Senator Bill Cassidy (a gastroenterologist from Louisiana) and Christopher Mores, professor of global health at George Washington University, discuss testing, herd immunity, and a national registry of the non-infectious:
“The Ebola virus spread rapidly in Sierra Leone in 2015 and killed many. One of us (Dr. Mores) was there and saw the local health-care system get overwhelmed. Without enough personal protective equipment, doctors and nurses worked tirelessly, always fearing infection. The economy was destroyed.
“Eventually, Ebola was contained. The new coronavirus will also be contained. Everyone is looking forward to the end, trying to figure a way out of the crisis. Social distancing reduces the virus’s ability to spread, but until cures and vaccines are discovered, the only way out is naturally occurring immunity…
“Coronavirus spreads rapidly. One person typically infects two or three other people, who then infect two or three others and so on. Most recover or never have symptoms, and most likely become immune. A vaccine works by mimicking the immune response of a naturally occurring infection. Herd immunity develops when 40% to 70% of a population becomes immune. The “herd” of people who are immune blocks the virus from taking hold and infecting others. A person’s immunity to the novel coronavirus could last 12 months. By then, a vaccine could be ready.
“When individual and herd immunity develop, society and the economy will begin to return to normal. When a nurse knows that she is immune, she can care for routine Covid-19 patients without wearing a respirator mask. An immune bartender can serve customers without fearing exposure. An immune insurance agent can have meetings without getting infected…
“The U.S. has experience recording immunity. States currently use online immunization registries to estimate herd immunity for a variety of vaccine-preventable diseases. These registries were paid for by taxpayers and comply with the Health Insurance Portability and Accountability Act. Doctors can enter information. Schools can look up student vaccination records.
“To restart the economy, the government needs to set up coronavirus-immunity registries. At the same time, widespread testing is necessary to document immunity in those who haven’t fallen sick. A recent report from China found that 100% of patients tested two weeks after symptoms cleared had antibodies for the coronavirus. Recovering from a known coronavirus infection or having a positive antibody test is likely to indicate immunity lasting for at least some time. Those who so demonstrate that they are immune can be allowed to return to work. The whole community is freer when herd immunity is established…
“There’s obviously still much more we need to learn about the new coronavirus. What we learn may change how we respond. But our suggestions here are based on sound public-health principles to address the medical crisis. Only when we find a way out of the medical crisis can we find our way out of the economic crisis.”
I’m all in favor of big data, including national databases for tracking human trends in every conceivable way, but let’s not forget that a national immunity registry would be functionally equivalent to a national gun registry. Even more, it would be susceptible to authoritarian exploitation like nothing we have ever experienced before.
There is no perfect way to go forward with such a registry. Our existing standards for the privacy and security of medical records are probably insufficient. Besides, somewhere some group of public servants will need to have access to the raw data, if only to verify and validate de-identified records as accurate. And that group of people will see and know things the rest of us may never see and know. They will become an unquestionable in-group, rather like spies who could “tell you what they do, but then would have to kill you.”
So, if we’re going to do this, let us not rush into it.