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Why immunity passports are a bad idea

61 points by bcaulfield 6y ago

zimpenfish 6y ago
Title is currently "Ten reasons why immunity passports are a bad idea"
- dang 6y ago
  Fixed now.
oxfordmale 6y ago
It will also result in illegal Corona rave parties, with the young, that are at very low risk, preferring to contract it and get on with their lifes.
- JulianMorrison 6y ago
  Except that they'll contract it, spread it to their family, some of them will actually die of it, and a lot more will suffer long term side effects that may be subtle but still dangerous. For example, this disease seems to cause blood clots. You could be fully recovered and drop dead half a year later from a clot breaking loose and getting lodged in your heart.
  - SpicyLemonZest 6y ago
    Even if it's as risky as you're implying, which I'm not sure it is, I think a lot of people would do it anyway. Drunk driving is surely a stupider risk, but it happens all the time.
    - HarryHirsch 6y ago
      Drunk driving is surely a stupider risk, but it happens all the time 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.
      - godelski 6y ago
        There's plenty of evidence that draconian laws aren't effective. So I'm not sure that a 5-10 year sentence would stop people from drunk driving. Plus, I'm pretty sure the corrections lobby has more power than the restaurant lobbies.
  - gruez 6y ago
    >For example, this disease seems to cause blood clots. You could be fully recovered and drop dead half a year later from a clot breaking loose and getting lodged in your heart. Isn't blood clots a side effect from lying in hospital beds all day, rather than the disease itself?
    - HarryHirsch 6y ago
      No. Coronaplague-related coagulopathies are well-documented.
    - JulianMorrison 6y ago
      It seems to be an endothelial disease. And it causes blood to clot in small vessels all over the body. This may be a mechanism by which is damages the lungs (as well as broken off clots lodging there).
  - Slartie 6y ago
    > spread it to their family 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.
    - JulianMorrison 6y ago
      They'd have to quarantine from the moment of potential infection too, because of asymptomatic spread.
      - Slartie 6y ago
        When talking about deliberate self-infection, I assumed that there was no "possible" infection. If someone self-infects in an organized fashion, he knows exactly with nearly 100% certainty the point in time at which he became infected, because that would be when he exposed himself to the virus deliberately in a way that practically guarantees a successful infection.
  - godelski 6y ago
    I'm not sure what you mean. You act like you can just go through life and never contract covid. Even if somehow we get a vaccine in a year (which would be a technological marvel) it looks like most people will get it. So why not get it in a controlled environment where you can minimize contact and spread while gaining immunity (which is what we want young and healthy to do so that we can build herd immunity)? 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.
    - HarryHirsch 6y ago
      The Chinese, the South Koreans and the New Zealanders managed to eradicate coronaplague through good old epidemiological detective work. It's looking good in the European countries, too, number of new infections declining. Why isn't this discussed in the context of the US? (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.)
      - SpicyLemonZest 6y ago
        The Chinese and the South Koreans did not eradicate it and do not expect they'll be able to. 100 million people are under lockdown orders in China right now.
        HarryHirsch 6y ago
        The number of new infections in South Korea is low, and I fully expect the Koreans to squash any new clusters that may appear. It helps that the population is onboard with the public health measures; when they had that cluster that originated in a nightspot they promptly shut down nightspots again, and that didn't trigger protests. 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.
    - 6y ago
- rglullis 6y ago
  As long as it was completely voluntary and that there was a very strict 3-week quarantine after, I really wish this was an option. A quick search tells me the US has about 5 million hotel rooms. Take all these hotels that are closed/empty and use them as Variolation centers. Let people come out only after they tested negative for the presence of the virus and positive for the antibody. Split the $1200.00 between the person and the hotel owner, get costs of health insurance also covered by patient and hotel owners. 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)
  - AmericanChopper 6y ago
