Hacker News new | past | comments | ask | show | jobs | submit login
Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity [pdf] (medrxiv.org)
187 points by yasp 25 days ago | hide | past | favorite | 249 comments



One thing to keep in mind when reading through this, it's a pre-print (not peer reviewed) that's citing other pre-prints like https://www.medrxiv.org/content/10.1101/2021.07.29.21261317v....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


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.


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.


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.


That’s like saying QA testing is a joke because it doesn’t catch everything so why not skip it. Peer review catches a lot of issues early but it’s based around the assumption papers are submitted in good faith. Compared to most things you read in say magazines they might be good enough, but it’s really not the same.


Have you seen peer review catch issues in papers you've submitted?

Of the papers I've submitted, exactly one received a quality peer review. The rest were nonsense. Both accepted and rejected papers clearly weren't read. All incentives align to giving a paper a quick skim and being done with it. NIPS showed the process is indistinguishable from noise in an experiment a few years back.

It's like QA testing with a six-sided die.


QA testing would be replication.

Peer review is more like code reviews... but the code is hidden and you can only see the comments.


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


hydroxycholoroquine and invermectin as treatment for Covid-19, as well as a vaccine->autism link, are all well supported by preprints. They have all since been disproven, but pre-prints aren't just as good.


Slightly related : how do you explain the (obviously) fraudulent lancet paper claiming for hcq toxicity, and retracted one week later ? (but that was enough time to have hcq be banned in a few countries, including france).

Since this story ( which smells a lot like corruption and lobbyist work) i must say i'm a bit confused about the true value of publication for things related to covid


Editor of BMJ estimates about 20% of scientific publications are fraudulent.

https://blogs.bmj.com/bmj/2021/07/05/time-to-assume-that-hea...

Fewer than half replicate. I would estimate a lot of that comes from softer research malpractice.

Being confused about the value is a fair reaction. It is high; without scientific research, though, we wouldn't have vaccines or monoclonal antibodies. On the other hand, it is lower than assumed, and trusting individual papers and peer review processes is a mistake.

How much value would Facebook have if it were your only source of information? A lot, actually. Imperfect information is valuable too.


Yet this article was published in the middle of the covid crisis on of the hot topics.

I can't imagine the journal's reviewers being careless.


Have you published much?

I haven't seen many careful reviewers. It's an anonymous process, and no reason to put in any effort at all. On the procrastination list, peer reviews are the very last thing scientists do.


I like to say that peer review is what happens after a paper is published.


no peer review is what happens after a manuscript is submitted, after a preprint is circulated, after a paper is submitted to a journal and after publication.

it is an ongoing continuum of process


meh, if you're going to publish something then I'd rather just have people get their papers hosted on arxiv asap and then get feedback from everyone. I have not seen significant value added by journals and the review process, in my field.


When I saw this was the first comment I knew the study showed natural immunity to be better than vaccine induced immunity without even clicking :P


Yes good point, this is early work but definitely a necessary step toward answering an important question.

It's important to note the tremendous amount of evidence from a wide body of peer-reviewed literature which supports the fact that immunity acquired through natural infection provides protection against reinfection that is at least equally effective as vaccination. This fact has been repeatedly demonstrated in multiple large scale and long term serological studies [1][2][3][4][5].

- A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals. [1] (N=25,661)

- The study results suggest that reinfections are rare events and patients who have recovered from COVID-19 have a lower risk of reinfection. Natural immunity to SARS-CoV-2 appears to confer a protective effect for at least a year, which is similar to the protection reported in recent vaccine studies. [3] (N=15,075)

- Reinfection is rare in the young and international population of Qatar. Natural infection appears to elicit strong protection against reinfection with an efficacy ~95% for at least seven months. [4] (N=192,967)

- The degree of protection (10-fold) associated with seropositivity appears to be comparable to that observed in the initial reports of the efficacy of mRNA vaccines in large clinical trials. [5] (N=3,257,478)

The OP is one of the first and largest scale studies to evaluate the risk of reinfection - in the context of the delta variant which is currently dominant in many countries around the world - by directly comparing naturally acquired immunity to vaccine-induced immunity.

> those vaccinated are still at a 5.96-fold increased risk for breakthrough infection and at a 7.13-fold increased risk for symptomatic disease compared to those previously infected.

> SARS-CoV-2-naïve vaccinees were also at a greater risk for COVID-19-related-hospitalization compared to those who were previously infected.

If the OP study holds up to peer-review (which it likely will), then we can expect further studies attempting to replicate this finding, and even more studies attempting to explain why naturally acquired immunity induces a more robust immune response. The findings from those studies will be leveraged in the design of future vaccines - so these results will be a win just about any way you look at them.

[1] SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN) https://pubmed.ncbi.nlm.nih.gov/33844963/

[2] Risk of Reinfection After Seroconversion to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Population-based Propensity-score Matched Cohort Study https://academic.oup.com/cid/advance-article/doi/10.1093/cid...

[3] Assessment of SARS-CoV-2 Reinfection 1 Year After Primary Infection in a Population in Lombardy, Italy https://jamanetwork.com/journals/jamainternalmedicine/fullar...

[4] SARS-CoV-2 antibody-positivity protects against reinfection for at least seven months with 95% efficacy https://www.sciencedirect.com/science/article/pii/S258953702...

[5] Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection https://jamanetwork.com/journals/jamainternalmedicine/fullar...


I saw some replies to the OP where people were implying that the study results have been known for some time and there's some kind of fanatical, pro-vaxx conspiracy which was suppressing this information. This is what motivated my original post.

Other than that, I agree with pretty much everything you just said. One thing to keep in mind when it comes to policy however, is data quality. The vaccine trials were double blind, controlled studies, which are the highest quality of medical study. This is why the short term, vaccine efficacy results were quickly acted on. By necessity, the OP and the studies you linked are retrospective, observational studies which are considerably more difficult to analyze correctly, and usually provide lower confidence results. Which is why the Israel study is so important (they seem to have high data quality) and why we're waiting for so many of these studies to come in before changing public health recommendation.

One concern I do have about the Israeli data is that the paper on waning vaccine efficacy is using de-anonymized data, which means that for privacy and national security reasons, it's more difficult for the scientific community to double check their results.


Yeah good points all around. Just wanted to mention that even in the high quality phase 3 vaccine trials they found evidence that immunity acquired from previous infection was effective at preventing subsequent symptomatic illness. Obviously that wasn't the primary goal so it was hardly even mentioned in the published papers, but you can see it in the raw data. For example, from the Moderna phase 3 RCT [1] see table S17 on page 42 [2].

Out of the people with natural immunity from previous infection: only 1 out of 337 unvaccinated people were reinfected, and 0 out of 343 vaccinated people were reinfected.

Admittedly they didn't have a large number of participants in this cohort, so their statistical power was limited in this respect, perhaps contributing to their rational for not mentioning it as a primary finding.

[1] Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine (Moderna) https://www.nejm.org/doi/full/10.1056/nejmoa2035389

[2] Table S17. Vaccine Efficacy by SARS-COV-2 Status, Modified Intent-to-Treat https://www.nejm.org/doi/suppl/10.1056/NEJMoa2035389/suppl_f...


Another thing to keep in mind is that a lot of bad science manages to get published even in the best journals. Science always is about preliminary information about the best current understanding of things.


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.


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.


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-116...


> 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?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/psp4.1... Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection https://rcm.imrpress.com/EN/article/downloadArticleFile.do?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/S03069...

[4] Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial 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.2021.6526...


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.


[flagged]


> 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.


Yep. And, if you get the vaccine but then later get Covid, your likelihood of surviving with minimal consequences are greatly improved and then you will have both types of immunity, probably preventing you from even registering should you get covid a second time, right?


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.


> 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-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.


> 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?


They've always had a good point. This is yet another paper in a line of good (and unsurprising) research going back to vaccine trials in 2020.

The discourse has become politicized, unfortunately, and for whatever reasons the voices of the pro-vaccine faction in the U.S. have become dominated by people who reflexively discount the science. This doesn't seem to be the case in Europe, where the EU-wide immunity passport treats those with prior documented infection the same as the fully vaccinated. This was pointed out to me on HN a few weeks ago, when I opined that it would be logistically impractical to verify and issue immunity passports to the previously infected.

Would it be better if those with a previous infection received a vaccine? Maybe. That's a more complex question. But at this juncture that's moving the goal posts; it's scientifically and politically unreasonable to make that demand.


One issue is that an FDA advisory in May 2021 discouraged doctors from antibody testing of immunity, https://noorchashm.medium.com/fdas-advisory-discouraging-ame... & https://www.fda.gov/medical-devices/safety-communications/an...

> [FDA] blocked Americans from finding out the status of their antibody immunity to SARS-CoV-2 ... prevents un-immune Americans from knowing that they are vulnerable ... exposes already immune Americans to the risk of an unnecessary or marginally beneficial vaccination ... prevents vaccinated Americans in whom the vaccine has not induced good immunity from knowing that they remain vulnerable ... discourages a vast majority of American physicians from providing the people with the necessary prescriptions to obtain COVID-19 antibody blood tests ... Every American deserves easy access to information about their personal immunity status in order to make a cogent decision to maximally protect themselves. Am I immune? Did my vaccine work for me? Am I still immune?


> it would be logistically impractical to verify and issue immunity passports to the previously infected.

If one is donating blood etc, this information is available such as in the Red Cross donor app.

The push by the pro-vaccine groups in the US without accounting for folks who have antibodies acquired naturally - reeks of ignorance from those who are supposedly 'of science'


"Pro-vaccine faction" sure sounds like a loaded term. Look, the CDC says if you were infected, you should still get the vaccine because it gives additional protections. This paper says the same. The vaccine is extremely safe from all of the data we have seen so far, much safer than getting COVID. So just get the vaccine. It's really not that hard unless you make it hard.


