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COVID-19 ‘immunity passports’ pose range of issues

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A grieving widower played by Matt Damon flashes a shiny coded wristband for security guards to scan in the 2011 movie “Contagion.”

After a quick beep and a green light, Damon is allowed into a store to buy a prom dress for his daughter.

That wristband was an “immunity passport” — a certification of his character’s immunity to the movie’s deadly virus.

With fiction quickly becoming reality, immunity passports are now being touted as a means to reopen the world following COVID-19 lockdowns. But experts worry that a host of practical and ethical problems make the concept unworkable and potentially dangerous to privacy and liberty.

Governments and private businesses are currently developing similar programs that would allow people who have proven immunity against COVID-19 to move freely about, without hewing to social distancing guidelines or public health measures.

For example, Chile is issuing three-month “medical release certificates” to people who have recovered from COVID-19, and Britain has announced plans to issue “antibody certificates” to those who test positive for coronavirus antibodies.

The private sector is moving even more rapidly toward adopting immunity passports, said Natalie Kofler, a lecturer with Harvard Medical School’s Center for Bioethics.

“You have these private companies developing these immunity passport apps,” Kofler said. “You have them partnering with other private businesses to help them use these immunity passports as ways to limit access either for customers or employees.”

But there are fundamental problems with these immunity passports, in terms of how they would work and how they would be used, Kofler and other experts say.

Antibodies may equal immunity

At this point, medical science can’t even say whether a person who has recovered from COVID-19 is indeed immune from the disease, or if the presence of coronavirus antibodies in your bloodstream conveys any level of immunity, said Gigi Kwik Gronvall, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

For example, people might need a certain level of coronavirus antibodies in their blood to be immune, Gronvall said. Immunity might not even depend on antibodies at all instead, other factors like the immune system’s innate memory might be the only thing that would prevent reinfection.

Worse, the accuracy rate of current antibody tests is so iffy that a person without immunity might actually get a false positive, getting a passport they shouldn’t have and increasing their risk of catching and spreading the virus, Kofler said.

Guidelines issued last week by the U.S. Centers for Disease Control and Prevention state that given their lack of accuracy, antibody test results “should not be used to make decisions about grouping persons residing in or being admitted to congregate settings, such as schools, dormitories, or correctional facilities,” or to “make decisions about returning persons to the workplace.”

“While I do think that there is a degree of immunity that individuals who have recovered from COVID possess, it will be very hard to operationalize an immunity passport,” agreed Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
“There are many questions about immunity, including its duration, its durability, and how to measure it that makes it difficult to rely completely on. That said, I do believe those with antibodies — as assessed by a highly specific test — do have some protection for a period of time from reinfection,” Adalja said.

Even if antibody tests say something meaningful, there’s not nearly enough access to testing to conduct an immunity passport program in a fair manner, said Françoise Baylis, a professor of ethics at Dalhousie University in Nova Scotia, Canada.

Nations would need at least double as many test kits available as there are citizens in their country, to conduct an equitable program, she said.

“In theory, you test everybody once, but not everybody is going to test as having been exposed to the virus and having recovered from COVID-19,” Baylis said. “So you’ve got to at least offer people a second chance, right? That gets you to two tests. People might fail this on the second attempt as well, so you’re going to have to be constantly able to test your population.”

There are 38 million people in Canada, but that country has said it would only be able to conduct 1 million antibody tests within the next two years, Baylis noted.

“What happens to the other 37 million Canadians?” she asked.

The United States would need even more tests — 660 million tests at minimum, to offer at least two opportunities for each of the country’s 330 million residents.

A small percentage infected

Additionally, too few people have been infected with COVID-19 at this point to make immunity passports a linchpin for reopening the economy in the United States or elsewhere.

Only 2 percent to 3 percent of the global population has recovered from the coronavirus, Kofler noted.

“A business isn’t going to want only 1 percent to 2 percent of their customers able to enter their store,” Kofler said. “You’re not going to be able to run a business if only 1 percent to 2 percent of your employees are able to work freely.”

Baylis noted that even in COVID-19 hotspots, only 15 percent to 30 percent of people have recovered from infection.

“You don’t reopen the economy with 30 percent of your population,” Baylis said.

Beyond those practical concerns, there also are ethical roadblocks to instituting an immunity passport program, experts said.

