Coronavirus and the Preferential Option for the ‘Certified Recovered’

In an attempt to create a path to reopen the economy, health officials are beginning to speak of “surveillance” and identifying and certifying people who have recovered from COVID-19 in order to exempt these individuals from restrictions on sheltering in place. This system would allow the United States to build a new labor force of the certified recovered—creating a dual labor force of those allowed to participate fully and those mandated to stay home.

It seems there is already a mechanism in place to allow that to happen. The U.S. Equal Employment Opportunity Commission recently reissued guidance suggesting that discrimination can be acceptable against those who have not developed immunity from the novel coronavirus.

In an April 6 STAT article touting the certification system for the recovered as having the potential to “speed economic recovery while slowing the virus,” authors Aaron Edlin, a health policy researcher, and Bryce Nesbitt, an entrepreneur, dismiss concerns about the preferential treatment given to those who have developed immunity.

“If immunity is important to safely perform a job, then giving preference to those who are certified as recovered is justified, particularly in our present emergency,” they write. “Getting more people working safely is paramount.”

Germany is already coordinating a study to investigate this question. Researchers at the Helmholtz Centre for Infection Research in Braunschweig are currently analyzing blood from more than 100,000 donors—testing for antibodies against the COVID-19 pathogen. The study is expected to provide an accurate picture of immunity and pandemic development because it will study whether there is an “unrecognized COVID-19 immunity in the population beyond the SARS-CoV-2 infections recorded.”

Gerard Krause, head of the Helmholtz Centre Department of Epidemiology, told Der Spiegel that “immune individuals could be issued with a kind of vaccination certificate, which would allow them to be exempted from restrictions on their activities.”

During an April 6 press conference, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, appeared to allude to such a system when he spoke of surveillance and extensive testing for antibodies. For STAT authors Edlin and Nesbitt, “certification could begin by drawing on existing tests and hospital records starting with individuals who already had both a positive test and matching symptoms. Now that fast antibody and viral tests have FDA approval, new testing will pick up speed. If certification piggybacks on such tests, the U.S. could create a substantial and vital new labor force of the certified recovered.”

Those who have obeyed the calls for sheltering in place would be less likely to be eligible to participate in that “vital new labor force” unless they have developed a natural immunity to the virus. The new labor force would be disproportionately younger. Ironically, those who participated in Mardi Gras celebrations in New Orleans, or Spring Break in Florida, or the Winter Party Festival in Miami would also be more likely to have been exposed to the virus and would be more likely to qualify for the new labor force.

While few in the media have mentioned it, large parties and celebrations with thousands of people attending continued well into March. Miami’s LGBTQ celebration, held at the height of the virus outbreak through March 10 when many were already beginning to shelter in place, is still claiming victims of the virus. Several Winter Festival attendees are now in the ICU and several have died. A headline last month in the Boston Globe read: “A Boston doctor and five friends went to Miami. All six came back sick.”

The reason that so many Winter Festival attendees, Mardi Gras revelers, and Spring Break partiers contracted the virus is due to the close physical contact over longer periods of time. Much like the young (and older) health care workers who are exposed to large amounts of the virus and appear to get very sick, participants in the large parties are exposed to a much greater dose—what health care researchers call the “viral load” or the viral burden.

An article in Lancet explains why “dose matters” with this virus. Small viral loads that do not overtax the body’s initial general immune response and that allow specific antibodies to be generated are almost exactly what attenuated live virus vaccines do. But, higher viral loads like those experienced by health care workers and Spring Breakers and Winter Festival attendees are associated with much more severe symptoms.

The good news is that those who have recovered can indeed jump-start the economy. Soon there will be millions of people who have recovered. The STAT authors suggest that New York, Washington, California, and other states with high caseloads should rush to set up credible, verifiable, and voluntary programs to identify individuals as certified recovered. And while that will bring a host of other problems, it is possible that it can begin to help the country recover.

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