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Comment by darthvoldemort | Hacker News Reader

A recent study from Israel said that natural immunity is an order of magnitude better than vaccine-induced immunity against delta variant. I don't know who to believe, but if that's the case, then the narrative of "well they should get vaccinated anyway" is really freaking suspicious. We need deeper research on this, and the fact that they haven't researched this is truly scary.

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I think the biggest issue is that a lot of people think they had covid previously but didn't get tested so they don't really know.

I thought I had covid early in the pandemic. Took a serology test and found out that I had not had it. I suspect a lot of people that think they had it are the same.

Interesting.

Does the US now have a digital verifiable certificate system for tested or previously infected as well as vaccinated or is it still a piece of paper?

Without this you have to just vaccinate everyone because there is no other way to manage it.

Except that antibodies don’t tell the whole story. They may wane after a while, but the immune system is primed to fight off the virus at the next infection thanks to memory B cells and T cells.

Unfortunately, T-cell tests are not available in Europe, and apparently not reliable in the US. Which confirms the original point: there seems to be little interest in detecting previous infections.

Which means that testing is really undependable. Probably better to vaccinate everyone, because our prediction of the immunity of people who have been vaccinated is a lot more reliable.

> apparently not reliable in the US

Which T-cell test(s) are you referencing? What are the rates of false negatives or false positives?

Good question. I wrote "apparently" because I don't know much about T-cell tests. I would be happy for any information on the topic.

From an economic perspective, if the cost of the vaccine is less than the cost of the test, you just use the vaccine. "Natural immunity" makes sense as an objection if the individual had a recorded earlier infection, but administering 300M pre-infection tests and 200M vaccines is likely to be less efficient than just administering 300M vaccines. The more sophisticated of a test you demand, the stronger this argument becomes.

I think Canada accepts positive covid tests as proof of prior infection, and many people already have those tests done and just sitting in their email.

Not true to my knowledge. Sorry. - A Canadian.

I mean, that's fine, but it's not what the parent was asking for. It seemed that they were implying we needed to catch every pre-infection, and the lack of development of highly sensitive tests for pre-infection was evidence of some negligence. I was arguing against developing "T-cell tests" for prior COVID infection.

My comment was not intended to be an argument against any testing for pre-infection; I think the rationale for that is pretty solid, but I think that the regulatory establishment needs to be prepared to inform people that they might not be able to prove their previous infection and in that case they should get vaccinated.

Canada doesn't have a national health care system, this is managed by each provinces.

Quebec is the only province that will let you get only 1 dose of the vaccine, instead of 2, if you were previously infected. With that 1 dose, that's enough to have access to the vaccine passport.

But there are absolutely no places in Canada that accepts prior infection as being fully vaccinated.

You should at least account for additional sick days, tens of millions of them.

Can you be sure the temporary side effects (caused by the engagement of the immune system) wouldn't be diminished for people with existing immunity? It might not be as much of a concern.

I can't be sure, could go either way. Remember for instance that the second dose causes on average worse side effects.

I believe one of the major studies that found that natural immunity was better than the Pfizer shot alone also found that natural immunity plus the shot was better still.

You would just be administering a cure, without having an actual diagnosis, which is by definition more wasteful.

Particularly when natural immunity comes for "free" and apparently works better, at that point insisting on vaccines for everybody is just completely nonsensical.

Rather shift resources to testing to get costs for that down, which is more work, but also doesn't come with the risk of later discovering "Oops, this vaccine that made people filthy rich turned out to have some nasty long-term side-effects!".

Which is also a very real possibility, considering they've been developed and approved in record time with the population at large acting as subjects for the first non-clinical trials.

A vaccine is an innoculation and prophylactic, not a cure.

The prophylactic costs less than the diagnostic. It has negligible risk of harm. It's a determinable and unambiguous event, unlike trying to verify a possible infection and sustained immune response.

The obvious rational policy decision for public health is to mandate the vaccine for everyone.

Those not previously infected gain immunity. Those previously infected ... either get a not-strictly-necessary injection, or far more likely, a useful booster.

And the administration, diagnostic, and monitoring costs are far lower.

https://www.nature.com/articles/d41586-021-01442-9

Many people who have been infected with SARS-CoV-2 will probably make antibodies against the virus for most of their lives. So suggest researchers who have identified long-lived antibody-producing cells in the bone marrow of people who have recovered from COVID-191.

The study provides evidence that immunity triggered by SARS-CoV-2 infection will be extraordinarily long-lasting. Adding to the good news, “the implications are that vaccines will have the same durable effect”, says Menno van Zelm, an immunologist at Monash University in Melbourne, Australia.

https://www.bloomberg.com/news/articles/2021-08-27/previous-...

Previous Covid Prevents Delta Infection Better Than Pfizer Shot

https://www.science.org/content/article/having-sars-cov-2-on...

