An open letter to the governors of Pennsylvania, New Jersey and Delaware about the need to prepare a large-scale program to determine who is or isn’t immune to the COVID-19 virus.

Dear Governors,

As hospitals and health professionals brace for the inevitable surge of COVID19 cases and the rest of us hunker down at home, it’s not too early to begin planning for a return to normal. I propose a state-led mass SARS-COV-2 immune antibody testing program to provide public health authorities with the data they need to sound the all-clear and get the regional economy up and running as quickly and safely as possible. This will also inform individuals about their potential immunity to this coronavirus.

Briefly, here are the key steps:

  • Using local pharmacies, create a program to test people for COVID-19 antibodies that operates separately to the regular healthcare system. Many pharmacists are trained to obtain blood samples and are very comfortable with this type of testing.

  • The state will purchase the antibody test kits directly from FDA-approved manufacturers.

  • Provide the test for free or at low cost to anyone who wants it. No one should be forced to choose between food and a test that might let them return to work.

  • Have your Commissioner of Health issue a blanket prescription for the test so people won’t need to bother their overburdened doctors.

  • Create a hard-to-fake card or wristband that provides proof the bearer is immune to the COVID-19 virus. This will be useful if they are stopped for violating shelter-in-place orders or even to apply for a job where immunity is an asset.

  • Use existing vaccine registry systems to track tested people and their willingness to donate their blood for treating others. This data will be critical for public health officials tracking and predicting the outcomes of the region’s epidemic. These systems are designed from the ground up with security and privacy protections.

Here’s why this program matters. The CDC estimates that 25% of the people who have COVID-19 are contagious but have no symptoms. As the virus spreads, an increasing number of people will contract and recover from the virus while experiencing mild to moderate symptoms that don’t warrant a virus test. These people will constitute an ever-growing percentage of the population who experts believe can neither catch COVID-19 again or spread it to others. Immune healthcare workers can treat COVID-19 patients or care for at-risk people with less fear, allowing their still-vulnerable colleagues to shift to less risky duties or take a break. Immune people can begin to resume normal lives.

There will be great demand for a specific antibody test by the many people who want or need to know if they can stop worrying. Businesses where work from home is not an option will wonder if they can restart operations with employees who are no longer a risk to themselves or others. Without proper testing, the return-to-work process will be more chaotic and risk reigniting the epidemic.

We don’t want these now-healthy folks rushing to hospitals, labs or doctor's offices demanding the test that will liberate them from government-mandated quarantine. A state-organized parallel testing system is an innovative approach that demonstrates your state’s commitment to opening the economy as soon as it’s safe to do so.

As I suggested, this proposal assumes that person with a positive antibody test is truly immune and not continuing to shed the virus, so any testing program should be developing in consultation with experts in your states and at CDC before moving forward. Researchers in Germany and elsewhere are proposing similar massive antibody testing programs to track the number of people who had the COVID-19 virus and give those who test positive an “Immunity Passport” so they can get back to work.

I appreciate that this is going to be expensive, but what better use of economic stimulus dollars than determining who can go back to work safely and getting our moribund economy going again? I would encourage pharmacies to see this as their contribution to the response effort and as a way to generate more store traffic.

States must take the lead in this testing effort. The epic failures in the federal government’s preparation and response to this pandemic call into question its ability to take the lead on this effort. Don’t wait for them to act. Use the authority you have now. Your citizens will thank you for your leadership.

Preparations for coming out of lock down must begin immediately. Until a vaccine, which provides the best immunity, is available, antibody testing is a stop-gap measure that allows us to save lives and put people back to work.

Drew Harris, a population health and health policy analyst at Thomas Jefferson University, is a member of The Inquirer’s Health Advisory Panel.

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