outbreak! (ebola, sars, coronavirus, etc)

Public-health officials ruined many lives by insisting that workers with natural immunity to Covid-19 be fired if they weren’t fully vaccinated. But after two years of accruing data, the superiority of natural immunity over vaccinated immunity is clear. By firing staff with natural immunity, employers got rid of those least likely to infect others. It’s time to reinstate those employees with an apology.

For most of last year, many of us called for the Centers for Disease Control and Prevention to release its data on reinfection rates, but the agency refused. Finally last week, the CDC released data from New York and California, which demonstrated natural immunity was 2.8 times as effective in preventing hospitalization and 3.3 to 4.7 times as effective in preventing Covid infection compared with vaccination.

Yet the CDC spun the report to fit its narrative, bannering the conclusion “vaccination remains the safest strategy.” It based this conclusion on the finding that hybrid immunity—the combination of prior infection and vaccination—was associated with a slightly lower risk of testing positive for Covid. But those with hybrid immunity had a similar low rate of hospitalization (3 per 10,000) to those with natural immunity alone. In other words, vaccinating people who had already had Covid didn’t significantly reduce the risk of hospitalization.

Similarly, the National Institutes of Health repeatedly has dismissed natural immunity by arguing that its duration is unknown—then failing to conduct studies to answer the question. Because of the NIH’s inaction, my Johns Hopkins colleagues and I conducted the study. We found that among 295 unvaccinated people who previously had Covid, antibodies were present in 99% of them up to nearly two years after infection. We also found that natural immunity developed from prior variants reduced the risk of infection with the Omicron variant. Meanwhile, the effectiveness of the two-dose Moderna vaccine against infection (not severe disease) declines to 61% against Delta and 16% against Omicron at six months, according to a recent Kaiser Southern California study. In general, Pfizer’s Covid vaccines have been less effective than Moderna’s.

The CDC study and ours confirm what more than 100 other studies on natural immunity have found: The immune system works. The largest of these studies, from Israel, found that natural immunity was 27 times as effective as vaccinated immunity in preventing symptomatic illness.

None of this should surprise us. For years, studies have shown that infection with the other coronaviruses that cause severe illness, SARS and MERS, confers lasting immunity. In a study published in May 2020, Covid-recovered monkeys that were rechallenged with the virus didn’t get sick.

Public-health officials have a lot of explaining to do. They used the wrong starting hypothesis, ignored contrary preliminary data, and dug in as more evidence emerged that called their position into question. Many, including Rochelle Walensky, now the CDC’s director, signed the John Snow memorandum in October 2020, which declared that “there is no evidence for lasting protective immunity to SARS-CoV-2 following natural infection.”

Many clinicians who talk to other physicians nationwide had have long observed that we don’t see reinfected patients end up on a ventilator or die from Covid, with rare exceptions who almost always have immune disorders. Meanwhile, public-health officials recklessly destroyed the careers of everyday Americans, rallying to fire pilots, truck drivers and others in the supply-chain workforce who didn’t get vaccinated. And in the early months of the vaccine rollout, when supplies were limited, we could have saved many more lives by giving priority to those who didn’t have recorded natural immunity.

The failure to recognize the data on natural immunity is hurting U.S. hospitals, especially in rural areas. MultiCare, a hospital system in Washington state, fired 55 staff members on Oct. 18 for being out of compliance with Gov. Jay Inslee’s vaccine mandate—and that was in addition to an undisclosed number of staffers who quit ahead of the vaccination deadline. The loss of workers contributed to a full-blown staffing crisis.

It got so bad that the hospital summoned staff who were Covid-positive to return to work even if they were sick, according to an internal memo obtained by Jason Rantz of KTTH radio. The memo stated that “positive staff with mild to moderate illness” could work, so long as they wear appropriate personal protective equipment, don’t take breaks with others, and agree to stay home “if symptoms worsen.” Managers were recommended to assign Covid-positive staff to Covid-positive patients and vaccinated patients, but not immunosuppressed patients.

