Some see them as get out of jail free cards to help economies stagger back to life. To others, the idea of “immunity passports” is COVID-19 madness.
As countries around the globe begin nervously emerging from pandemic lockdown, several are mulling the idea of immunity certificates — passes that would permit those who have tested positive for antibodies to COVID-19 to return to work, shop, board airplanes and otherwise circulate freely in public while the non-immune would remain mostly sheltered in place until vaccines become available.
This week, Chile said it was proceeding with plans to issue “immunity passports” that would liberate holders from quarantines and other restrictions. Germany, Italy and the U.K. have also floated the idea, while Anthony Fauci, a key member of the White House COVID-19 taskforce, told CNN last week the idea “might actually have some merit, under certain circumstances.” U.K. Health Secretary Matt Hancock has said that, should the science support it, the U.K. could introduce an immunity wristband “that says I’ve had it and I’m immune and I can’t pass it on and I’m highly unlikely to catch it.”
The idea of a hall pass out of lockdown hinges on the mass availability of antibody tests — also known as serological tests — that can identify who has been infected and developed antibodies thought to give them some protection from future infection. About half of those infected never develop symptoms, meaning there could be tens of thousands of Canadians who never knew they had the illness.
A dozen companies are seeking Health Canada approval for serological tests, including Halifax-based MedMira Inc., whose rapid antibody test takes three minutes start to finish, using a drop of blood specimen. In the U.S., more than 70 developers have notified the Food and Drug Administration they have tests ready to launch. The agency has issued four emergency use applications for antibody tests and expects that number to grow in coming weeks. “Within a period of a week or so we’re going to have a rather large number of tests that are available,” Fauci said. New York Gov. Andrew Cuomo, meanwhile, has said people who can get antibody tests — people who can “show they have had the virus and resolved” — can go back to work when the state starts to reopen. U.K.-based software company Bizagi has already developed a “CoronaPass” app to “automate, track and validate” a person’s immunity status, based on his or her antibody test. A QR code could be scanned like a boarding pass and presented to “authorities” as needed. “Those with evidence of immunity can help care for the most vulnerable in the community, staff a restricted re-opening of a retail location, or be safely prioritized for front-line healthcare work to help those still in need,” the company says.
The science, however, is still seriously murky: There are concerns about sensitivity — how good are the tests at identifying people who have had the disease — and specificity, meaning, are they cross-reacting with other coronaviruses that cause the common cold? A positive test may only indicate the person has been exposed, no more, no less. There’s no known understanding of how long immunity lasts — three months? three years? — or the level of antibodies necessary to presume a person is now “noncontagious.” Do the immune wear lanyards and badges? Would it trigger a black market of fake immunity passes? How would it be implemented and patrolled? Is a world of the immunes and the non-immunes a future we really want?
“For years, decades, we’ve been writing about stigma in infectious disease and how it’s problematic and now people are thinking of actually employing something that is by definition stigmatizing as a way out,” said University of Toronto bioethicist Dr. Ross Upshur, of the Dalla Lana School of Public Health.
“Play this out in your mind in several different scenarios,” said Upshur, an internationally recognized public health and bioethics expert. “You have to have an immunity pass. Do you get a jacket? Do you get a hat? How is it that people identify the fact they have an immunity pass or not? What happens if somebody who doesn’t have an immunity pass is found in a group of people who do? Do they get beaten up? We know humans can behave very savagely to each other under these types of circumstances.”
The proposal is tone deaf to how similar practices have worked in the past, Upshur added — “apartheid, colonial Africa, Nazi Germany” — and has a high likelihood of being used against already disadvantaged groups. Nobody wants to stay in lockdown longer than they absolutely have to. “But we do not have a valid serological test for determining immunity to SARS-Cov2,” Upshur said, and to base major decisions on who gets out and who doesn’t on antibody testing is not only premature, “it’s madness.”
We cannot all march forward out our doors
During the 1878 yellow fever epidemic in the Deep South, survivors became “acclimated,” Kathryn Olivarius, an assistant professor of history at Stanford University, wrote in New York Times. Unacclimated white people couldn’t get a job. “If you were white, immunity-status impacted where you lived, how much you earned, your ability to get credit and whom you were able to marry.”
Immunity passports could also present a perverse motivation to get deliberately infected, like misguided mothers who bundled their children off to chickenpox parties. “That may be unthinkable for those fortunate enough to be able to weather this economic storm from behind a monitor in their home office, but that option just isn’t available to millions,” Noah Rothman, author of Unjust: Social Justice and the Unmasking of America, wrote in Commentary magazine. With rolling lockdown-lift-lockdown cycles that could stretch a year or longer until vaccines become available, people with families to support and crushing debt “could begin to seek out the status that allows them to live fully once again — as dangerous as that may be,” Rothman said.
