Pandemic Passport And The Danger Of Immuno Discrimination

1193px-SARS-CoV-2_without_backgroundBelow is a longer version of my column that ran in the Los Angeles Times on the danger of using antibody testing as a basis for discrimination.  The concept of a pandemic passport of course will only be plausible if such antibodies truly yield a form of immunity.  The WHO has declared that there is no evidence to support that claim.  Yet, plasma treatments are reportedly successful.

Here is the column:

With the coronavirus antibody tests being rolled out, the country is about to be flooded with millions of tests to determine if individuals have already been exposed to the virus and presumably have immunity from it. The development is key for researchers to understand both the scope and spread of the virus as well as how close we may be to a type of “herd immunity.” That public health breakthrough however could trigger some difficult legal questions. First and foremost, what if you are not part of the herd? The country may soon have to deal with a new concept of bias: antibody or immuno discrimination.

There is a growing and urgent need to get this economy rolling as the virus outbreak subsides. President Donald Trump is correct that destroying this economy will ruin the lives and dreams (and yes health) of tens of millions of citizens. It could reduce the horizon for an entire generation saddled with crippling debt and reduced markets.

Recovery will occur only to the degree that people feel comfortable about getting on airplanes, trains, buses, restaurants, and other closed spaces. With a vaccine projected as still a year away, the population could soon be divided into the immunized and the potentially contagious. If you are in the later group, the question is whether you can be denied certain services.

It is not as far-fetched as you might think. Take the airlines. Planes need to be near capacity to be profitable as a general rule. Social distancing on an airplane is not economically viable. One solution is to require proof of antibodies in your system with one of these available tests. Indeed, the airlines this week floated the idea of a required blood test. That conversely would create barriers to those who are immuno signatures.

Various countries are already using tracking technology to identify carriers and the same technology can be used to distinguish those who are immune. In Moscow, the government has issued “digital permits” to travel that bars others from public transport and even car traffic.

Our legal system is poorly suited for discrimination based on antigens. The discrimination laws focus on immutable characteristics like race and there are both constitutional and statutory protections for those singled out for their religion, gender, sexual orientation, and other classifications. This is not an immutable characteristic but one based on the status of a person’s immunity from a virus.

The other area of relevant law covers quarantine powers in a pandemic. However, those laws and cases focus on confining the contagious, not the potentially contagious.

This issue could actually become more acute once a vaccination is available. The imposition of a mandatory vaccine would be necessary to prevent a renewed outbreak. Putting aside the logistics of vaccinating over 300 million people, many will object or fail to comply. They will continue to represent a fertile population for the virus to take hold. There are three ways to maximize immunization. First, make it mandatory. Second, convince people that they need it. Third, give him an incentive or disincentive in complying.

The first option will turn on a 1905 case where the Supreme Court upheld a state mandatory vaccination program of school children for small pox in Massachusetts. In Jacobson v. Massachusetts (1905), the Court found that such programs are the quintessential state power rather than a federal power. It also held that “every well-ordered society charged with the duty of conserving the safety of its members the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.” States are allowed to subject citizens to restraints to protect “general comfort, health, and prosperity of the State.” The Congress should fund a national vaccinations program and leave mandatory compliance orders to the states.

The second option is already well-established in the minds of most citizens. A deadly pandemic helps. However, we continue to be ministers die who defied orders against large services and young people who put spring break above survival concerns. There will continue to be a percentage of citizens who simply do not believe the virus will touch them or faith or youth will protect them.

That leaves the third option. If people face limitations on travel and employment, a rational actor is likely to comply even if they see little need to do so otherwise. Yet, such a system of proven immunization will create an insular group of the immune deficient. In Jacobson, the law focused on children and the penalties were being blocked from school and a small fine. With the coronavirus, a state would have to compel the population at large of every age.

Some may raise religious or other constitutional rights to refuse a vaccine. The states will have a strong argument that this is not a case of simply self-inflicted harm like those who handle snakes as a matter of faith. By not complying, individuals are fueling the spread to others, particularly more vulnerable populations. In 1922, the Court ruled in Zucht v. King that a school system does not violate the 14th Amendment’s Equal Protection Clause in denying school to students who refused for any reason to be vaccination.

