COVID-19 Immunity Passport to Ease Travel Restrictions?

Chen, Lin H.; Freedman, David O.; Visser, Leo G.

doi:10.1093/jtm/taaa085

Cited by 58 publications

(44 citation statements)

References 10 publications

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“…Since early on in the COVID-19 pandemic, it has been suggested that serological tests could be used to issue so-called 'immunity passports' [18][19][20]. This has caused heated discussions about potential ethical, equitable and legal implications as well as public health ramifications due to potentially increased/encouraged risky behavior by 'immunity passport' holders [17,21].…”

Section: Discussionmentioning

confidence: 99%

Two-tiered SARS-CoV-2 seroconversion screening in the Netherlands and stability of nucleocapsid, spike protein domain 1 and neutralizing antibodies

Garritsen¹,

Scholzen²,

Nieuwenhof³

et al. 2020

Preprint

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Serological testing in the COVID-19 pandemic is mainly implemented to gain sero-epidemiological data, but can also retrospectively inform about suspected SARS-CoV-2 infection. We verified and applied a two-tiered testing strategy combining a SARS-CoV-2 receptor-binding domain (RBD)-specific lateral flow assay (LFA) with a nucleocapsid protein (NCP) IgG ELISA to assess seroconversion in n=7241 individuals. The majority had experienced symptoms consistent with COVID-19, but had no access to RT-PCR testing. Longitudinal follow-up in n=97 LFA+ individuals was performed up to 20 weeks after initial infection using NCP and spike protein S1 domain (S1) IgG ELISAs and a surrogate virus neutralization test (sVNT). Individuals reporting symptoms from January 2020 onwards showed seroconversion, as did a considerable proportion of asymptomatic individuals. Seroconversion for symptomatic and asymptomatic individuals was higher in an area with a known infection cluster compared to a low incidence area. Overall, 94% of individuals with a positive IgG result by LFA were confirmed by NCP ELISA. The proportion of ELISA-confirmed LFA results declined over time, in line with contracting NCP IgG titers during longitudinal follow-up. Neutralizing antibody activity was considerably more stable than S1 and NCP IgG titers, and both reach a plateau after approximately 100 days. The sVNT proved to be not only highly specific, but also more sensitive than the specificity-focussed two-tiered serology approach. Our results demonstrate the high specificity of two-tiered serology testing and highlight the sVNT used as a valuable tool to support modelling of SARS-CoV-2 transmission dynamics, complement molecular testing and provide relevant information to individuals.

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Section: Discussionmentioning

confidence: 99%

Two-tiered SARS-CoV-2 seroconversion screening in the Netherlands and stability of nucleocapsid, spike protein domain 1 and neutralizing antibodies

Garritsen¹,

Scholzen²,

Nieuwenhof³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…As countries take tentative steps towards the relaxation of stringent border control measures, the future landscape of international travel is being hotly debated [104]. Inevitably, travellers with pre-existing conditions will face uncertainty about their medical fitness to fly in particular until, or if, an effective vaccine against SARS-CoV-2 has been developed.…”

Section: Future Directions and Research Prioritiesmentioning

confidence: 99%

COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations

Flaherty

Hession

Liew

et al. 2020

Trop Dis Travel Med Vaccines

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Background: A high burden of severe disease and death from the coronavirus disease 2019 (COVID-19) has been consistently observed in older patients, especially those with pre-existing medical co-morbidities. The global pandemic lockdown has isolated many patients with chronic illnesses from their routine medical care. This narrative review article analyses the multitude of issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. Methods: Sources for this publication were identified through searches of PubMed for articles published between 31st December 2019 and 4th June 2020, using combinations of search terms. Guidelines and updates from reputable agencies were also consulted. Only articles published in the English language were included. Results: The volume of literature on COVID-19 continues to expand, with 17,845 articles indexed on PubMed by 4th June 2020, 130 of which were deemed particularly relevant to the subject matter of this review. Older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with preexisting cardiovascular disease, especially hypertension and coronary heart disease, are at greatly increased risk of developing severe and fatal COVID-19 disease. A controversial aspect of the management of COVID-19 disease has been the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Obese COVID-19 patients are more likely to require complex ICU management. Putative mechanisms of increased COVID-19 disease severity in diabetes include hyperglycaemia, altered immune function, sub-optimal glycaemic control during hospitalisation, a pro-thrombotic and pro-inflammatory state. Patients with mental health disorders are particularly vulnerable to social isolation, and this has been compounded by the suspension of non-emergency care in hospitals around the world, making it difficult for patients with chronic mental illness to attend outpatient appointments.

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“…The concept of an ‘immunity passport’ has been advanced, whereby serologic evidence of SARS-CoV-2 antibody production indicates immunity to a second infection. 2 In the case of international travel, such ‘risk-free certificates’ could reassure an anxious travelling public and potentially satisfy national border control requirements. Immunity passports already exist in public health and travel medicine.…”

mentioning

confidence: 99%

Immunity passports to travel during the COVID-19 pandemic: controversies and public health risks

Liew

Flaherty

2020

Journal of Public Health

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As countries emerge from pandemic lockdown, many countries are relaxing international travel restrictions. Commercially available serologic tests for anti-SARS-CoV-2 antibodies are being performed. The concept of an ‘immunity passport’ has gained popularity, whereby evidence of SARS-CoV-2 antibody production would signal immunity to reinfection. For an immunity certificate to be validated for travel purposes, it should meet certain criteria. The introduction of such certificates faces multiple challenges. While there may be a future role for immunity passports in limited circumstances in the event that a protective vaccine becomes freely available, for now at least the risks of such an approach outweigh the perceived benefits.

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COVID-19 Immunity Passport to Ease Travel Restrictions?

Cited by 58 publications

References 10 publications

Two-tiered SARS-CoV-2 seroconversion screening in the Netherlands and stability of nucleocapsid, spike protein domain 1 and neutralizing antibodies

Two-tiered SARS-CoV-2 seroconversion screening in the Netherlands and stability of nucleocapsid, spike protein domain 1 and neutralizing antibodies

COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations

Immunity passports to travel during the COVID-19 pandemic: controversies and public health risks

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