Others have argued that it would be entirely ethical for grocery stores, restaurants and other businesses to require immunity passports of customers — that, the price of coming out is to surrender some civil liberties. “If you don’t want to carry that document or don’t trust it, you’re not coming out,” said NYU Langone Medical Center bioethicist Arthur Caplan.
The tests measure the amount of antibodies, or proteins present in blood when the body responds to an infection caused by the virus. The tests don’t detect the virus itself, or an active infection, like the nasal and throat swab used to diagnose COVID-19, but whether the person’s immune system produced antibodies after having encountered the infection some time in the past.
However, it’s not clear which particular antibodies are actually providing immunity after the person recovers, or for how long.
It’s nice to think of an immunity passport if you’re the one “immune,” Upshur added. “Because that means there is at least the possibility that some of us would be able to freely move in the environment.”
But how to do the testing fairly and equitably? “You would need a regimen to give everybody the fair opportunity to have the test, and look at how well we’ve been rolling out testing in Ontario in the first place,” he said.
The plan would also be premised on the idea that the non-immune would remain largely sheltered until vaccines become available. But Upshur, who has been on multiple meetings with top scientific minds on World Health Organization teleconferences, says the probability that there will be a vaccine in the near future with over 90 per cent efficacy and available in seven billion doses “is almost non-existent.”
It’s likely that people exposed to the pandemic virus in the past would have some reasonable degree of immunity. “One hundred percent immunity? Probably not. One hundred per cent of the time? Definitely not. But better than nothing,” said Amir Attaran, a professor of law and medicine at the University of Ottawa who has a PhD in immunology.
However, in our shelter-in-place isolation, we didn’t magically develop immunity, Attaran noted. “We’ve been sitting on the couch watching Netflix and drinking beer.
“We cannot all march forward out our doors. We are going to have to divide it up into batches, into cohorts of people who go back, more or less, to society and more or less the jobs they left behind, in stages,” based on disease susceptibility and occupation, he said.
Young people are just as likely as older ones to get infected, but they’re much less likely to die. “So, the first batch would favour young people over old, assuming they don’t have a pre-existing condition that makes them more vulnerable,” Attaran said. Later batches could include older people and the immune suppressed. “All the boomers get to take a little longer time out. This is the time of Gen X and Gen Y.”
Attaran said we ought to consider immune passporting, “giving those who are thought to be immune a bill of health that says they can circulate more extensively in society without risking the health of others.”
But what level of immunity makes someone passport worthy? How would it work? “The head waiter can go back to work but nobody else?” tweeted one Imperial College London scientist.
There are currently no validated serology tests in Canada “and thus there is no mechanism to implement such an initiative,” a spokeswoman for the Ontario health ministry said in an email. However, the province is working with the Public Health Agency of Canada “to understand the evolving technology and its applications,” she said.
While we wait for the testing to be sorted out, everyone wants to know the answer to, how soon can we come out? “Unfortunately, there is no clear answer,” Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health said this week. It won’t be like a light switch, she said, “you know, on-off.” It will be gradual, and the impact of each change will have to be monitored carefully for signs of any fresh outbreaks. But once the genie is out of the bottle it will hard to put her back in. “Once we lift it, it will be very hard to go back,” Yaffe said.
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City asking people to wear masks on buses, but not mandatory – GuelphToday
As the city prepares to allow more riders on Guelph Transit buses, it is asking riders to wear a non-medical mask or face covering.
They are not mandatory.
Free 30-minute Guelph Transit service will continue for the rest of June but the city says thta with more businesses reopening and more people heading back to work, Guelph Transit is preparing to resume fare collection and regular schedules later in the summer.
In a news release Friday morning, the city said the request is based advice from Wellington-Dufferin-Guelph Public Health.
“According to health officials, wearing a homemade face covering/non-medical mask is not a substitute for physical distancing and hand washing. Wearing a mask has not been proven to protect the person wearing it, but it can help protect others around you,” the release said.
“As the buses get busy again, physical distancing may not always be possible. We’re asking riders to wear a non-medical mask or face covering to help prevent the spread of COVID-19,” says Robin Gerus, general manager of Guelph Transit.
Guelph Transit is encouraging face coverings, not requiring them.
“It’s becoming more common to wear a mask on public transit in other cities, but it’s new for Guelph. Some riders may not be aware of or understand the latest guidelines from health officials. Some may not have resources to purchase or make a mask, or they may have a medical reason for not wearing one,” added Gerus. Everyone is welcome to use Guelph Transit, and we’re asking people to protect and respect each other as ridership increases.”
