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Re-opening a nightclub in New York seems crazy at this point, as that’s just the kind of setting in which Covid-19 can spread like wildfire. But it wouldn’t be crazy if all of the workers and patrons had previously had Covid-19 and recovered from it.

Someday soon there will be millions of people in the U.S. who have recovered from Covid-19. The best evidence suggests that they can’t get infected again soon and won’t infect others by shedding the virus.

That suggests a path to run essential services more safely and to reopen sectors of the economy faster than would otherwise be possible. 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” from Covid-19. Researchers in Germany have recently proposed a similar program there.

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Federal policymakers are currently being pulled in two directions. One is to close much of the economy and shelter people at home to limit the spread of the virus that causes Covid-19. But we all recoil at the economic and human devastation this creates, so Congress passed a $2 trillion stimulus package geared mostly to keep the economy open and stimulate demand. Yet demand is hard to stimulate when so many things are closed, and it is dangerous to stimulate in ways that increase social contact and spread the virus.

Creating a path for the certified recovered from Covid-19 reduces the tension between jump-starting the economy and letting the virus run rampant.

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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 specialized labor force of the certified recovered in the short term.

Although no one knows with absolute certainty if people with antibodies to the SARS-CoV-2 coronavirus can be re-infected by it, immunity to the coronavirus that causes severe acute respiratory syndrome (SARS) lasted two years. For SARS-CoV-2, monkeys infected with SARS-CoV-2 are known to have developed immunity. And according to Martin Hibberd, an infectious disease expert at the London School of Hygiene and Tropical Medicine, people who have recovered “are unlikely to be infected with SARS-CoV-2 again.”

These early indications justify starting now to build a certification system. We urgently need to get as many people safely back to work as possible.

Certified recovered people could take up frontline contact positions in medicine and retail to make operations safer. They could work with the elderly and the vulnerable. Certified recovered persons could also work in food preparation. A service that prepared and delivered food only with recovered people would be quite popular. Buses on routes going to hospitals could be driven by recovered drivers. Possibilities abound as trust rebuilds. Just knowing that more and more people have beaten the virus and are back to work would be an immense boost to confidence.

To be sure, health conditions are a private matter, and no one should be forced to certify themselves. That said, demand by individuals to be voluntarily tested and certified could be intense.

The program would be ideal if it allowed undocumented workers to participate without fear or risk. It was cruel to leave them out of the stimulus support. It was also unwise from a public health perspective, as undocumented families will be forced to join an underground economy and work in defiance of local shelter-in-place ordinances, thereby endangering everyone.

One concern is that the uninfected could face job discrimination in certain jobs once a system for verifying the certified recovered is created. Recently reissued guidance from the U.S. Equal Employment Opportunity Commission, however, suggests that the commission sees such discrimination as acceptable. 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. Getting more people working safely is paramount.

Quickly creating a certification system could speed economic recovery while slowing the virus. And perhaps the certified recovered, after working all day for the rest of us, could safely enjoy dancing the night away.

Aaron Edlin is a visiting scholar at the USC Schaeffer Center for Health Policy and Economics and professor of economics and law at UC Berkeley. Bryce Nesbitt is a co-founder of NextBus, a public transit information company.

    • Current science is that COVID-19 appears to be mutating quite slowly.

      Regardless, partial immunity is better than no immunity. A certification program has limits, and it is likely that given certifications must end based on antibody decline over time, the local presence of a strain the individual has not experienced, or the development of a superior vaccine.

  • Hey I am really afraid of HBV and HCV as well as AIDS. Both of which can be transmitted in a workplace (hence OSHA standards of training), do we get to “jew star” them also?? Asking for a friend.

    Also if you think that Bill Gates plan to start “immunizing” is the answer when natural immunity for the 90% of the population who have no to mild symptoms then I can see Fascism rising fast. Out here in the wild West, you start forcing vaccines against people’s wills and a range war will start. Just saying

  • There is no need for a scarlet letter “certificate” type of system. And in fact, this system could cause much, much more harm than good, while being entirely ineffective.

