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COVID-19: What Can We Do to Reduce Social Distancing March 27, 2020

Posted by mwidlake in biology, COVID-19, off-topic, science.
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The impact of COVID-19 on our society and our economy is going to be long and hard. I hope I am not the first to come up with this idea, but just in case…

Having everyone on lock-down on and off for months will be hard to maintain. But not everyone will need to be in lock-down. You do not need to be locked down if you are immune.

I think we need to look at having a “COVID-19 Immunity Card” – you get the card to prove that you are probably immune to COVID-19 and that you are no longer a danger to others and are not in danger yourself.

Once you have a card you no longer have to abide by social distancing measures in the same way as those not immune. You are also a known “safe” person who can interact with those who are not. This would be particularly reassuring in the “caring” industries.

The number of people with cards will grow over time due to:

  • People being diagnosed with the disease and recovering – not many yet.
  • People being tested and found to have had the disease (possibly without knowing and have recovered) – coming soon?
  • People who have been vaccinated against it – future group.

There are potentially serous drawbacks to this idea. Such a card would be a source of division for as long as we have them and they would be a huge target for criminal activity, but it could help us “sleep with the tiger” of COVID-19.

It could/would allow our economy, health services, and society function more effectively whilst we are living with COVID-19.

Background – Once we “stop” COVID-19 this time, we have a problem…

The UK, like a growing number of countries, is now in a strong, country-wide, social shut-down. The aim is to suppress COVID-19 (see COVID-19: What’s Going To Happen Now ) i.e. drop the levels of person-to-person transmission (The “R” number) below 1. If each person with COVID_19 infects fewer than 1 other person on average, the spread stops. Quickly. It will take another 2-3 weeks for those already infected or sick (as of the date I am writing this, 27/3/20) to develop the symptoms and possibly need hospital treatment, so between now and mid-April we will see cases continuing to rise rapidly, followed by the number of deaths.

Then, something like Mid-April onwards, new cases will drop and, less slowly, the number of deaths.

COVID-19 will have been stopped. However, it will not have gone away, it will still be in the population. If we relax the social isolation we are currently living under, it will start spreading again and we will have another outbreak. Why? As only a small percentage of the population will be immune to the SARS-COV-2 virus. Governments are giving the impression that we will have “beaten COVID-19!” at this point, when the first peak of cases has come and gone, but the scientific consensus is clear that it will return if we all start living normally again. There are several studies going on at present to model what we can do and how. For example, China is relaxing restrictions and the world-wide epidemiological community is watching. For example, this Imperial College Paper on how China is coming out of strict social distancing is interesting.

I think of this as sleeping with a tiger that we don’t want to wake up.

The Imperial/WHO/MRC paper does cover all of this and suggests a way of relaxing social isolation steps and re-introducing them, over a 2 year period. The chances are, this is all going to go on far longer than most people realise and way longer than any of us want!

Reasoning on why COVID-19 will be with us “until something changes”.

The rest of this post is me being an “Armchair Epidemiologist” – proposing untested ideas with only a tenuous grasp of the true facts. But I thought I would put this out there. Note, there will be a lack of links to any solid references from this point. When you see this in articles discussing scientific ideas, it usually indicates it is a thought experiment.

There is general scientific consensus that, if we had better testing, the Case Fatality Rate would be about 1-2%. Case Fatality Rate (CFR) is the percentage of diagnosed cases that die. What we actually need is the Infection Fatality Rate (IFR) of COVID-19:- Taking into account all people who get the disease (whether they show symptoms or not or were tested or not) what is the percentage of people who die. See the Wikipedia entry on CFR for more details of CFR and IFR.

IFR is being argued about by the scientific community as you have to test a large, random set of people to see how common the disease is and testing by most countries is limited to suspected cases. Thus estimates are being made. The really good news is that the estimates of IFR are a lot lower than CFR. numbers seem to vary from 0.2% to 0.6%. See this pre-print of an article on CFR/IFR  and this paper by Nuffield Primary Care Health Sciences  at Oxford University. I’ll be pessimistic and take 0.5%

I am assuming the  Infection Fatality Rate is 0.5%

The reason we need the Infection Fatality Rate is that we can then calculate the number of infected people from the number of people who died – ONCE number of infection and deaths have reduced to low numbers again. You can’t do this (well, I can’t) when the number of new cases or deaths is increasing.

If 10,000 people die in the peak of cases we are currently enduring, if it is killing 0.5% of people and ICU limits are NOT exceeded, that means 2 million people will be immune once the peak has passed (as 99.5% of that 2 million have it and survive).

However, 64 Million will not be immune.

As has been described, we could now relax social distancing and let businesses and the economy start up to some degree again – but then tighten up social distancing again when cases or ICU admissions rise. We have a series of mini-outbreaks.

We have a population of 66 million. At 2 Million becoming immune in each “Outbreak”, we would need 20 outbreaks to get to a level of people who have had the disease where herd immunity is stopping the disease spreading – 60% or 44 or so million people (but we would still have 22 million susceptible to the disease).

