48 ms·

Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity [pdf]

187 points by yasp 5y ago

nanis 5y ago
> SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021. There is, of course, no profit or gold-plated post civil "service" career in big pharma or book deals associated with acknowledging this.
- thickly 5y ago
  Please downvote and flag this. In no way are Pfizer, Moderna and AstraZeneca profiting off of this pandemic. I'm tired of misinformation being spread on HN by the alt-right.
  - georgiaj 5y ago
    "In no way are Pfizer, Moderna and AstraZeneca profiting off of this pandemic" Absurd remark. These companies are selling vaccines to governments around the world. Any reasonable, straightforward definition of 'profit' would apply here, as pharmaceutical companies are not non-profit entities.
    - quicklime 5y ago
      AstraZeneca are selling their vaccine at cost. The other two aren’t, and they are significantly more expensive.
      - elzbardico 5y ago
        Pfizer changed their mind and actually made good profits. Not that I think that this is inherently immoral.
      - nanis 5y ago
        > AstraZeneca are selling their vaccine at cost. There is a difference between accounting profit (receipts vs outlays) vs economic profit (benefits of doing something vs opportunity cost of doing it). It is almost tautological that there is nothing to gain for the people involved in the vaccine food chain from limiting the scope of the government-cajoled "market" for them but acknowledging that natural immunity does exist and is stronger than what the vaccine-provided protection. Therefore, the statement: >> SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021. > "There is, of course, no profit or gold-plated post civil "service" career in big pharma or book deals associated with acknowledging this." does not refer to the balance sheet of AstraZeneca or any other company. It refers to the prospective incentives of people involved in the vaccine food chain.
    - thickly 5y ago
      Take a look at Pfizer's R&P charts from the last handful of years. It's hardly made a dent over all. I'm tired of this right wing nonsense on this site that is one step away from claiming these companies want to keep the pandemic going for as long as they can. It's complete FUD. It's one dog whistle after another. Go take a look at their stock price chart. I'll wait. They're just now recovering from the 2009 crash and that's in today's inflated dollars. We have too many people who are quick to jump to comment on headlines but who can't look into earnings and revenue reports and see how a company is really performing. EBITDA? Why on earth are you on a forum that specializes in startups and venture funding with this little due diligence? I'm glad the other comment got flagged but this is just a nonsensical dog and pony show for right wingers who are playing coy, grasping at headlines and asking rhetorical "Gee they wouldn't profit off if it would they, fellas?" trying to whistle their way. Despicable, really.
      - georgiaj 5y ago
        "Why on earth are you on a forum that specializes in startups and venture funding with this little due diligence?" You are awfully quick to sling insults with a 37-minute old account. For-profit companies aim to make profits. Pharmaceutical companies make profits from selling pharmaceuticals. This is not controversial nor is it some kind of "dog whistle".
        thickly 5y ago
        I stay away from political poo-slinging on my main account. I'm tired of these threads to be honest, it's like a script that plays out and that's why I'm saying to flag this kind of speech. Go ahead and find something else to pin on me please. Yes, we get it, "non-non-profits make profit" (news at 11). You missed the forest for the trees here buddy boy. The reason why the OP was flagged was because it was inviting a certain kind of rhetoric which seems to allude that these companies are going to try to prolong the pandemic (or make it seem "worse" in some way) for profit gain because "money." We are trying to get through the pandemic and it's hard enough to get people vaccinated. And now this nonsense on HN. We get it - you're woke and us plebs are completely unaware these companies are charging for their products (wow - shock and awe!), and you want to point out some conflict of interest. Except you're doing in such a negative way that it's absolutely obvious there's a political slant here. Just give it up. Ridiculous.
samename 5y ago
> This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. Do the people who are refusing a vaccine because they were already infected have a good point now?
- asveikau 5y ago
  Well... Has it been studied what happens to people with natural immunity who also get vaccinated? Is it better, worse, or the same?
  - prox 5y ago
