6 ms·

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 app

by 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...
  - bart__ 5y ago
    On your second point: The paper shows, when comparing recovered to recovered with single dose, that there are about half as many re-infections. And yes we're talking about 0.3% vs 0.15% reinfection (that's why there is not enough power for significance), but halving the chances may still be important. I'm opposed to compulsory vaccination either way though.
- sfteus 5y ago
  W/R/T your second point, one of the things I touched on was whether or not those with natural immunity are more likely to experience repeated exposure after acquiring immunity. For instance, is a healthcare worker more likely to experience "micro-doses" of virus exposure that helps consistently refresh antibody levels? This is a potential reason as some sources have stated that the third booster shot is generating 5-10x the antibody levels as observed than after the second shot, and a higher number of free antibodies should be associated with a smaller chance of re-infection. The other potential that jumps out to me is that only targeting the spike protein is causing the drop in protection, as in theory that should be the only type of antibody a only-vaccinated person would have. The potential conclusion to draw there is that antibodies developed for other antigens on the virus may not be as effective as the spike protein, but when combined help retain that higher level of effectiveness when the spike protein mutates. If that's the case, I wonder if having a inactivated/attenuated vaccine as the "third-dose" may end up being more effective, or if the immune system would ignore the additional antigens in favor of the one it already has. [1]: https://www.wsj.com/articles/covid-19-third-shot-booster-11623421703 https://www.wsj.com/articles/covid-19-third-shot-booster-116...
113480085 5y ago
Well, isn't the most OBVIOUS thing to notice the fact that this study proves that the vaccines are not worth getting; certainly not worth requiring...
- bserge 5y ago
  The opposite imo. Vaccines are as good as natural immunity. You can get a vaccine and risk minimal side effects or you can risk getting Covid and then risk getting the extreme effects that put you in the hospital or ground. Guess it depends on how risk averse you are, but the end payoff is the same anyway. I do hate how people seem to shit on natural immunity as if it's obviously worse than a vaccine.
  - LurkingPenguin 5y ago
    > Vaccines are as good as natural immunity. The study directly calls this into question: > 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. A lot of the newer data is suggesting that the B and T cell responses to natural infection are broader and more robust than those to the vaccines. Example: > Vaccination produces greater amounts of circulating antibodies than natural infection. But a new study suggests that not all memory B cells are created equal. While vaccination gives rise to memory B cells that evolve over a few weeks, natural infection births memory B cells that continue to evolve over several months, producing highly potent antibodies adept at eliminating even viral variants. https://www.rockefeller.edu/news/30919-natural-infection-versus-vaccination-differences-in-covid-antibody-responses-emerge/ https://www.rockefeller.edu/news/30919-natural-infection-ver... One interesting question is whether somebody who was vaccinated before natural infection is capable of developing B and T cells as robust and broad as those who were infected before they were vaccinated. If not, we could be in for an unfortunate situation in which lots of us are forced to constantly boost to keep antibodies circulating.
- bart_spoon 5y ago
  > Well, isn't the most OBVIOUS thing to notice the fact that this study proves that the vaccines are not worth getting Absolutely not. The point is that immunity from natural infection is as good or possibly better than immunity from vaccination, but the protection of both is very strong and the cost of getting that immunity is not remotely similar. Natural immunity, while potentially stronger, also has a much, much greater chance of causing hospitalization, death, or negative long term health outcomes than vaccination for those with no pre-existing immunity. There would be orders of magnitude more people getting severely ill and dying were we to just count on everyone getting sick naturally, rather than utilizing vaccination. What this means is that there is a potentially good argument for not requiring those who have gotten sick naturally to get vaccinated. It also has implications for vaccine boosters and variant specific vaccines. If vaccine protection against hospitalization and death remains strong over time, then even if protection against infection wanes, like is already being seen, there isn't much of a point for giving boosters. Instead, initial vaccination can be seen as a way of priming the immune system for Covid, allowing individuals to eventually acquire natural immunity without the naked risk associated with infection up until this point. In either case, the vaccines are crucial.

