This post will attempt to answer the following questions:
- How can we get people back to work and restart the economy without increasing spread of disease?
- How do we make sure people who are allowed back in the workplace are not a risk to the population as a whole?
- How do we enforce this?
14 days after my recovery from COVID-19, even after I was no longer contagious, I was surprised by the accusing glares and distrust I was receiving. It was a bit disturbing. I felt like an outcast as if I was wearing a scarlet letter or mark of Cain. This was in spite of the clear evidence that, since I had recovered, I was almost certainly no longer contagious (for why you can read here).. I was not a threat, in fact, I was one of the safest people to be around. The reason people were so cautious was probably driven by fear overriding rational thought.
I’m sure mine is not a unique experience. It occurred to me that this problem of trust and fear will likely impede our collective recovery from the virus both in terms of our health but also economically. In reality, people who have been infected and recovered should be able to return to society and work without being afraid themselves and without engendering fear in others but there needs to be a way to alleviate the fear of the general public. Perhaps the greatest tragedy of COVID-19 is that people are dying alone. Because of the restrictions on visitation that have become necessary people are dropping off their loved ones at the hospital and often never seeing them again. Many of the hospitalized were in a home where other people were infected as well but recovered. Those who are immune could be allowed to sit with their dying loved ones and prevent this tragic reality.
Those who have recovered could reopen essential businesses and get the economy going again. Some of the millions who are out of work have had the infection and are no longer a threat could go back to their prior jobs or take other temporary jobs filling in gaps in the workforce until their own jobs are restored. They could be allowed to work in healthcare settings filling in gaps left by sick or quarantined hospital workers; they could help comfort those who are sick and alone in hospitals; or they could work as desk clerks or runners. This could free up trained healthcare workers to care for patients.
In reality, people who have been infected and recovered should be able to return to society and work without being afraid themselves and without engendering fear in others.
People who have recovered could also fill in other essential roles in society. They could visit the isolated and elderly individuals that need assistance. They could work in grocery stores (which currently is a major potential source of the spread of infection). They could take on delivery roles. The possibilities are endless. While they are helping fill in gaps for business they will also be generating income for themselves to hold them over until they can return to their prior employment.
Those who have recovered could be vital in restoring life back to normal but there are some issues that would need to be addressed first:
- How do you determine who is immune and can fill these roles safely?
- How do those who are immune identify themselves so as not to create fear and distrust?
- How do we enforce this?
Below is a brainstorm of a possible solution. There are likely many other ways to solve the above problems but I have yet to hear of anything in the works. I thought I would put my idea out there to get your thoughts. Maybe we can even make it a reality.
Step one is to identify who would be eligible to qualify as COVID immune. Step two is to create an identification that can be used to publicize their immune status. Finally, step three is to create a way to enforce the rules to make sure people who are not immune do not abuse the system and put others at risk.
Step 1: To be eligible you would need to have either:
- Tested positive for COVID-19 and have been symptom free for a period of time to be determined by the public health authorities or
- Had antibody testing documenting recovery and the presence of virus specific IgG antibodies.
Step 2: Creation of an identification card:
- The government (federal, state, or local) will set up an office to verify the person’s name and immunity via the above criteria.
- The government will issue an immunity card that is brightly colored and easily identifiable from a distance. This will contain the person’s photo (taken from their driver’s license), name, and a unique QR code. It will come with a lanyard to hang the card around your neck.
- The person will wear this card around their neck when out in public.
Step 3. How it will be enforced:
- The government will create an app with a QR reader that will be made available to the general public.
- Employers and healthcare settings will scan the QR reader to determine eligibility to return to work or to visit a healthcare setting.
- Elderly or high risk individuals could ask to scan someone’s card before allowing them to visit.
- People in general could scan the card to determine who they can come in contact with.
- Fines or other punishments will be established for employers who allow employees to return to work who do not have an immunity card and for individuals who get a card inappropriately.
Imagine if we could start coming out of our homes safely, get back to work, and start stimulating the economy.
This system creates a way for the public to feel at ease when contacting people who are immune. It allows for mass enforcement. It empowers people to identify who is safe to return to work or other high risk environments. It will create a population that can hold the hand of those who are dying.
This system will allow people to gradually fill in gaps in society and in the economy in a way that is safe. As more people become immune more gaps will be filled and more people can start stimulating the economy. This system will act as a bridge until the virus is gone or until a vaccine becomes available. It can then be shelved until the next pandemic arrives.
One obvious key aspect to this system is the need for more widely availability to testing. We need more testing to identify who is ill. We also need to develop on a mass scale testing for antibodies to determine who is immune. This is something that is necessary for preventing the spread as well.
Someone needs to start planning for the transition out of this mess now so that we can minimize the terrible economic damage left in the wake of the virus. Imagine if we could start coming out of our homes safely, get back to work, and start stimulating the economy. If the plan is not set in motion now, we will be left in a position where many immune and recovered people are stuck at home unnecessarily when they could be out improving the situation.