The Centers for Medicare and Medicaid Services took the hospital mandate national by decreeing that all medical facilities under its jurisdiction require vaccination for employees, including those with natural immunity. The Supreme Court upheld the rule on Jan. 13, the same day it issued a stay against a similar mandate from the Occupational Safety and Health Administration, which OSHA formally withdrew Tuesday.

Connecticut has suspended its vaccine mandate for state employees, and Starbucks is rehiring employees fired for being unvaccinated. Other states and businesses should follow their lead. Politicians and public-health officials owe an apology to Americans who lost their jobs on the false premises that only unvaccinated people could spread the virus and only vaccination could prevent its spread. Soldiers who have been dishonorably discharged should be restored their rank. Teachers, first responders, and others who have been denied their livelihood should be reinstated. Everyone is essential.

Dr. Makary is a professor at the Johns Hopkins School of Medicine and author of “The Price We Pay: What Broke American Health Care and How to Fix It.”

Here is the link: https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm

Wesley Clark has a leadership institute

I must start one.

FWIW Mr Makary's book seems like an indictment of the US healthcare system, which I'm 100% down with indicting.

I just want my overly-anxious friends and family to relax a bit once they've had COVID, and not keep telling me that getting COVID doesn't matter. I seriously thought vaccines were better until today.

I'm not excited about the article framing, though, which is of the let's-get-everyone-back-to-work-ASAP variety.

Marty Makary is a quack and has been disowned by most of his peers

he also said we'd have herd immunity by last April. he definitely doesn't represent the majority opinion on these matters, including natural immunity being better than vaccine immunity.

During the COVID-19 pandemic, Makary has been a critic of COVID-19 mitigation policies that led to shutdowns of businesses and schools as well as non-targeted efforts to mandate vaccination. He describes his views as "different from the 'standard party line'".[33][34] Makary was an early supporter of universal masking, writing a New York Times op-ed in May 2020 in which he suggested it would enable safe reopening of businesses and schools.[35]

When COVID-19 vaccines became available, Makary argued in a February 2021 op-ed in The Wall Street Journal that the United States would achieve herd immunity for COVID-19 around April 2021, and later criticized Anthony Fauci for predicting that 75-80% vaccination rates would be required for herd immunity.[36][37] His methodology and conclusion were criticized and disputed by William Hanage and Jeremy Faust[38] of Harvard University, A. Marm Kilpatrick of the University of California, Santa Cruz, and Eric Topol of Scripps Research, who called Makary's article a "deeply flawed oped" in need of fact checking.[8] Tara Smith commented of the study, "There are a lot of errors here, probably because the author has no background in infectious disease."[8] Makary's prediction later proved to be incorrect, in part due to the rise of the Delta and Omicron variants.[39]

Makary considers himself pro-vaccine, but has also criticized vaccination mandates for populations other than healthcare workers, highlighting the risk of myocarditis in young male vaccine recipients as a reason to exercise caution.[34]

In January 2022, Ashish Jha, speaking on Kara Swisher's New York Times podcast Sway, criticized Makary as an example of a "quasi expert." Jha stated "I take someone like a Marty Makary, who’s at Hopkins, who has said some smart things. And he’s a smart guy. But he is not afraid to go way beyond his area of expertise. And he has never been held back by being wrong."[7]

Yeah I would not throw a ton of weight and importance behind Makary. Ime and reading other experts' opinions on him, he's a couple levels better than Fiegl-Ding but largely only by being less hysterical.

I hate the term "covid minimizer" because it's often used to tar people who share a whiff of positive news or don't have as bleak an outlook as other people, but Makary is pretty much only popular amongst covid minimizers.

that is all, I now return to ignoring this thread....just don't want THAT particular doc RTed if possible

DUDE I DON'T FUCKING CARE WHAT THIS GUY SAYS OR WHO HE IS.

Please just read the study from Israel and the report from the CDC.

From the CDC, last week: "Rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19."

I swear, Neanderthal, when anyone posts anything that isn't gloom-and-doom, I picture you immediately trying to discredit the source, even before reading the article!