    Creating the incentive is still a problem though. If a certain percentage of those people require hospitalization, then you have a limited capacity for how many people can voluntarily infect themselves. The best case scenario would be that infections are successfully rationed, and you end up with a government imposed class system of immune/not-immune. The more likely scenario is that you can’t effectively control voluntary infection, and create the serious risk of running out of hospital beds. And that’s really just the logistical challenge, putting aside a number of other ethical concerns, which include the government saying “in order to regain your liberty, you must infect yourself with a deadly virus”.
    - remote_phone 6y ago
      35% are completely asymptomatic, 45% have mild symptoms, 15% need hospitalization and 2-3% die, mostly old people. 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.
- LatteLazy 6y ago
  This is the main actual reason.
- Uehreka 6y ago
  Between the fact that a nontrivial number of 20-30 year olds have died, and the serious but poorly understood post-Corona symptoms which may be chronic or lifelong (blood clots, paralysis, lung tissue scarring/reduced lung capacity, Corona Toe, etc) I don’t think any 20-something who’s been reading the news is going to be too keen on the idea of “just getting it over with”. 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.
  - SpicyLemonZest 6y ago
    I mean, it depends on how many things are locked behind immunity passports. If it's just a convenience that exempts you from international travel quarantines, sure, that doesn't really change the calculus. If bars reopen in July for immune people and 2022 for everyone else... I think there are a lot of young party animals who legitimately like clubbing enough that they'd consider it worth the risk.
  - ramraj07 6y ago
    Not sure if you've been to a college town in recent years. I doubt more than 10% of the American student population is that forward thinking.
- DeonPenny 6y ago
  That's going to happen anyone way. There are parties happening at least in the states. I don't know if its a good idea to prevent people from living their lives in this way.
avancemos 6y ago
“There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection”(see go.nature.com/3cutjqz). As of 3 days ago there is: https://science.sciencemag.org/content/early/2020/05/19/science.abc4776?fbclid=IwAR0crCPeMEZ1Zwzsq8BuONaajH_EOSG4hPNl5OHaMVJi8cqJVvhqR1rAB94 https://science.sciencemag.org/content/early/2020/05/19/scie...
- jedberg 6y ago
  In monkeys. That may or may not apply to humans. 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.
  - elbasti 6y ago
    Reminds me of the joke "if you're a mouse and you still have Alzheimer's, you need to get a new agent"
    - wolfhumble 6y ago
      The twitter account: https://twitter.com/justsaysinmice https://twitter.com/justsaysinmice might (?) agree with you! ;-)
- StanislavPetrov 6y ago
  Nor is there currently evidence that people who recovered from COVID-19 and have antibodies aren't immune.
  - pbhjpbhj 6y ago
    I've read a few reports indicating reinfection, so I'm not sure that's true. There seems to be evidence, it needs collating, assessing, and interpreting by experts.
    - 6y ago
dvt 6y ago
> Strategies that focus on the individual — using conceptions of ethics rooted in libertarianism — contradict the mission of public health. 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.
- ceejayoz 6y ago
  > 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). 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.
  - hutzlibu 6y ago
    But that does not explain the same effect in sweden, where also the people of color were much more affected. And sweden is very homogenized, compared to US.
    - SiempreViernes 6y ago
      > And sweden is very homogenized [Citation needed]
      - hutzlibu 6y ago
        "The Income inequality in Sweden ranks low in the Gini coefficient, being 25.2 as of 2015 which is one of the lowest in the world" https://en.wikipedia.org/wiki/Income_inequality_in_Sweden https://en.wikipedia.org/wiki/Income_inequality_in_Sweden
naringas 6y ago
but, alas, they are a great idea if you are sufficiently scared...
m3kw9 6y ago
Is bad because of the incentives to cheat to get one, fake one, could create false sense of security when Covid mutate, and dangerous behaviour seeking to get infected to chance immunity because of advantages offered of having one
jedberg 6y ago
On the one hand I agree with the gist of this article -- that those with less privilege will be worse off because it will be harder for them to get the certificate. 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.
- SiempreViernes 6y ago
