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Why Chilean coronavirus immunity cards might be a waste of time

The Chilean government plants to certify people who are "immune" to COVID-19, but we don't know if this strategy can work.

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Chile is asking itself the same question as all the other countries: when is "this" going to end, when will we be able to return to the life we knew before the pandemic, or at least how to begin to recover what used to be normal life, starting with circulation and the economy.

As a first response, the Chilean Ministry of Health has announced that this week it will begin issuing the "Carnet COVID-19", a document with which it hopes to distinguish those who have developed antibodies against the coronavirus.

In principle, people who have tested positive for COVID-19 and have been symptom-free for 14 days or more will be eligible for antibody testing. In that order of ideas, of the almost 19 million people that Chile has, they could apply 4,676 that are currently reported as recovered from the disease. 

If the strategy works, in the ideal world of abstractions, the implementation of the COVID-19 Card would mean that, little by little, Chile could get its population back to work, to the extent that they develop immunity, while opening and closing quarantines by sectors, according to the dynamic quarantine strategy that the country is using.

However, the strategy's four main drawbacks may outweigh its short-term advantages: the black market, the temptation of deliberate contagion, the uncertainty of the number of infections and the uncertainty of immunity.

The black market and intentional contagion

At the moment, the Chilean Ministry of Health is still determining how the production and delivery of the cards will be, however, it is clear that for each rule there is a way around and the creation of this certificate that would allow privileged circulation to certain sectors of the population will also encourage them to seek ways to obtain it, legally or illegally.

The mechanism determined by the Ministry of Health will also give way to one or another vulnerability in the system, but these can range from falsification of COVID-19 test results - which will make the statistics available more inaccurate and cause infected people to infect others - to people who have not contracted the coronavirus seeking to become infected intentionally.

There is several historical precedent for intentional transmission to seek immunity: before smallpox vaccines existed, it was relatively common for parents to take pus from the pustules of infected people to expose their children to the secretion. Doing so could have one of two effects: a mild smallpox infection, from which the children recovered and after which they were immune to the virus, or the death of the infant.

Another precedent is the HIV sanatoriums that the Cuban government implemented in the 1990s as a measure to try to contain the epidemic on the island. Recalling the history of leprocomics, the Cuban government tried to isolate positive patients on land where it provided food and even formed theater groups and other cultural activities.

The establishment of these kinds of places led many young people to seek out contagion by sharing blood or needles in order to be admitted to sanatoriums. Years after they were interned, when the friends they met inside began to die, they also understood that the arrival of a cure would not be as early or as simple as they had hoped.

As the idea of acquired immunity to the coronavirus gains strength, this practice will tend to become more common. As "immune people" become more in demand as a workforce, there will be a greater temptation to sacrifice security for freedom and economic well-being, at any price.

How many cases of contagion are there in Chile?

To date, Chile reports 10,507 confirmed cases of infection, 139 deaths and 4,676 people who have recovered from the disease. According to Bloomberg, Chile has already conducted more than 95,000 tests, making it one of the highest per capita testing rates in the region.

However, the high level of testing finds a major drawback in the country's dynamic quarantine strategy. According to the article by the Center for Investigative Journalism (CIPER) "COVID-19: Chile is not flattening the curve, we lost sight of it", Chile's strategy is to track contagion cases as they occur and selectively isolate the areas needed to prevent the spread of the outbreak.

This implies the following things: it is a strategy that must be adopted very early, having excellent infrastructure conditions, and testing must follow the rhythm of virus replication. If these three conditions are not met, a full quarantine strategy is preferable. This strategy is being successfully implemented, for example, in Iceland, where ten percent of the population has already been tested.

According to the CIPER article, if on April 1 Chile had done 3,500 tests, today, April 21, they would have to do 112,000 and by April 25 they would have to be doing 224,000. Not otherwise they could be sure which part of the population was infected with the virus. 95,000 tests in total is a high number for the region's average, but clearly insufficient in this scenario.

That means not only that by opening and closing the quarantines that the Chilean government has selectively implemented, they are rapidly increasing the chances of contagion of their population, but they have no way of measuring it. In fact, the estimate published by the CIPER indicates that Chile would have stopped measuring properly by March 25.

Chile will certify immunity, but does it exist?

The idea that a person who recovers from COVID-19 can be immune to the virus has its foundations in the way the human body reacts to thousands more viruses that we live with in our daily lives.

Since there is no specific treatment for COVID-19 at this time, the goal is to keep the patient as stable as possible while his or her immune system copes with the virus.To this extent, it is understood that those who manage to recover have developed the necessary antibodies to do so.  Some recovered patients are even being "harvested" to inject their antibodies into people still afflicted with the disease.

However, the World Health Organization has explicitly discouraged the issuance of immunity cards because the presence of antibodies indicates that the body has dealt with the virus, not necessarily proof of immunity.

The Chilean Association of Immunology also called for caution in warning of the lack of studies on the development of immunity for COVID-19 and recalled that for other known coronaviruses, experience with other classes indicates that this immunity could be around three months.

In this vein, if a person were to become immune for only three months, the State would have to check that he or she was only exposed and circulating for that period of time and then return to shelter, which would be a colossal logistical challenge, to say the least.

The other point to which the Chilean Association of Immunology draws attention to is that once a person stops showing symptoms of the disease, he or she does not stop transmitting it. The reduction of the viral load in the patient is progressive, not abrupt, and for the moment we do not know how long a "recovered" person continues to have the potential to infect others.

We will necessarily have to look for ways to reinvent our lives while at least the estimated 18 months it will take to develop any vaccine pass, but the process of achieving this will be slow, painful and mined with grief. Nonetheless, caution and listening to the recommendations of the scientific community can help along the way.

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