Most importantly, in 1944 in Prince v. Massachusetts, the Court upheld such mandatory programs because “the right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.”

The coronavirus vaccination program would be broader but still rely on the same precedent. Congress can impose limits on interstate travel and the Transportation Security Administration could impose entry requirements but gate areas. The question is whether private businesses like airlines could also make vaccination or immunity a condition for customers. Airlines are part of a regulated industry and could face difficulty in the unilateral imposition of such conditions.

Thus, while states are key to mandatory vaccinations, the federal government would be key to allowing travel restrictions and other barriers to the noncompliant. In doing so, the restrictions would have to trump the right to travel and other constitutional rights. The coercive impact on individuals would be extreme. Noncompliant and non-immune citizens would be isolated physically and socially. Moreover, to make such a system work, there would have to be an easy form of proof of immunization or vaccination – a type of antibody passport.

In the end, the federal and state government may decide to accept a certain level of noncompliance and resulting contraction of the virus. If this is a slowly mutating virus, a second wave may be manageable with therapeutics and ramped up resources. However, if the country wants to impose a mandatory program, it will have to deal with a new status dividing the population between the immune and non-immune.

 

73 thoughts on “Pandemic Passport And The Danger Of Immuno Discrimination”

  1. The current antibody field test kits that I’ve seen are qualitative, not quantitative. It’s yes/no for the control, IgG, and IgM. (IgM means there was a recent exposure or illness, while IgG are more protective, but take longer to form.) There might be quantitative field assays out there but I just haven’t read about them.

    Just because you have antibodies does not mean you have immunity, or if you got sick.

    It would be helpful if we had a billion tests (at least) to determine if someone had Covid-19 before they were symptomatic. That is why so many tests would be needed.

    On my wishlist before re-opening would be:
    1. Easy availability of N95s to the general public as well as medical staff
    2. plenty of tests
    3. approved treatment protocol that would prevent escalation of symptoms and intubation.

    So far, there are some success at preventing the vent. A hospital in Chicago, in Turley’s neck of the woods, has had positive results using high flow nasal cannulas instead of ventilators, with their associated risk of lung injury.

    There are a variety of drugs under clinical trials for treating Covid-19. We really need to get a treatment hammered out. People are straining at the bounds of the quarantine. Young people are showing up with lung and heart damage, and even Kawasaki disease. People with health problems, like me with asthma, are doomed, as the disease savages the lungs.

    We have these 3 prerequisites we must satisfy before we re-open. I hope to God we can get them done, because I don’t think people are going to hold out much longer. I don’t want my family to get this disease.

    https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/uchicago-medicine-doctors-see-truly-remarkable-success-using-ventilator-alternatives-to-treat-covid19

  2. There is a nondiscriminatory option: ‘go at your own risk’. Let’s take the airline example. Let’s say the airlines/ TSA decide on a ‘go at your own risk’ policy. People with antibodies and are assumed immune will choose to fly because they won’t be at risk.
    People who aren’t immune and potentially contagious are given the choice whether they want to risk exposing themselves or not. People who aren’t immune and are potentially contagious pose no risk to those who have the antibodies and/ or are presumed immune and vice versa. People who aren’t immune and potentially contagious only pose a risk to other people who aren’t immune and potentially contagious.
    If you have an underlying health condition or a compromised immune system and are thus at greater risk, then you probably won’t choose to fly. You don’t have to. You can stay safely quarantined at home.
    Because it is not possible to provide a safe environment for one susceptible member of the populace without restricting access to that environment to everyone else that is also not immune and potentially contagious, this outcome for immuno-compromised individuals under the ‘go at your own risk’ policy is no worse than under a discriminatory policy. Under the ‘go at your own risk’ policy, the upshot for every group would be the same as under an immuno-discriminatory policy *EXCEPT* those willing to ‘go at their own risk’ because they would not be prohibited from.. going at their own risk. And there wouldn’t be any discrimination.
    Once vaccines become available, those will further ameliorate ‘go at your own risk’. If you are worried about engaging in public activities like flying, you can get the vaccine before engaging in them. If you are indifferent to the risk, you aren’t prohibited.