    Vaccination and natural immunity seems to add to the protection according to the study.
  - mikepurvis 5y ago
    Indeed, but the GP excluded the very next sentence from their sizzle quote: "Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant."
    - _justinfunk 5y ago
      Honest question, help me understand where this argument is wrong: if those with natural antibodies are encouraged to get a vaccination in order to gain "additional protection"... those with a vaccination be encouraged to expose themselves to covid-19 in hope to get a breakthrough infection to generate natural antibodies for "additional protection"?
      - deleted 5y ago
        [deleted]
      - maxerickson 5y ago
space_fountain 5y ago
Am I right reading this to see that they never actually compared a vaccinated group to a group that had received no vaccines? I think the groups compared here were people with no history of infection and at least two doses and people with a history of infection and at most one dose
- foolinaround 5y ago
  they compare 3 groups. see under "Methods"
  - space_fountain 5y ago
    Yeah, but they don't compare all of the combinations right? Maybe comparing no vaccine and previous infection to one dose and previously infected plus the other comparisons are enough?
tynpeddler 5y ago
One thing to keep in mind when reading through this, it's a pre-print (not peer reviewed) that's citing other pre-prints like https://www.medrxiv.org/content/10.1101/2021.07.29.21261317v1.full.pdf https://www.medrxiv.org/content/10.1101/2021.07.29.21261317v.... It's preliminary work and may change before final publication.
- rolph 5y ago
  i wish there was some way to amplify or emphasize what you have said. this is the pitfall with preprints, then there is the pitfall of preprint supported by citation of preprint. agreed we should warp speed, but not so warp as to pile hypothesis upon hypothesis.
  - woofie11 5y ago
    I wish there was a way for me to transform this statement. The peer review process is a joke. Preprints are every bit as good as peer-reviewed publications, for now. This will change if pre-prints ever offer bona fide academic points, but for now, there is no difference in quality.
    - sterlind 5y ago
      peer review or not, when reading you have to: * determine whether the numbers are intentionally fudged. * read the methods and results and check for possible systematic errors. * see if the data supports the conclusions of the authors. * make sure you understand the limits and implications of what the authors claim. as a layperson, I can't really do this for biology. so inevitably, I give things a quick once-over, come up with questions and look to the people I trust for answers or contradictory data. so it's basically an ad-hoc peer review.
    - rolph 5y ago
      the whole purpose of a preprint is to confer with others having experience or specialty regarding the subject of thesis. Noone knows it all, or has a perfect version of the contemporary facts. peer review is quality control
devit 5y ago
I wonder if after being vaccinated it might be beneficial to intentionally get infected with the actual virus? The downside is of course the risk of severe illness and having to quarantine until the virus is cleared, but the upside is that the resulting natural immunity might be effective against a possible future vaccine escaping variant.
- Kognito 5y ago
  I suspect, given the way things are going in even the most highly vaccinated countries, everyone will end up being exposed eventually now.
  - kbenson 5y ago
    Honestly, I kinda always assumed the game plan was first to get as many vaccinated as we could, then use exposure and/or more vaccines for variants, and eventually we have an inbuilt resistance to most the tricks it can throw at us and it becomes more like the flu and/or rhinovirus seasonal variants that we're already used to.
- walterbell 5y ago
  Those healthy individuals who can survive infection will gain nasal/mucosal immunity in upper respiratory system, which is not available via blood/serum antibodies from an intramuscular, non-sterilizing vaccine.
- gpm 5y ago
  On a public health level you would be making the probability of a vaccine escaping variant more likely by incubating a bunch of virus in an environment where vaccine escaping mutations have a competitive advantage. On a personal level, it seems like if you succeed in getting it you're likely going to be feel fairly sick (a fairly substantial downside in my opinion), and the upside seems to be relatively minor since in the case of a vaccine escaping variant we will be well positioned to make a variant of the vaccine for it quickly and with minimal red tape.
- SnowProblem 5y ago
jleyank 5y ago
