Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 650 days since the first documented human case of COVID-19. Sometime around the year 650, the ruling elite (at least) of the Turkic Khazar Khaganate converted to Judaism, the only time I’m aware of a major nation that isn’t Israel making that their official religion. Unfortunately this has spawned a legitimacy libel against modern Jews, accusing us of being Khazars rather than authentic Israelites—a claim which has been demonstrated to be untrue in a variety of ways. Still, it is a very interesting episode in history.
Today, we’ll discuss vaccination vs natural infection, in light of a new paper from Israel that presents a challenge to the narrative as I’ve understood it so far. This is a confusing one, I’ll admit.
We’ll also discuss a new vaccination milestone among US teens, and a modeling paper about predicting future pandemics.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Half of US teens now have at least one vaccine dose
This is some good news: https://www.nytimes.com/2021/08/27/us/adolescents-covid-vaccine-shot.html
Half of teens in the US have now received at least one dose of a COVID-19 vaccine. Let’s make that 85% or more, though.
Israeli results suggest natural infection produces robust immunity compared with vaccines
A recent preprint out of Israel is causing some confusion, so I thought I would share it here: https://www.sciencemag.org/news/2021/08/having-sars-cov-2-once-confers-much-greater-immunity-vaccine-no-infection-parties
The bottom line of this study is that people in Israel infected with COVID-19 were more likely to be protected, over the course of this summer, from COVID-19 infection and disease than those who were vaccinated with the Pfizer vaccine. This adds fuel to a debate over whether natural infection or vaccination is “better,” and I know this has been the source of some controversy in the past, which I’ve discussed here. The study comes with some caveats, though. In particular, it could be that one or the other of these two groups were less likely to seek out COVID-19 testing, and that might have distorted the results. Still, let’s consider that this might be real.
I want to be clear that we do not understand at this time how to predict if a specific individual is protected from COVID-19; we do not have the immunological understanding or tools to be able to do this. We know there is wide variation in natural antibody responses, and we also know that vaccinated antibody responses are more consistently high. On the other hand, we do know that naturally infected people are to some degree protected, for at least 6 months. Beyond that, the Delta variant seems to be pretty good at reinfecting people. At least, this is what we know from data around the world. At this time, there is no way that I know of that could tell a recovered, naturally infected person in the individual case whether or not they are protected. Their best bet is still to become vaccinated.
The Israeli data seem to suggest that infection still leaves people somewhat protected against Delta, perhaps even better than vaccination, but this is hard to square against global data. This is a confusing situation, and we are seeing science-in-progress here. The answers will not necessarily be clear.
But let’s sit with these for a moment more. This would hardly be the first time that a vaccine has induced slightly poorer immunity than natural infection—and while the paper suggests that natural infection is many multiples better than vaccination, let’s remember that the vaccines already offer excellent protection, so this large relative difference is actually quite slight in absolute terms. I can think of many examples of this sort of phenomenon, and they are all united by one fact: natural infection has an enormous number of safety problems. Specifically, natural infection means getting the disease. For COVID-19, that comes with a risk of death and debilitation; recent estimates suggest that as many as half of people who get sick with COVID-19 still have at least one symptom a year later. Meanwhile, the vaccines all appear to induce extremely short-lived safety events that are minor in nature. It is definitive that in terms of safety, the vaccines are better.
So, if indeed natural immunity produces better forward protection, but at much greater risk, we should approach these data with one question in our minds: how can we design the vaccines to produce better immunity, by learning from the natural infection experience?
In this regard, we need to understand the immunological underpinnings of the effect observed here—that is, if it is really genuine. This could all be an artifact of testing strategies, with naturally-infected people just not thinking they need to be tested, just to remind about that. But if it is genuine, it could teach us something about how to improve the vaccines—either through additional doses, modifications to the design, or alterations to the dosing schedule.
The take-home here is that we have a lot to learn about immunity to COVID-19, though we should still be grateful to have such effective vaccines. No one should use this paper as a means to make individual decisions. We know the vaccines are very consistently protective, but we do not know that for natural infection. One study does not upend that.
However, it does tell us that we have more to learn. One thing I am eager to learn is what particular aspects of the immune response actually would allow us to predict if a person is protected or not. This would allow us to design better vaccines, and also to tell who may need them. Work such as this may help to point us in that direction.
Forecasting future pandemics
I’ve been interested in pandemic-potential viruses for a long time; professionally, for about 13 years. One thing that is important in the study of such viruses is attempting to understand how likely they are to emerge. A new paper in the Proceedings of the National Academy of Sciences (PNAS) presents a model for predicting future pandemics based on their severity—the assumption being that more severe pandemics are less common. Using this model, the authors propose that with increasing climate-based encroachment on animal habitats, the chances of novel pandemics may triple over the next several decades: https://www.pnas.org/content/118/35/e2105482118
I don’t put a lot of stock in predictive models, but I do find them interesting. Perhaps you will as well.
What am I doing to cope with the pandemic? This:
Application
Yesterday, I completed an application for a professional opportunity I am very excited about. I’ll leave it there, until I have more news.
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Always,
JS
Hi John, I love your great public service! I have a question about another study. One of my friends is one of those people who has drunk the Kook-Aid hook, line, and sinker. He forwarded this study to me from the American Journal of Therapeutics which seems to show that Ivermectin has some therapeutic use. What is your opinion on this study? I see that it has cited the retracted Elgazzar paper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/. I am very skeptical, but then again there is a history of groupthink in medicine, as in other fields.