by sfteus 5y ago

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...
- bart__ 5y ago
  On your second point: The paper shows, when comparing recovered to recovered with single dose, that there are about half as many re-infections. And yes we're talking about 0.3% vs 0.15% reinfection (that's why there is not enough power for significance), but halving the chances may still be important. I'm opposed to compulsory vaccination either way though.
sfteus 5y ago
W/R/T your second point, one of the things I touched on was whether or not those with natural immunity are more likely to experience repeated exposure after acquiring immunity. For instance, is a healthcare worker more likely to experience "micro-doses" of virus exposure that helps consistently refresh antibody levels? This is a potential reason as some sources have stated that the third booster shot is generating 5-10x the antibody levels as observed than after the second shot, and a higher number of free antibodies should be associated with a smaller chance of re-infection. The other potential that jumps out to me is that only targeting the spike protein is causing the drop in protection, as in theory that should be the only type of antibody a only-vaccinated person would have. The potential conclusion to draw there is that antibodies developed for other antigens on the virus may not be as effective as the spike protein, but when combined help retain that higher level of effectiveness when the spike protein mutates. If that's the case, I wonder if having a inactivated/attenuated vaccine as the "third-dose" may end up being more effective, or if the immune system would ignore the additional antigens in favor of the one it already has. [1]: https://www.wsj.com/articles/covid-19-third-shot-booster-11623421703 https://www.wsj.com/articles/covid-19-third-shot-booster-116...

113480085 5y ago

Well, isn't the most OBVIOUS thing to notice the fact that this study proves that the vaccines are not worth getting; certainly not worth requiring...

bserge 5y ago
The opposite imo. Vaccines are as good as natural immunity. You can get a vaccine and risk minimal side effects or you can risk getting Covid and then risk getting the extreme effects that put you in the hospital or ground. Guess it depends on how risk averse you are, but the end payoff is the same anyway. I do hate how people seem to shit on natural immunity as if it's obviously worse than a vaccine.
- LurkingPenguin 5y ago
  > Vaccines are as good as natural immunity. The study directly calls this into question: > 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. A lot of the newer data is suggesting that the B and T cell responses to natural infection are broader and more robust than those to the vaccines. Example: > Vaccination produces greater amounts of circulating antibodies than natural infection. But a new study suggests that not all memory B cells are created equal. While vaccination gives rise to memory B cells that evolve over a few weeks, natural infection births memory B cells that continue to evolve over several months, producing highly potent antibodies adept at eliminating even viral variants. https://www.rockefeller.edu/news/30919-natural-infection-versus-vaccination-differences-in-covid-antibody-responses-emerge/ https://www.rockefeller.edu/news/30919-natural-infection-ver... One interesting question is whether somebody who was vaccinated before natural infection is capable of developing B and T cells as robust and broad as those who were infected before they were vaccinated. If not, we could be in for an unfortunate situation in which lots of us are forced to constantly boost to keep antibodies circulating.
bart_spoon 5y ago
> Well, isn't the most OBVIOUS thing to notice the fact that this study proves that the vaccines are not worth getting Absolutely not. The point is that immunity from natural infection is as good or possibly better than immunity from vaccination, but the protection of both is very strong and the cost of getting that immunity is not remotely similar. Natural immunity, while potentially stronger, also has a much, much greater chance of causing hospitalization, death, or negative long term health outcomes than vaccination for those with no pre-existing immunity. There would be orders of magnitude more people getting severely ill and dying were we to just count on everyone getting sick naturally, rather than utilizing vaccination. What this means is that there is a potentially good argument for not requiring those who have gotten sick naturally to get vaccinated. It also has implications for vaccine boosters and variant specific vaccines. If vaccine protection against hospitalization and death remains strong over time, then even if protection against infection wanes, like is already being seen, there isn't much of a point for giving boosters. Instead, initial vaccination can be seen as a way of priming the immune system for Covid, allowing individuals to eventually acquire natural immunity without the naked risk associated with infection up until this point. In either case, the vaccines are crucial.