Better to phrase it as “surviving a COVID infection yields immunity”. It seems analogous to a single mRNA dose, particularly from Moderna. Further vaccination, or I guess surviving a second COVID infection increases protection. Antibodies fade over time, but there hope that the memory b/t cells let it reappear when needed. And I suspect next years booster will fight delta directly. I would think people would be interested in whatever might keep them out of hospital, and hopefully be willing to protect those they interact with. And hope you don’t end up with an a overly aggressive response to COVID triggering a cytokine storm. This is one of the big reasons to get tested with flu-like symptoms, and why steroids are a go to drug.
ajkdhcb2 5y ago
If there has been enough study to be confident enough to strongly coerce most of the population to get the vaccines, how is it possible that results like this are still coming out and surprising people / creating contention? There are no other studies on this to even compare to?
- anonuser123456 5y ago
  It's not clear what you are asking. The data from this study could not have come out earlier; we needed to wait until there were large enough samples infected with Delta to even know this. But this study doesn't imply vaccines are not the right answer. It just says natural infection provides stronger immunity. What it leaves out is the price you pay to achieve natural immunity.
  - ajkdhcb2 5y ago
    I find it disturbing how little information there is, and that the vaccines are being pushed incredibly strongly despite this. It seems to me that the science is not sufficiently explored. >The data from this study could not have come out earlier; we needed to wait until there were large enough samples infected with Delta to even know this. The situation should then be re-evaluated while studies are done >But this study doesn't imply vaccines are not the right answer. It just says natural infection provides stronger immunity. What it leaves out is the price you pay to achieve natural immunity. How can people be so sure that they are the right answer? You just admitted that the data is only just coming out to begin to study it. Delta has changed the situation significantly
    - anonuser123456 5y ago
      The data on vaccine efficacy is not new. The data on relative immunity post disease course vs. vaccine is what's new. But when when choosing to vaccinate or get infected, one has to evaluate the cost of infection and vaccination. The cost of vaccination is a day or so of malaise. The cost of infection is 10+ days of flu like symptoms, the possibility of hospitalization, the possibility of death and the possibility of long term morbidity. It's a pretty straight forward computation; vaccination has very low cost vs. natural disease course.
gexla 5y ago
One item never covered is "infection." What is infection? Seems like this wouldn't be a binary thing? What would your protection be like if you had the vaccine and then got infected? How many people get infected but show no symptoms because they received immunity from an earlier infection? If I were infected in the 1st wave, how likely would it be that I would be infected in every wave since?
- AzzieElbab 5y ago
  Are you trying to say that we need a cheap reliable anti-bodies test?
  - gexla 5y ago
    I guess that's what I'm saying if the answer to my question were to show up in the data. ;)
sfteus 5y ago
Couple things of note, outside of the vaccinated vs natural infection debate: First, even group with the largest infection rate was still under 1.5% in all applicable models. Whether immunity is achieved via vaccine or natural immunity, it appears that it will overwhelmingly prevent you from being re-infected. There's obviously a ton of variables here (are vaccinated individuals being overly cautious or reckless after vaccination, are natural infections more likely to receive repeat exposures to build immunity, etc). Second, by my count there were a total of ~106k-152k subjects observed in that study across all groups and models (not sure if there is overlap between models). Across all subjects, only 34 hospitalizations were reported, and there were no recorded deaths. A hospitalization rate of <= 0.032% is pretty damn impressive. Zero deaths is phenomenal. Finally, across all models the only factors outside of immunity type affecting reinfection were socio-economic status and age > 60. Comorbidities don't appear to affect the chance of reinfection, though I'm sure a breakthrough infection/re-infection would still likely be more severe in cases with co-morbidities.
- ImaCake 5y ago
  I agree completely with this comment. The numbers in this paper are a casually spectacular defense of the vaccines. You would be hard pressed to find 100k unvaccinated people anywhere in the world with outcomes like that. Nonetheless, the interrogation of natural immunity (+1 dose of pfizer) against naive with 2 doses of pfizer is incredibly valuable and I am intrigued by the outcomes here. What this suggests to me is the vaccines are good, but we can do even better with careful applications of science. I look forward to what scientists and drug companies produce over the next few years.
