CAMBRIDGE — As the coronavirus pandemic shuts down the world’s economies, stock markets plummet, and unemployment rises, policymakers will be forced to figure out how to contain the outbreak while preventing financial and economic collapse. Most economic proposals in developed countries focus on cash payments to people, deferred tax payments, and business bailouts.
But biomedicine is critical to saving the economy, and of the three major biomedical channels now in play, the least important medically is the one that could impede an economic Armageddon.
It’s a test to check whether a person has had, recovered from, and thus become immune to COVID-19. Scientists say that low-symptom and symptomless cases exceed the symptomatic. When these asymptomatic people are over the infection, they could go to work—they will not infect those with whom they come into contact. But we need to know who they are.
Imagine that we could test the low-symptom and no-symptom cases for immunity today. This is not the widely discussed (and still not widely available) test for the illness itself. That test shows whether the virus is in one’s system, not whether it came, went, and conferred immunity. Testing those who have been exposed, recovered, and are healthy could allow them to return to work and reopen businesses and institutions.
Initial public discussion of immunity testing — which is sparse — has focused on how understanding COVID-19 immunity could lead to a vaccine or antiviral to treat the sick, and could tell us how widely the virus has spread. But a major and immediate economic use of an immunity test is that it can be deployed before we have a cure or a treatment. Initial research suggests that, as with other viral diseases, recovery from COVID-19 does indeed lead to post-illness immunity. This still needs to be fully confirmed — and, equally important, confirmed to be long-lasting. But such testing is now possible and, with a push, could be widely available.
That push could be well worth the effort. The public-health focus is, of course, on developing therapeutic drugs and a vaccine as soon as possible. But no widely available vaccine is expected to be available for 12-18 months—far longer than the world’s economies can stay shut down.
Consider how an immunity test could be used today. My wife and I had a cold for a day last week: a light, dry cough and a little congestion. Was it a mild form of COVID-19, which our immune systems fought off without serious symptoms? Probably not, but maybe it was—and maybe we’re now immune. If an immunity test were available, we’d check, and if we were immune, we would go out and back to the office. But because we don’t know, we’re still staying home.
I’m not an epidemiologist, although an epidemiologist at my university has raised similar possibilities. Much about COVID-19 is uncertain in public discourse and, so it seems, in experts’ knowledge. For example, the economic value of the immunity test depends on how many people get it without being symptomatic and on the overall level of infection in the coming months, neither of which we know now with any precision. An immunity test would have to be easy to use, because it’s the asymptomatic who would have to use it. Presumably, some of the first users would be businesses that would have to close unless they could be staffed with a handful of immune employees. Perversely, the worse the public-health situation is, the higher the economic value of the immunity test. If more people are infected, the economy is more disrupted, and the number of symptomless patients who need not stay home rises as well.
That might be a path to a low-casualty means of minimizing the pandemic’s economic: Those who have recovered resume their normal routine. The numbers will increase sharply, according to some projections. The problem is finding out who they are.
An immunity test could tell us who doesn’t need to be taken out of economic circulation, and using it well could start our economic recovery, or impede a further decline. And if the uncertainties are overcome, it could proceed while the more complete biomedical efforts — to develop antivirals and a vaccine — percolate toward a solution in laboratories around the world. —Project Syndicate
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Mark Roe is a professor at Harvard Law School and the author of studies of the impact of politics on corporate organization and corporate governance in the United States and around the world.