Privacy is a problem

A physical passport worn by a recipient would “make it very easy to tell across the street if somebody has a wristband that signifies them as immune or not immune,” said Dakota Gruener, executive director of the ID2020 Alliance, a global public/private alliance focused on the development of digital ID programs.

Gruener said many also are uncomfortable with the notion of centralized databases maintained by government organizations that would be “pinged” every time someone is asked to prove their COVID-19 immunity.

Gruener favors a decentralized system, where a person would carry their immunity passport around with them on their smartphone.

“Your data remains your own, stored locally on your own device,” Gruener said.

But what if you don’t have a smartphone because you can’t afford one? What if you can’t afford to be tested in the first place? Economic concerns like these would put people who earn less money at a disadvantage, Baylis said.

Experts also are concerned that authorities would use immunity passports as one more means of harassing blacks and other minorities, promoting “stop-and-frisk” policies.

“We see this as one more reason to stop somebody who’s freely walking about to be able to demand, ‘Do you have the right certification to be out in public?'” Baylis said.

These sort of concerns are being bulldozed by companies eager to get folks back to work, Gruener said, and officials and ethicists need to work with private firms to make sure these problems are addressed.

But Baylis countered that any efforts by private companies to develop immunity passports should be halted, rather than accommodated.

“It’s wrong to allow the private sector to answer that question for us and then to think that society, by its governance, just has to respond by putting parameters that would somehow satisfy certain kinds of ethical or social concerns,” Baylis said.

“The first question is whether we should be doing this,” Baylis said. “Only when you answer that question in the affirmative do you then move on to the second series of questions about how we do this ethically.”

More information

The U.S. Centers for Disease Control and Prevention has more about COVID-19.

Copyright 2020 HealthDay. All rights reserved.



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Antidepressant might help prevent severe COVID-19

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The antidepressant drug fluvoxamine — best known by the brand name Luvox — may help prevent serious illness in COVID-19 patients who aren’t yet hospitalized, a new study finds.

The study included 152 patients infected with mild-to-moderate COVID-19. Of those, 80 took fluvoxamine and 72 took a placebo for 15 days.

By the end of that time, none of the patients who took the drug had seen their infection progress to serious illness, compared with six (8.3%) of the patients who took the placebo, according to researchers at Washington University School of Medicine in St. Louis.

“The patients who took fluvoxamine did not develop serious breathing difficulties or require hospitalization for problems with lung function,” said first author Dr. Eric Lenze, professor of psychiatry.

“Most investigational treatments for COVID-19 have been aimed at the very sickest patients, but it’s also important to find therapies that prevent patients from getting sick enough to require supplemental oxygen or to have to go to the hospital. Our study suggests fluvoxamine may help fill that niche,” Lenze noted in a university news release.

Fluvoxamine — widely used to treat depression, obsessive-compulsive disorder and social anxiety disorder — is a type of drug called a selective serotonin-reuptake inhibitor (SSRI). This class of drugs also includes medicines such as Prozac, Zoloft and Celexa.

But unlike other SSRIs, fluvoxamine has a strong interaction with a protein called the sigma-1 receptor, which helps regulate the body’s inflammatory response.

“There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules,” explained study senior author Dr. Angela Reiersen, associate professor of psychiatry.

“Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients,” she said in the release.

By reducing inflammation, fluvoxamine may prevent a hyperactive immune response in COVID-19 patients. That, in turn, may decrease their risk of serious illness and death, Reiersen said.

“Our goal is to help patients who are initially well enough to be at home and to prevent them from getting sick enough to be hospitalized,” Dr. Caline Mattar, assistant professor of medicine in the Division of Infectious Diseases, said in the release. “What we’ve seen so far suggests that fluvoxamine may be an important tool in achieving that goal.”

Dr. Amesh Adalja is a senior scholar at the Johns Hopkins Center for Health Security in Baltimore. He wasn’t involved in the study, but said the research is “notable not only because of its positive outcome — we desperately need a medication that keeps COVID patients out of the hospital — but also because of the manner in which it was conducted.”

But Adalja stressed that a larger trial is needed “to see if the promising findings hold up.”

The researchers said they plan to begin such a study in the next few weeks and it will include patients from across the United States.

The preliminary study was published online Nov. 12 in the Journal of the American Medical Association.