  """ If universal, timely, free access to a vaccination becomes possible, then it could be ethically permissible to require vaccine certification for participation in certain activities. But if access to a vaccine is limited in any way, then some of the inequities we highlight could still apply, as the literature on uptake of other vaccines attests """
stared 6y ago
> Strategies that focus on the individual — using conceptions of ethics rooted in libertarianism — contradict the mission of public health. 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).
- SiempreViernes 6y ago
  Uh, how is a personal document something that focus on the overall population? Population level solutions of this type would universally grant rights to (at least) entire blocks of a city.
  - SpicyLemonZest 6y ago
    Maybe there's some confusion in terms about what "focus on the overall population" means, but a mandatory license to go about your business is surely not libertarian as the article suggests.
  - stared 6y ago
    Not infecting the population? 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.
jariel 6y ago
I'm resigned to the fact that our leaders are fools, living in intellectual bubble candy-lands, totally unaware of human nature. 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.
- paganel 6y ago
  I personally find it highly immoral to remove the rights of some people only for not having had a disease, this is very, very close to eugenics in my book.
  - jariel 6y ago
    "This is very, very close to eugenics in my book." 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.
JumpCrisscross 6y ago
Whether antibody tests are made official or not, their results will begin being requested before their efficacy has been proven. I’ve already started seeing it in New York, if only as a polite request. 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.
trhway 6y ago
so, immunity passports are bad while vaccination certificates are good? What is the difference?
- SpicyLemonZest 6y ago
  Vaccination certificates can be easily obtained through a quick, safe, procedure, and are waived in the rare cases where the procedure wouldn't be safe.
remote_phone 6y ago
Immunity Passports are a great idea because it decreases fear. This is assuming that people aren’t forging these certificates. But if I know that the delivery person is verifiably immune and won’t transmit the disease, or if the cook at a restaurant and the servers are immune, I’m more likely to go there. I would even pay extra. Decreasing fear is what is going to save this economy otherwise we are looking at another 2-3 years of economic paralysis.
- deegles 6y ago
  What happens when workplaces start demanding immunity in order to come back to work? Does that not punish those who keep themselves safe?
  - remote_phone 6y ago
    I think they would rather give immunity bonuses to those with passports and pass that to customers. I’m okay paying more for people that I know are immune.
  - smnrchrds 6y ago
    This is my biggest fear. That the government support for people rendered jobless or furloughed due to covid would end, businesses would start reopening, but they require immunity passports. This would cause many people, especially those in poverty, to purposefully contract corona so they can get a job.
Animats 6y ago
That article makes a good argument for immunity passports. - 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.
- buboard 6y ago
  > right now, yes; over time, no. 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
  - Animats 6y ago
    the rate of infection (and immunity development) is going down everywhere. 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&areasRegional=usny&areasRegional=usnj&cumulative=0&logScale=0&perMillion=1&values=cases https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&are...
    - buboard 6y ago
      the graph shows new cases are down from the peak and decreasing. this means immunity development is going to be a lot slower than it has been until now
- 6y ago
buboard 6y ago
is any country actually issuing those "passports"? afaik none of the countries that opened up do that 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
- SpicyLemonZest 6y ago
  A lot of countries have publicly floated the idea, but as far as I know none have ended up implementing it.
darawk 6y ago
These arguments are uniformly terrible. Let's go over them point by point. > 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.
brownbat 6y ago
I'm surprised those who have survived covid haven't found a way to self-identify, like green wristbands or something that say "immune" or "survivor," and wear those in place of masks. 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.
- Slartie 6y ago
  What would that change? 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".
davisskola200 6y ago
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61 points by bcaulfield 6y ago