Many pro vaccine people basically attack people who have had the infection and don’t want the vaccine, and call them anti science and anti vaccine, and judging by your tone you have similar views.

Yet from a science perspective they have a point, already having the disease matters.


Still, many people don't have proof that they actually had covid-19, some have falsely identified the symptoms of other infections as covid-19, and getting the vaccine will still boost the immune response for an extended period of time. Just get the vaccine, it's not hard.


>Just get the vaccine, it's not hard.

Getting the Vaccine is easy. What is hard is to trust the what every biased, safety studies done on it and the fact the AEFI reporting system is not strictly mandated, indicating a bias from the authorities to not want to know about potential vaccine injuries.

As usual, this comment will get flagged. If you see this comment check back a bit later to see the shilling on HN.


If vaccine injuries were a problem on the same scale as bad outcomes from COVID infections it would be impossible to hide.


> it would be impossible to hide.

There is nothing to hide if there is no data collected in the first place. Here in this video, you can see that even injuries sustained by people who took part in the trials are being rejected by the doctors citing as caused by "anxiety".

https://www.youtube.com/watch?v=6mxqC9SiRh8

I think people are completely oblivious to this issue, and is under this fallacy that if there was something wrong with the vaccines, then the information will automatically appear in public perception. If you think this, you need to only look at how smoking went on for a long time without the people noticing any problem with it.

With vaccines, we know that the signal is killed right at the point of generation, because the medical practicioners are conditioned (being charitable here) to reject any injury as not being caused by the Vaccines.


The US paused the J&J vaccine after a small number of cases of adverse reactions: https://www.fda.gov/news-events/press-announcements/fda-and-...

AstraZeneca has not been approved in the US because of potential blood clot risks.

Nearly 2 billion people have been vaccinated against COVID-19, including >150 million people in the US, and hundreds of millions in the EU. There are very few adverse reactions, and no deaths. The risks of COVID-19 injury and death are far higher.


Is it? Seeing how quickly European countries were to suspend the AstraZeneca vaccine I only see evidence of the opposite.


How do vaccine injuries compare to bad outcomes from Covid REinfections, though?


And two days later, your comment is not flagged or even downvoted below zero.


An antibody test will give you the proof. And also help determine more accurately how long antibodies last.


Or better still give the vaccines to countries and people that actually want them. Or is that much harder?


Actually it is in fact much harder.


Currently, the best science says if you had COVID you should still get the vaccine. The CDC and all of the evidence points to that. This isn't close. This isn't like, what happens if you fall into a black hole, where there are multiple interpretations. If you had COVID, you should still get the vaccine. If you don't believe that, you are not using science to make your decisions.


Thank you for saying this. Despite taking all precautions, I was infected in Jan 2021 before becoming eligible for the vaccine. Once I recovered, I was comfortable venturing outside again and doing some traveling but there was practically zero information about natural immunity following infection. As states easing travel restrictions, these only applied to people who had been vaccinated. There was no exception for folks who were previously infected (at least for the states I researched). At a time when vaccine appointments were scarce and there were long waiting lists (my how times have changed), I still got the first appointment I could so I could get my vaccine card.

The lack of guidance for those who were previously infected was strange. When I'd read about immunization rates and progress towards "herd immunity", previous infections also weren't included in these stats, which again was strange.

I'm in Europe now, and here it seems like natural immunity is essentially as valid as vaccination, at least for travel.

I can't explain why previous infections seem so widely discounted in the US. It feels like an intentional omission, which makes it hard for me to trust at face value what I hear and read about the pandemic.


I imagine they're trying to discourage people from getting deliberately infected to avoid a shot.


Except the CDC decided to hang their hat (https://www.cdc.gov/media/releases/2021/s0806-vaccination-pr...) on the one published article that claimed to show vaccination was dramatically more efficacious than previous infection, despite that study contradicting multiple, better studies, and despite the study itself admitting in a footnote that the data was exceptionally suspect. Also note how the CDC hedges their bets in the press release, saying that vaccination is better than prior infection alone, which only begs the question.

Here's the rub: is previous infection as good as Moderna? Probably not, especially given the new variants. (Though last year studies were showing infection providing 90%+ immunity.) But nothing is as good as Moderna. (Except maybe Novavax?) Should we require J&J vaccine recipients to be re-vaccinated with Moderna? Nobody is demanding that, though very roughly speaking J&J-level immunity may be about where things stand now for the previously infected.

This seems to be another unforced err by the CDC. Not as bad as some others, but unforced and very politically costly. It also complicates things going forward because it seems we're quickly approaching the point where we'll need to begin requiring a 2nd round of vaccinations. The CDC will need every last shred of credibility and good will left for that initiative. It could have been in a position where it could say, "hey, we tolerated the previously infected skipping vaccination before, but now the situation has changed." Instead, they'll have much less capital to work with.


I'm curious why you think previous infection is not better than Moderna. If we grant that Moderna is better than the vaccine used in the study in the OP, can it possibly be a factor of 6 better? a factor of 12? Those are the kinds of numbers they're seeing in this study. Admittedly it's not yet peer-reviewed and maybe those factors get watered down or thrown out, but if they don't, it would look like the difference between vaccine efficacies are down in the noise compared to the difference between any vaccine and natural immunity.


> I'm curious why you think previous infection is not better than Moderna.

I was trying to be conservative. I don't have any hard opinion on this one way or another. It seems like a degree of precision we'd be lucky to achieve in the best of times--i.e. when the virus and demographics aren't constantly evolving. And it's a degree of precision that is unnecessary to establish in this particular debate, even if we could. It feels like bike shedding.

The question isn't which is better--infection or vaccination. The question is, do we demand that the infected be vaccinated even though the substantial and consistent weight of scientific evidence gives us little reason to believe the previously infected put the population at more risk than the vaccinated, especially relative to vaccines that we affirmatively accept as sufficiently efficacious? The only scientifically justified answer is an unqualified, "No".

There are innumerable other questions people can debate, but from a pandemic policy perspective there's no need to venture there. And, frankly, it seems imprudent considering the level of uncertainty surrounding everything--not just the quality and relevance of data, but even if you're technically correct one moment, things can go sideways the next moment, necessitating a change in policy.


I think you're stuck on the word "previously" infected. If the government says you must be vaccinated or pass an antibody test by Sept 15 to keep your job, what are people going to do?


Well, given how many people have already dropped out of the labor market, I suspect some people will use this as another justification not to work.


Thanks, good points.


You misread the study. It does not contradict any study that I am aware of and agrees with the study that this discussion is attached to in particular.

The CDC study you're pointing to says that among people who have been previously infected, those who have been given vaccines are less likely to be reinfected than those who have not.

There is no error from the CDC here, nor any lost credibility.


The CDC study doesn’t control for behavioral differences between the two studied populations, though, which weakens their conjecture that there is a clear causal relationship that confers more immunity to those who’ve had Covid+vaccine compared to those having had just Covid. It seems entirely plausible that people who’ve refrained from getting vaccinated after having Covid are probably not especially careful about their exposure, which can lead to higher rates of infection.


One could just as easily suggest the opposite: that people who have gotten the vaccine, feeling even safer, will engage in more risk-taking behavior because they have the added safety.

With the absence of evidence in either direction, it is unwise to draw either conclusion.


I didn't say anything about the methodology of this CDC study or the study that this comment section is attached to, only that they both say the same thing. They both say that getting the Pfizer vaccine after infection confers additional protection against reinfection. There is no disagreement between these studies' conclusions.

An alternate conclusion to your own is that people who get the vaccine did so in order to take advantage of the reduced restrictions on vaccinated people at the time.


I mean, you know what’s happening here, I presume. The anti-vaccine faction will just lie about prior infection and keep spreading the plague. In exactly the same way as we have people forging vaccination cards now. There’s been a consistent anti-science and pro-disease stance on the right since pretty much day one. It’s breathtaking, no pun intended, to watch.


>> Do the people who are refusing a vaccine because they were already infected have a good point now?

Yes. But this has been speculated about for several months now. I'm not an anti-vaxxer but was holding out. On the verge of getting the vaccine I caught covid. I currently see no point in getting the vaccine. With indications that the real deal is more effective at providing future immunity (simple logic suggests that too) I think someone needs to prove some benefit to me getting the vaccine.

This is not my fight, I do find it annoying that people forget about us previously infected folks and act like there are 2 categories - vaxxed or not.


I'm not sure I care where people get their antibodies from as long as they're effective, but since you're here, mind my asking what the aversion is to the vaccine now? Is it a convenience factor, or not wanting to deal with being sick, or something else? The risks seem fairly well established at this point, from what I've been able to see.

Even if there's no proven benefit, there's plenty of things in life we almost all do because of possible benefit, so this just seems like another one of those case. We buy insurance in case we might need it. We wear seat belts even though the crash might be such that they provide no benefit. What's the point that tips you over the edge of not wanting the vaccine in this case? My understanding is that for a short inconvenience (in both time and physical well being) and zero cost you get something that might prove extremely beneficial later.


It might prove to be bad too. There have been adverse reactions to the vaccine. Is that likely to happen to me? Probably less likely than a person chosen at random given prior exposure to the virus, but why risk it?

My Covid experience was not life threatening, but it was no walk in the park either. I've had more than enough of that crap in my body, thank you very much. (Yes, I understand the difference between the virus and the vaccine, in fact that's why the real deal is thought to offer better immunity.)

There really is no argument in favor of getting it at this time, just peoples cognitive bias.


Wait. Your fearmongering about adverse reactions to the vaccine, but you acknowledge that you had an adverse reaction to COVID and indeed, the # of people with serious COVID complications dwarfs those with vaccine complications by orders of magnitude.

Also, this study doesn't seem to segment what the strain the 'natural infection'. The current vaccines are not engineered from the delta strain, but the alpha strains, and therefore it is not surprising you get breakthrough infections. But they don't seem to distinguish in this study between a natural alpha or a natural delta infection.