With a peak every 2 months (so no single one exceeds the expanded capabilities of our NHS) getting to 60% immunity would take… several years. This is why all those discussions about getting herd immunity in weeks or months is, frankly, naive. We could only have that happen if we did not control the outbreak.

It might be that we can work out a level of social distancing that allows the economy to keep some semblance of normality and the COVID-19 cases at a level the NHS can keep up with, but that is a very, very fine tightrope to walk.

In any case, if we do not simply let COVID-19 rip through our society (killing more people than it would if controlled, as it vastly overwhelms the health services) we have to sleep with the tiger until we we have another option. But I think there is a way to make sleeping with the tiger more comfortable.

People will become immune to SARS-COV-2

A reliable, widely available test for seeing if someone has had COVID-19 and is now resistant to the  SARS-COV-2 is desperately needed and, I think, will become available soon – in a couple of months, long before a vaccine arrives.

We will then have 2 ways of knowing someone is immune:

  • Those who were tested positive for COVID and survived. They are immune.
  • Those that pass an antibody test. They are probably immune – depending on the reliability of the test. There could be several tests that have different levels of reliability.

These people can be given an “I am immune” card and they will not be limited (at least not so much) in lock downs.

Initially there will only be a hundred thousand people who can have the card, as they have been identified by testing to have had COVID_19,  have got better, and are now immune . But, crucially, a disproportionately high percentage of them will be NHS and first responder workers. This is because those groups are suffering very high exposure to COVID-19, by the very nature of what they do. The ranks of these groups are (and will continue to be) literally decimated by COVID-19. Lots and lots and lots of nurses, doctors, lab staff, cleaners, police, paramedics, GPs are going to be in the first wave getting ill.

Once we have the cheap, reliable antibody test , we can look for the rest of the 2 million.

As you can see, the more testing we do, both for having COVID-19 or for having antibodies against SARS-COV-2, the more people we can give an immunity card.

Over time, especially if we have further outbreaks, the number of people who are immune and are found via the above will increase.

Later, when vaccines are developed, there will be a third group of people we can count as immune:

  • Those who are vaccinated
  • Better still, those who are vaccinated and are latter tested for (and pass) an antibody test.

The first vaccines are likely to not be very effective – think the low end of the level of protection the annul ‘flu vaccines achieve, 20-40%. The antibody tests to confirm you have immune to SARS-COV-2 might also vary. But the details on the card will give which tests and vaccines you have had.

The card will hold details of why the person is immune, what test(s) were used to identify they had the disease, what vaccine(s) they had had, and when these events occurred. Minimal details would be held on the card itself.

A central database would hold the details of vaccination & test efficacy, corroborative information about the person etc.

If the reliability of historical tests or vaccinations change, then the immunity status of the individual may change.

The database of information would of course need to be well secured, kept in more than one place (so that a single IT disaster does not destroy all this key information) and protected. These are technical problems that can be solved.

Drawbacks off the COVID-19 Immunity Card

The cards will need to be very reliable, trusted, and protected from abuse.

Both the data they hold (or link to) and the information about the person the card is for needs to be highly dependable. The data needs to specify which sort of immunity this person has, when they were ill (if they have been) or tested, when any vaccine(s) were administered and when. It may turn out that immunity to SARS-COV-2 will reduce over time (that is, our immune systems “forget” about the disease) and the virus may mutate over time such that it avoids our immune response (whether natural or via vaccine).

The link to the person will need to be reliable, so no one can use a stolen or fake card. Obviously pictures, basic information, etc need to be on the card for a quick check, and information on the card links to a data source that can be used to further check identity and give more detailed information about immunity, such as may be needed if the person is in a medical situation.

It strikes me that this is a perfect use for blockchain. Each card, the data associated with it, when & how it is updates, can be accurately tracked in a way that is very, very hard to fake.

The data and the card should link to nothing else. There would be a temptation to be able cross reference the medical data with socioeconomic data, geographic information, even information about shopping habits to see if there are any correlations between between these factors and how people respond to COVID-19. This would be a nightmare as it introduces questions of consent, privacy, abuse of the data, fear of being spied upon.  Ensuring this card is for one purpose alone, with no link to anything else, would reduce the next drawback.

ID cards by the back door.

This will effectively be introducing ID cards, which some people object to strongly on moral or philosophical grounds. I’m not going to do more than note that this is an issue and observe that many societies have ID cards already. If these cards are kept to this one purpose, it would help make them more acceptable.


Of course, as soon as such a valuable thing as a card that allows you to avoid social limitations is available, some people will want one, even though they know they are not immune. Criminals will want to create and sell them, so we need something, probably several things, (again, like a blockchain identifier on the card) to help guard against this. I would also suggest we would want to see strong punishment of individuals who try to use a fake card or get one by deceit. After all, these are probably the same selfish gits who bought all the toilet paper. As for criminals trying to make and sell fake cards, the punishments would be draconian – they would be putting a lot of people at risk.