  3. CORONAVIRUS REALITY CHECK
    by R. R. Reno

    firsthings.com

    Data are coming in, and their import is clear. The coronavirus pandemic is not and never was a threat to society. COVID-19 poses a danger to the elderly and the medically compromised. Otherwise, for most who present symptoms, it can be nasty and persistent, but is not life-threatening. A majority of those infected do not notice that they have the disease. Coronavirus presents us with a medical challenge, not a crisis. The crisis has been of our own making.

    By the end of March, most of the United States had been locked down. Tens of millions of Americans have lost their jobs. More than $6 trillion has been spent to save society from complete collapse. Relentless warnings have whipped the populace into frenzies of fear. All of this to contain a disease that, as far as we can tell at this point, is not significantly more fatal than the flu. Moreover, given how rapidly the coronavirus spreads, it seems likely that the radical and untested method of lockdown does little to control it.

    In other words, the science increasingly shows that the measures we have taken in the last few weeks have been both harmful—with freedoms lost, money spent, livelihoods destroyed—and pointless.

    Journalists continue to sustain the pandemic narrative. Ioannidis is still ignored, though the evidence I outlined above has been building for weeks. Scientists who should know better are either gullible or too cowardly to speak.

    We’ve been stampeded into a regime of social control that is unprecedented in our history. Our economy has been shattered. Ordinary people have been terrorized by death-infused propaganda designed to motivate obedience to the limits on free movement. We have been reduced to life as medical subjects in our condition of self-quarantine. As unemployment numbers skyrocket and Congress spends trillions, the political stakes rise.

    1. It’s easy to be Next Day Quarterback when you know the outcome.

      Q: How many people were turned away from ERs and told to come back that came back in respiratory distress and then died because treatment was “too late?”

      Q: What percentage of those treated were young, healthy athletes under 35 delayed coming to ER and died within 3 days?

      Q: Why are males more likely than females to get the disease and die?

      If you don’t know the answers you know nothing and should reserve comments while the death too is 61,000 and counting.

      Q: If you are within the next several thousand that die, will your tombstone read the true reason you died, in your own words: “Our economy has been shattered. Ordinary people have been terrorized by death-infused propaganda designed to motivate obedience to the limits on free movement”?

  4. “‘Brave, compassionate and dedicated’: ER doctor who treated coronavirus patients dies by suicide”

    Grace Hauck
    USA TODAY

    https://www.usatoday.com/story/news/nation/2020/04/28/new-york-coronavirus-emergency-room-doctor-lorna-breen-dies-suicide/3038704001/

    Breen’s father told the Times that his daughter had described devastating scenes of the toll the coronavirus took on patients. She had contracted the coronavirus but returned to work after about a week and a half, Breen told the Times. When the hospital sent her home, Breen’s family brought her to Charlottesville.

    Breen’s father told the Times that she did not have a history of mental illness. The last time he spoke with her, Breen had seemed detached, he told the Times. – USA Today

    1. Stop pasting a wall of text on here. A link will be more than sufficient.

      If you can not contribute something original, do not resort to plastering walls of texts from other news sites

        1. If only Amy demonstrated what she meant by chugging bleach.
          Brief excerpt follows

          Klobuchar: Trump Implying ‘You Can Chug Bleach’ Is the ‘Exact Opposite’ of Leadership

          Tuesday on ABC’s “The View,” Sen. Amy Klobuchar (D-MN) said President Donald Trump’s comment about injecting disinfectants was “the exact opposite of what a leader should be doing.”

          Klobuchar said, “I just think so many people watch the president. He’s the leader of our country. And when you see him, whether he’s joking or not, literally looking at people and saying, basically implying, oh you can chug bleach or, you know, maybe we can inject some light into you, that is the exact opposite of what a leader should be doing.”