  - criticaltinker 5y ago
    > The numbers in this paper are a casually spectacular defense of the vaccines Yes the paper is certainly not an attack on vaccines. The crucial implications of the findings in OP are especially relevant to public health policy: 1) There are diminishing returns to vaccinating individuals who have already acquired immunity through natural infection. The benefits are borderline insignificant. Therefore when faced with a limited supply of vaccines, vaccination strategies should be highly focused on immunologically naive or vulnerable individuals. 2) Compulsory mass vaccination mandates need to accommodate naturally immune individuals. If they do not, such mandates are not only wasteful, but are also effectively ordering unnecessary medical procedures which is a violation of medical ethics and likely a violation of constitutional rights to bodily integrity and informed consent. 3) If vaccine effectiveness at preventing infections continues to be undermined by viral evolution, new formulations will need to be tested and deployed. The mRNA delivery mechanism supports rapid iteration in that respect, but those efforts will still take months at minimum. Consequently it will likely be necessary to supplement mass vaccination with other viral elimination strategies, such as early treatment with multi-drug therapy based on existing and widely available medicines [1][2][3][4][5]. [1] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1139&context=infectiousdiseases_articles https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a... [2] Timing of Antiviral Treatment Initiation is Critical to Reduce SARS-CoV-2 Viral Load https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/psp4.12543 https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/psp4.1... Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection https://rcm.imrpress.com/EN/article/downloadArticleFile.do?attachType=PDF&id=5074 https://rcm.imrpress.com/EN/article/downloadArticleFile.do?a... [3] Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents https://www.sciencedirect.com/science/article/abs/pii/S0306987721001419 https://www.sciencedirect.com/science/article/abs/pii/S03069... [4] Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial https://pubmed.ncbi.nlm.nih.gov/33983065/ https://pubmed.ncbi.nlm.nih.gov/33983065/ [5] Fluvoxamine: A Review of Its Mechanism of Action and Its Role in COVID-19 https://www.frontiersin.org/articles/10.3389/fphar.2021.652688/full https://www.frontiersin.org/articles/10.3389/fphar.2021.6526...
nsxwolf 5y ago
Can you be certain you had COVID if you only had a positive PCR test? It seems like that’s only circumstantial evidence of infection. I would probably go with the vaccine just to be sure.
- walterbell 5y ago
  You can get an antibody or T-cell (https://t-detect.com https://t-detect.com) test.
  - nsxwolf 5y ago
    Weird downvotes on this. People are willing to bet their life on a PCR test? Even if you were asymptomatic? We're letting that cycle count do a lot of work. Seems like an antibody test is prudent if you're going to consider skipping the vaccine.
bjornsing 5y ago
Interesting. But I would be weary of confounding variables here… E.g. those who got infected and those who got vaccinated in Jan/Feb were probably pretty different groups (in terms of age, social habits, health, etc). They try to control for that in the statistical analysis, but this is often hard to do well when groups are very different. EDIT: An obvious problem if you are looking at deaths is (literal) survival bias.
xenonite 5y ago
So far to the peer review, I guess there is a calculation error in model 3 (previously infected vs. previously infected with a single dose vaccine): > ... we found that the latter group had a significant 0.53-fold (95% CI, 0.3 to 0.92) (Table 4a) decreased risk for reinfection, as 20 had a positive RT-PCR test, compared to 37 in the previously infected and unvaccinated group. Symptomatic disease was present in 16 single dose vaccinees and in 23 of their unvaccinated counterparts. 20/37=0.54, not 0.53... ;-)
anovikov 5y ago
But it means that vaccines are better than we think. If people are vaccinated and then gradually all get infected with the covid, infections still being largely asymptomatic or light symptomatic, these people will get lasting protection with negligible health costs.
deleted 5y ago
[deleted]
vmception 5y ago
Ok for all the flu people, here is your time to shine! “natural immunity to this years flu works better than vaccine immunity to last years flu” sounds silly right? there will eventually be delta specific vaccines, compare then.

