.”

Many of these workers say they’re working longer hours but don’t even have the adequate supplies to keep themselves safe. 

“The proposed guidelines would require companies to provide workers with adequate protective gear and notify employees who may have been exposed to an infected colleague,” Abha reports. “They also seek protections for whistleblowers who speak out about unsafe working conditions, extra funding for child-care centers and free health care for essential workers, many of whom earn little more than the minimum wage.” 

The congressional stalemate over another coronavirus relief package deepens. 

The Trump administration is pushing for additional funding for small businesses, but House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) said they won’t agree unless they get more funding for hospitals, state and local governments and food stamp recipients.

But Mnuchin said hospitals and states “haven’t come close to using that money.” He said small businesses need more money immediately, while the demands from Democrats can wait. 

“The developments appeared to harden a stalemate on Capitol Hill over how or when the federal government will take further action to address the worsening economic impacts of the coronavirus, with millions newly unemployed and much commerce in the nation at a virtual standstill as the U.S. confronts recession conditions,” our colleague Erica Werner reports. 

Coronavirus latest

Other headlines and developments to catch up on this morning: 

Know the victims: 

  • This is what we’ve learned about the who the first U.S. victims were, an important effort from our colleagues Abigail Hauslohner, Reis Thebault and Jacqueline Dupree.

By the numbers: 

  • More than 1 in 100 residents in New York state have tested positive for the disease, more than in hard-hit nations like Spain, where the figure is only a third of a percent by comparison, our colleagues Chris Mooney and Ben Guarino report.

Good to know: 

  • Cuomo indicated for the first time he believes the “worst can be over, and it is over, unless we do something reckless,” the New York Times reports.

The administration’s response: 

  • The Centers for Medicare and Medicaid Services is set to push nursing homes across the country to share more information with residents, family and staff about coronavirus cases, the Wall Street Journal’s Anna Wilde Mathews and Jon Kamp report.
  • Former FDA chief Scott Gottlieb is advising lawmakers, governors and Trump administration officials on plans to beat back the pandemic, our colleagues Laurie McGinley, Josh Dawsey and Yasmeen Abutaleb report.

In the states: 

  • South Dakota is now one of the nation’s coronavirus hot spots, after Gov. Kristi L. Noem (R) argued it was up to individuals to “exercise their right to work, to worship and to play. Or to even stay at home,” as The Post’s Griff Witte reports.

On the front lines

  • Some local officials in Canada are calling for restrictions to limit the number of Canadian medical personnel working across the border in the United States, our colleague Amanda Coletta reports.

Sugar rush

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