And there is an argument for getting it at this time:

1) If you get a booster, the chances of re-infection/breakthrough go down. In other words, you will not be an infectious disease vector that spreads to other people and increases the R0 value.

2) If you don't, and get re-infected, you will go on to infect other people. Maybe the symptoms won't be bad for you, but they may be deadly to someone else.

Whenever these debates about vaccines or masks come up, people always talk about my body and my freedom, but they never seem to consider the fact that their decisions are actually impacting the wider community. This isn't like a libertarian property rights decision about your own fenced in property, when you are infected by COVID, you are invading other people's bodies from your territory, and it behooves you to try and stop spreading to other people.


It’s confusing - alpha is not the original strain. It’s the original variant.

The vaccines are based on the original strain, not the alpha variant.


Everyone's decisions affect everyone.

Anyone who used a plane. Went to work. Went out to eat. Left their home. All put society are risk. Have you left your home in the last year? If so you have put others at risk.


Not all risks are the same, either in probability, or expected value, or avoidability or cost to mitigate. You're just trying to hand wave away the argument.

The cost-benefit of a mask compared with the cost-benefit of never leaving your home. You sure these two scenarios are equal?


Masks are a bad joke. Respirators are the only thing that work with aerosol size particles and covid is well below the size that aerosols are classed at. See Edwards et al 2/23/2021 (figure 4.) for a start. Go and read the package insert on an N95 mask (the weakest kind of respirator), it warns they are not suitable for asbestos particles which are many times larger than the covid virus. Masks leak because they are impossible to seal, they don't do anything beneficial. The infection rates in schools in Florida where some were under mask mandates and others were not were identical and tracked the general community rates.


Congratulations on being another vector for misinformation.

It has never been the case that anyone suggested that N95 masks could stop the passage of naked SARS-COV-2 particles.

However, when ejected from the respiratory passages during breathing, coughing, sneezing, the viral particles are not naked, but bound into much larger particles comprised mostly of bodily fluids. N95 masks do a stellar job of preventing the passage of such particles. Yes, edge sealing is an issue, but it is completely incorrect to claim that as a result "they don't do anything beneficial". Citing a single statistic from schools in Florida is not a legitimate way of overturning worldwide, vast-N studies that support the efficacy of mask wearing.


In general, would you rather a person open sneezed at you with or without a mask?


In my entire life, no one has directly sneezed on me except for my own kids when they were little. I'd rather they cover with their elbow than us all wear a mask.

If they are covid infectious, I've already inhaled their particles before they sneezed if we were both wearing surgical masks. See that study I referenced.


You should watch some of those clever (thermal?) imaging videos of what happens when people sneeze when using various kinds of coverings (or none at all).

The aerosol spray from even an elbow-covered sneezed is something to behold.


The favourite trick of misinformation purveyors is stripping away context.

Then they can hide behind equivocation.

Risk is risk! Even manifest risk is risk!


I do wonder what is disagreeable about what was said here. This is the reasoning for vaccines around the world.


the best efficacy numbers come from a combination of viral exposure and vaccination, the greatest risk comes from infection with the virus.

there is a feature of the spike protien that is partially stealthy; it is conformational change.

the vaccine generates modified spike protien that is locked into conformation so that immune response is biased toward a spike protien with RBD extended to infect a cell.

natural infection will generate such response however to a lower degree, further however opsinizing responses are generated, thus provoking memory immunity.

the vaccine is biased toward producing antibodies that bind to the receptor binding domain of the spike, thus producing binding inhibition of RBD ACE2 recognition thus prophylaxis.

there is a hypothetical sweet spot where vaccine induced antibody titre is at peak and will inhibit viral entry and spike RBD dynamics, meaning reduced chance of unmanaged infection and reduced severity of illness due to perturbation of the RAS system via ACE2 interference


[flagged]


Nobody on this site but yourself truly cares what you, personally, do. This entire subthread is about what people in general do.

And it's not particularly surprising that people here find that vaccine reticence is absurd, whether you've caught the thing or not.

I likely caught COVID early on (unproven), and I was part of a clinical trial for a vaccine, where I got two real shots of CureVac. The clinical trial didn't pass and I had to get two more shots of Moderna so I could count as vaccinated for things like events and travels.

Overkill? Yes. Unnecessary? Almost definitely. Annoying to do? Well I did get fever from two of the four shots so yes.

Still did it, and would do it again if I have to, because there is zero fucking risk compared to anything we do in the day to day life such as crossing the street.

I'm on a bicycle for several hours a week roaming the streets of Brussels. I will statistically die from that.


You are not wrong about the efficacy of naturally acquired immunity. It's not a hard call at all. There is a clear order of magnitude plus difference. The math is super simple.

It can be maddening, and make you feel like you live in crazy town, to not see people acknowledge this, and to have leaders at the CDC spout pure lies about it over and over again.

Here's how I made peace with it.

Pfizer will sell $33B worth of vaccines this year. The annual budgets of every news organization in America sum to $10B. So Pfizer's COVID revenue alone could pay for every newsroom all across America, and they'd still have $23B left over. And then there's Moderna, J&J, CVS, and so on.

There are an enormous amount of people working full time and part-time to promote and sell as many vaccines as possible. The biggest competitor to the vax is naturally acquired immunity. So that in particular is a big target of the shills and censors.

People always respond to incentives. This is not specific to the vax industry, and is all around us. I guess the surprising thing is how there may be no exceptions to that rule.

Looking at the data, I see no reason for anyone who's naturally recovered to get it, nor anyone under 20. If you haven't had COVID and are over 30, I think it's a good bet.


Personally I want as many people to have as much immunity to covid as possible, in order to limit (and ideally eradicate) the spread of covid. So the stronger your immunity gets, the more likely it is you will harbor less virus and therefore less likely to spread it to others.

Also, over the last year and a half, my mom went into chemo for like 6 months, had a minor heart attack (and was in the ICU twice for almost two weeks), and went into the ER recently—the majority of those times the hospital wouldn't even let me or my dad into the hospital to visit because covid cases were so high.

For me, the goal is societal (global) reduction or eradication of the virus and for that so that we don't have to argue about masks or vaccines or watch friends and family die or get wickedly sick.


Since there are multiple animal reservoirs your eradication goal is impossible. The most likely scenario is that we'll all be infected eventually no matter what we do. Fortunately the vaccines are very effective at preventing death.


Fair point on the reservoirs. Then I'd hope that thru vaccines, we train our immune system to get better and better at responding to the virus without having to take on the full viral load. I read an article a few months back describing how the immune system is like an info gathering machine, trying to catalog different threats that exist, and I dunno, I guess I just prefer to practice how to swim in a controlled pool than being tossed into the ocean.


Then why shouldn't people with natural immunity (whether vaccinated or not) demand the vaccinated be intentionally exposed to COVID? (And quarantine after exposure.)

Presuming risk of severity of breakthrough cases is as low as we've been told (over and over), isn't demanding intentional exposure a justifiable risk, if it improves a vaccinated individual's immunity to the levels of natural immunity?

Does it make a difference if risk of breakthrough infection severity ends up being lower than risk of vaccine side-effect severity?


well I'd assume that one can also get more immunity thru more vaccine shots and it's a much less risky strategy (aka no virus that can self-replicate) than intentionally exposing oneself to the virus.


Not by the logic that's been applied up to now. "Better immunity is worth the personal risk of vaccination" is the mantra that's been repeated over and over to those who already had covid.

All of a sudden risk-benefit analysis is debatable? Why is breakthrough infection not a risk worth taking, but vaccine side effects are?

Especially vaccine risk vs the limited marginal benefit for those with natural immunity?


If the breakthrough infection risk is lower to oneself and to others than the vaccine risk is to oneself and to others, then I think it would make sense to encourage people to expose themselves to the virus as a way to increase immunity.

I currently believe that the vaccine is much lower short-term risk to oneself (and especially to others) than getting a breakthrough infection. I also believe that the vaccines probably have lower medium- and long-term risks as well.

So yes, for me, if the risk equation changes, I'd be open to changing course. Until then, vaccines seem to be much lower in risk to oneself and to others than the virus itself.

Would you agree?


I agree the logic is internally consistent.

I also think it's absolutely absurd and that people will justify anything. Especially if they're already committed to it, and don't want to find out they're previous actions were nothing but show.

Including "you should intentionally get sick to prevent you from possibly unintentionally getting sick."


Which actions do you think were for show?


it is not impossible to make informed intelligent decisions regarding your behavior, or the situations you choose to become involved in. there are behavioral alternatives that will minimise your risk and others risk, these alternatives are not for everyone, the psychological challenge of social isolation is not bourne well by many people, however it was the best we had until vaccine production was sufficient to provide population scale administration.

please believe me, this is not fear mongering when i say that the >potential< risk posed if this virus generates omega strain variation [hypothetical doomsday strain] would be large and unmanagable.

this can happen if, long road taken variations accumulate over time as a result of unchecked transmission and incubation.

the short road is co-circulation of variants recombining genetic elements as a result of concurrent multivariant infection.

...and apology accepted, i see you are very passionate about your decision


That's just unscientific fear mongering nonsense. Humans are social creatures. For most people social isolation is more harmful than the virus. The human race has already survived previous coronavirus pandemics and they didn't cause doomsday.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252012/


you are wrong this is not fear mongering, this is a high potential of increased danger with each successive modification, please explain what bottleneck eliminated the majority of hominoid species but left us here.


