In the first phase of the covid-19 pandemic, most countries tried to starve the disease of the oxygen it needed to spread by implementing lockdowns and aggressively tracking down everyone who an infected person might have come in contact with, to limit its further spread. While that strategy seems to have worked in some countries like New Zealand, it hasn’t been effective everywhere.
Most countries that haven’t been able to halt the disease in its tracks have to resign themselves to the fact that they are in the “community spread” phase of the disease. The only options available to them are to achieve herd immunity or develop a viable vaccine. In the short term, this means that we will have to learn to live with the disease—recognising that as we ease the lockdown and restart the economy, there will be asymptomatic people among us, potentially infecting those that they come in contact with. Even if it is no longer an option to keep people locked up in their homes, it remains incumbent upon us to find an effective way to identify those who are infected so that they can isolate themselves at home till they are no longer a threat to people around them.
App-based contact-tracing is one way of doing this. These mobile phone-based technologies use bluetooth to algorithmically assess the likelihood that the primary and secondary contacts of someone who is confirmed positive have been infected so that they can be appropriately warned to either isolate themselves at home or get tested for covid. But even the best contact-tracing app is no substitute for actual virological testing. In this next phase of the epidemic, it is this sort of testing that will assume crucial importance.
In a recent article, Paul Romer suggested that as nations come out of lockdown, they should be adopting an “identify and isolate” strategy. To do this, they need to dramatically increase the volume of their testing. His recommendation for the US is that everyone should be tested once every two weeks—an approach that translates to 25 million tests per day in that country alone. This frequency is necessary because there is no guarantee that someone who tests negative today will not get infected tomorrow. It is only by testing everyone again and again that those who happen to test negative should be let to interact with others who are disease-free, while the infected stay locked down till they recover.
In order to even consider this approach, tests need to be widely available at a low-enough cost for them to be iteratively administered at population scale. Their results should be available as soon as possible after testing, so that infected people don’t end up infecting others while waiting for their results. At present, there is no cost-effective test capable of providing near-instant results that has been approved. But this is what we need to be pouring resources into.
Once this level of testing becomes a reality, countries will be able to issue health passports—certificates of a people having been tested recently and found to be negative. Those in possession of these passports will be able to engage in activities that bring them in close contact with others. If at any time they test positive, they will have to isolate themselves till they are no longer contagious.
For those who have recovered from the disease and are immune, countries will begin to issue immunity passports (bit.ly/3fuGl6A)—universally accepted documents that confirm that the holder can no longer contract or spread the disease. These documents will become pre-requisites for global travel—much like the yellow fever card you need, even today, to enter certain countries in West Africa.
As inevitable as immunity passports might be for international travel, there is a real likelihood that we will see them rolled out in various social contexts well before they are used for travel.
As more people recover from the disease, the world will start splitting along the lines of those who are immune to the disease and those who are not. When that happens, immunity passports may become yet another fault-line down which society begins to fracture.
As with most things, the affluent have a greater chance of recovering from a disease that, at its most extreme, requires long weeks of expensive treatment in intensive care. That being the case, immunity passports might become yet another manifestation of privilege.
When immunity passports deny opportunities to those who haven’t yet built up the necessary antibodies to not be a threat to those around them, it will affect the poor and marginalized more than the privileged. Immunity will become yet another invisible basis for social stratification—one more reason for denying access. This, in turn, could give rise to perverse outcomes—forcing otherwise healthy people to get themselves infected in order to become eligible for the passport and thus the opportunities that open up.
This sort of thinking might seem far-fetched, but it has taken hold of societies before. According to a recent article in The New York Times, it was exactly this sort of immuno-privilege that greatly exacerbated the social divide during the yellow fever epidemic in 19th century America.