The natural immune protection that develops after a SARS-CoV-2 infection offers considerably more of a shield against the Delta variant of the pandemic coronavirus than two doses of the Pfizer-BioNTech vaccine, according to a large Israeli study that some scientists wish came with a “Don’t try this at home” label.

>Took a serology test and found out that I had not had it.

How soon after you were ill? Aren't the antibodies nigh undetectable XX weeks after you recover?

IgG antibodies linger for a while, like months or longer. It’s a quick way of telling whether your vaccine worked, by just getting an antibody test.

I had a friend think he had it 3 times (and the third time was probably legitimate). The symptoms the first two times? Typical cold symptoms. No fever. No major cough. No real loss of taste. I had another friend do the same thing.

This was back before tests were widely available. I have genuinely had it twice myself, but people largely have though for the past two years that if they were sick it was COVID.

Any serious policy which brings natural immunity into the fold would include the need for an actual medical diagnosis. I don't see the issue to raise to be a valid one because there are easy solutions.

Serum tests are currently being used in the UK and other places. They can be taken up to 180 days after one has been infected.

What if you do have a positive test in your history?

This is a reasonable concern. My wife had it and got the test to prove it, I also had it and did not get tested, but considering that she was asymptomatic, and we continued all normal activities, as well as quarantining together, it would be silly to question if I had it.

Then, say that instead of lying that natural immunity doesn't work.

13 times actually

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

I think this will be more relevant to vaccinating kids: If this result holds for kids as well, and considering that Covid is not dangerous for kids, maybe kids are better off getting covid

I've seen this cited several times in this thread, but I've seen no one mention that (according their own FAQ):

> medRxiv (pronounced "med-archive") is a free online archive and distribution server for complete but unpublished manuscripts (preprints) in the medical, clinical, and related health sciences. Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

The context is important, even if it turns out to be true.

Indeed the final version has not been published yet, but there are no major reasons to doubt its validity. Here's an evaluation of the preprint from Johns Hopkins: https://ncrc.jhsph.edu/research/comparing-sars-cov-2-natural...

For teens, UK [edit:] Chief Medical Officer recommends but not mandates first dose, and does not recommend second dose at least until spring. The benefits are marginal.

2 ICU prevented admissions / million first doses

87 hospital prevented admissions / million first doses

0.16 ICU prevented admissions / million second doses

6 hospital prevented admissions / million second doses

> Having the vaccine is not compulsory.

> Prof Whitty said an "offer" of vaccination will be made to all children aged 12-15.

> But he said young people and their parents needed to be supported and there should be no stigma attached to their choice.

https://www.bbc.com/news/health-57888429

On the other hand, the UK vaccination advisory board does not recommend vaccinating under-16s because they consider there to be inadequate evidence the risks outweigh the benefits. (Despite considerable and very public political pressure to come to a different conclusion, and if I remember correctly even some of the members who were most sceptical about it resigning and being replaced.)

Quoting from the recent BBC article: "The UK's chief medical officers recommended a single Pfizer dose for all children aged 12 to 15." Perhaps there is a difference of position between 'advisory board' and 'chief medical officer', I am not that familiar with the UK scene.

From the article: "They made their recommendation after the JCVI - the scientific body advising the government on vaccines - said it did not recommend vaccinating healthy children on health grounds alone." The JCVI are the body that normally makes these decisions and has for the pandemic so far, but they kept on repeatedly refusing to recommend vaccination for under-16s unless they had a pre-existing condition no matter how many times the government asked or how unsubtle their hints - so there was a kind of weird political fudge where the government found another body that'd approve of them, largely based on the potential to reduce disruption to kids' education. (However, that disruption was itself mostly a result of government policy decisions, and the main reason the UK actually seems to be vaccinating under-16s is because other countries have been doing it which makde it politically untenable not to do the same.)

Thanks for clarifying!

Absolutely not the case. Children should be vaccinated. The Israeli study was useful in establishing that infection results in immunity. That’s it. It does not establish that infection is lower risk than vaccination.

Children are at low risk from COVIS

Pushed reply too soon. Children are at low risk, but not no risk. To the extent that kids are running around with infections, they’re transmitting virus to others and providing a reservoir for mutation. That is not productive.

Let’s get the kids vaccinated. It’s the cheapest way out of this thing.

I don’t buy the “unvaccinated as a reservoir for mutation” line of thinking. For one, there are many, many countries with a low vaccination rate and it’s going to be like that for a long time.

Also, I haven’t see data on what the R0 is from vaccinated person to vaccinated person with Delta. If it’s above 1 then all we’re doing is creating immense selective pressure for vaccine escape.

The latter seems likely to me. I don’t understand how anyone thinks the blame for mutations lies solely or even mostly with the unvaccinated. Vaccines, distributed in a pandemic, are likely to cause immense selective pressure, and that is one of the reasons that the WHO originally planned on non-vaccine herd immunity when they wrote their respiratory pandemic game-plan prior to 2020.

