An illustration of a person about to fly away on a hot air balloon but others are pulling it down amongst a bed of covid.
Illustration: Virginia Gabrielli

In an effort to stop the spread of Covid-19, the Chinese government earlier this year instituted an app-based smartphone program that continues to govern the movement of many of its citizens.

Each person’s phone displays a colored QR code. A green code means that a person is permitted to take public transportation and move about with few restrictions. A yellow code means that a person must stay at home, while a red code mandates a two-week quarantine. “Green code, travel freely. Red or yellow, report immediately,” read government notices and posters advertising the app, according to reporting from the New York Times.

Although Chinese officials have been tight-lipped about the app’s design, it’s ostensibly based on location and travel-history data, as well as self-reported symptoms and health information. Russia is now using a similar program in some of its major cities. European officials have discussed a less-restrictive app that could track Covid-19 infections and alert those who are at risk of exposure. And, despite privacy concerns, similar tech-based “contact tracing” proposals have been floated in the U.S. for the last two months.

No one knows what the future will bring. Just six months ago, the idea that nearly every U.S. state would issue stay-at-home directives and mandate business closures would have seemed unthinkable. While it may seem unlikely today, it’s possible that the continued threat of Covid-19 will lead to the implementation of what some are calling “smart quarantine” programs based on risk stratifications — a system somewhat like the color-coded QR app deployed in China.

In such a system, those who have already contracted the virus could be granted freedoms denied to people at high risk who have not yet had Covid-19. Even if things never go that far, improved antibody testing will probably soon show that a lot of people who never experienced serious symptoms have already had Covid-19, and so are likely protected from it.

In either scenario, immunity jealousy is probably going to be a thing. And experts say it could make an already difficult situation a lot worse.

Forecasting a future in which immunity = freedom

In a best-case situation, the world’s scientists and drug makers will develop, produce, and distribute a highly effective Covid-19 vaccine sometime in the next year. Experts say the efficacy of the vaccine is predicated on the human body’s ability to develop immunity to the virus in response to a previous infection or exposure.

“Experience suggests that people who have been infected and recovered will be protected for some period and won’t be able to transmit the virus to others,” says Stephen Morse, PhD, an infectious disease expert and professor of epidemiology at the Columbia University Medical Center. Even if it turns out that people can be reinfected, he says that their second bout with the virus would likely be a milder one.

That bodes well for the efficacy of a potential vaccine. But it also means that, until a vaccine is ready, those who have been infected with Covid-19 will likely be shielded from the virus in ways that the never-infected are not. The longer it takes the medical science community to develop a vaccine, the more politicians may feel pressure to open up businesses, venues, and other gathering places to people who have immunity, while at the same time restricting access to those who don’t.

Already, some public health experts are advocating for different quarantine rules based on risk.

One of them is David Katz, MD, PhD, founding director of the Prevention Research Center at the Yale School of Public Health and Griffin Hospital. “If the point of policies is to minimize total harm, then it certainly makes sense to target [those policies] accordingly,” he explains.

Katz says that he can “absolutely” envision scenarios in which older adults or immunocompromised are subject to stay-at-home orders or movement restrictions that are not imposed on other Americans. And if it turns out that those who have had Covid-19 are immune from the virus — a likelihood, but still an unanswered question — it’s possible that previously infected people will enjoy liberties that are denied those who have not yet contracted the virus. They may be granted an “immunity passport,” as some are calling it, which allows them to return to workplaces and public spaces to which others are barred.

“If immune, you can’t transmit, so it makes sense that you should be able to mingle more freely,” Katz says. “This is not about any special privilege, it’s simply a matter of form following function — of not fixing a problem where it doesn’t exist.”

While very much a hypothetical, this scenario has some historical precedent. In the wake of a yellow fever outbreak in the 19th Century, Americans who had contracted and survived the illness had access to jobs, loans, and other privileges denied those who were still at risk.

If such a scenario came to pass in the U.S. today, experts say it would surely create immense resentment, envy, and, possibly, dangerous attempts to contract Covid-19 in order to secure immunity.