          Brief excerpt on Nancy Antoinette

          Pelosi to Trump: Ice Cream in My Freezer Is Better Than ‘Lysol in Somebody’s Lungs’

          Tuesday on MSNBC’s “Deadline,” House Speaker Nancy Pelosi (D-CA) shot back at President Donald Trump for commenting about her freezer full of ice cream today at the White House.

          While discussing Pelosi canceling plans to call Congress back to Washington, Trump said, “The Democrats, they don’t want to come back. I think they should be back here, but they don’t, they’re enjoying their vacation…If you look at Nancy Pelosi eating ice cream on late-night television.”

          Pelosi said, “We have a problem with the president. I don’t know why some other Republicans in the country, in the establishment, you know many of them well, are not just speaking out and saying this is not the Republican Party. The Republican Party is a Grand Old Party in our country. I say to my Republican friends, and I do have some, take your back your party. We need a strong Republican party in our country that has contributed so much to the success in America. And yet we have people being silent on this behavior.”

          Host Nicolle Wallace said, “It’s such a good point that as you’re talking, I’m trying to figure out what John McCain or John Boehner, what their profanity-laced response would have been, that I couldn’t have put on this program but that you certainly would have heard and I might have heard about injecting bleach.”

          She continued, “I mean, you’re right. It’s Trump. He’s the problem. And he is more likely to see you on TV than if you went down there. They’re not wearing masks anyway, so I’m not sure that is a safe idea. Just expand a little bit on this idea of a zombie GOP. Did they speak out in the same way that the state of Washington spoke out, and the makers of Lysol spoke out, I think Governor Hogan spoke out? Where are the Republican House members who don’t want their kids or loved ones injecting bleach to their body to clean their lungs? Have you heard from any of them?”

          Pelosi said, “Governor Hogan is Republican, and he certainly has spoken up and other governors. We had strong bipartisan support, Democrats, and Republicans in support of state and local investments as we go forward in the next bill. That is to support our heroes, our healthcare providers, our first responders, police, fire, emergency services, people, our teachers, our transit workers, our postal workers who deliver the mail and medicine to many people in our country certainly our seniors over time, our food providers, the list goes on.”

          She continued, “So rather than spending talking about the president saying we are injecting Lysol in our lungs —he mades a big fuss about my having ice cream in my freezer. That is his latest today, his most current today, she has Lysol in her freezer. I have ice cream in my freezer. I guess that’s better than having Lysol in somebody’s lungs as he is suggesting.”

          She added, “Again, enough of him, enough of him, it’s not worth it to just dwell on him. We have to go forward, and the Republicans will have to make their own decision. I can just imagine what John McCain would be saying now, that great American patriot who was treated disrespectfully by this president.”

        1. People who bark orders are despicable.

          If only Amy demonstrated what she meant by chugging bleach.
          Brief excerpt follows

          Klobuchar: Trump Implying ‘You Can Chug Bleach’ Is the ‘Exact Opposite’ of Leadership

          Tuesday on ABC’s “The View,” Sen. Amy Klobuchar (D-MN) said President Donald Trump’s comment about injecting disinfectants was “the exact opposite of what a leader should be doing.”

          Klobuchar said, “I just think so many people watch the president. He’s the leader of our country. And when you see him, whether he’s joking or not, literally looking at people and saying, basically implying, oh you can chug bleach or, you know, maybe we can inject some light into you, that is the exact opposite of what a leader should be doing.”

          Brief excerpt on Nancy Antoinette

          Pelosi to Trump: Ice Cream in My Freezer Is Better Than ‘Lysol in Somebody’s Lungs’

          Tuesday on MSNBC’s “Deadline,” House Speaker Nancy Pelosi (D-CA) shot back at President Donald Trump for commenting about her freezer full of ice cream today at the White House.

          While discussing Pelosi canceling plans to call Congress back to Washington, Trump said, “The Democrats, they don’t want to come back. I think they should be back here, but they don’t, they’re enjoying their vacation…If you look at Nancy Pelosi eating ice cream on late-night television.”

