Exiting Coronavirus Confinement Is a Shot in the Dark Without Immunity Testing

Empty street due to coronavirus outbreak
Image credit: Chad Davis / Flickr

The threat posed by the spread of coronavirus to even essential US defense functions highlights that the urgency of testing for immunity is growing each day.

The commander of the US aircraft carrier the USS Theodore Roosevelt sought authorisation to evacuate as the virus spread through the crew. A senior officer aboard the ship reported that between 150 to 200 (out of approximately 4,000) sailors had tested positive. But the request to evacuate was refused by US Secretary of State for Defense Mark Esper, who judged that the situation was not yet sufficiently serious.

The availability of tests for coronavirus immunity, as explained in my article for The Geopolitics on March 27, would have provided a way to resolve the dilemma. Instead of using polymerase chain reaction (PCR) tests to find out which sailors were positive and had the virus, all of the sailors should have been given a serological test to identify which of them are immune and therefore necessarily negative for a PCR test, which would not then be needed. Those with immunity would remain on board and the rest, without the antibodies in their blood to provide immunity, would be evacuated. Those who have neither the virus nor antibodies would normally be considered vulnerable. But they can stay on board because they are not at risk of being contaminated by those with immunity. Only the infected would be disembarked. The naval mission would have been able to continue, albeit with reduced manpower, with the health of the whole of the crew having been protected.

Since publication on March 27 of my article “How To Prevent COVID-19 From Paralysing The World’s Economy” in which I propose the use of serological tests to choose which parts of the population will be released from confinement first and allowed to safely return to work, there have been a stream of government announcements that correspond with this approach.  

Luxembourg on March 30 became the first country to adopt the proposal on serological testing. The country expects delivery of the tests next week, and will use the results to help determine its strategy for exiting lockdown. Germany followed suit on March 31. The country plans to issue coronavirus ‘immunity certificates’ which will allow the bearers to restart work. Also on March 31 The Netherlands announced it would be doing the same, and plans to test 29,000 people per day to allow those with immunity to go back to work. 

In the US, laboratories and medical companies are trying to accelerate production of serological tests. The Food and Drug Administration has relaxed rules to allow these tests to proceed to market without full agency review and approval. Regulators elsewhere should do what they responsibly can to allow the tests to be rapidly used at scale.

My proposal has drawn support from Lord Alderdice, a clinical and academic physician who sits in the UK House of Lords, who described it as a “very useful” and “very worthwhile” contribution. In his response to my article, Lord Alderdice underlined that a vaccine which has been tested and approved for use is still months away. In the meantime, he says, the widely available PCR tests for coronavirus are not completely reliable, while serological tests are reliable but not yet widespread.

The conclusion is clear: massive serological testing is urgently necessary. This will give us the two essential pieces of information about the health of every individual in the context of COVID-19 pandemic: the presence or otherwise of coronavirus in their body, and their immunological status. 

Blunt Instrument

Confinement is a blunt instrument and its impacts are expensive and hard to manage. The increases in domestic violence and mental breakdowns already apparent in confined families in many countries are an obvious danger that the proposal can help to avoid. The alternative is worsening global paralysis that will pose unpredictable threats to core economic, military and governmental structures. Countries which don’t carry out testing for immunity will be shooting in the dark as they balance the risks to their economies from prolonging shutdowns with the dangers to the population from ending them.

In very poor countries with slums and shantytowns, social distancing is impossible. In such overcrowded contexts, polymerase chain reaction (PCR) tests, able to detect the presence of coronavirus, will in themselves do nothing to enable isolation or prevent further contagion. Simply waiting for collective immunity to develop – as Boris Johnson initially wanted to do in the UK – means paying a heavy human price. Time and valuable human resources can be saved by identifying those who already have immunity. Those who are immune can go back to work to support their families without posing a danger to them or anyone else.

Serological tests, of course, will need to be used with caution, with appropriate delays added before a person can return to the community. Experts such as Dr. Timothy Brewer, professor of epidemiology at the UCLA Fielding School of Public Health, have said that it takes time for the body’s immune system to generate antibodies, so false negatives are possible early in the course of infection. And further mutations of the coronavirus, which could allow it to overcome antibodies, can’t be ruled out.

What we currently know and are able to measure points to the conclusion that if a choice has to be made between PCR and serological tests, then the latter must have priority. The shift in the response by some governments is encouraging as it shows that the public health and economic dimensions of the pandemic can be simultaneously addressed – if the right tests are used on a sufficient scale. Other countries need to follow the lead if the pandemic’s impact on the global economy is to be minimised.

What is needed now is the vision to identify immediate and future needs, and the political will to fulfil them. US President Donald Trump has made a start by telling General Electric and Ford to convert part of their capacity to produce ventilators to treat coronavirus cases. The redeployment needs to go much further: global industrial capacity needs to be redeployed to enable mass serological testing. Millions of human lives are at stake, as is the future of the global economy.

The views and opinions expressed in this article are those of the author.