The psychological threat of “immunity envy”

If it turns out that those who have already had the virus are protected from it, experts say this would surely inflame some existing animosities and would likely cause Americans a number of psychological challenges. That’s especially true if the previously exposed are granted liberties denied to everyone else.

“At best, people will think it’s unfair,” says Gwendolyn Seidman, PhD, chair of the psychology department at Albright College in Reading, Pennsylvania. “At worst, people will recognize that those who were not social distancing and who continued to have gatherings would be more likely to be immune, so the people who followed the rules and stayed home would basically be punished for it.”

“We all want to think that as long as we do things the right way, we shouldn’t get screwed. And it’s really upsetting when we see that’s not the case.”

Not only would this create incredible bitterness among those who aren’t immune, but Seidman says that it would also upset many people’s deeply ingrained belief in fairness and justice. She mentions a concept known as the “just-world hypothesis,” which has been around since the 1960s. It contends that most people strive to view the world as a fundamentally fair place — one that rewards those who behave properly and morally while punishing those who do not. These views on life are wrapped up in the precepts of many major religions, and there’s evidence that those who hew to this belief in a just world are less likely to experience depression and are more likely to feel satisfied with life than those who do not.

Seidman says the unfairness of an immunity passport system would shake this just-world belief for a great many people, and that could have serious consequences for mental health. “We all want to think that as long as we do things the right way, we shouldn’t get screwed,” she says. “And it’s really upsetting when we see that’s not the case.”

She says one way to combat the feelings of resentment and injustice that may arise from an immunity-passport program would be to focus on and cultivate an attitude of “we’re in this together” and a feeling of noble self-sacrifice for the greater good. “While unfair, it’s better for everyone — even those stuck at home — if others are allowed to go back to work,” she says.

Unfortunately, adopting such an altruistic mindset would likely be a struggle for most Americans. “Unlike some other cultures, like China’s, which is very collectivist, our culture is very individualistic, so it’s much harder here to get people to cooperate with one another on a mass scale,” she says. “That’s just not how we roll.” On the other hand, she says that she could envision the establishment of some kind of special welfare program to compensate those who don’t have an immunity passport, which would take away some of the sting.

All of this would be enormously difficult, but it is not unthinkable. It may even be likely.

“There are innumerable examples in society of rules, laws, practices, and policies that differ by group in order to address risk realistically,” says Katz, pointing out that there are age restrictions on certain substances, and driving restrictions based on age and vision. “That should certainly pertain to pandemic control.”

Playing Russian roulette with the virus

During that yellow fever outbreak in the 19th Century, people reportedly attempted to contract the illness in order to gain immunity — despite the fact that yellow fever back then killed up to half of those who contracted it.

Columbia University’s Morse points out that most cases of Covid-19 among those who are not older or immune-compromised are mild or asymptomatic. And so it’s plausible that in the absence of a vaccine, healthy individuals will eventually seek out the virus in an attempt to gain immunity.

“I strongly advise against playing Russian roulette with the virus by getting infected intentionally,” he says. “We don’t know enough to stake anybody’s life on this.”

He says the prospect of this is worrying. “We can’t yet predict the outcome in any individual, even if the odds are in their favor,” he says. “Severe illness and even death can occur in apparently healthy young adults.” He also says that it’s still unclear whether today’s antibody tests are able to identify those who have mounted a true immune response to the condition, and are therefore protected against severe reinfection. The only prudent course is to try to avoid the virus and hope for the speedy development of a vaccine. But people don’t always do what’s prudent.

“I strongly advise against playing Russian roulette with the virus by getting infected intentionally,” he says. “We don’t know enough to stake anybody’s life on this.”

One way or another, immunity jealousy is probably coming soon to the U.S. The longer the country has to wait for a vaccine, the more likely all of these fraught scenarios become distinctly possible.

I write about health and science. I live in Detroit with my wife and kids. I’m trying to learn German, but my progress so far is nicht gut.

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