I’m fully vaccinated, not anti-vax, and not an expert. This is just my understanding based on what I’ve read.

Has there ever been a vaccination program that was so successful, so fast, that we reached nearly 100% vaccination in less than what, a year or so? Why wouldn't every other virus simply mutate in these "reservoirs" and make vaccines a failed idea?

Not all viruses are created equal; some are much more prone to mutation than others. And indeed, vaccines for highly mutation-prone ones do "fail" in some sense -- that's why we need flu shots every year but one or two doses of the chickenpox vaccine are preventative for a lifetime: the flu is an RNA virus and also has a mechanism for swapping genes between different strains infecting an individual organism (including animals), so it changes a lot, and vaccines only last until the in-the-wild flu changes out from under them, whereas chickenpox/varicella is a DNA virus that's much more genetically stable.

> Not all viruses are created equal

Emphasis on created

* Flu, which has a particularly high mutation rate, does exactly that: in some years the flu vaccine is only 10% effective.

* Most viruses are less infectious than covid, especially delta covid.

* The covid vaccines are novel, targeting a specific protein. Natural immunity targets more than one protein, I've heard up to 28 in case of covid. This should make vaccine escape much harder, as it is significantly more difficult to mutate around 28 proteins at the same time. By 'natural immunity' I mean immunity gained by exposure to the natural pathogen, either through live infection or an inactivated pathogen vaccine.

> To the extent that kids are running around with infections, they’re transmitting virus to others and providing a reservoir for mutation

Can make the same argument for the vaccinated people. Vaccines don’t prevent infection, they reduce symptoms. So by same logic they run around with the infection spreading it to everyone.

Vaccines don't 100% prevent infections, but there's strong evidence that they both significantly reduce the rate at which people become infected and, should they become infected, the rate at which they can retransmit the virus to others, and we have no reason to believe they wouldn't do the same in children. It's not an all-or-nothing affair.

> It’s the cheapest way out of this thing.

I think we should be wary of those "easy way outs", because nothing seems to indicate that vaccines are a panacea. They are of course the best that us adults can do right now to protect ourselves, but if restrictions get too relaxed simultaneously, then we ve just created pressure on the virus to create a variant that will escape completely. This is a marathon and we are not yet done. a combination of vaccines with distancing will be required for a long time. Humans are adaptible, the earlier we start the better.

(Also, we shouldn't argue in absolutes, it s not going to fix anything)

Some children are at greater risk from the vaccine than covid so it seems reckless to just push vaccines. You will quite possibility kill more kids by pushing the vaccine on them.

https://www.theguardian.com/world/2021/sep/10/boys-more-at-r...

Not dangerous for them except for all the ones who have died from it, you mean.

I don't understand this whole push to vaccinate kids.

In the beginning all the panic was about the "most vulnerable" in the population, while the young ones apparently could deal with it fine enough.

A year and a half later and we are rushing to vaccinate the youngest ones, even tho it doesn't prevent them from spreading and they have great chances to get trough the disease without the vaccine already.

The ultimate goal here seems to be to just get everybody vaccinated, possibly even yearly.

In the beginning it was about the most vulnerable because those were the people dying and we didn't have enough vaccines.

Now we have enough for everyone and it turns out kids are spreading it to each other. It's true the vaccine doesn't totally stop someone from spreading the vaccine, but it does help.

Same study came to the result that getting a shot after surviving an infection (unvaccinated) gives even better protection. The real interesting comparison would be immunity after getting a breakthrough infection compared to other kinds of acquired immunity. I'm sure we'll get that study eventually.

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

This second result is a lot weaker than the first, however:

“Individuals who were previously infected with SARS-CoV-2 seem to gain additional protection from a subsequent single-dose vaccine regimen. Though this finding corresponds to previous reports, we could not demonstrate significance in our cohort.”

At the moment, this does not justify mandating the vaccine for those previously infected.

I mean for someone with natural immunity to get the vaccine is not going to reduce their immunity, and might boost it (or might not). So with fairly little downside, it makes sense to vaccinate them surely?

I still think everybody should be vaccinated as far as it is possible, BUT it seems that what you said might not be true. The second vaccine dose can make your natural type immunity weaker.

That would be very surprising if true.

That is a statement that really needs some backup.

The downside is that if you already have a strong immune response you will have a much harsher reaction to the vaccine, basically four days out of commission. A reaction that’s rather comparable to breakthrough COVID.

Definitely need some citation on that please.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/af...

>Side effects can affect your ability to do daily activities, but they should go away in a few days.

> Common side effects: [Tiredness, Headache, Muscle pain, Chills, Fever, Nausea]

>Side effects after your second shot may be more intense than the ones you experienced after your first shot. These side effects are normal signs that your body is building protection and should go away within a few days.