          Pelosi said, “We have a problem with the president. I don’t know why some other Republicans in the country, in the establishment, you know many of them well, are not just speaking out and saying this is not the Republican Party. The Republican Party is a Grand Old Party in our country. I say to my Republican friends, and I do have some, take your back your party. We need a strong Republican party in our country that has contributed so much to the success in America. And yet we have people being silent on this behavior.”

          Host Nicolle Wallace said, “It’s such a good point that as you’re talking, I’m trying to figure out what John McCain or John Boehner, what their profanity-laced response would have been, that I couldn’t have put on this program but that you certainly would have heard and I might have heard about injecting bleach.”

          She continued, “I mean, you’re right. It’s Trump. He’s the problem. And he is more likely to see you on TV than if you went down there. They’re not wearing masks anyway, so I’m not sure that is a safe idea. Just expand a little bit on this idea of a zombie GOP. Did they speak out in the same way that the state of Washington spoke out, and the makers of Lysol spoke out, I think Governor Hogan spoke out? Where are the Republican House members who don’t want their kids or loved ones injecting bleach to their body to clean their lungs? Have you heard from any of them?”

          Pelosi said, “Governor Hogan is Republican, and he certainly has spoken up and other governors. We had strong bipartisan support, Democrats, and Republicans in support of state and local investments as we go forward in the next bill. That is to support our heroes, our healthcare providers, our first responders, police, fire, emergency services, people, our teachers, our transit workers, our postal workers who deliver the mail and medicine to many people in our country certainly our seniors over time, our food providers, the list goes on.”

          She continued, “So rather than spending talking about the president saying we are injecting Lysol in our lungs —he mades a big fuss about my having ice cream in my freezer. That is his latest today, his most current today, she has Lysol in her freezer. I have ice cream in my freezer. I guess that’s better than having Lysol in somebody’s lungs as he is suggesting.”

          She added, “Again, enough of him, enough of him, it’s not worth it to just dwell on him. We have to go forward, and the Republicans will have to make their own decision. I can just imagine what John McCain would be saying now, that great American patriot who was treated disrespectfully by this president.”

  5. Everybody has been to the same grocery stores touching the same grimy carts, baskets, and number pads. There has been no functional quarantine, only dysfunctional. Tracking contacts thus has nothing to do with health and everything to do with an elitist overlord agenda.

    This is how the Warsaw Ghetto began.

  6. Kaiser Health News:

    “LOST ON THE FRONTLINE”

    “True Toll Of COVID-19 On U.S. Health Care Workers Unknown”

    By Christina Jewett and Liz Szabo

    April 15th, 2020

    https://khn.org/news/true-toll-of-covid-19-on-u-s-health-care-workers-unknown/

    Excerpt:

    The CDC data released Tuesday showed that 73% of the health workers falling ill are female and their median age is 42.

    That so many are getting sick is alarming to Christopher Friese, a nurse who continues to see patients and is director of the University of Michigan’s Center for Improving Patient and Population Health. He said it’s also concerning that the names of those who die are so hard to come by.

    “It’s an insult that we can’t even honor or respect these colleagues in a respectful way,” he said. “We have nurses in Manhattan in garbage bags and goggles, and we have no way to track our fallen clinicians. We cannot even grieve properly: We can’t even honor them because we may not even know who we’ve lost.”

    https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e6.htm?s_cid=mm6915e6_x

    1. excess deaths compared to all the usual sources is the most relevant number, which gets beyond the epistemological quandry created by the big lack of testing

  7. “A whip-smart neurologist, a social worker who sang Broadway: US health workers who died from Covid-19”

    “We are documenting the lives of every US medical worker who dies helping patients during the pandemic. These are some of the first tragic cases”

    “Help us document the US healthcare workers who die fighting coronavirus”

    https://www.theguardian.com/us-news/2020/apr/15/nurses-surgeons-janitors-first-us-health-workers-to-die-covid-19

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