Two-Tier Society

The cards would by their nature split society. Those who have a card would have more freedom. Those who do not would not.

Some people would never be able to get a card as they are immunocompromised  or similarly unable to be vaccinated.

Human nature says some people would discriminate or persecute people who are not immune if there was a way to identify this. I actually see this as the main reason to not have such a card.

Laws would be required to back up a repeated and strong message about why such discrimination is utterly wrong.

SARS-COV-2 Could Change

We do not yet know how the virus underlying COVID-19 will change over time. It is mutating – but ALL life mutates. We use the mutation to track how SARS-COV-2 has spread across the globe and the mutations, so far, are not known to alter it’s infection rate or how it impacts people (though I think I have seen some suggestions about this on social media that are more trustworthy than general scuttle).

However if it turns out that C-19 becomes C-23 and C-28 etc like Influenzela A, the card scheme still works but you are now stuck with identity cards and potential discrimination against those who are not immune etc.

End Life of the cards

I would want to see an agreed termination point for the cards stated when they are brought in. They or the data they link to will be deleted utterly in 3 years time. This can only be changed by a cross-political-party agreement.


That’s my idea. If you have any comments – for, against, highlight things I have wrong – I would love to hear.


1. sydoracle1 - March 31, 2020

Doesn’t anyone comment on blogs anymore ?

I’ve been thinking about the contact tracing apps that were used in Singapore and South Korea. Given a immune person may still carry the virus on skin or clothes, there are still risks in having anyone ‘at large’ in the community. Tying that privilege to an app / mobile device carried by the individual makes it more secure (we now have a driving licence app in NSW so ‘id by device’ is a solved problem).

On a wider front, I suspect the speed at which governments have had to deliver financial support to people will lead to much stronger hooks from the government into the financial situations of individuals and families.

mwidlake - March 31, 2020

Not so many people comment these days, but you did so thank you!

I agree we can do a lot more with technology to help with this. I’m not sure how much people in countries without a strong sense of civil obedience will accept being tracked (or indeed my idea for this card) but if enough people volunteer to be tracked, it could tip the balance enough to allow social distancing to be relaxed. I’d want to see a way of giving the most benefit to those who agree to take part though.

I’m wary of apps that are designed to tell you if you have C-19 as they are basically totally unreliable. The symptoms are so generic and similar to many other illnesses (especially Influenza and the common cold) and vary between patients that a diagnosis based on symptoms is still highly questionable. A wrong diagnosis can be cause a lot of issues.

2. AndyP - June 30, 2020

I particularly like the 185cm height joke on your ID card – excellent!

mwidlake - June 30, 2020

You are only the second person (I think) to mention that to me 🙂 Well spotted

3. gary - January 15, 2021

Digging out the old post to reply to, but I’ve just seen the first government indication about an “immunity card”

“When asked about the vaccine, Ms Berejiklian said she expected the Service NSW app would show a tick if a person had received the jab.”

The Service NSW app isn’t mandatory, but we are required to ‘check in’ (and out) of some venues using either the App or their web-form. As an example, I had a haircut earlier this week and, besides being masked, had to scan a QR code to record in the state government database when I was on the premises. The staff help out if anyone doesn’t have a phone/app. The app is already linked to my driving licence, and the phone number confirmed by SMS. When a covid positive case is identified, they interview and ask where the person has been and can access the data to find other people in the same place/time to get them to isolate and tested.

(Of our last outbreak, around 10 cases out of 150 were associated with hair-dressers. Ref page 13 of
https://www.health.nsw.gov.au/Infectious/covid-19/Documents/covid-19-surveillance-report-20210109.pdf )

It has been interesting to see the gradual creep of the registration requirements. It started off as signing into a book, then electronic registration was required and then (partly because some venues were using the contact info for marketing, and partly because people were signing is a Donald Duck etc) moved to requiring use of the state government stack. And next the vaccination record coming in. Meanwhile the bluetooth tracking app from the Federal government, with all the privacy focussed “we don’t track your location, won’t make it mandatory, and can’t access the data without your cooperation” has faded into obscurity.

mwidlake - January 15, 2021

Thank you Gary, I appreciate you taking time to find the post and letting us know that this is really becoming a thing where you are.
There has been some brief mentions of an “immunisation card” in the UK since the vaccines became available, people wanting to be able to show one to demonstrate they are “safe” (though it is not yet clear how “safe” they are, both themselves and to others) but the government keep saying it won’t happen. So it probably will… 😉

We have a government supplied app in the UK – but it’s rubbish. I keep thinking I should try it again but initially it drained the battery in our phones at an alarming rate and kept false-alerting. It also seemed to mess up other things, so we deleted it. I can’t remember seeing anything more than a handful of people registering at a venue with it. Mind you, I’ve been a hermit for 10 months!

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