IMMUNITY CERTIFICATE offer enticing promise that more people can stop sheltering in place and instead help the world revive- could play important role in the period before we have excellent treatments or effective vaccine. But many caveats : #COVID19 https://www.statnews.com/2020/04/10/immunity-certificates-covid-19-practical-ethical-conundrums/

2) German researchers have proposed testing 100,000 people for antibodies to SARS-CoV-2, the virus that causes #Covid19, and giving “immunity certificates” to those who have these antibodies, which presumably make them resistant to reinfection.

3) The UK has floated the idea of “Covid passports,” Italy is discussing the idea, and it is being raised in the U.S. as well. But raise issues about the science of #Covid19 immunity, about how such certificates would be provided and policed and, split between free/confined.

4) No one knows whether infection confers immunity to reinfection and, if it does, how strong that immunity is and for how long it lasts. Not only is that information missing, but we cannot get it soon — it will be 9 months before we can know if antibodies last a year. #COVID19

5) Some other coronaviruses, eg many common colds, produce antibodies and immunity for only a few months. One questioned study found that some patients who recovered from #Covid19 had few or no antibodies. some individuals who recovered have become re-infected/reactivated.

6) The current best guess is that SARS-CoV-2 infection provides some immunity, probably between the few months of some cold-causing coronaviruses and the several years for SARS. Assuming that’s true, how should we determine whether someone has immunity to #Covid19?

7) The best way would be to test people directly for SARS-CoV-2 antibodies. (This isn’t the same as testing for infection, which looks for the genetic material of the virus.) But no test is perfect.

8) Some detect antibodies that do not exist (false positives), others miss antibodies (false negatives). False positives may be a particular problem here, as a test might signal positive for SARS-CoV-2 antibodies when it is really detecting antibodies to common cold coronaviruses

9) Verifying applicants’ claims and identities is another issue. If immunity certificates provide benefits, people will want them. They may be willing to provide test results from phony labs (imagine an entire underground industry springing up to meet this demand) or might lie.

10) Some people would use another’s immunity certificate, unless it had a driver’s license-like photograph and ID or required thumbprints, retinal scans, or other identity verification, raising new privacy issues. black market in forged immunity certificates would likely arise.

11) The stakes are high. 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. Those are the easy issues. Here are the harder ones...

12) If we had sufficiently accurate immunity certificates, how should we use them? Employers or governments might require that only people with immunity certificates be allowed to work in jobs involving human contact, like health care, food, service, retail, transport...

13) Restaurants, bars, sporting events, concerts, etc might admit only those with immunity certificates. Travel by public transportation or the privilege to attend classes in person might be limited to individuals with immunity certificates. But should they be so restricted?

14) certificates have appeal — unless you are one of the many who end up locked out of the world due to no fault of your own. For you, it is discrimination: some people can work, play, or travel while you cannot. The legal issues aren’t clear. ADA and EEO legal issues abound.

15) Other federal and state statutory and constitutional rights might also be invoked, such as the Federal Rehabilitation Act, state statutes, and federal and state due process, equal protection, and possibly right to travel guarantees.

16) Immunity certificates may turn out to be an impt part of the #Covid19 pandemic. But, as with everything in human affairs, they are complicated. And getting them wrong could do more harm than good. We need to think carefully about them. (Thx to @HankGreelyLSJU for great oped)