Our ancestors eliminated the majority of hominid species, leaving us here. There is no scientific evidence that any early hominid species was wiped out by a viral pandemic.


there is plenty of genetic evidence linking neanderthal genetic features to outcome of disease and genetic infirmity, as well as outcome of covid infection, primarily to do with interferon production and signaling, as well as receptor domains, these are heteroallelic as well, so strong neanderthal heritage with respect to population at large may provide a protective allele, or a predispositional allele.

https://www.sciencemag.org/news/2020/12/neanderthal-gene-fou...

https://www.biorxiv.org/content/10.1101/2020.12.11.422139v1

https://www.nature.com/articles/s41586-020-2818-3

https://www.news-medical.net/news/20201215/Neanderthal-gene-...

https://www.nejm.org/doi/full/10.1056/NEJMe2025501

https://www.pnas.org/content/118/9/e2026309118

https://www.biorxiv.org/content/10.1101/2020.12.11.422139v1


You should risk it because the risk really is minimal and the greater benefit for society is enormous. I don't think people have cognitive bias. There are plenty of arguments in favor of getting it.


Dude! The risk may be small, but it is not zero.

For someone who already has natural immunity, that matters.

If serious adverse events are 1 in 100,000 - and I believe they are higher the younger you are - then that's significantly better odds than playing the lottery to end up hurt.

And for what?

"The greater benefit for society" is actually negative if you've been confirmed to have natural immunity.

If there's any point that you have to argue against this, I'd hope you make it instead of throwing out assertions.


> "The greater benefit for society" is actually negative if you've been confirmed to have natural immunity.

No, it's not. The very linked article and many others agree that people exposed to both scenarios have more effective, longer lasting immunity than the ones affected by either scenario individually.

And the adverse effect risk of a vaccine is not a lottery. At this point with billions of people vaccinated around the world, the risk profiles are pretty accurate, the side effects very well known and unless you are a kid under 18, all vaccines being widely distributed in western countries - which are the ones I cared to do any research on - are effectively zero risk.


>At this point with billions of people vaccinated around the world, the risk profiles are pretty accurate

No. With out no strictly mandated reporting of AEFIs, billions of administrated doses cannot indicate a safety profile..

Even with around 1% events reported, the serious events are around 1 in 5000

https://news.ycombinator.com/item?id=28311640


>If serious adverse events are 1 in 100,000

They are not. They are like 1 in 5000 (still based on volutary reporting)

https://www.medsafe.govt.nz/COVID-19/vaccine-report-overview...


Ask these exact questions to the person who originally hesitated to vaccinate and got COVID.

The risk of hospitalisation/death wasn’t zero. And yet… they chose COVID through inaction.

And for what?

“I am not an anti-vaxxer but was holding out” spells “I am an anti-vaxxer but I lucked out”.


_Nobody_ chose COVID.

And, in the early days, there was no vaccine.

In the middle days, the vaccines that were made were used.

Now, those who shun a free vaccine - and haven't already caught COVID - are choosing not to lower their risk of contracting COVID in that one way... But that doesn't really help your argument.


Guess you don’t understand default choice, huh?

Choosing not to choose commits you to the status quo: risk of COVID hospitalisation/death.


Then by that logic, you should risk a breakthrough infection to achieve natural immunity levels.

Because breakthrough severity risk is "minimal" and the greater benefit for society is enormous.

There are plenty of arguments for increasing your immunity by catching it.


It's not zero cost, there is some risk.

Maybe someone could do the math but the chances of catching covid again with natural immunity should be lower than the chance of a side effect from the vaccine.

More so, the effects of covid with immunity are much more diminished. The side effects of the vaccine range from very mild to very severe (death). https://openvaers.com/covid-data

I don't see a good reason for a person with natural immunity to get the vaccine if there is no benefit and some, even if slight, risk.

"Because everyone else is doing it" is not a good reason for people to do it because the more you scale the more side effects you get, the more absolute deaths and critical conditions.


VAERS is a flawed data set, because it is pure correlation, not causation. Quoting VAERS: "When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event."

You could get the vaccine, and then days later, you get diarrhea, or a headache, or a charlie horse in your calf, and you reason "oh, it must have been the vaccine", and boom it goes into VAERS: garbage in, garbage out.

VAERS is best realized as a regulatory capture of the personal injury lawyer industry.


It's not perfect, but there's some use to it, are you saying we should not collect and analyze adverse reactions after vaccination?

The reported adverse reactions are very serious and only occurred after the vaccine a lot of times in an otherwise healthy individual.

It should be used as a canary of safety and each report should be evaluated to see if the vaccine is the causation, especially when the individual was healthy.

Ignoring reports of adverse reactions is not proper science. Sure, we could dismiss ALL of the reports as coincidences, but is that right?

VAERS also states the data is under-reported, because not all side effects are reported to VAERS. This means for all false reports there could be true side effects not reported, this evens out the cases to some extent.

> You could get the vaccine, and then days later, you get diarrhea, or a headache, or a charlie horse in your calf,

Look at the side effects listed, it's full paralysis, death, miscarriages, etc. These are serious events that should be looked into. Those are much more rare cases than a "headache", or "diarrhea". Headaches are not reported to VAERS.


You have to compare it to the background rate to tease out signal from noise. That said any intervention (including a vaccine) carries non-zero risk. Taking aspirin, Zantac, laxatives, NyQuil etc., all can destroy you, but it’s rare.

The safety monitoring is actually pretty good as well. We caught a 1 in ~100k issue with AZ/JnJ vaccine very early on in the rollout. We caught mild myocarditis (though COVID risk > vaccine for myocarditis). There was even a massive preprint today from Israel around vaccine side effects. Few were concerning. Link to study + summary https://twitter.com/erictopol/status/1430636357626466307?s=2...

> “ Bob Wachter of UCSF had a very good thread on Twitter about vaccine rollouts the other day, and one of the good points he made was this one. We’re talking about treating very, very large populations, which means that you’re going to see the usual run of mortality and morbidity that you see across large samples. Specifically, if you take 10 million people and just wave your hand back and forth over their upper arms, in the next two months you would expect to see about 4,000 heart attacks. About 4,000 strokes. Over 9,000 new diagnoses of cancer. And about 14,000 of that ten million will die, out of usual all-causes mortality. No one would notice. That’s how many people die and get sick anyway”


> We’re talking about treating very, very large populations, which means that you’re going to see the usual run of mortality and morbidity that you see across large samples.

Exactly, that's why I said when you scale up you will get more absolute deaths and critical conditions. There's no point for those very few deaths or reactions to occur if those people had better natural immunity through previous infection.


I think you misunderstood the quote. It is saying that if you take 10 million people the background rate of death, disease, stroke etc., (unrelated to vaccine) will be high and a confounding issue, even if you didn’t give them the vaccine.

Edit: I think you have a point about whether those who have previous infection truly need the vaccine, but the way you are using VAERS data diminishes your point


There is literally a scam based on this statistical fallacy: https://en.wikipedia.org/wiki/List_of_confidence_tricks#Balt...

In short: in a large enough population with a random distribution of outcomes, you'll eventually have one member of the population who sees "you" (who is picking results at random, but mutually exclusively to individuals) pick the correct result of a sportsgame everytime.

This is the VAERS dataset: because it records any event proximate to vaccination, eventually every event is proximate to vaccination on a long enough timeline with a large enough population. It exists because, yes, they should be looked into...but only if they're occurring at a statistically higher rate then the average rate for the population over the time after vaccination. This is, for example, how AstraZeneca's clotting risk was identified and how the Pfizer myocarditis risk was identified.


With half the population vaccinated, around 1/6th of the disorders diagnoses across the entire population in a year can be expected to happen 4 months after vaccination and be reported in VAERS.

There's about 16,000 new cases of Lupus ever year, there should be around 2,500 cases of Lupus following vaccination that could be reported into VAERS.


I have absolutely no idea why you're being downvoted, other than group-think.

It's weird. And it's everywhere.


There is no doubt that society is in a state of hysteria. This reaches through the scientific process too, so there is reason to question everything


At the heart of science you are taught to question everything. It is a more honest state.


Because the serious proven cases of side effects from the vaccine are astronomically low compared to infection by actual COVID, and vaccines don't result in spread to other people, but natural infections do.

It's just that simple.


What's simple is that if my natural-immunity levels are better than your vaccine-only immunity levels, then you are the greater risk to the public.

And that's whether I decide to get vaccinated or not.


The jury is still out on that, but the question is, how did you attain your natural immunity levels? If it was a breakthrough infection, or because it happened before vaccinations, sure. If it was because you purposely infected yourself, you are a risk to the public, because while your were infected, you spread the disease, and moreover, if you had serious symptoms, you consumed hospital resources and risked frontline workers that would have been better utilized for people were had other illnesses or unavoidable COVID (e.g. immunocompromised)

All I see is a bunch of selfish people with incredibly weak excuses not to get vax'ed or wear masks, often for ostensibly stupid political reasons (e.g. "I'm a libertarian/conservative and no one tells me what to do! Freedom!!!!!" As in, I know motorcycle helmets will save my life, but I refuse to wear one if you tell me I need to, so there!), or based on astronomically rare vaccine complications well below the risk of the disease complications themselves.

Antivaccination beliefs are on par with moon landing hoaxers and flat earthers and deepak chopra followers IMHO. It's intellectual snake oil.


>The jury is still out on that

Lol- any other result and it'd be plastered on billboards along with the hospital population scare numbers.

>motorcycle helmets will save my life

Do you wear a helmet, fire-retardant suit, and 5-point harness in a car? It will save your life.

>based on astronomically rare vaccine complications well below the risk of the disease complications themselves.

Oh- we're saying the jury isn't still out on this one? Even though we've got less than a year of data?

And besides the fact that it ignores individual risk factors, including age, weight, and natural immunity?

My family got it when the cdc said it couldn't possibly be here yet, that masks were worse than no masks, and back before Trump was called xenophobic for wanting to shut down international travel and Nancy said we should go spend money in Chinatown.

And we got it because family members are the front line, dealing with "safe-side" idiots who are the infected ones, but are more worried about catching it "again" from hospital staff with 3 layers of uncomfortable ppe on because they heard that 4 layers is safer.