187 points by yasp 5y ago

> SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021. There is, of course, no profit or gold-plated post civil "service" career in big pharma or book deals associated with acknowledging this.

thickly 5y ago
Please downvote and flag this. In no way are Pfizer, Moderna and AstraZeneca profiting off of this pandemic. I'm tired of misinformation being spread on HN by the alt-right.
- georgiaj 5y ago
  "In no way are Pfizer, Moderna and AstraZeneca profiting off of this pandemic" Absurd remark. These companies are selling vaccines to governments around the world. Any reasonable, straightforward definition of 'profit' would apply here, as pharmaceutical companies are not non-profit entities.
  - quicklime 5y ago
    AstraZeneca are selling their vaccine at cost. The other two aren’t, and they are significantly more expensive.
    - elzbardico 5y ago
      Pfizer changed their mind and actually made good profits. Not that I think that this is inherently immoral.
    - nanis 5y ago
      > AstraZeneca are selling their vaccine at cost. There is a difference between accounting profit (receipts vs outlays) vs economic profit (benefits of doing something vs opportunity cost of doing it). It is almost tautological that there is nothing to gain for the people involved in the vaccine food chain from limiting the scope of the government-cajoled "market" for them but acknowledging that natural immunity does exist and is stronger than what the vaccine-provided protection. Therefore, the statement: >> SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021. > "There is, of course, no profit or gold-plated post civil "service" career in big pharma or book deals associated with acknowledging this." does not refer to the balance sheet of AstraZeneca or any other company. It refers to the prospective incentives of people involved in the vaccine food chain.
  - thickly 5y ago
    Take a look at Pfizer's R&P charts from the last handful of years. It's hardly made a dent over all. I'm tired of this right wing nonsense on this site that is one step away from claiming these companies want to keep the pandemic going for as long as they can. It's complete FUD. It's one dog whistle after another. Go take a look at their stock price chart. I'll wait. They're just now recovering from the 2009 crash and that's in today's inflated dollars. We have too many people who are quick to jump to comment on headlines but who can't look into earnings and revenue reports and see how a company is really performing. EBITDA? Why on earth are you on a forum that specializes in startups and venture funding with this little due diligence? I'm glad the other comment got flagged but this is just a nonsensical dog and pony show for right wingers who are playing coy, grasping at headlines and asking rhetorical "Gee they wouldn't profit off if it would they, fellas?" trying to whistle their way. Despicable, really.
    - georgiaj 5y ago
      "Why on earth are you on a forum that specializes in startups and venture funding with this little due diligence?" You are awfully quick to sling insults with a 37-minute old account. For-profit companies aim to make profits. Pharmaceutical companies make profits from selling pharmaceuticals. This is not controversial nor is it some kind of "dog whistle".
      - thickly 5y ago
        I stay away from political poo-slinging on my main account. I'm tired of these threads to be honest, it's like a script that plays out and that's why I'm saying to flag this kind of speech. Go ahead and find something else to pin on me please. Yes, we get it, "non-non-profits make profit" (news at 11). You missed the forest for the trees here buddy boy. The reason why the OP was flagged was because it was inviting a certain kind of rhetoric which seems to allude that these companies are going to try to prolong the pandemic (or make it seem "worse" in some way) for profit gain because "money." We are trying to get through the pandemic and it's hard enough to get people vaccinated. And now this nonsense on HN. We get it - you're woke and us plebs are completely unaware these companies are charging for their products (wow - shock and awe!), and you want to point out some conflict of interest. Except you're doing in such a negative way that it's absolutely obvious there's a political slant here. Just give it up. Ridiculous.

samename 5y ago

> This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. Do the people who are refusing a vaccine because they were already infected have a good point now?

