COVID-19: Will “proof of health and immunity” be a new societal norm?

THE COVID-19 outbreak is causing worldwide havoc, highlighting how ill-prepared societies are for viral outbreaks and pandemics. The cost of economic and social shutdown within multiple countries, with the subsequent need for multibillion- or multitrillion-dollar government bailouts, has some people questioning the appropriateness of pandemic management.

If history teaches us anything, it is that following global disasters, low-cost long-term societal and generational changes are required to avoid repeat catastrophes. Given the impact of the COVID-19 virus pandemic, will society now demand “proof of health and immunity” to protect population health in the modern world?

After the 11 September 2001 terrorist attacks in the US, widespread surveillance and screenings were instituted to improve the global safety of the airline industry, business and other sectors. It became a new societal norm. The digital surveillance and screenings were considered a small price to pay for the basic freedom to be with other people and use modern services.

The viral pandemic risk, although foreseeable, had not reached a public conscience level before this COVID-19 outbreak. While many of us do the right thing, there are those who flagrantly divorce themselves from their social responsibilities when ill with a virus. That person openly coughing and sneezing on the packed train, tram or at the football, or going to work when unwell. I am sure we can all recall the respiratory infection after the plane flight or boat trip or catching the “work flu”.

It was accepted then, but I doubt it will be tolerated in the post-COVID-19 world.

The problem is crowds and mass transport do not allow for personal hygiene and social distancing standards to be maintained. We can all imagine the expense of plane flights with one seat per row, or public transport and stadiums with one-quarter of the seats.

Governments, airlines, sports and entertainment businesses, the travel and tourism industries will be examining strategies to ensure the safety of their communities and a resilience to future viral pandemics. This is where proof of health and immunity could be a low-cost, simple means to manage risk.

To be clear, by proof of health and immunity, I mean clear record of accepted vaccination, a serological response to that vaccination and lack of infective symptoms for the past 2–3 weeks.

A record of vaccination is currently required for all health-related employment now; it is also required for children to go to day care, schools and for certain trips. Similarly, a vaccination record and lack of communicable disease certificate are required for contact sports. It is not a quantum step then to transfer this responsibility to all society members to ensure patron resilience.

Further, adding proof of wellness (eg, lack of fever, cough or tachycardia for the past 2–3 weeks) for a complete standard is not obtrusive or cumbersome. The wearable technology to monitor personal physiology exists already and is widely being used; it would be a simple app to allow digital verification to your personal smartphone to any authority that may need it.

Using technology and boosting primary health care have been proposed responses to pandemic prevention.While no system is perfect, it would at least be a reminder to people about their obligations when experiencing a viral illness. Risk communication is a pillar of pandemic prevention and management.

There would need to be standardisation of software and algorithms to ensure the validity and reliability of the health analysis (eg, an exercise session would not cause a false exclusion). To protect personal privacy, there may also need to be some regulation surrounding tracking of biophysical data; but these problems are not insurmountable.

In the coming months, governments, workplaces, businesses and organisations will be considering interventions to ensure the safety of workers, customers and patrons; reduced use of cash and increased use of perspex protective screens being common in plans to protect staff. In addition, communities would expect organisations to improve the safety for patrons against viral transmission at events.

A proof of health and immunity would be a reasonable standard to allow access to events and services where crowds are inevitable; it enables access on an individual basis rather than imposing restrictions on a community basis that we are experiencing now. In the future, proof of health and immunity conceivably can be used to enable flights, public transport and major events to be as biologically safe as possible.

If we are serious as a society about managing all viral outbreaks, we should not go back to the previous routines. We should institute new societal norms with respect to viral disease, to raise community resilience and minimise risk of viral transmission. The personal hygiene changes and social distancing standards are here to stay. Where these standards are not practical, proof of health and immunity could be a logical low-cost method to support the safety of others. It’s not a big sacrifice to get back to the football.

Dr Evan Ackermann is a GP on the Gold Coast, and was formerly Chair of the RACGP Expert Committee Quality Care. 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.