Editor’s note: This editorial was originally published by STAT on April 6, 2020.
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.
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.
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.