zimpenfish 6y ago

Title is currently "Ten reasons why immunity passports are a bad idea"

dang 6y ago
Fixed now.

oxfordmale 6y ago

It will also result in illegal Corona rave parties, with the young, that are at very low risk, preferring to contract it and get on with their lifes.

JulianMorrison 6y ago
Except that they'll contract it, spread it to their family, some of them will actually die of it, and a lot more will suffer long term side effects that may be subtle but still dangerous. For example, this disease seems to cause blood clots. You could be fully recovered and drop dead half a year later from a clot breaking loose and getting lodged in your heart.
- SpicyLemonZest 6y ago
  Even if it's as risky as you're implying, which I'm not sure it is, I think a lot of people would do it anyway. Drunk driving is surely a stupider risk, but it happens all the time.
  - HarryHirsch 6y ago
    Drunk driving is surely a stupider risk, but it happens all the time 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.
    - godelski 6y ago
      There's plenty of evidence that draconian laws aren't effective. So I'm not sure that a 5-10 year sentence would stop people from drunk driving. Plus, I'm pretty sure the corrections lobby has more power than the restaurant lobbies.
- gruez 6y ago
  >For example, this disease seems to cause blood clots. You could be fully recovered and drop dead half a year later from a clot breaking loose and getting lodged in your heart. Isn't blood clots a side effect from lying in hospital beds all day, rather than the disease itself?
  - HarryHirsch 6y ago
    No. Coronaplague-related coagulopathies are well-documented.
  - JulianMorrison 6y ago
    It seems to be an endothelial disease. And it causes blood to clot in small vessels all over the body. This may be a mechanism by which is damages the lungs (as well as broken off clots lodging there).
- Slartie 6y ago
  > spread it to their family 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.
  - JulianMorrison 6y ago
    They'd have to quarantine from the moment of potential infection too, because of asymptomatic spread.
    - Slartie 6y ago
      When talking about deliberate self-infection, I assumed that there was no "possible" infection. If someone self-infects in an organized fashion, he knows exactly with nearly 100% certainty the point in time at which he became infected, because that would be when he exposed himself to the virus deliberately in a way that practically guarantees a successful infection.
- godelski 6y ago
  I'm not sure what you mean. You act like you can just go through life and never contract covid. Even if somehow we get a vaccine in a year (which would be a technological marvel) it looks like most people will get it. So why not get it in a controlled environment where you can minimize contact and spread while gaining immunity (which is what we want young and healthy to do so that we can build herd immunity)? 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.
  - HarryHirsch 6y ago
    The Chinese, the South Koreans and the New Zealanders managed to eradicate coronaplague through good old epidemiological detective work. It's looking good in the European countries, too, number of new infections declining. Why isn't this discussed in the context of the US? (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.)
    - SpicyLemonZest 6y ago
      The Chinese and the South Koreans did not eradicate it and do not expect they'll be able to. 100 million people are under lockdown orders in China right now.
      - HarryHirsch 6y ago
        The number of new infections in South Korea is low, and I fully expect the Koreans to squash any new clusters that may appear. It helps that the population is onboard with the public health measures; when they had that cluster that originated in a nightspot they promptly shut down nightspots again, and that didn't trigger protests. 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.
  - 6y ago
rglullis 6y ago
As long as it was completely voluntary and that there was a very strict 3-week quarantine after, I really wish this was an option. A quick search tells me the US has about 5 million hotel rooms. Take all these hotels that are closed/empty and use them as Variolation centers. Let people come out only after they tested negative for the presence of the virus and positive for the antibody. Split the $1200.00 between the person and the hotel owner, get costs of health insurance also covered by patient and hotel owners. 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)
- AmericanChopper 6y ago
  Creating the incentive is still a problem though. If a certain percentage of those people require hospitalization, then you have a limited capacity for how many people can voluntarily infect themselves. The best case scenario would be that infections are successfully rationed, and you end up with a government imposed class system of immune/not-immune. The more likely scenario is that you can’t effectively control voluntary infection, and create the serious risk of running out of hospital beds. And that’s really just the logistical challenge, putting aside a number of other ethical concerns, which include the government saying “in order to regain your liberty, you must infect yourself with a deadly virus”.
  - remote_phone 6y ago
    35% are completely asymptomatic, 45% have mild symptoms, 15% need hospitalization and 2-3% die, mostly old people. 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.
LatteLazy 6y ago
This is the main actual reason.
Uehreka 6y ago
Between the fact that a nontrivial number of 20-30 year olds have died, and the serious but poorly understood post-Corona symptoms which may be chronic or lifelong (blood clots, paralysis, lung tissue scarring/reduced lung capacity, Corona Toe, etc) I don’t think any 20-something who’s been reading the news is going to be too keen on the idea of “just getting it over with”. 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.
- SpicyLemonZest 6y ago
  I mean, it depends on how many things are locked behind immunity passports. If it's just a convenience that exempts you from international travel quarantines, sure, that doesn't really change the calculus. If bars reopen in July for immune people and 2022 for everyone else... I think there are a lot of young party animals who legitimately like clubbing enough that they'd consider it worth the risk.
- ramraj07 6y ago
  Not sure if you've been to a college town in recent years. I doubt more than 10% of the American student population is that forward thinking.
DeonPenny 6y ago
That's going to happen anyone way. There are parties happening at least in the states. I don't know if its a good idea to prevent people from living their lives in this way.

avancemos 6y ago

“There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection”(see go.nature.com/3cutjqz). As of 3 days ago there is: https://science.sciencemag.org/content/early/2020/05/19/science.abc4776?fbclid=IwAR0crCPeMEZ1Zwzsq8BuONaajH_EOSG4hPNl5OHaMVJi8cqJVvhqR1rAB94 https://science.sciencemag.org/content/early/2020/05/19/scie...

jedberg 6y ago
In monkeys. That may or may not apply to humans. 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.
- elbasti 6y ago
  Reminds me of the joke "if you're a mouse and you still have Alzheimer's, you need to get a new agent"
  - wolfhumble 6y ago
    The twitter account: https://twitter.com/justsaysinmice https://twitter.com/justsaysinmice might (?) agree with you! ;-)
StanislavPetrov 6y ago
Nor is there currently evidence that people who recovered from COVID-19 and have antibodies aren't immune.
- pbhjpbhj 6y ago
  I've read a few reports indicating reinfection, so I'm not sure that's true. There seems to be evidence, it needs collating, assessing, and interpreting by experts.
  - 6y ago

dvt 6y ago

> Strategies that focus on the individual — using conceptions of ethics rooted in libertarianism — contradict the mission of public health. 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.