Since March, Guelph Transit made the following adjustments to slow the spread of COVID-19:
- free 30-minute service allows passengers to avoid using the farebox and board from the rear door
- plastic barrier between the driver and passengers
- hand sanitizing stations and cleaning supplies for drivers
- no more than 10 people per bus
- blocked several seats to encourage physical distancing between passengers
To prevent the spread of COVID-19, the City and Guelph Transit encourage riders to continue following the latest advice from Wellington-Dufferin-Guelph Public Health:
- wash your hands regularly or use hand sanitizer
- stay at least two metres away from people you don’t live with
- when you can’t maintain physical distancing, wear a non-medical mask or face covering
WHO resumes hydroxychloroquine trial on Covid-19 patients – ITIJ
On May 25, WHO suspended the trial of the drug, which is usually used to treat malaria patients, after a study published in medical journal The Lancet found that Covid-19 hospitalised patients treated with hydroxychloroquine had a higher risk of death, as well as an increased frequency of irregular heartbeats, than those who weren’t treated with it.
However, WHO officials have since asserted that there is no evidence that the drug reduces the mortality in these patients, and the study has since been retracted over data concerns.
“The executive group received this recommendation and endorsed the continuation of all arms of solidarity trial including hydroxychloroquine,” said WHO Director-General Tedros Adhanom Ghebreyesus during a press conference 3 June, adding that WHO planned to continue to monitor the safety of the therapeutics being tested in trials involving over 3,500 patients spanning over 35 countries.
“WHO is committed to accelerating the development of effective therapeutics, vaccines and diagnostics as part of our commitment to serving the world with science, solutions and solidarity,” Ghebreyesus said.
'Truly sorry': Scientists pull panned Lancet study of Trump-touted drug – National Post
NEW YORK/LONDON — An influential study that found hydroxychloroquine increased the risk of death in COVID-19 patients has been withdrawn a week after it led to major trials being halted, adding to confusion about a malaria drug championed by U.S. President Donald Trump.
The Lancet medical journal pulled the study after three of its authors retracted it, citing concerns about the quality and veracity of data in it. The World Health Organization (WHO) will resume its hydroxychloroquine trials after pausing them in the wake of the study. Dozens of other trials have resumed or are in process.
The three authors said Surgisphere, the company that provided the data, would not transfer the dataset for an independent review and they “can no longer vouch for the veracity of the primary data sources.”
The fourth author of the study, Dr. Sapan Desai, chief executive of Surgisphere, declined to comment on the retraction.
The Lancet said it “takes issues of scientific integrity extremely seriously” adding: “There are many outstanding questions about Surgisphere and the data that were allegedly included in this study.”
Another study in the New England Journal of Medicine (NEJM) that used Surgisphere data and shared the same lead author, Harvard Medical School Professor Mandeep Mehra, was retracted for the same reason.
The Lancet said reviews of Surgisphere’s research collaborations were urgently needed.
The race to understand and treat the new coronavirus causing the COVID-19 pandemic has accelerated the pace of research and peer-reviewed scientific journals are go-to sources of information for doctors, policymakers and lay people alike.
Chris Chambers, a professor of psychology and an expert at the UK Center for Open Science, said The Lancet and the NEJM – which he described as “ostensibly two of the world’s most prestigious medical journals” – should investigate how the studies got through peer review and editorial checks.
“The failure to resolve such basic concerns about the data” raises “serious questions about the standard of editing” and about the process of peer review, he said.
The Lancet did not immediately respond to a Reuters request for comment. The NEJM could not immediately be reached for comment.
The observational study published in The Lancet on May 22 said it looked at 96,000 hospitalized COVID-19 patients, some treated with the decades-old malaria drug. It claimed that those treated with hydroxychloroquine or the related chloroquine had higher risk of death and heart rhythm problems than patients who were not given the medicines.
“I did not do enough to ensure that the data source was appropriate for this use,” the study’s lead author, Professor Mehra, said in a statement. “For that, and for all the disruptions – both directly and indirectly – I am truly sorry.”
Many scientists voiced concern about the study, which had already been corrected last week because some location data was wrong. Nearly 150 doctors signed an open letter to The Lancet calling the article’s conclusions into question and asking to make public the peer review comments that preceded publication.
Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine said the retraction decision was “correct” but still left unanswered the question about whether hydroxychloroquine is effective in COVID-19.
“It remains the case that the results from randomized trials are necessary to draw reliable conclusions,” he said. (Reporting by Michael Erman, Peter Henderson, Kate Kelland and Josephine Mason Editing by Leslie Adler, Tom Brown, Giles Elgood and Carmel Crimmins)
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