So take your conspiracy theory projections and shove it. Some people still value autonomy, even if you don't. You have no problem with unnecessary mandated medical treatments, but probably were part of the choir on here last week complaining about "muh device privacy! and muh software freedom!" with apple scanning for blacklisted hashes, and government wanting e2ee backdoors. Why are you worried if you have nothing to hide?

>Antivaccination beliefs are on par with moon landing hoaxers and flat earthers and deepak chopra followers IMHO. It's intellectual snake oil.

LOL- you forgot "Think of the Children!"


I was referring to actual monetary cost. Immediately prior to saying "zero cost" I outlined some other costs (time, physical well being). I'm open to discussions that try to explain other costs (that's why I asked).


There's more to immunity than antibodies. When comparing the effects of vaccines versus prior infections we also need to look at memory T cell activity over an extended period of time. So far I don't think we have any conclusive evidence on that one way or the other.


The J&J and mRNA vaccines (reliably) induce antibodies to the pre-fusion spike protein, so you may have a wider range of antibodies with vaccination than without.

(It's the only target they present to the immune system is why I put reliably; there's no saying infection doesn't induce similar antibodies)


There have been studies suggesting vaccination indeed provides better immunity to mutations.

e.g, Vaccine-induced immunity provides more robust heterotypic immunity than natural infection to emerging SARS-CoV-2 variants of concern:

https://www.researchsquare.com/article/rs-226857/v1


> I'm not an anti-vaxxer but was holding out.

No judgement, just genuinely curious, but what was your reason for holding out?


Not OP but I am in a similar situation where I am holding out too. I am in the 20-29 age group in Canada, healthy, no co-morbidities, I have been regularly exercising for over a decade, eat healthy, don't smoke/drink/drugs etc. Also I believe I have already caught COVID earlier last year (though I wasn't tested so this could be wrong).

There's been a total of 67 deaths in my age group for entire Canada in entire 20 months of the disease. Even the hospitalization in the entire 20 months for my age group has been 3,144 which isn't much in my eyes. And vast majority of these occurred in people who had pre-existing conditions.

And as it has now been widely reported, vaccinated can not only catch covid, they have the same (and sometimes higher) viral load as unvaccinated and can infect others. And the vaccine is waning off in 3-6 months. So I don't see how me getting vaccinated is "for the common good".

Canada is also 2-3 months behind Israel in terms of COVID trends (case peaks). So what's happening in Israel right now will happen in 2-3 months from Canada.

So I don't see how I can benefit from it and am willing to take chances.

What we should be doing is saving the vaccines for the elders for booster shots and working on improved vaccines for the new variants. There's a huge population in the world which can't even get their first dose of vaccine while here we are giving out 3rd doses.


>they have the same (and sometimes higher) viral load as unvaccinated and can infect others.

The higher part is categorically untrue. The 'same' part is only true in a very narrow sense. Yes, vaccinated individuals have peak viral titers that are the same level as unvaccinated. But vaccinated individual titer levels drop off substantially faster than unvaccinated individuals. So, while an immunologically naive individual might be infectious for 5 or 6 days, a vaccinated individual may only be infectious for 1 or 2.

This is exactly what one would predict based on our understanding of the human immune system. Memory B cells that respond to the antigen would start kicking out antibodies. Some will also undergo further affinity maturation with the Delta antigen. Affinity maturation of these B cells will occur much faster since the target is already very close.

>And the vaccine is waning off in 3-6 months. So I don't see how me getting vaccinated is "for the common good".

As stated above, you would be less infectious having had the vaccine.

One thing to consider is that the outcome of COVID is not 'alive or dead'. There is a spectrum of outcomes that are not captured in official mortality statistics. While it's not clear exactly what that spectrum is (e.g. how many long covid cases really exist), I would note that there are a lot of anecdotes out there about athletes that can't climb a flight of stairs 12 months out after covid.


> The higher part is categorically untrue. The 'same' part is only true in a very narrow sense.

3 studies showing that vaccinated have the same viral load as unvaccinated. When we are talking about many variable numbers, especially of a highly transmissible one, if something can be same, then there are also cases of them being higher.

https://www.medrxiv.org/content/10.1101/2021.07.31.21261387v...

https://www.medrxiv.org/content/10.1101/2021.07.19.21260808v...

https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm

> We find no difference in viral loads when comparing unvaccinated individuals to those who have vaccine “breakthrough” infections. Furthermore, individuals with vaccine breakthrough infections frequently test positive with viral loads consistent with the ability to shed infectious viruses. Our results, while preliminary, suggest that if vaccinated individuals become infected with the delta variant, they may be sources of SARS-CoV-2 transmission to others.

> One thing to consider is that the outcome of COVID is not 'alive or dead'. There is a spectrum of outcomes that are not captured in official mortality statistics. While it's not clear exactly what that spectrum is (e.g. how many long covid cases really exist), I would note that there are a lot of anecdotes out there about athletes that can't climb a flight of stairs 12 months out after covid.

I am aware. And that's why I have made my own calculated decision. Things such as what to inject in my body are deeply personal choices and I have done my cost vs benefit analysis to conclude I will skip the current vaccine until it gets updated to be more effective for longer periods of time and when long term studies have been done. There's a certain risk we are all willing to take in making decisions. I am willing to take this risk.

Especially when the data is consistently changing. What's the guarantee than the efficacy won't further drop in the next 3-6 months? Nor will there be any long term studies for a while. I can also sympathize with many in the black, hispanic and Philippine community who have severe distrust in the medical community.

Just look at the number of deaths and serious injuries which happen in my age group of 20-29:

https://tc.canada.ca/en/road-transportation/motor-vehicle-sa...

That doesn't mean I stop being in a car (even though I don't drive).

Plus I have most likely already caught covid last year (I have never been sick in over 11 years except last year with very similar symptoms).


>When we are talking about many variable numbers, especially of a highly transmissible one, if something can be same, then there are also cases of them being higher.

So, you went with your feelings as opposed to scientific backing on that one. By that rational, they could also be lower too. In fact, they could be on average lower. That statement, however, has some backing. From a vastly larger and more random survey:

https://www.imperial.ac.uk/medicine/research-and-impact/grou...

>The 13th round of the REACT-1 study looked at swab test data from almost 100,000 people in England between 24 June and 12 July. The research found that infections were three times lower in people who were fully vaccinated, compared to unvaccinated people. The data also suggested that people who were fully vaccinated were less likely to pass the virus on to others, due to having a lower viral load on average and therefore shedding less virus.


I states

> they have the same (and sometimes higher) viral load

The "same" is surely a fact as has been shown by 3 studies. The sometimes higher doesn't mean always higher - it means it can be sometimes higher, sometimes lower but on average, it's been determined to be the same. So it's not based on my "feelings".

What matters is how these will turn out in 3-6 more months. When vast majority of people around the world still haven't gotten a single dose while us healthy and young people are being pushed to take it, it doesn't seem well advised in my eyes. They should be saving these for the elders and especially the ones in poorer countries.


The particular issue is, why specifically mention "sometimes higher" if there are no studies to back up that assertion or if you're going to rationalize your assertion on inferences about statistical noise? "Sometimes", "could", and "can" are doing the work of Atlas here. It's a genuinely pointless thing to say and somewhat bewildering to see someone continue to defend.

It's important to note the population of those 3 studies. For generally symptomatic individuals that sought testing, were hospital system patients, or were contact traced individuals, respectively, viral loads(Ct values) are similar between vaccinated and unvaccinated.

Even your first cited paper mentions deficiencies for asymptomatic individuals: >It is also difficult to determine the rate of asymptomatic or paucisymptomatic breakthrough infections and to ascertain whether viral loads in such cases are as high as those in symptomatic breakthrough infections. The “true” proportion of breakthrough infections with high viral loads would require comprehensive, frequent surveillance testing of vaccinated populations to identify these individuals.

The REACT-1 study data is from a large, random sampling of the population.


  > They should be saving these for the elders and especially the ones in poorer countries.
dont they just throw away the vaccine if its not used?

if that's true, im not sure how declining to get a free vaccine helps the elderly...


This study by FAIR Health attempted to assess the prevalence of Long COVID from billions of US healthcare claims looking for problems that occurred 30+ days after a diagnosis of COVID-19:

https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/as...


> And as it has now been widely reported, vaccinated can not only catch covid, they have the same viral load as unvaccinated and can infect others.

They have the same viral load if they get infected. But the mRNA vaccines still reduce the chance of being infected by about 80% (according to [1]), which in effect reduces the chance of infecting others.

> And the vaccine is waning off in 3-6 months.

Its effectiveness goes down, but it would likely take years for it to go to zero. Regardless, that's what booster shots are for.

> There's a huge population in the world which can't even get their first dose of vaccine while here we are giving out 3rd doses.

True.

[1] https://www.medrxiv.org/content/10.1101/2021.08.18.21262237v...


Please don't hang out in public & around vulnerable people (kids, elderly) or those who live with them. There's only one way to be responsibly unvaccinated, and that's very cautiously.

(This whole "vaccinated people have higher viral loads of Delta in their mouths" thing makes me doubt your understanding of the science, as well.)


“Kids” are actually the least vulnerable people, when it comes to this virus.


> This whole "vaccinated people have higher viral loads of Delta in their mouths" thing makes me doubt your understanding of the science, as well.

Why are changing what I said? I never said mouth. Where are you getting that from?

Please refrain from using snark and ad-hominem attacks on HN. Especially when you yourself seem to not understand that kids are the least vulnerable group.


> And as it has now been widely reported, vaccinated can not only catch covid, they have the same viral load as unvaccinated and can infect others.

Widely reported and wildly inaccurate.

They studied patients with ‘breakthrough’ infections, i.e. where the vaccine didn’t work. And guess what they found? The vaccine didn’t work!!


