The State of COVID-19: COVID Passports

As COVID-19 vaccines become available, a massive effort is underway to track the vaccinations of millions of people. This is vital to ensure that everyone gets vaccinated,  are vaccinated properly,  do not miss a shot, and that they get booster shots for virus variants if needed.

This effort is joined by a struggling program to track people who have had COVID-19 and recovered. Often, the word being used to discuss these tracking efforts is “passport.”

Not all passports are created equal.

The current effort  to track vaccinations as well as  those who have recovered is essential. But it cannot be the end of our tracking efforts. If it is, we run the risk of reigniting the pandemic.

To achieve maximum safety, we must begin to track immunity itself.

This article is part of an on-going series that closely examines COVID-19 from several angles. We have already looked closely at testing. Later on, we will explore vaccines and the virus itself.

This installment of the State of COVID-19 focuses on the state of “Passports.” This article will be broken into two parts:

Let’s look at the types of  COVID-19 passports.

Types of COVID-19 Passports

The word “passport” might make you think of jet-setting around the world. While there is an effort underway to establish COVID-19 specific travel documentation, that is not what I want to talk about today.

I want you to think of the word “passport” as a systematic, organized monitoring of your “travel” through a disease or viral infection. In  much the same way as your actual passport is stamped when you cross an international border, your “virus passport” is stamped when you cross a specific point on your path to full and long-lasting immunity.

There are three paths someone can take on his or her journey through COVID-19:

Recovery Tracking

COVID-19 Recovery Tracking

Vaccine Passport

COVID-19 Vaccination Passport

Verified Immunity Passport

COVID-19 Verified Immunity Passport

There is currently no national policy regarding the tracking of recovery, vaccinations, or immunity. Patients, doctors, and health professionals are doing their best, thus far, to track everyone’s progress through these various processes.

We can—and we must—do better. A standardized system for tracking these three key categories is integral to maximizing the vaccines’ effectiveness and ensuring that when we return to normal, we stay there.

Let’s take a look at each “passport” and what they can tell us.

TYPES of COVID-19 PASSPORTS

Name

Recovery Tracking

Vaccine Passport

Verified Immunity Passport

First “Border Crossing:”

Initial Symptoms Arrive.

May or may not include positive diagnostic test.

1st Shot Received.

Antibody Test Administered

Final “Border Crossing:”

Symptoms Subside. May or may not include negative diagnostic test

2nd Shot Received.

Potential additional “border crossing” with booster shots in the future

Antibody test results show and verify current immunity.

Continued, regular testing recommended

Documentation:

Poor.

Many who have recovered from COVID-19 did so without professional assistance. This could mean a lack of documentation altogether.

[For more on the issues here, see the rest of the article below.]

Good.

Health care professionals, along with patients, are maintaining records of vaccinations. Record keeping and documentation must be standardized and improved.

Excellent.

This passport program provides detailed documentation that individuals can use to prove current immunity. This will allow safe returns to work, travel, and other routine activities.

Safety Level Achieved:

Very Low.

We don’t know what recovery means or if it confers long-term immunity.

Unknown.

We do not yet know if vaccines provide long-term immunity.

Excellent.

Antibody testing is the only way to verify that a person is currently immune to the virus. This has the added benefit of working for both vaccinated and recovered persons.

COVID-19 Recovery Tracking

The lack of national policy has meant that necessary documentation in this category is spotty at best and, at worst, nonexistent.

We can’t realistically use the word “passport” here because so few people have been adequately monitored through the recovery process. That is why I am calling it “tracking.” But even that is an optimistic term because there are many issues to effectively track recovery.

Many people who contracted and recovered from the coronavirus never interacted with healthcare officials. These individuals were never registered in any kind of tracking system. This is due in part to following the CDC’s pragmatic, solid guidance.

The CDC’s guidelines—which are designed to keep hospitals from being overrun with patients—recommend staying home until your symptoms reach a point where you need professional medical attention.

Even in areas where the number of people who recovered from COVID-19 is closely tracked, there are still unresolved problems.

For these reasons (and more), The Atlantic recently stopped including “recovery” numbers on its official statistics page.

Recovery tracking is further complicated by the fact that we have little long-term data on the virus. We are still unsure if recovery from COVID-19 confers long-term immunity to COVID-19.

It has only been a year, so all of our data is only one year old. With more time, we will have better data. But along with better data, we need better policies and procedures.

The truth is, we simply do not know—and most likely will never know—how many people have recovered from COVID-19. This process must be dramatically improved. It may be too late to make a difference in our fight against COVID-19. But, there will be other pandemics. By the time the next one hits, we must have better recovery tracking policies in place.

Fortunately for everyone, vaccines have arrived in record time.

COVID-19 Vaccine Passport

Both vaccines currently available in America require two shots, in the shoulder, given several weeks apart. For more specific information on them, please visit the CDC’s page on the vaccines. Perhaps update with J&J; one shot!

Because both of these are two-step vaccinations, tracking is critical. Without both shots, you are not fully vaccinated. And you cannot mix shots. If your first shot is the Moderna vaccine, your second cannot be a Pfizer shot; it must be Moderna. (Are we sure?)