If you agree with my idea or have helpful feedback, I’d love to hear it. I would love to get an audience with my governor (Larry Hogan of Maryland), your governor, the president, mayor, or anybody who will listen. Let’s work together to make it happen.
14 thoughts on “How we can get out of this crisis”
Totally agree – my husband is an ICU doc. We will do anything at all to help further this initiative. It’s imperative!
Send this to post to all your state government officials: City of Baltimore, the counties, state lawmakers,your governor, and your House of Representatives and your Senators. Department of Health. There must be some agencies open that could look this over!
Excellent concepts. I thought of some of these as well, but not as comprehensively and coherently as you. There is nothing I can do to help in this effort except to offer encouragement and share your post. Good luck to all of us!
Sharing the post is all I ask. Thanks so much!
Those who are immune can still spread infection though, no?
They would still have to wash their hands and wear appropriate PPE because they could carry it on their hands and clothes but they would not spread it through their respiratory droplets.
Hi Dan, Sounds like you are on the mend! I posted your blog to my FB page and one of my peeps shared it. Also got 6 likes. Be well and hag sameach to you and your beautiful family!
A. Sheila Sent from my iPhone
Hello Dr G, I have lots to say about the first part of your post. First, l’m sorry you were feeling like an outcast upon your return to work. I wasn’t there, or we could have chatted. I would like to share my thoughts, and I believe the thoughts of others as well.
When I heard you were positive, I felt all kinds of feelings, including sad for you, and scared for everyone, including your family. I then heard you went to a gathering of more then 10, after Governor Hogan had put in effect a ban of, no gatherings of more then 10. I then felt very disappointed, then angry, very angry at you. How dare you put our lives, and our families, and others lives at risk like that. I thought it was irresponsible, selfish, cocky, careless, and wreak-less, on your part, when you knew you had to come to work on Monday, and jeopardize an entire unit in a hospital. You being an ICU doctor, pulmonologist, of all doctors, you should have known better, and had been setting a better example. I really don’t think you realize just how many lives your decision to do this had/has effected.
Now, I understand we are health care workers, and we are all at more risk for getting this, but we were working really hard on making sure we had all the proper PPE, reviewing policy, and videos of how to don and doff properly, making changes to our environment, and on and on. So imagine the shock of finding out that the virus came in from the back door, when we were working so hard to protect ourselves from the front door. Just imagine that for a minute. So, my question to you is, the day you returned to work, did you gather the people there, and apologize for your bad choice, and jeopardizing the unit and there families?
So now it seems as though you are sounding a little like we, the ones who have not gotten sick, are the problem. I would like to ask you to please keep that in mind as we move forward. I get what you are saying, but it is still the majority of us out there, that have not gotten the virus.
Since 25-50% of people with COVID are asymptomatic there is a large population of people who get infected by people for whom there was no reason to suspect they were sick. For you to imply that I somehow intentionally or negligently put myself at risk and then coldly exposed the ICU is unfair to me and to all the people who got infected through no fault of their own. I had no symptoms and no reason to believe I was infected. I followed the recommendations of all the appropriate health authorities and did not actually infect anybody in the hospital because of strict adherence to appropriate hand hygiene and PPE. The minute I developed even mild symptoms I got coverage even though the head of ID said I could round in the morning and wear a mask until I was tested. The stigma that this attitude creates is fueling the spread of disease. To blame those who get infected in spite of following all public health guidelines is unjust and will only make matters worse. I wish that you do not get this infection but that, if you do, you are not blamed by those around you.
I agree, and I’m with you, isn’t it good that I put these feelings out there so they can be discussed. I know those feelings of outcast as well with just “being an ICU nurse”. Non health care people, neighbors etc, only getting knowledge from what they hear on TV, think I’m going to give the virus to them.
Plus there’s way to much inaccurate, or info that changes from day to day, and then people don’t trust what they hear. It’s creating fear in the overkill level.
That’s one of the reasons I’m doing this.
Nicholas Christakis had a pretty good thread about this on Twitter a couple of weeks ago. https://mobile.twitter.com/NAChristakis/status/1240689935557865472
Tweets I found most interesting (detailing problems to be considered) are:
“New dystopian thought: a market will emerge over near term whereby employers will be willing to pay more to (and compete for) workers with serologically documented COVID19 immunity. This is a scary thought in very particular ethical ways that I’ll need to think more about.”
” This thread nicely illustrates some difficulties w applying serological tests (or any tests) to large & low prevalence population. Even if test is very good, if disease is uncommon, false positives will overwhelm true positives. “PVP” will be low. [link to thread] ”
Don’t get me wrong I totally agree with you – – this is the only way forward. But I also find both of these problems to be both interesting and important to consider (and try to troubleshoot). Interested to hear your thoughts!
I agree but we shouldn’t let perfect be the enemy of good. The reality is going to be terrible with no intervention. If the unintended consequences are less terrible the consequences of not implementing the intervention we should do it .