asveikau 5y ago
Well... Has it been studied what happens to people with natural immunity who also get vaccinated? Is it better, worse, or the same?
- prox 5y ago
  Vaccination and natural immunity seems to add to the protection according to the study.
- mikepurvis 5y ago
  Indeed, but the GP excluded the very next sentence from their sizzle quote: "Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant."
  - _justinfunk 5y ago
    Honest question, help me understand where this argument is wrong: if those with natural antibodies are encouraged to get a vaccination in order to gain "additional protection"... those with a vaccination be encouraged to expose themselves to covid-19 in hope to get a breakthrough infection to generate natural antibodies for "additional protection"?
    - deleted 5y ago
      [deleted]
    - maxerickson 5y ago

space_fountain 5y ago

Am I right reading this to see that they never actually compared a vaccinated group to a group that had received no vaccines? I think the groups compared here were people with no history of infection and at least two doses and people with a history of infection and at most one dose

foolinaround 5y ago
they compare 3 groups. see under "Methods"
- space_fountain 5y ago
  Yeah, but they don't compare all of the combinations right? Maybe comparing no vaccine and previous infection to one dose and previously infected plus the other comparisons are enough?

tynpeddler 5y ago

One thing to keep in mind when reading through this, it's a pre-print (not peer reviewed) that's citing other pre-prints like https://www.medrxiv.org/content/10.1101/2021.07.29.21261317v1.full.pdf https://www.medrxiv.org/content/10.1101/2021.07.29.21261317v.... It's preliminary work and may change before final publication.

rolph 5y ago
i wish there was some way to amplify or emphasize what you have said. this is the pitfall with preprints, then there is the pitfall of preprint supported by citation of preprint. agreed we should warp speed, but not so warp as to pile hypothesis upon hypothesis.
- woofie11 5y ago
  I wish there was a way for me to transform this statement. The peer review process is a joke. Preprints are every bit as good as peer-reviewed publications, for now. This will change if pre-prints ever offer bona fide academic points, but for now, there is no difference in quality.
  - sterlind 5y ago
    peer review or not, when reading you have to: * determine whether the numbers are intentionally fudged. * read the methods and results and check for possible systematic errors. * see if the data supports the conclusions of the authors. * make sure you understand the limits and implications of what the authors claim. as a layperson, I can't really do this for biology. so inevitably, I give things a quick once-over, come up with questions and look to the people I trust for answers or contradictory data. so it's basically an ad-hoc peer review.
  - rolph 5y ago
    the whole purpose of a preprint is to confer with others having experience or specialty regarding the subject of thesis. Noone knows it all, or has a perfect version of the contemporary facts. peer review is quality control

devit 5y ago

I wonder if after being vaccinated it might be beneficial to intentionally get infected with the actual virus? The downside is of course the risk of severe illness and having to quarantine until the virus is cleared, but the upside is that the resulting natural immunity might be effective against a possible future vaccine escaping variant.

Kognito 5y ago
I suspect, given the way things are going in even the most highly vaccinated countries, everyone will end up being exposed eventually now.
- kbenson 5y ago
  Honestly, I kinda always assumed the game plan was first to get as many vaccinated as we could, then use exposure and/or more vaccines for variants, and eventually we have an inbuilt resistance to most the tricks it can throw at us and it becomes more like the flu and/or rhinovirus seasonal variants that we're already used to.
walterbell 5y ago
Those healthy individuals who can survive infection will gain nasal/mucosal immunity in upper respiratory system, which is not available via blood/serum antibodies from an intramuscular, non-sterilizing vaccine.
gpm 5y ago
On a public health level you would be making the probability of a vaccine escaping variant more likely by incubating a bunch of virus in an environment where vaccine escaping mutations have a competitive advantage. On a personal level, it seems like if you succeed in getting it you're likely going to be feel fairly sick (a fairly substantial downside in my opinion), and the upside seems to be relatively minor since in the case of a vaccine escaping variant we will be well positioned to make a variant of the vaccine for it quickly and with minimal red tape.
SnowProblem 5y ago

jleyank 5y ago

Better to phrase it as “surviving a COVID infection yields immunity”. It seems analogous to a single mRNA dose, particularly from Moderna. Further vaccination, or I guess surviving a second COVID infection increases protection. Antibodies fade over time, but there hope that the memory b/t cells let it reappear when needed. And I suspect next years booster will fight delta directly. I would think people would be interested in whatever might keep them out of hospital, and hopefully be willing to protect those they interact with. And hope you don’t end up with an a overly aggressive response to COVID triggering a cytokine storm. This is one of the big reasons to get tested with flu-like symptoms, and why steroids are a go to drug.