You're probably better off if what's being said about anti-body monoculture from vaccine acquired immunity is true. You'd have higher probability of resistance to variants given the greater diversity of anti-bodies leftover from naturally acquired immunity.


From a recent BBC article on immunity, https://www.bbc.com/news/health-58270098

> There is a whole different suite of antibodies (known as immunoglobulin As) in the nose and lungs, compared with those (immunoglobulin Gs) that we measure in the blood. The former is more important as a barrier to infection. Natural infection, because it is in the nose rather than a jab in the arm, may be a better route to those antibodies, and nasal vaccines are being investigated too.

Intramuscular (arm injection) vs intranasal (inhaled) vaccines: https://news.ycombinator.com/item?id=28165287

Nasal vaccine trials: https://news.ycombinator.com/item?id=28284504


A friend who got corona in the first wave went to donate plasma to a critical patient, this was 4 months after his infection. His plasma tests indicated that his antibodies had severely reduced and doctors suggested that he take the vaccine as he was not immune anymore (or wouldn't be in a few months). This is one of the many plasma donor cases I've read about, specially in India. I don't really trust word of mouth cases but this one was a real life friend. Maybe try getting some bloodwork done and confirming this with an immunologist. Stay safe nonetheless.

edit- this post has made me realize how many people on hn are holding out on th vaccines. Kinda unexpected and sad.


You don't need antibodies to be immune. The body also develops T-cells which are much longer lasting.


[flagged]


You are a name caller. There are downsides to getting the vaccine. I know people who were down and out with side effects to the vaccine for a week. If this is accurate, then people who had covid are 18x protected vs those vaccinated.

Maybe we should introduce a covid card and only let those with them into restaurants. After all, it is likely that the combination of the reopening and breakthrough caused the spike.


[flagged]


I stand by my statement about name calling. The person who has had covid is less likely to spread it to others than someone with just the vaccine.

I see little point in forcing them to take the vaccine much less enforce a vaccine mandate. If you want a mandate it should be natural immunity or vaccine or mask or far better just tests and masks since anyone can still catch and spread it.

You are right about 13x. I just misread that (reading on my iPhone).

I was not concerned with cost so I am not going to bother to address that.


Name calling is okay, if true. If someone is an anti-vaxxer, not calling them such only supports that extremely harmful movement. Preventing calling them anti-vaxxes is literally censorship, and likely something that you are against.


Society locked me down for 18 months already without any regard of my individual wellbeing, risk tolerance and the fact that I got natural immunity early.

So why should I care about the well-being of the society?

(I still do, because I’m a good person, but I feel no “social contract” obligation whatsoever.)


The choice is not black-and-white as you insist. Yes public policy pronouncements ("get vaccinated") must be simple and unequivocal, but my personal, informed, personal-biology choices do not need to be so.

Further, governments and big pharma have made huge mistakes or have perpetrated ulterior motives ask through their history. Recent science is no more immune to politicking and groupthink than the hamfisted past.

I'll rationally take my natural immunity as sufficient and not alter my biology further and superfluously with an experimental, non-recourse drug.

Side-effect databases severely systematically underreport mild chronic harm, such as, who knows, a couple points of IQ decline or vascular damage in certain internal organs. No thanks. I'll avoid the untestable hypothesis that the my harm is worth the societal good.


There are many rational reasons for not doing it.

Just because you disagree does not make them irrational, or a person who chooses not to get this vaccine "antivaxxer".

Take a look at CDC VAERS for many rational reasons[1] why people may not want to do this, especially kids.

When choosing to undergo a medical procedure or to take a medication one must always do a risk/reward analysis. This is known as informed consent.

We should encourage this, not name call those who elect to do so.

[1] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/ad...


>With indications that the real deal is more effective at providing future immunity (simple logic suggests that too)

Simple logic does not suggest that at all. When you're infected, your immune system crushes up and snorts various pieces of the virus to try to understand how to recognize it. The antibodies it makes "naturally" are only effective for the bits on the virus' surface that it can see. It also does so in a moderated way so it doesn't accidentally kill healthy cells. If it happened to snort up a bit on the inside of the virus, it won't help as much as if it snorted up a surface bit.

The RNA vaccine specifically encodes for a highly visible, relatively well-preserved segment of virus (the spike protein), and it comes with an adjuvant that makes your immune system ever so slightly overreact at the site of injection. Your immune system will then go on to "naturally" create antibodies via the same crush and snort process, but they'll tend to be specifically tailored to recognizing the surface spike.

So no, it's not simple logic at all. A simpleton's logic maybe, but not simple.


the way you describe it sounds like the natural way is more resistant to mutations. And the low efficacy of the current vaccines against delta dovetails well to it.

>they'll tend to be specifically tailored to recognizing the surface spike

the situation is worse than that. Most of the current covid vaccines are targeting only a segment of the spike protein, and all those segments are largely overlap, ie. union of those segments of different vaccines isn't much bigger than their intersection, so just a couple of mutations (https://journals.plos.org/plosone/article?id=10.1371/journal...) is enough for the virus to escape almost all of those vaccines.


No, that isn't a conclusion from the study.

> 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.

Note also...

> evidence of waning natural immunity was demonstrated,

they didn't compare against 2 dose vaccinated, presumably because of lack of data.


Even though it wasn't a conclusion of the study, if someone wants to make the point that they already had Covid, and therefore have at least the same immunity as a vaccinated person, that's a very reasonable position. They should not be restricted from anything a vaccinated person can do.


No, because covid tests are not 100% conclusive, so from a statistical point of view it will always be better to get a vaccine shot anyway.


You are trying to not trigger autoimmune disorders. Someone recovered from covid with potentially three additional shots is at greater risk for autoimmune reactions.


We really need to be careful making claims like that. There is no evidence this is true and there is evidence that getting a vaccine gives additional protections even if you already had COVID.

https://www.cdc.gov/media/releases/2021/s0806-vaccination-pr...


Considering the sars-1 and mers vaccine attempts had over-stimulated immune response problems, it absolutely should be a concern.

Vaccination induced immunity levels were sufficient, but now that natural immunity levels are higher, that's not good enough?

Since I've been told over and over that the vaccine reduces the severity of breakthrough infections, shouldn't we also demand vaccinated people intentionally catch covid and quarantine, since that will also boost their immunity and prevent public spread?

Where's the study that shows breakthrough cases are any greater of a risk than vaccine side-effects?

And if the risks are comparable, why wouldn't it be reasonable to demand vaccinated individuals intentionally catch the virus to also boost their immunity?


Due care is called for in both directions. My daughter's immune system took 13 years to decide that she didn't need insulin any more.

If anything comes from this particular pandemic I'm hoping that one of them is that we need to be honest and transparent about risk/benefit and knowns/unknowns rather that try to brush the long tails under the rug as if they don't exist.


How do you weigh that against the long tail of a COVID infection having long term effects? We already have evidence of that, and zero evidence of that with the vaccine.


You would weight them based on individual risk factors.

If you have a risk of autoimmune disorders because of genes or other factors you would weight it against other factors.

Maybe you have left the house 4 times in the last year and you have an autoimmune worries perhaps avoiding the vaccine makes sense. Your risk rises wheb even going to the place to get the vaccine.

Everyone wants one piece of advice to fit everyone. Everyone is different.

If you get the vaccine and go out three times to every one time an unvaccinated person goes out you both have the same risk profile. If you go out 4 times you are more likely to catch it.

If you really want to stop this, stay at home unless you must go out. The vaccine adds 3x the protection.. not 10x or 100x


I don’t think there’s a great answer to your question.

One has to weigh the guaranteed exposure to risks of the vaccine, which currently appear to be extremely low but not zero, versus the less certain exposure to the demonstrably greater short term and long-term risks of a covid infection.

Ultimately that wasn’t my point, my main point is that transparency and humility in communication will likely create less of a backlash than what we are seeing today.


There is evidence of possible "long COVID" symptoms in breakthrough infections.

https://www.nejm.org/doi/full/10.1056/NEJMoa2109072

In breakthrough cases where the individual has a high viral load and typical COVID symptoms (shortness of breath, fatigue, etc.) it's not unreasonable to assume that the person might suffer from the same course of illness as an unvaccinated person. While the vaccines clearly reduce the incidence of hospitalization and death, there are people whose breakthrough cases aren't exactly what the average person would call "mild".


The FDA has asked Pfizer to perform 5-year studies for known adverse side effects of vaccines, like myocarditis.

As of 2021, we do not have long term (e.g. five years) data on either vaccines or Covid.


This week, the FDA approval required Pfizer to perform multi-year studies to assess risks of adverse events, https://www.fda.gov/media/151710/download

> ... to evaluate the occurrence of myocarditis and pericarditis following administration of COMIRNATY ... substudy to describe the natural history of myocarditis and pericarditis following administration of COMIRNATY ... prospective cohort study with at least 5 years of follow-up for potential long-term sequelae of myocarditis after vaccination

Vaccine injuries are rare but nonzero. A German pathologist has been performing autopsies, https://translate.google.com/translate?sl=auto&tl=en&u=https...

> The doctor now wants to get to the bottom of rare, serious side effects of the vaccination - such as cerebral vein thrombosis or autoimmune diseases. The problem from his point of view: Vaccinated people usually do not die under clinical observation ... More than 40 people have already been autopsied who died within two weeks of being vaccinated. Schirmacher estimates that 30 to 40 percent of them died from the vaccination. In his opinion, the frequency of fatal consequences of vaccinations is underestimated

Self-reported VAERS lists 5,000+ US deaths after [does not imply causality] Covid vaccination, but such reports are much less informative than tissue samples from an expensive autopsy. Note that if someone develops Covid or dies within two weeks of being vaccinated, CDC statistics categorize that person as unvaccinated. It would be more accurate to create a new U.S. reporting category for those who are partly vaccinated.