ceejayoz 6y ago
> 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). 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.
- hutzlibu 6y ago
  But that does not explain the same effect in sweden, where also the people of color were much more affected. And sweden is very homogenized, compared to US.
  - SiempreViernes 6y ago
    > And sweden is very homogenized [Citation needed]
    - hutzlibu 6y ago
      "The Income inequality in Sweden ranks low in the Gini coefficient, being 25.2 as of 2015 which is one of the lowest in the world" https://en.wikipedia.org/wiki/Income_inequality_in_Sweden https://en.wikipedia.org/wiki/Income_inequality_in_Sweden

naringas 6y ago

but, alas, they are a great idea if you are sufficiently scared...

m3kw9 6y ago

Is bad because of the incentives to cheat to get one, fake one, could create false sense of security when Covid mutate, and dangerous behaviour seeking to get infected to chance immunity because of advantages offered of having one

jedberg 6y ago

On the one hand I agree with the gist of this article -- that those with less privilege will be worse off because it will be harder for them to get the certificate. 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.

SiempreViernes 6y ago
""" If universal, timely, free access to a vaccination becomes possible, then it could be ethically permissible to require vaccine certification for participation in certain activities. But if access to a vaccine is limited in any way, then some of the inequities we highlight could still apply, as the literature on uptake of other vaccines attests """

stared 6y ago

> Strategies that focus on the individual — using conceptions of ethics rooted in libertarianism — contradict the mission of public health. 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).

SiempreViernes 6y ago
Uh, how is a personal document something that focus on the overall population? Population level solutions of this type would universally grant rights to (at least) entire blocks of a city.
- SpicyLemonZest 6y ago
  Maybe there's some confusion in terms about what "focus on the overall population" means, but a mandatory license to go about your business is surely not libertarian as the article suggests.
- stared 6y ago
  Not infecting the population? 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.

jariel 6y ago

I'm resigned to the fact that our leaders are fools, living in intellectual bubble candy-lands, totally unaware of human nature. 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.

paganel 6y ago
I personally find it highly immoral to remove the rights of some people only for not having had a disease, this is very, very close to eugenics in my book.
- jariel 6y ago
  "This is very, very close to eugenics in my book." 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.

JumpCrisscross 6y ago

Whether antibody tests are made official or not, their results will begin being requested before their efficacy has been proven. I’ve already started seeing it in New York, if only as a polite request. 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.

trhway 6y ago

so, immunity passports are bad while vaccination certificates are good? What is the difference?

SpicyLemonZest 6y ago
Vaccination certificates can be easily obtained through a quick, safe, procedure, and are waived in the rare cases where the procedure wouldn't be safe.

remote_phone 6y ago

Immunity Passports are a great idea because it decreases fear. This is assuming that people aren’t forging these certificates. But if I know that the delivery person is verifiably immune and won’t transmit the disease, or if the cook at a restaurant and the servers are immune, I’m more likely to go there. I would even pay extra. Decreasing fear is what is going to save this economy otherwise we are looking at another 2-3 years of economic paralysis.

deegles 6y ago
What happens when workplaces start demanding immunity in order to come back to work? Does that not punish those who keep themselves safe?
- remote_phone 6y ago
  I think they would rather give immunity bonuses to those with passports and pass that to customers. I’m okay paying more for people that I know are immune.
- smnrchrds 6y ago
  This is my biggest fear. That the government support for people rendered jobless or furloughed due to covid would end, businesses would start reopening, but they require immunity passports. This would cause many people, especially those in poverty, to purposefully contract corona so they can get a job.

Animats 6y ago

That article makes a good argument for immunity passports. - 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.

buboard 6y ago
> right now, yes; over time, no. 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
- Animats 6y ago
  the rate of infection (and immunity development) is going down everywhere. 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&areasRegional=usny&areasRegional=usnj&cumulative=0&logScale=0&perMillion=1&values=cases https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&are...
  - buboard 6y ago
    the graph shows new cases are down from the peak and decreasing. this means immunity development is going to be a lot slower than it has been until now
6y ago

buboard 6y ago

is any country actually issuing those "passports"? afaik none of the countries that opened up do that 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

SpicyLemonZest 6y ago
A lot of countries have publicly floated the idea, but as far as I know none have ended up implementing it.

darawk 6y ago

These arguments are uniformly terrible. Let's go over them point by point. > 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.

brownbat 6y ago

I'm surprised those who have survived covid haven't found a way to self-identify, like green wristbands or something that say "immune" or "survivor," and wear those in place of masks. 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.

Slartie 6y ago
What would that change? 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".

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