ajkdhcb2 5y ago

If there has been enough study to be confident enough to strongly coerce most of the population to get the vaccines, how is it possible that results like this are still coming out and surprising people / creating contention? There are no other studies on this to even compare to?

anonuser123456 5y ago
It's not clear what you are asking. The data from this study could not have come out earlier; we needed to wait until there were large enough samples infected with Delta to even know this. But this study doesn't imply vaccines are not the right answer. It just says natural infection provides stronger immunity. What it leaves out is the price you pay to achieve natural immunity.
- ajkdhcb2 5y ago
  I find it disturbing how little information there is, and that the vaccines are being pushed incredibly strongly despite this. It seems to me that the science is not sufficiently explored. >The data from this study could not have come out earlier; we needed to wait until there were large enough samples infected with Delta to even know this. The situation should then be re-evaluated while studies are done >But this study doesn't imply vaccines are not the right answer. It just says natural infection provides stronger immunity. What it leaves out is the price you pay to achieve natural immunity. How can people be so sure that they are the right answer? You just admitted that the data is only just coming out to begin to study it. Delta has changed the situation significantly
  - anonuser123456 5y ago
    The data on vaccine efficacy is not new. The data on relative immunity post disease course vs. vaccine is what's new. But when when choosing to vaccinate or get infected, one has to evaluate the cost of infection and vaccination. The cost of vaccination is a day or so of malaise. The cost of infection is 10+ days of flu like symptoms, the possibility of hospitalization, the possibility of death and the possibility of long term morbidity. It's a pretty straight forward computation; vaccination has very low cost vs. natural disease course.

gexla 5y ago

One item never covered is "infection." What is infection? Seems like this wouldn't be a binary thing? What would your protection be like if you had the vaccine and then got infected? How many people get infected but show no symptoms because they received immunity from an earlier infection? If I were infected in the 1st wave, how likely would it be that I would be infected in every wave since?

AzzieElbab 5y ago
Are you trying to say that we need a cheap reliable anti-bodies test?
- gexla 5y ago
  I guess that's what I'm saying if the answer to my question were to show up in the data. ;)

sfteus 5y ago

Couple things of note, outside of the vaccinated vs natural infection debate: First, even group with the largest infection rate was still under 1.5% in all applicable models. Whether immunity is achieved via vaccine or natural immunity, it appears that it will overwhelmingly prevent you from being re-infected. There's obviously a ton of variables here (are vaccinated individuals being overly cautious or reckless after vaccination, are natural infections more likely to receive repeat exposures to build immunity, etc). Second, by my count there were a total of ~106k-152k subjects observed in that study across all groups and models (not sure if there is overlap between models). Across all subjects, only 34 hospitalizations were reported, and there were no recorded deaths. A hospitalization rate of <= 0.032% is pretty damn impressive. Zero deaths is phenomenal. Finally, across all models the only factors outside of immunity type affecting reinfection were socio-economic status and age > 60. Comorbidities don't appear to affect the chance of reinfection, though I'm sure a breakthrough infection/re-infection would still likely be more severe in cases with co-morbidities.