"Note that if someone develops Covid or dies within two weeks of being vaccinated, CDC statistics categorize that person as unvaccinated." This is concerning and shows how much care is taken to sweep negative outcomes under the rug.


We need CDC to provide more granular data on partially vaccinated people, instead of bundling them with unvaccinated people, https://www.cdc.gov/vaccines/covid-19/health-departments/bre...

> For the purpose of this surveillance, a vaccine breakthrough infection is defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person ≥14 days after they have completed all recommended doses of a U.S. Food and Drug Administration (FDA)-authorized COVID-19 vaccine.

Redline changes were made in April 2021, https://www.cms.gov/files/document/qso-20-38-nh.pdf

> Fully vaccinated” refers to a person who is ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine. “Unvaccinated” refers to a person who does not fit the definition of “fully vaccinated,” including people whose vaccination status is not known, for the purposes of this guidance


Restrictions being placed on unvaccinated individuals with natural immunity is based on the premise that it's not as effective or long-lasting as the vaccine.

That might not be an excuse to not get vaccinated, but it's absolutely a reason that individuals with natural immunity should not be treated any worse or differently than vaccinated individuals.

Regardless of whether vaccination improves on extant natural immunity.

And based on what we know about sars-1 and mers, that's not necessarily a safe assumption. For cases of repeated exposure and vaccination over time, the problems with those vaccine attempts were primarily over-stimulating an immune response.


regarding reduction of observed antibody titre == evidence of waning natural immunity.

this is not evidence of waning immunity this is evidence of efficiency and conservation of function

the presence of antibodies has been used as an indicator that vaccination produces an immune response, unfortunately far too many people have conflated reduction of this antibody titre over time as a reduction of immunity, when it is a modality of immunity.

antibody titre is a better indicator of prophylactic efficacy than immune status.

unfortunately it is very inconveinient to work with T cells and B cells as a measure of intensity of immune response.

this however can be inferred by observation of changes in antibody titre following infections/challenges subsequent to reduction of post innocual antibody titre


The FDA recently approved the T-Detect COVID test to check memory T cell response.

https://www.fda.gov/news-events/press-announcements/coronavi...


I did a T-Detect test. Their website states "A recent study demonstrated 95% of patients tested positive for T cells up to five months after a confirmed positive PCR test.1 Clinically validated data for T-Detect COVID performance beyond five months is not available yet." but it has stated this for months now.

I assume they are tracking how long their test detects T cells in subjects who had confirmed infections and hope they will provide public updates on this more frequently because "up to 5 months" is of limited value to people like me who were interested in knowing if they had the virus back in the earliest days of the pandemic.


Presumably the 5-month duration was based on the date of their 2020 submission for FDA EUA approval, relative to the earliest date of infection of their test subjects. If those early test subjects are participating in the ongoing trial of T-Detect, it's now probably a year since their infection & recovery. Hopefully we'll see a longer duration in their next FDA submission.


yes this is a good thing, the virus[sars2] has a feww features that allow partial stealth, and has accumulated variations that contribute to possible immune evasion.

this should not be taken casually, and perturberance of memory immunity should it occur would be a variant profile of high concern.


Sorry I’m not quite sure I follow. You’re saying antibodies are the “quick and easy” way to measure whether a person’s body is (correctly) reacting to the vaccine. So when someone has antibodies soon after vaccination it’s a sign it’s worked, but the antibodies dissipating isn’t necessarily a sign a person no longer has immunity? But since testing for antibodies is the only feasible test available to measure immune response in response to the vaccine it’s become conflated with actual immunity?

So someone could (in theory) get the vaccine, have tons of antibodies 6 weeks later, then have greatly reduced antibodies and it doesn’t tell us anything about whether or how much immunity that person will have if they’re infected?


Someone will have tons of antibodies 4-6 weeks later and then experience a drop off. Especially if you’re measuring from the first vaccine dose.

This is literally how the Adaptive immune system works.

Initial adaptive response, production of IgM, Vdj recombination, class switching and global proliferation (especially in the face of a repeated antigen insult), followed by a tone down of B cells as the memory effect is preserved and the antibody titre falls back (antibodies have a half life of 3-4 weeks).

Because (at least currently) the antibody response in humans is non-sterilising (talk of boosters to generate IgA abound, along with a more specific Delta variant vaccine may change this) you can’t equate a titre in humans yet with a ‘level’ of immunity


you as well understand at a deeper level


More or less. There's cells that remember how to make the antibodies, speeding up the response to a second exposure even long after the initial exposure.

Having lots of antibodies when exposed can maybe prevent infection or lessen severity, so it isn't a complete non-concern that they fade.


you understand the concept in a practical form


you seem to understand it correctly, the level of >protection< may be inferred by observing titre of antibodies, the strength of immune response may be inferred by observing increase of titre after challenge by pathogen.

the durability of immunity may be inferred by observing the increased response to challenge over points in time.


Your right, but anybody else making this argument up until now in defense of natural immunity got ignored or ridiculed.


The study compared against 2-dose vaccinated. The three groups are as follows:

1. Two-dose vaccinated 2. Previously infected and not vaccinated 3. Previously infected and single-dose vaccinated


It would have been great to find out a fourth scenario: infected post double vaccination


I think they are working on that, and it will be important, but they just need time. Break through cases seem to be high recently, but folks need to recover, then they need to run around in the wild and get (or not get) COVID, and then they need to write the paper... Stay tuned, I can't wait to see, since I feel like this is where most people will end up.


But even though the protection waned, it was still a factor of 6 better than the vaccine at the same point in time. It waned to be "only" 6 times better.

Clearly, you want natural immunity if you can get it safely, which is a big question. It still makes sense to get vaccinated for most adults. You can always get your natural immunity through a break-through infection, which you'll ride out more easily having been vaccinated.


Where does the concept of diminishing marginal returns come in you think?

There’s got to be a point where we say, it’s “good enough” to not warrant exposure to 50 Billion copies of mRNA.


There is very little risk to the mRNA vaccine. So, what do you mean "warrant exposure to 50 Billion copies if mRNA." This is just trying to throw out a big number to sound scary, but in fact tells you nothing about the risks.


The 50Billon was a stat thrown at my feet by a phd arguing that the exposure to Covid is unknown in people with previous infections… they claim the more numerous the spike Protein exposure the better the immunity.

0. Less exposure to spike proteins the better: in all cases the less one is exposed to novel, man made stimuli into intimate bodily functions (read less than 1000 years of human existence) the better. And a counter point to the benefit of modern medicine… many still die in their sleep, if one is exceedingly lucky and very healthy, then they will have no need for the man made interventions.

1. Inadvertent intravenous injection: lack of properly aspirated needles can potentially send a majority of the mRNA into a vein, producing complications. This is my hypothesis for the wide range in side effects

2. Faulty Fatty Anchors: it is claimed that the lipid anchor keeps the spike protein in a safe state. Potentially this is not true and potentially when your body attacks the vaccine the protein is set free due to incomplete distraction

There are quite a few others, but these I’ve found to be the most compelling.

These and the others I will reserve unless anyone is curios.. these all require much more observation than a few years to complete.


I've had 5 shots so far (pfizerx2, AZx3) because of exactly this. Natural immunity (which I already have) doesn't confer complete protection, but in combination with the vaccines I believe I'm fully protected.


I guess when you make something free you can't cry fowl when people go back for seconds thirds fourths and fifths.


That's possibly a world record! Any reason for this?


Interestingly, it is not a world record. In July, I noticed that in VAERS, there are a few people with 4-5 shots. The reports made for interesting reading.



Yes, they always did. Natural immunity is the rule not the exception.


First, you skipped the fact that this is about the Delta variant. Those folks have been refusing vaccines since much earlier than when Delta became prevalent.

> Our study has several limitations. First, as the Delta variant was the dominant strain in Israel during the outcome period, the decreased long-term protection of the vaccine compared to that afforded by previous infection cannot be ascertained against other strains.

Second... how do you reconcile your position with [1]?

> Kentucky residents who were not vaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated.

Third, note that they describe another limitation:

> Additionally, as this is an observational real-world study, where PCR screening was not performed by protocol, we might be underestimating asymptomatic infections, as these individuals often do not get tested.

This is particularly important given that vaccines appeared to reduce viral loads (and thus transmission) for strains preceding the Delta variant, but they don't seem to have this effect for Delta anymore. One huge reason the CDC kept telling people to get vaccinated was to reduce transmission rates. It's not just about your personal health here. Yet people didn't listen, and now we have a strain whose transmission appears to be far less affected by vaccination. So if people are refusing it on that basis for Delta, that doesn't make it a "good point", but rather a self-fulfilling prophecy (and one that quite possibly sabotaged a public health campaign).

[1] https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm


From your same paper.

>These findings suggest that among persons with previous SARS-CoV-2 infection, full vaccination provides additional protection against reinfection

What "2.34 times" is referencing is two groups had COVID-19 but one of them got the vaccine as well. In which case the COVID-19 + Vaccine group has less chance of reinfection compared to those who only had COVID-19.

The original article does mention that COVID-19 + infection does provide more protection as well I believe.


You're only looking at "protection". It's not just about that individual. That's only half the story. Transmissibility is the other half.

Think about it this way: if we could tell already-vaccinated people to get COVID for extra reduction of transmissions (!), we would do that too. For obvious reasons, we don't do that. But this clearly doesn't apply in the reverse direction!


> Kentucky residents who were not vaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated.

Simple. Not vaccinated != infected previously

Those who are both not vaccinated, and not previously infected, will raise that number significantly.


The cited study explicitly compares previously infected (not vaccinated) individuals to vaccinated individuals, so your claim is wrong.

However I will say, in a lot of the CDC literature they inconsistently refer to "unvaccinated" individuals in a manner that often does not distinguish between those with prior infection and those who are immunologically naive. I think this has been a major point of confusion for the general public who are trying to interpret the results of such studies.


> how do you reconcile your position with [1]?

