‘Are you immune?’ The new class system that could shape the Covid-19 world

By Miranda Bryant

Scrolling through Airbnbs in Brooklyn, one listing stands out. “IMMUNE HOST,” claims the heading in caps. Among photos of rooftop sunsets and interiors, lies something else unexpected – a picture of a positive antibody test.

Host Martin Eaton says he got tested a few weeks after getting sick with what he suspected was Covid-19 in March. When the results came back positive, he decided to include it in his profile to attract reservations.

“If I was having to travel to New York I’d prefer staying with somebody who had the antibodies versus somebody who didn’t,” says the 48-year-old writer. So far, he adds, “it’s proved pretty successful”.

In the absence of a vaccine, immunity is emerging as a potential key to resuming normal life after the pandemic – leading some to believe that testing positive may not be such a bad thing. Providing they survive, they will at least – they hope – be immune. But as states and countries slowly reopen businesses to the public, how important will it be?

Questions remain over the accuracy of Covid-19 antibody tests and the World Health Organization has warned that there is no evidence that people who have recovered from the virus and have antibodies are protected from getting it a second time.

But experts predict that if survivors are found to be immune, they could perform a range of jobs and services – such as volunteering in hospitals and nursing homes, caring for coronavirus patients and working in shops and food processing plants – risk-free. And, depending on how authorities, business and society at large respond, they could also be entitled to greater freedoms.

In Chile, the government is issuing “release certificates” (but they will not confirm immunity) to people who complete quarantine after testing positive. In China, “health code” apps are being used to determine who can travel where.

Dr Anthony Fauci, director of America’s National Institute of Allergy and Infectious Diseases, has said immunity certificates are “possible” in the US and that they “might actually have some merit under certain circumstances”.

Providing there is a way to certify that people have had the test, that it was effective and that the antibodies last, Dr Ezekiel J Emanuel, chairman of the department of medical ethics and health policy at the University of Pennsylvania, says immunity passports could have “real positives” for both the patient and the wider community.

He also believes it will become necessary for travel – even after a vaccine – to prove immunity and as a means to skip quarantine. “Showing that you’ve been infected and are immune and can’t transmit the virus is a really powerful mechanism.”

The concept is already being adopted by the private sector. The hotel booking app Sidehide and verification company Onfido are developing an immunity passport for hotels – set to launch in Miami this month.

Such are the perceived benefits of immunity that some people are intentionally trying to get the potentially deadly virus.

Dr Jerome Williams Jr, cardiologist and senior vice-president of consumer engagement at Novant Health, says they have had multiple people test positive in Winston-Salem, North Carolina, after attending “coronavirus parties” – gathering unprotected with positive people – in the hope of getting infected.

Without knowing exactly how immunity works, the parties are, he says, “a bad idea all round”.

Despite the perceived advantages of immunity, creating a system that publicly identifies people with antibodies opens safety and privacy issues. 

The ACLU has warned against immunity passports, which it fears could incentivise poor people to risk their lives to intentionally get sick so they can work, exacerbate racial and economic disparities, encourage health surveillance and endanger privacy rights.

Eric Klinenberg, sociologist and director of the Institute for Public Knowledge at New York University, says immunity is not “the new golden ticket” it is perceived to be.

“That just opens up a Pandora’s box of questions about how we determine who’s immune, about how we record and register who’s immune, about how we track people and what happens to people who are not?” he says. “So I can very easily see it becoming yet another source of controversy in an already divided country.”

A positive antibody test may become necessary for travel – even after a vaccine – to prove immunity and as a means to skip quarantine.
A positive antibody test may become necessary for travel – even after a vaccine – to prove immunity and as a means to skip quarantine. Photograph: Toby Melville/Reuters

During the 19th century in the American south, yellow fever – which had a 50% death rate – created an “epidemiological hierarchy” of those who had and had not had it, says Kathryn Olivarius, assistant professor of history at Stanford University.

This, she adds, created “immunocapital” that affected newly arrived white people’s ability to get jobs, homes and insurance policies, which meant they had little option but to try to get infected.

Olivarius fears a similar situation could be created today if employers start hiring only people with antibodies. “I’m worried we’ll develop this system, the haves of immunity, the have-nots, it sounds science fictional almost.”

Immune status could also result in discrimination. Last month, it was revealed that the US military was considering banning people who had been hospitalised by coronavirus from enlisting – guidance it has since walked back.

There is, Olivarius warns, “a fine line between privilege and stigma”. “Even if there are benefits to being immune potentially, like being able to work, maybe later immunity could turn into a kind of stigmatised status.”

But according to Cathy O’Neil, mathematician and author of Weapons of Math Destruction, it is unlikely that immunity will grant people much power, considering brown and black people are the ones hardest hit by the virus and therefore the most likely to be immune.

“Most powerful people in this country will not have immunity and they will not set up a system that excludes them from things that they like to do.”

It’s possible that, given regional differences in infection rate and its distribution in the population, only a very small number of people in some areas would actually be eligible for an immunity certificate. And the concept may be most compelling now, as the public anxiously awaits a vaccine. 

But once one is developed, O’Neil predicts the advantages of any immunity certificates will fade. The infrastructure set up to track it, however, would probably live on.

“I do worry that it’s like we’re welcoming our algorithmic overlords to our lives in order to deal with this public health menace,” she says. “And then we’ll be stuck with them.”