More than 1 in 34,000 humans on the planet have tested positive and then recovered from Covid-19. The actual number of the recovered is much greater and continues to grow. They are a vastly underappreciated resource!
Their privileged immune state makes them ideal candidates for a hopeful concept: the CoronaCorps, a civilian army that may be able to fill in gaps in public services, insulate the vulnerable from infection, help map the spread of the virus, and give our medical system room to breathe.
The instantiation of this army should be a national priority. We need to identify as many immune individuals as possible, certify their immunity in an official and interoperable manner, and deploy them to positions of maximal utility. We are at war, and this is our draft. Immunity comes with responsibility.
While it is still too early to know the exact duration of immunity to this novel virus, serological testing has already demonstrated an antibody response among the recovered. These tests are in clinical use at leading research institutions today. Instead of measuring the presence of the virus—and telling us whether someone might be sick—they suggest the presence of body armor against it. A positive result is a good result.
The potential for rebooting the economy via the recovered and immune has been recognized by many; and various notions for how such individuals might be distinguished have been proposed. In an interview last month with WIRED, Larry Brilliant suggested using concert wristbands or stamped ID cards. On Twitter, the sociologist Nicholas Christakis noted the potential value of certifying individuals with immunity certificates but called it a “somewhat creepy notion.” Doctors in Germany hope to start issuing immunity certificates this month, clearing people to return to work. Last Thursday, the UK’s health secretary announced a plan to assign “immunity passports” for the same purpose, while Italian politicians continued to discuss whether to distribute “Covid passes” to the public.
In the coming weeks (which will feel like years), as these tests are refined and pressure mounts to approve them for use in outpatient settings, manufacturers will be scaling up their stocks, and existing kits will be imported from abroad by the millions. But let’s dream big about their application. Instead of thinking of immunity as an individual checkpoint on the journey back to jobs which might no longer exist, let’s dare to think of it as something much more powerful: a means to accelerate our collective recovery by mobilizing a volunteer army to protect the nation.
To make it all work, we'll need a way to help those who have this newfound superpower use it for the common good. Here are the steps:
1. Screen candidates for immune certification.
The FDA should move to license at-home, direct-to-consumer testing for immunity using pin pricks, at the earliest opportunity. (My friends in the Bay Area are already doing this with kits acquired from abroad.) Such tests would likely be imperfect; false-positives could be a problem, for example, if detected antibodies were produced in response to coronaviruses other than SARS-CoV-2, or if they target SARS-CoV-2 in such a way that fails to neutralize it. Even so, they could at least help identify candidates for more rigorous follow-up testing and official certification. They may also facilitate crowdsourced contact tracing and improve our understanding of the total prevalence of Covid-19 in the U.S. population.
So as not to inundate the system, tele-screenings should be set up for people who have been diagnosed with Covid-19 or who have had symptoms and subsequently recovered.
Issue immunity certificates in a trustworthy and interoperable manner.
Candidates identified via at-home tests or tele-screenings should be scheduled for formal immune-status certification at drive-through clinics. The standard for this certification should be set at a national level and updated continually to keep pace with ongoing research into the best proxies for determining immunity. To start with, the standard might specify a threshold for detection of persistent antibodies targeting currently known neutralizing sites on the virus. The testing methodology is likely to evolve at a rapid pace in the weeks and months to come, with implications for the certificate’s duration of validity and required frequency of retesting. Official guidance for the standard must accept and acknowledge this fact.
Immunity of the individual has implications for public health, labor, transportation, and national security. Therefore, certification of individuals should be done by all capable and available agencies at county, state, and federal levels, and then recorded in a common online registry. The most immediate candidate agencies to mobilize are the state Departments of Motor Vehicles (with a system akin to the one used for recording organ donors) or the federal Transportation Security Administration (as a spin-off of its system for PreCheck/Global Entry).
The significance of immune certification will depend on regional factors. For example, in places that have reached the threshold of herd immunity (whether by infection and/or vaccination) this distinction will cease to matter. As a result, while the administration of standards for certification and the online registry should be national, their application in a local context across the US should be left up to local public health departments.
Similarly, means of individual verification would vary to suit the purpose at hand. It can be physical or digital—a QR code sticker affixed to your driver’s license, for instance, or a mobile pass on your phone. The existence of multiple, compatible methods of identifying the recovered will accelerate the rebooting of normalcy, by making the system easier to adapt to real-world situations. For example, those deployed in active service such as serving food to the elderly, where it is important to have one’s immunity status prominently and reassuringly displayed, may wear a bracelet or an armband. A mobile pass, on the other hand, would allow existing technologies to be adapted for the regulation of access to crowded places.
Read all of our coronavirus coverage here.
Those with a historical imagination may shudder at these suggestions, and their evocation of humans marked for nefarious purposes within a government-run caste system (or worse). But this is exactly the moment to redeem humanity, to atone for those sins of the past. It is not other humans who divide us now. It is the virus. We must stand apart in order to stand together. Our bodies are being reconfigured into factories for making body armor for a raging war. This is our choice: Do we use that capacity for the benefit of all? Or do we hide behind HIPAA, keeping the superpower of immunity private and protected?
If we choose the former, and put in place the system described above, then society would self-organize around the value of this certification in good and bad ways. The open market would determine the value of such a certificate. Certified individuals would command a premium in the market for certain jobs. Some would try to capitalize on these certifications by setting up concierge “immune” services for the rich. Desperate individuals may decide it is worth the risk of getting infected and becoming immune, rather than remaining isolated and marginalized from lucrative opportunities.
To accelerate society’s recovery from this pandemic in an equitable manner, and to avoid these perverse incentives, we must do more …
3. Recruit an army of recovered and immune and deploy them to places of maximal need.
Those who receive their immune certification should be encouraged to volunteer for the CoronaCorps, a standing army of individuals committed to helping us heal together. You don’t need to have been infected to be of help. The CoronaCorps needs all kinds. The advantage of the immune-certified is that they can pass among and between the quarantined, providing goods and services with reduced personal risk of infection. (Of course, they will need basic training in decontamination protocols to protect others.)
The intake process for CoronaCorps, as well as training and job-matching, should be handled at the city and county government level, with help from the private sector for identifying needs. Don’t reinvent the wheel: Reuse existing job boards, engage professional recruiters, and make it easy for those who are participating in essential services to ask for help.
Place the immune individuals in strategic positions where they can act as insulators to break chains of transmission. Public health specialists and epidemiologists should provide guidance for the most efficient deployment of immune individuals to slow the spread. Just by redistributing ourselves effectively, we can build a potent weapon against the virus. We must take up a battle formation:
- Protect the front lines: CoronaCorps members provide childcare for health care workers or train as ventilator technicians.
- Fortify the home front: CoronaCorps members staff a food service and delivery operation that caters to the elderly and immunocompromised.
- Scouting and reconnaissance: CoronaCorps members deploy to map viral spread through contact tracing, or deliver and collect field test kits and supplies to those under quarantine.
Ideally these regional efforts would be buttressed by congressional action, such that the CoronaCorps could be mobilized nationally to help extinguish local outbreaks. It could stand beside and benefit from the organizational capacities of the AmeriCorps, which puts more than 75,000 people into service every year, and the Senior Corps.
4. Support the census, and make a survey of the unwelcome pathogens in our midst.
The door-to-door operational challenges of the US census provides an opportunity to deploy the CoronaCorps in large numbers. The 2010 census employed over 600,000 people, myself included. It is our constitutional responsibility to let the census go on and give it meaning in our current moment. Now, more than ever, it is important to let each person know they count.
It is also of the utmost national interest to survey public health. The mandate of the current census should be expanded to include questions relevant to the current pandemic and to measure human needs. Who is cooped up, isolated, fearful, and in need of help? Who is sick, and who has recovered?
5. Create a global adaptive immune system.
Raising an army of the recovered is more than a pandemic surge-remediation strategy. By turning the sick into the healers, we also create a narrative of hope.
The bodies of CoronaCorps volunteers will contribute to our collective immune system. This is an advantage humanity has over the virus: Our defense strategies are more mutable; we adapt at multiple scales. We can self-organize and allocate our resources for maximum efficiency. We may be able to redeploy the antibodies in our blood, using them as a medicine to protect others, sharing our body armor. We can adjust our battle formation based on epidemiological models and insulate paths of transmission. Let us mobilize this advantage.
Yet the process of stratifying the population by immune status will take an emotional toll. This project entails the creation of different classes of people with different privileges: the immune, the vulnerable, the frontline health care workers, the herd. While most are isolated, some are mobile. We need to anticipate and diffuse the tensions this will create. One of the strengths of the CoronaCorps is its potential to diffuse this tension by giving us a narrative for celebrating the individuals facilitating our collective recovery, rather than feeding a divisive resentment of the kids who sneaked out of detention. We must stand apart now so we can stand together in the future.
Life is practice for life. Pandemics are practice for pandemics. This is a test for every nation and humanity as a whole. How clever is our collective immune response going to be? Our grade will be assigned on the basis of lives saved, lessons learned, and the strength of our communities when we come out of this.
WIRED Opinion publishes articles by outside contributors representing a wide range of viewpoints. Read more opinions here. Submit an op-ed at firstname.lastname@example.org.