This issue has mandated a more organized tracking process. Most people receive a card after their first shot. This card serves two purposes:

  • It acts as a verification of the initial shot.
  • It includes information about when and where to get your second shot.

This is an excellent first step, and it has helped guide many in the first vaccination groups to safely getting their second shots. From a national standpoint, this is where vaccine tracking currently ends.

 

This card is helpful, but it is not a proper COVID-19 Vaccine Passport. The necessity for a more robust vaccine tracking program has led many people—in both the private and public sectors—to support the idea of a comprehensive COVID-19 Vaccine Passport.  And for a good reason: people want to know if their employees, coworkers, and fellow citizens are vaccinated.

 

An organized, standardized vaccination tracking program makes perfect sense. With booster shots potentially on the horizon, adequate tracking of vaccinations is a must.

The issues arise when we misunderstand what vaccination means.

COMMON MISUNDERSTANDINGS ABOUT COVID-19 VACCINES

MISUNDERSTANDING

THE TRUTH

Vaccination = Long-term Immunity

PCR, Nucleic Acid Tests, Viral RNA Tests

Vaccinations = 100% Effective

This is not true. Preliminary data suggests that Moderna’s vaccine has a 94.5% rate of effectiveness, and Pfizer’s 95%.

[Those are great! But not 100%]

Vaccinated = Not Contagious

We do not know for sure yet. More data is needed.

There is still much we don’t know about the vaccines, namely how long immunity lasts and if vaccinations confer a lack of contagiousness. These two blind spots provide COVID-19 ample room for continued spread.

A COVID-19 Vaccine Passport program is an important step in tracking the progress of the vaccine rollout and for maintaining vaccination levels in the face of potential booster shots. But it cannot track one vital detail; it cannot track immunity.

I support continued efforts toward adopting a COVID-19 Vaccine Passport Program, but it is not enough. Until we have more long-term data on these vaccines’ effectiveness, all a COVID-19 Vaccine Passport program will do is track vaccinations. It tells us nothing about immunity. This is why we must adopt immunity tracking.

COVID-19 Verified Immunity Passport

Vaccination rates do not tell us enough. We must know more in order to safely return to anything close to normal operations. The most vital piece of information right now is immunity levels.

The only way to accurately assess immunity levels is through antibody testing. This is a relatively straightforward process. A phlebotomist takes a small blood sample and sends it to a lab to be tested for antibodies.

I covered antibody testing in-depth in my last article. What I want to talk about today is how antibody testing can help us get this pandemic under control.

Unlike recovery tracking (which is a minefield of bad data) and unlike vaccine passport programs (which only tell us who has been vaccinated) a COVID-19 Verified Immunity Passport provides actionable information.

Antibody testing answers a crucial question: Are you immune right now? A Verified Immunity Passport would provide states, businesses, and organizations with a clear path forward through this pandemic.

Establishing a COVID-19 Verified Immunity Passport program requires setting up recurring antibody testing to ensure continued immunity levels. With proper documentation and tracking through the Immunity Passport, we could all safely get back to something close to normal.

A comprehensive COVID-19 Verified Immunity Passport program provides maximum safety by providing the most vital information: who is currently immune. It is also not biased toward the source of immunity. Antibody tests work on both recovered and vaccinated persons.

It is important to note that antibody testing is not a panacea. Because we still know so little about the virus, we do not yet know if the presence of antibodies in the blood means a lack of contagiousness. Proper PPE and social distancing are imperative until we get the virus under control.

The Path Forward

The only way we will safely return to normal is by using a combination of testing methods and tracking techniques. We must continue to control the virus’s spread by wearing maskssocial distancingwashing our hands, and other contaminated surfaces. We must do a better job of tracking infection and recovery. We must continue our efforts toward contact tracing. We must also get vaccinated and understand what, exactly, the vaccine does. These steps are all vital.

We also need a standardized COVID-19 Vaccine Passport program to help ensure maximum vaccination and to assist in potential booster shot administration. But we cannot stop there.

We must begin to track immunity through a COVID-19 Verified Immunity Passport program. This must include clear documentation, tracking, and routine testing.

When all of these are combined, we will have a phenomenal defense against this pandemic and a safe path back to normal. Join me again in a couple of weeks when I’ll take a look at the state of COVID-19 vaccines.

 

Marvin S. Hausman, MD, is an immunologist and board-certified urological surgeon. He has more than 30 years of drug research and development experience with various pharmaceutical companies, including Bristol-Myers International, Mead-Johnson Pharmaceutical Co., E.R. Squibb, Medco Research, and Axonyx. Dr. Hausman founded Medco Research, which in the 1980s became one of the top contract research organizations (CRO) and a successful pharmaceutical company. At Axonyx, Dr. Hausman successfully licensed in and developed inhibitors for acetyl and butyrylcholinesterase and the drug Posiphen®, a compound that inhibits synthesis of amyloid precursor protein (APP). Dr. Hausman has done residencies in General Surgery at Mt. Sinai Hospital in New York and in Urological Surgery at UCLA Medical Center. He received his medical degree from New York University School of Medicine.

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*DISCLAIMER: This information should not be considered comprehensive and is not a substitute for discussing these matters with your doctor or medical professional. Please consult with your insurance company, your doctors, and all applicable health professionals for personalized advice and information regarding COVID-19 and your health.  

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