The CDC publication you cited has a relatively small sample size (N=738) and uses data from a single state during a 2-month period. The confidence interval on the "2.34" odds ratio is large (95% CI = 1.58–3.47). Most importantly, a tremendous amount of literature has contradicted their findings.

Multiple large scale and long term serological studies have demonstrated that immunity acquired through previous infection has been at least equally durable and effective as vaccination in preventing reinfection.

- A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals. [1] (N=25,661)

- In conclusion, documented SARS-CoV-2 reinfections were exceedingly rare, with an incidence of 0.3 infections for every 1000 persons-week, and none were severe. Seroconversion after symptomatic or asymptomatic SARS-CoV-2 infection seems to be associated with a 10-fold reduction in risk of successive viral infection contamination, lasting at least 8 months. [2] (N=1,494)

- The study results suggest that reinfections are rare events and patients who have recovered from COVID-19 have a lower risk of reinfection. Natural immunity to SARS-CoV-2 appears to confer a protective effect for at least a year, which is similar to the protection reported in recent vaccine studies. [3] (N=15,075)

- Reinfection is rare in the young and international population of Qatar. Natural infection appears to elicit strong protection against reinfection with an efficacy ~95% for at least seven months. [4] (N=192,967)

- The degree of protection (10-fold) associated with seropositivity appears to be comparable to that observed in the initial reports of the efficacy of mRNA vaccines in large clinical trials. [5] (N=3,257,478)

> One huge reason the CDC kept telling people to get vaccinated was to reduce transmission rates

It's important to note that transmission is also equally well reduced by immunity acquired through natural infection.

> It's not just about your personal health here. Yet people didn't listen, and now we have a strain whose transmission appears to be far less affected by vaccination.

You seem to be implying that if everyone had been vaccinated the virus wouldn't have mutated into a variant with increased transmission/virulence. That fact is that the current vaccines do not provide sterilizing immunity. Therefore transmission, mutation, and selective pressure would have continued at a rate that would still be extremely likely to evolve into VOCs [6]. Moreover, analogous to antibiotic resistance, evolution of vaccine resistance is a non-trivial risk associated with mass vaccination strategies [7][8]. This brings us back to OP which is strong evidence suggesting that natural infection may induce an immune response that is more robust to variants of concern such as delta.

Considering all of these facts, the optimal public health strategy will likely involve a mix of vaccination, naturally acquired immunity, and other viral elimination strategies such as early treatment using multi-drug therapies based on existing and widely available medications which have been proven to be effective at reducing hospitalization and death [9][10][11][12][13][14].

[1] SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN) https://pubmed.ncbi.nlm.nih.gov/33844963/

[2] Risk of Reinfection After Seroconversion to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Population-based Propensity-score Matched Cohort Study https://academic.oup.com/cid/advance-article/doi/10.1093/cid...

[3] Assessment of SARS-CoV-2 Reinfection 1 Year After Primary Infection in a Population in Lombardy, Italy https://jamanetwork.com/journals/jamainternalmedicine/fullar...

[4] SARS-CoV-2 antibody-positivity protects against reinfection for at least seven months with 95% efficacy https://www.sciencedirect.com/science/article/pii/S258953702...

[5] Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection https://jamanetwork.com/journals/jamainternalmedicine/fullar...

[6] The total number and mass of SARS-CoV-2 virions https://www.pnas.org/content/118/25/e2024815118

[7] Risk of rapid evolutionary escape from biomedical interventions targeting SARS-CoV-2 spike protein https://pubmed.ncbi.nlm.nih.gov/33909660/

[8] Can we predict the limits of SARS-CoV-2 variants and their phenotypic consequences? https://www.gov.uk/government/publications/long-term-evoluti...

[9] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a...

[10] Timing of Antiviral Treatment Initiation is Critical to Reduce SARS-CoV-2 Viral Load https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/psp4.1...

[11] Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection https://rcm.imrpress.com/EN/article/downloadArticleFile.do?a...

[12] 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/S03069...

[13] Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial https://pubmed.ncbi.nlm.nih.gov/33983065/

[14] Fluvoxamine: A Review of Its Mechanism of Action and Its Role in COVID-19 https://www.frontiersin.org/articles/10.3389/fphar.2021.6526...


If you're playing Russian Roulette, you probably still rather have that first exposure be the vaccine and then take the chances of breakthrough as opposed to the first exposure being the virus itself.


Well... Has it been studied what happens to people with natural immunity who also get vaccinated? Is it better, worse, or the same?


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."


Giving a third dose of the vaccine would probably also give people in the two-dose group additional protection against the Delta variant. The question is whether that additional protection is actually worth the additional doses of vaccine required and the side effects. There are arguments in the mainstream media that giving those extra booster doses would be outright immoral because they could be used on people in the developing world who haven't been vaccinated yet; those arguments never get applied to requiring the previous-infected to get vaccinated, presumably because vaccination is a partisan political topic.


It is easy to stand at a distance and claim that it would be immoral to give booster shots when many countries don't have enough first shots. However, they (WHO) are ignoring the realities of the logistics problems that these countries have in distributing and shipping these vaccines that have stringent storage and utilization requirements. Those countries need to fix their medical distribution systems first to handle the volumes that are really needed for the vaccines that they have access to.


There are multiple vaccines out there that don't have such stringent requirements. Even the J&J vaccine doesn't have those requirements.


As far as I know, only Comirnaty is currently being used as a booster, and it is the most restrictive of all currently approved vaccines.


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"?


It's wrong because the risks aren't similar.

Not just to the individual, people getting infected after vaccination are more likely to spread the infection to people that are immunologically naive to the virus than people getting vaccinated after recovery.


Vaccination and natural immunity seems to add to the protection according to the study.


>Do the people who are refusing a vaccine because they were already infected have a good point now?

Not from this, because a vaccine does not cancel 'natural' immunity. In fact this study and others show previously infected people which get vaccinated get better immunity.

If their argument was that they'd rather have the dose go for someone else they would have had a better point, but it's obvious they'd benefit from a single dose.


This says that natural immunity is 18x better. There is virtually no need for the vaccine.


I misread the 13 for an 18. It is 13x with a relatively wide confidence interval. Another commentator pointed this out to me.


We need to separate public policy (where I live getting a shot is entirely optional for previously infected) and the individual decision to get vaccinated.

For the individual, the risk of reinfection is still higher than the risk of a vaccine. Also note the small risk of a false positive for the initial COVID diagnosis.


Uhhh... Is that the only metric by which a vaccine is evaluated?


As far as you taking it, pretty much yes.

The unvaccinated can take it. That is of better community benefit.

There is barely any additional protection for you.


The vaccine also hells reduce the severity of infection.


Rate of reinfection is currently rare, but vaccination post infection does lower that rate.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm...

"Among Kentucky residents infected with SARS-CoV-2 in 2020, vaccination status of those reinfected during May–June 2021 was compared with that of residents who were not reinfected. In this case-control study, being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated."

Additionally, there have also been some preprints indicating reduction of long covid symptoms following vaccination in a good portion of those surveyed.


No.

Read the next sentence in the paper.


> 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.

I think they still have a point. How much more? 95% efficacy to 96% efficacy?


Not according to Pfizer executives.


wait wait wait, its only a matter of time before delta variant mRNA vaccines come out though

this is comparing two different things, which is a facepalm

but just like the last 18 months it is not possible to compare the things you actually want because the data and materials dont even exist yet and wont for another year

leaving us at square one: react

but your reaction cant be based on things merely tangentially related like natural immunity to this years virus versus vaccine immunity to last years virus

here, finally an actually flu analogy can be used: “natural immunity to this years flu works better than vaccine immunity to last years flu” wooowww stop the presses, uhm except not really its not news


Don't stop the presses, stop the mandates based on overly general recommendations.


Only if we ignore the entire profit motive behind pushing vaccines for all, including for children, and chimpanzees:

https://www.sciencemag.org/news/2021/08/us-chimp-sanctuary-p...


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.


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.


I suspect, given the way things are going in even the most highly vaccinated countries, everyone will end up being exposed eventually now.


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.


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.


Dr. John Campbell had a video on this last week: https://www.youtube.com/watch?v=20DxL8KhvgA.


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.


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


they compare 3 groups. see under "Methods"


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?


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.


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?


Are you trying to say that we need a cheap reliable anti-bodies test?


I guess that's what I'm saying if the answer to my question were to show up in the data. ;)


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... ;-)


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.


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.


You can get an antibody or T-cell (https://t-detect.com) test.


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.


[flagged]


[flagged]


"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.


AstraZeneca are selling their vaccine at cost. The other two aren’t, and they are significantly more expensive.


> 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.


Pfizer changed their mind and actually made good profits. Not that I think that this is inherently immoral.


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.


"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".


When one makes profit from providing to others who are not compelled to use it a good or service they are not compelled to produce, the "profit" is pure goodness.

When the market for a thing exists solely through government action, compulsion, coercion, or cajoling, the same cannot be said.

But that is an aside. My comment simply pointed out the tautology that no entity involved in the vaccine food chain has any incentive to acknowledge the strong protection conferred by natural immunity.

If you are aware of such incentives, please point them out. If you are aware of big pharma executives pleading with governments not to create panic or use compulsion to increase the vaccination, please do point them out.

None of what I said is "right wing nonsense". Simply a sober look at the incentives faced by various entities who have full liability protection from the consequences of any decisions they make.


[flagged]


AFAIK, Pfizer is actually mandating previously infected employees to get vaccinated. Not FUD.

> "Well gee, the headline says they made $22B from the pandemic, I guess they must be filthy rich off of this!".

There is a difference between having something to lose from acknowledging that previously infected individuals have strong protection against Covid19 and the way you make it sound.

> Read a balance sheet. It will do you some good.

I have. Some very deeply. Thank you very much for your concern.


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.


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?


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.


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


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.




Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: