Dr Abdul Ghafur, Consultant in Infectious Diseases, Apollo Hospital, Chennai, Coordinator, Chennai Declaration explains why the WHO as well as our Government should issue ‘COVID recovered’ certificates to all individuals recovered from COVID would be equivalent of having over 15 lakh soldiers in our national effort to alleviate the economic consequences and poverty inflicted by the COVID pandemic
COVID-19 pandemic has resulted in the death of hundreds of thousands of individuals at the global level. The prompt response of countries and international organisations such as the WHO has prevented several times more casualties. The lockdown at the global, regional, and local levels played a significant positive role in the COVID control. Unfortunately, global lockdown also resulted in the loss of trillions of dollars to the global economy, with several million citizens losing their jobs in many countries, including ours.
No doubt we may be able to resume the economic activities only gradually, without risking a massive second wave of the outbreak. Unrestricted travel will result in further dissemination of the virus. One of the most important reasons for the economic crisis is the existing travel restriction locally and globally. Since January this year, more than 18 million individuals have contracted the virus. We do know that those individuals recovered from infection are immune to reinfection, though the period of this protection is unknown. The exact mechanism of the immunity and the relative contributions of antibody and the cell-mediated immunity, are still being worked out by the scientific community.
But we are indeed confident of one aspect- so far, we haven’t witnessed any significant challenge of large-scale reinfection. Currently, six months after the emergence of SARS-CoV-2, there have been no confirmed cases of SARS-CoV-2 reinfection (as per the US CDC). There are a few anecdotal reports of a hand full of potential cases of reinfection (or reactivation), though the situation may change in the future. However, up until now, reinfection is not a serious concern. If reinfections were a significant issue; by now, we could have had tens of thousands of cases of reinfection at the global level, if not more.
COVID infected individuals, after their complete recovery (at least three weeks after diagnosis of the infection), should be permitted to travel without restrictions at regional and global levels. These individuals should be viewed as soldiers in our war against COVID.
Most families will have at least one member who has been COVID recovered. Most companies will have employees who are COVID recovered. Allowing these individuals to travel and work freely, would be equivalent of having over 15 lakh soldiers in our national effort to alleviate the economic consequences and poverty inflicted by the COVID pandemic. They can serve as front line workers in fields of employment such as healthcare, law enforcement, media and other organisations (both private and public sector). They can travel by road, rail and air without restrictions. They can be encouraged to execute jobs that require national and international travel (without quarantine) that would potentially be riskier to the individuals unsensitised to the SARS-CoV-2 virus.
This certificate will help lakhs of daily wage workers even in containment zones in our country to commute and make a living. Tens of thousands of individuals join the COVID recovered list on a daily basis, strengthening our army of COVID recovered and immune warriors, ready to contribute actively to our economy.
As the relative contributions of various types of immunity mechanisms are not yet fully delineated, we don’t have to depend on antibody testing and immunity passports. Antibody testing has caveats with false positivity and false negativity reports and cross reactivity with other common corona virus infections. Hence, “Immunity passports” based on antibody testing may be unreliable.
But PCR testing is the gold standard in the diagnosis of COVID infection. Union health ministry and state Governments have all the details of the COVID PCR positive patients in our country and, can just easily, issue a “COVID recovered” certificates to these individuals with a validity of three to six months or more. Based on the presence or absence of significant and genuine reports of reinfections in the future, we can revoke or extend these certificates.
Of course, we need to advise these COVID recovered individuals on the importance of strict adherence to hand hygiene, masking, and social distancing, at the best possible level. There is no doubt the availability of an effective vaccine may help us ease the travel and work restrictions further, as most of the Indian population is still naive to the virus.
World Health Organisation should seriously consider recommending the strategy of issuing COVID recovered certificates. Our Government should issue ‘COVID recovered’ certificates to all individuals recovered from COVID. We have the moral and ethical responsibility to initiate all measures to alleviate the economic and social hardships of millions of our fellow citizens.