More information

For more on COVID-19, go to the U.S. Centers for Disease Control and Prevention.

SOURCES: Amesh Adalja, M.D., senior scholar, Johns Hopkins Center for Health Security, Baltimore; Washington University in St. Louis, news release, Nov. 12, 2020

Copyright 2020 HealthDay. All rights reserved.



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Survey: 40% in U.S. planning large gatherings for holidays despite COVID-19 warnings

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Nov. 12 (UPI) — Nearly 40% of U.S. residents plan to participate in gatherings of 10 or more people this holiday season despite concerns over the spread of COVID-19, according to the findings of a survey released Thursday by Ohio State University.

In addition, one-third of respondents said they wouldn’t ask attendees at holiday parties with family or friends to wear masks, and just over 25% indicated that they wouldn’t practice social distancing, the data showed.

“We’re going to look back at what happened during this holiday season and ask ourselves, ‘Were we part of the solution or were we part of the problem?'” Dr. Iahn Gonsenhauser, part of the team that conducted the survey, said in a statement.

“When you’re gathered together around the table, engaged in conversation, sitting less than 6 feet apart with your masks down, even in a small group, that’s when the spread of this virus can really happen,” said Gonsenhauser, chief quality and patient safety officer at Ohio State University Wexner Medical Center.

Researchers at Ohio State surveyed more than 2,000 U.S. residents on their holiday plans in the context of the COVID-19 pandemic.

As of Thursday afternoon, nearly 10.5 million people nationally have been sickened by the virus, and more than 240,000 have died, according to figures from Johns Hopkins University.

In recent weeks, federal, state and local public health officials have advised against traveling or partaking in large social gatherings as the holiday season approaches to limit the risk of spreading the new coronavirus to vulnerable loved ones.

At the very least, they’ve asked that gatherings not happen without wearing a mask and practicing social distancing, or staying 6 feet apart.

Those at risk for severe COVID-19 include the elderly, as well as those with diabetes, heart disease and high blood pressure, all of which are common across the United States, according to the Centers for Disease Control and Prevention.

Still, 38% of respondents to the Ohio State survey indicated they would host or attend a gathering with 10 or more people during the holidays and 33% would not ask others to wear masks, the researchers said.

However, 73% of respondents said they would practice social distancing during the holidays and 79% suggested that they would celebrate or gather only with people with whom they live, the data showed.

Just over 80% indicated that they would ask family and friends invited to events not to come if they had symptoms of COVID-19.

“If you have someone in your household who’s high risk and you’re in a low incidence area, you’re going to want to think twice about having a celebration where people are coming from an area where there’s a lot of virus in the community,” Gonsenhauser said.



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Healthy diet, exercise good for heart regardless of medication use

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No matter how many medications you take, eating a healthy diet, not smoking and getting plenty of exercise will help keep you alive, a new study finds.

“We’ve long known about the benefits of leading a healthy lifestyle. The results from our study underscore the importance of each person’s ability to improve their health through lifestyle changes even if they are dealing with multiple health issues and taking multiple prescription medications,” said researcher Neil Kelly. He’s a medical student at Weill Cornell Medicine of Cornell University in New York City.

For the study, Kelly’s team collected data on more than 20,000 people who took part in a study on racial differences in stroke.

At the start of the study, 44% of participants were taking four or fewer prescription medications, 39% were taking five to nine, and 17% were taking 10 or more medications.

After about 10 years, the researchers found that a healthy lifestyle reduced the risk of death during the study period regardless of the number of medications a person was taking, and the more healthy lifestyle habits one had, the lower the risk of death.

The findings were scheduled for presentation at the American Heart Association’s virtual annual meeting, Nov. 13 to 17. Such research should be considered preliminary until published in a peer-reviewed journal.

“It’s especially important for health care professionals to counsel patients and develop interventions that can maximize healthy lifestyle behaviors, even among patients with several prescription medications,” Kelly said in an AHA news release.

“It’s important for the public to understand that there is never a bad time to adopt healthy behaviors. These can range from eating a healthier diet to taking a daily walk in their neighborhood,” he added. “A healthier lifestyle buys more time.”

More information

For more on a healthy lifestyle, head to the American Heart Association.

Copyright 2020 HealthDay. All rights reserved.



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