    1) This creates a perverse incentive – people will purposefully try to get themselves infected. Specifically, people who are desperate to return to work. They might get themselves killed in the process and certainly will expose more healthcare workers to unnecessary cases.

    2) This will result in employment discrimination based on health status which is illegal in the US for good reason. Particularly the subgroup of people who are very vulnerable to the virus (those with pre-existing conditions, immuno compromised, etc) would be discriminated against.

    3) For those proposing serology, while the sensitivity and specificity of serology tests *may* be high (>90%), given that the estimated of % of the population infected are low, the ability of serology to accurately “certify” individuals as previously-infected will actually remain quite low. If you don’t understand this, read up on sensitivity, specificity, and the base rate fallacy, or, better yet, leave this kind of decision-making up to actual experts – epidemiologists and medical professionals experienced in this specific field.

    4) Best estimates right now tell us that, even in hard-hit countries, a relatively low % of the population is likely to have been infected. Not enough to make a dent in returning to normalcy.

    Which brings me to:
    5) There are many other public health interventions that can be utilized which will protect more people. Among them (and i’m sure there are more): improved diagnostic testing, screening testing, surveillance testing (both diagnostic and serology), continued limitations on large gatherings and travel (this one just isn’t going to go away any time soon, sorry), extensive comprehensive contact tracing, excellent hygiene, and excelled PPE for medical workers and other front line staff (police officers, etc).

  • Testing on the scale proposed will never happen in a country the size of the US and it is illogical (see Allan’s post below). Once new cases drop to an acceptable level (TBD) then we must get back to work opening business sequentially based on risk. So gyms might have to wait for example. By the Fall perhaps effective treatments will make the virus’s mortality like that of the seasonal flu. Once that occurs we can all exhale the then beat China’s ass.

  • The many reports of reinfections indicate that immunity is limited or non-existent for this flu.
    It is also not known that a recovered person can no longer shed the virus.

  • Why restrict testing to only those who were hospitalized and showed corresponding symptoms? If the goal is to restart the economy by providing immune workers why not test the population? Otherwise the even larger pool of asymptomatic and recovered people get excluded.

    Certainly there are better examples than reopening nightclubs and discrimination against illegals. How about impoverished Americans that are fundamentally excluded in the initial proposal?

    There are fundamental logic flaws in the article, the acumen of the authors not withstanding. Utilization of Venn Diagrams beginning with the population is one suggestion.

    • I think the requirement of having shown symptoms is to protect against false positive tests. If someone tests positive and has no symptoms then there’s no way to differentiate between an asymptomatic infection and a false positive.

  • I have a HUGE problem with this. As the article so note, BECAUSE MY WIFE AND I DID THE RIGHT THING AND FOLLOWED STAY AT HOME RULES AFTER BEING LAID OFF DUE TO COVID 129 WE MAY NOT BE REHIRED?

    If the government sees that as “acceptable? discrimination then they can pay us both to stay AT HOME until WE feel that any released vaccine is safe and has no side effects because we will NOT be the first to take any rushed to market vaccine as is being done today.

  • Wishful thinking. Instead, I can foresee a jump in workplace tensions and discrimination based on being immune or not. With workers finding themselves having to chose between willingly getting infected and jeopardizing their lives, or being laid off and left behind for not being immune

    • FOLLOW UP
      Researchers in Germany have recently proposed a similar program there.

      The difference with Germany is that they have a social welfare, and workers protection laws that allow to cushion those worries. Unlike in the US, where everyone is pretty much left to fend for themselves.

  • This recommendation from an economist and an entrepreneur, neither with significant clinical knowledge, is premature. For example, as they acknowledge, the potential for reinfection remains an open question. The “best evidence” the authors cite is preliminary and provisional. Without that type of knowledge this essay is tautological: if it’s safe to go back to work then it’s safe to go back to work.

    Some of the new Federal legislation is — and more could be — geared to weathering the storm, with paid sick and family leave, assistance with or postponement of rent and mortgages, support for basic provisioning, and attention to safety and logistics for essential workers.

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