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As people clamor for coronavirus antibody tests, could ‘immunity passes’ be next?

Lori Winer, 39, of Walpole, had an antibody test at PM Pediatrics in Dedham. She was sick in March with COVID-19 symptoms, including loss of taste and smell, and is dealing with a COVID stress-induced bout of alopecia, which causes hair loss.
Lori Winer, 39, of Walpole, had an antibody test at PM Pediatrics in Dedham. She was sick in March with COVID-19 symptoms, including loss of taste and smell, and is dealing with a COVID stress-induced bout of alopecia, which causes hair loss.Suzanne Kreiter/Globe staff

Across Massachusetts, people have begun lining up for blood tests to learn whether they were previously infected with the coronavirus and now possess antibodies that could give them immunity.

“The first thing I’d do is run over and attack my niece with kisses and hugs and say, ‘I’m OK, I already had it!’” said Lori Winer, 39, after being tested last week in Dedham.

But the newly available tests aren’t just appealing to people who yearn for pre-pandemic activities. They have also captured the attention of businesses and governments desperate to safely reopen the economy, raising the possibility that people whose blood contains COVID-19 antibodies would be able to obtain “immunity passports.”

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Such passes, which could be physical cards or smartphone QR codes, could allow people who aren’t at risk of spreading or contracting the virus to be freed from social distancing restrictions. They could even gain access to eat in restaurants, fly on planes, attend sports games or concerts, live in university dorms, and work in public-facing jobs.

The CEO of Delta Airlines raised the prospect last month of the authorities potentially requiring immunity passports for travelers. American, British, French, and German officials have all said they are considering such passes to help get people back to work. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said the idea “might actually have some merit, under certain circumstances.”

Public health specialists say antibody tests are useful to grasp the true reach of the pandemic and the virus’s mortality rate. And some have advocated for strategically deploying immune workers to care for infectious coronavirus patients and to protect vulnerable nursing home and cancer patients.

But using antibody tests as a way to broadly return to some semblance of normalcy remains highly controversial. Health experts question the reliability of the tests, most of which have not been fully vetted by regulators. And it’s still unclear whether the presence of antibodies confers immunity to the virus, to what degree, or for how long.

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Chloe Fren, 16, and her mother, Michelle Fren, received antibody tests at PM Pediatrics in Dedham in early May to determine whether an illness months ago could have been COVID-19.
Chloe Fren, 16, and her mother, Michelle Fren, received antibody tests at PM Pediatrics in Dedham in early May to determine whether an illness months ago could have been COVID-19. Suzanne Kreiter/Globe staff

Even if the science were clear, experts also warn of the dangers of granting privileges based on immunity, which could justify discrimination based on age and health, exacerbate racial and economic inequalities, and even motivate people to risk their lives by purposefully getting infected.

“If employers say, ‘You have to have antibodies to keep your job,’ or ‘You have to prove you have antibodies to get a job in the first place,’ it will create a two-tiered economy,” said Kathryn Olivarius, a Stanford University history professor. “Quite the rational choice will be for people to take on a lot of epidemiological risk to keep their jobs.”

This has happened before, Olivarius said: In New Orleans during the 1800s, employers required passes verifying recovery from yellow fever, which killed half those infected. To get jobs, people rolled in the bed sheets of recently deceased victims to try to infect themselves.

So far, COVID immunity passes remain largely theoretical, but the concept is starting to take shape.

Chile is pressing ahead with the world’s first “release certificates” for recovered patients, which would exempt people from curfews and other restrictions. Socios, a company that promotes European professional soccer teams, is making a pitch to the teams and the health authorities about a smartphone app for fans to be able to show their antibody test results for admission to games.

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“We can help the sports team actually have people, fans, being able to go back to the stadium,” said Socios’s chief executive, Alex Dreyfus. That would benefit not only the team owners, but also the thousands of people who earn a living serving food to fans or cleaning after matches, Dreyfus said.

The idea, while tantalizing, is at odds with current science. The World Health Organization recently warned against the use of immunity passports, saying that most people who have recovered from the coronavirus probably have “some level” of protection from reinfection, but there is “no evidence” they’re immune.

Epidemiologists believe, based on their knowledge of other viruses, that recovery from COVID infection is likely to confer some immunity for at least three months to a year, or possibly longer. But no studies have proven that, or whether mild cases are just as protective as severe ones, or whether people with antibodies could still be contagious.

Despite the unanswered questions, antibody tests are a helpful tool for health authorities to gauge the pandemic’s trajectory.

The tests, which typically cost $50 to $120, are offered at doctors’ offices, urgent care clinics, and private labs. The state is notified of any positive test results. Some places may require a doctor’s order, which insurers may cover, while others, like Quest Diagnostics, allow anyone to purchase one.

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Researchers are also randomly testing people to understand how much of an area’s population is still susceptible to the virus if there’s a second wave of infections. In hard-hit Chelsea, nearly one-third of 200 people randomly tested were found to have the antibodies. Researchers are randomly testing 1,000 Boston residents.

Antibody, or serology, tests, will be “an important part of recovery from this pandemic and will be especially important for surveillance to help assess the true number of people exposed to the virus," said Dr. Catherine Brown, state epidemiologist at the Massachusetts Department of Public Health. Besides that, she said, the tool “should be used sparingly and with a solid understanding of its limitations.”

PM Pediatrics urgent care, which tests children and their families in Dedham, said it counsels people that a positive result does not mean immunity or that someone can stop wearing masks and practicing social distancing.

The company said its test has an 80 percent chance of correctly identifying those with antibodies and a 98 percent chance of correctly identifying those without them. That means there is a 2 percent chance that someone without antibodies could receive a false-positive result.

“We’re very careful to tell people, ‘Look, don’t let this create a false sense of security,’” said Dr. Christina Johns, senior medical adviser. She said the tests are useful for people to learn their health histories, but the science isn’t adequate yet for the results to be used as “the definitive hall pass.”

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In a report, public health specialists at the American Enterprise Institute suggested people with immunity could be used to serve in high-risk roles, such as on the front lines of health care, and support the elderly and other vulnerable people in quarantine.

Several Boston hospitals said they’re not using employees who have recovered from COVID in any positions other than their normal jobs. But they acknowledged the attractiveness of the idea, if the science catches up.

“For health care workers, you wouldn’t have to be anxious every single day," said Dr. Shira Doron, hospital epidemiologist at Tufts Medical Center. But, she added, the concept of immunity passes being used broadly in society “worries me a lot.”

Scholars warn the passes could violate the Constitution. In a report, Harvard’s Edmond J. Safra Center for Ethics said immunity certificates would probably be permissible only if everyone had equal access to testing and immunity didn’t grant any special privileges not conferred by a recent negative COVID test.

The Massachusetts Restaurant Association said it’s likely to discuss the concept with the state Department of Public Health in determining how to safely reopen eateries.

Colleges, too, are interested. A Boston University committee is considering the possible role of antibody tests in reopening campus, but until the tests are more trustworthy and it’s clearer how long immunity lasts, the idea is “premature,” said Dr. David Hamer, professor of global health and medicine.

“Right now, we are not going to include serological testing like an immunity test as part of the process," Hamer said. “In the future, it could be useful.”

Correction: Based on incorrect information provided by the company, an earlier version of this story misstated the accuracy of antibody tests used by PM Pediatrics. The tests have a 2 percent chance of producing a false-positive result in someone without antibodies.


Naomi Martin can be reached at naomi.martin@globe.com. Hiawatha Bray can be reached at hiawatha.bray@globe.com. Follow him on Twitter @GlobeTechLab.