ImaCake 5y ago
I agree completely with this comment. The numbers in this paper are a casually spectacular defense of the vaccines. You would be hard pressed to find 100k unvaccinated people anywhere in the world with outcomes like that. Nonetheless, the interrogation of natural immunity (+1 dose of pfizer) against naive with 2 doses of pfizer is incredibly valuable and I am intrigued by the outcomes here. What this suggests to me is the vaccines are good, but we can do even better with careful applications of science. I look forward to what scientists and drug companies produce over the next few years.
- criticaltinker 5y ago
  > The numbers in this paper are a casually spectacular defense of the vaccines Yes the paper is certainly not an attack on vaccines. The crucial implications of the findings in OP are especially relevant to public health policy: 1) There are diminishing returns to vaccinating individuals who have already acquired immunity through natural infection. The benefits are borderline insignificant. Therefore when faced with a limited supply of vaccines, vaccination strategies should be highly focused on immunologically naive or vulnerable individuals. 2) Compulsory mass vaccination mandates need to accommodate naturally immune individuals. If they do not, such mandates are not only wasteful, but are also effectively ordering unnecessary medical procedures which is a violation of medical ethics and likely a violation of constitutional rights to bodily integrity and informed consent. 3) If vaccine effectiveness at preventing infections continues to be undermined by viral evolution, new formulations will need to be tested and deployed. The mRNA delivery mechanism supports rapid iteration in that respect, but those efforts will still take months at minimum. Consequently it will likely be necessary to supplement mass vaccination with other viral elimination strategies, such as early treatment with multi-drug therapy based on existing and widely available medicines [1][2][3][4][5]. [1] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1139&context=infectiousdiseases_articles https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a... [2] Timing of Antiviral Treatment Initiation is Critical to Reduce SARS-CoV-2 Viral Load https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/psp4.12543 https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/psp4.1... Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection https://rcm.imrpress.com/EN/article/downloadArticleFile.do?attachType=PDF&id=5074 https://rcm.imrpress.com/EN/article/downloadArticleFile.do?a... [3] Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents https://www.sciencedirect.com/science/article/abs/pii/S0306987721001419 https://www.sciencedirect.com/science/article/abs/pii/S03069... [4] Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial https://pubmed.ncbi.nlm.nih.gov/33983065/ https://pubmed.ncbi.nlm.nih.gov/33983065/ [5] Fluvoxamine: A Review of Its Mechanism of Action and Its Role in COVID-19 https://www.frontiersin.org/articles/10.3389/fphar.2021.652688/full https://www.frontiersin.org/articles/10.3389/fphar.2021.6526...

nsxwolf 5y ago

Can you be certain you had COVID if you only had a positive PCR test? It seems like that’s only circumstantial evidence of infection. I would probably go with the vaccine just to be sure.

walterbell 5y ago
You can get an antibody or T-cell (https://t-detect.com https://t-detect.com) test.
- nsxwolf 5y ago
  Weird downvotes on this. People are willing to bet their life on a PCR test? Even if you were asymptomatic? We're letting that cycle count do a lot of work. Seems like an antibody test is prudent if you're going to consider skipping the vaccine.

bjornsing 5y ago

Interesting. But I would be weary of confounding variables here… E.g. those who got infected and those who got vaccinated in Jan/Feb were probably pretty different groups (in terms of age, social habits, health, etc). They try to control for that in the statistical analysis, but this is often hard to do well when groups are very different. EDIT: An obvious problem if you are looking at deaths is (literal) survival bias.

xenonite 5y ago

So far to the peer review, I guess there is a calculation error in model 3 (previously infected vs. previously infected with a single dose vaccine): > ... we found that the latter group had a significant 0.53-fold (95% CI, 0.3 to 0.92) (Table 4a) decreased risk for reinfection, as 20 had a positive RT-PCR test, compared to 37 in the previously infected and unvaccinated group. Symptomatic disease was present in 16 single dose vaccinees and in 23 of their unvaccinated counterparts. 20/37=0.54, not 0.53... ;-)

anovikov 5y ago

But it means that vaccines are better than we think. If people are vaccinated and then gradually all get infected with the covid, infections still being largely asymptomatic or light symptomatic, these people will get lasting protection with negligible health costs.

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vmception 5y ago

Ok for all the flu people, here is your time to shine! “natural immunity to this years flu works better than vaccine immunity to last years flu” sounds silly right? there will eventually be delta specific vaccines, compare then.