I don't have a specific study for prior immunity vs. second shot, but neither COVID nor the vaccine are magic - both behave in a more or less standard manner. I've seen references to studies though:

>Dr. Erin Morcomb, a family medicine physician at the Mayo Clinic Health System in La Crosse, Wis., and head of its COVID-19 vaccination team, confirms that the reactions can vary based on your health history. "What we've seen in studies is that the second dose does tend to have a little bit more potential to cause side effects than the first dose, but for people who have had COVID-19 infection previously and then recovered, they are at higher risk of having those same side effects after their first dose," she says.

from https://www.msn.com/en-us/health/medical/strong-reaction-to-...

I had Covid Original Flavor(tm). My case was considered "mild"--I "only" had a 103 fever for 2 1/2 weeks and my stamina was shot.

I also got vaccinated later. I had about a 24 hour reaction each time.

I wanted to make sure my body latched onto the spike protein. Immune systems latch onto all manner of things--sometimes relevant, sometimes not relevant, sometimes actively harmful.

This is an important point. Your body's reaction to natural Covid is far more unpredictable than to the vaccine. That may give you a more robust immune response--or that may give you something related to an autoimmune disorder.

As a comparison, I had a much worse reaction to Shingrix (the shingles vaccine) which hit me hard for about 4 days and I could barely move the arm that got the shot.

Your mileage may vary.

The same Israeli study found that among previously infected people, those who received a single dose of the vaccine were half as likely to be reinfected, compared to those who received zero doses.

One might argue that there is also fairly little downside to not getting the vaccination.

And without some hard numbers comparing the two fairly little downsides we shouldn't attempt to compel people's behavior either way.

They would face all the potential side-effects of the vaccine without much of an upside...

How does it make sense then for them to vaccinate?

There's no evidence that having the vaccine stops you from developing natural immunity if you have a breakthrough.

If the vaccine fails you then you will get covid (like you would have in the same situation without vaccine) and will develop natural immunity then.

Even if you do get a breakthrough, chance of not going to a hospital is significantly lower.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

I think you had an extra 'not' and meant something like 'Even if you do get a breakthrough, chances of going to a hospital is significantly lower.'

You are right, and not wrong :p. Thanks for spotting that.

I got vaxxed as soon as I reasonably could and I never want to get COVID, but if that's true it really does seem insulting to require vaccination for people who can prove they already had COVID. It's like they did get vaccinated but picked a much more difficult/risky and much more effective way to do so -- if that were their intention (and they avoided spreading it once they got it), one could say it was a heroic choice...

At the same time though, I can imagine it would be really difficult/expensive to verify the proof of previous infection vs. verifying vaccination, and there could be the appearance of incentivizing anti-vaxxers to go infect themselves with COVID.

I was sick earlier this year. A few weeks later I paid a pharmacy $20 or $25 to test my blood for antibodies. Strongly positive. Dr. agreed and wrote a letter with my facts.

I thought the process was straightforward, convenient, and cheap.

I had it before the vaccine. It was an absolute joke of an illness, and I'd rather not be referred to as "heroic" for getting a sneeze and a poor sense of smell for a while.

I suspect the marginal utility is better in having a larger % vaccinated. If those on the fence about it hear that there are circumstances where it’s better to only take one dose, or none, many won’t vaccinate at all because it seems less important.

It's deeply unfortunate but not really surprising, these kinds of large scale experiments on humans are rather difficult to organize (for good reason) and outside of a naturally occurring disaster may not have happened at all.

It probably is, however that enhanced immunity can come at the cost of damaged organs.

Please provide a credible source (preferably a peer reviewed publication) for such a bold claim.

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

It's pre-print FWIW

The entire administration has set vaccination percentage as their OKR; they're not going to risk that number just because of the facts.

I wish they were that easy, then they'd know to juice the numbers by allowing all kinds of immunity. Talk about an effective administration!

And natural immunity + 2 doses of vaccine is likely even better.

Do take an antibody test and decide for yourself. How can one make decisions without any metric?

You know what's easier than getting an antibody tests and ensures immunity to COVID?

Follow the money. Lots of money to be made with each round of shots the population is encouraged to get

Follow the money, lots of money to be made by dissuading people from becoming vaccinated, so they are more likely to need expensive medical services.

>the fact that they haven't researched this is truly scary

Can you clarify who you mean by "they"? I don't suspect you mean Israel in that context.

There is finally a relevant flu analogy for those people to use, but they completely miss it in favor of some other non sequitur:

Exposure to this years seasonal flu will give better immunity to this year’s seasonal flu, than the vaccine for last year’s seasonal flu will give to this year’s seasonal fly. One day we’ll be able to say “Duh” in response to annual COVID flavors.

There will be vaccines specifically made for the delta variant and others.

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