I'm glad you're out there making sure nobody ever hears or reads a dangerous opinion!

Ok, that's bullshit and you know it

What, the CDC study?

i hate reading, sometimes, and thinking. i just want to collapse into dust particles. i can't read this without contesting so many parts of it as i go, from individual lines or supporting evidence to the entire premise. but yet, i know that i rank in about the 20th percentile of covid knowledge. i follow this shit, a little, i lived through some of it, but also had to cut myself off from it as much as possible just to avoid losing my fucking mind. work in progress.

Similarly, the National Institutes of Health repeatedly has dismissed natural immunity by arguing that its duration is unknown—then failing to conduct studies to answer the question. Because of the NIH’s inaction, my Johns Hopkins colleagues and I conducted the study. We found that among 295 unvaccinated people who previously had Covid, antibodies were present in 99% of them up to nearly two years after infection.
ok. but to what degree were the antibodies still present, compared to immediately after the infection? if i took mandarin lessons 15 years ago and a handful of those words are still "present" in my mind today, does that mean i'm fluent?

We also found that natural immunity developed from prior variants reduced the risk of infection with the Omicron variant.
so? how much?

Meanwhile, the effectiveness of the two-dose Moderna vaccine against infection (not severe disease) declines to 61% against Delta and 16% against Omicron at six months, according to a recent Kaiser Southern California study. In general, Pfizer’s Covid vaccines have been less effective than Moderna’s.
"meanwhile", yes. meanwhile, there are also vaccines, which have their own declining rate of efficacy over time, just like anything else would. how do they compare to natural immunity? beats me. "meanwhile". i retain a percentage of my Mandarin vocabulary from 15 years ago. meanwhile, those who learned Mandarin via an online course lose a certain percentage of their Mandarin vocabulary every year, if they don't continue studying on their own. Also, he's talking about 2-dose vaccine studies. why isn't he talking about Booster studies too? probably no reason...

The CDC study and ours confirm what more than 100 other studies on natural immunity have found: The immune system works.
i read this three times out loud, and that is enough

Public-health officials have a lot of explaining to do. They used the wrong starting hypothesis, ignored contrary preliminary data, and dug in as more evidence emerged that called their position into question. Many, including Rochelle Walensky, now the CDC’s director, signed the John Snow memorandum in October 2020, which declared that “there is no evidence for lasting protective immunity to SARS-CoV-2 following natural infection.”

"lasting protecting immunity", and we're talking October 2020. At that point, any study on the effects of infection immunity would be on people who were infected in Spring 2020, and comparing them to a control population in summer 2020, in the living hell that was Trump being in charge, no tests anywhere, no plan, "a patchwork quilt" of policies ranging from lockdowns to "let the poor people die". is it even possible to say there's evidence for "lasting immunity" 6 months out from the start of the pandemic? i don't know. there are just a lot of statements in this op-ed that push up against that boundary of credulity and make think, "i don't know about that."

then all the stuff about the american patriots who were fired from their jobs, unjustly, because they knew they had natural immunity (they just KNEW! like scientist-civilians, self-taught!) but the evil government fired them anyway, just because they hate their freedoms. iirc, the people who got fired weren't talking about their supposed "immunity" (remember, a lot of people who swear 100% they have had covid just got SICK at some point, never got tested, never got antibody tests afterward, but they just know they had it, ok), but instead about their freedom to not wear a mask and not get a vaccine and to do whatever the hell they want. maybe i'm not recalling correctly and the thrust of that movement was all about how they already had covid and there was no reason for them to take the extra step of getting vaccinated because it was so clear at that point (2020-present) that natural immunity was statistically insignificant from vaccines (if you take Makary at their word on their own research)

Please, Makary, don't herd 'em.

Oy. I wish I'd just linked to the studies.

For completeness, here is the study from Israel in August of last year:
https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

Results 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. The increased risk was significant (P<0.001) for symptomatic disease as well. When allowing the infection to occur at any time before vaccination (from March 2020 to February 2021), evidence of waning natural immunity was demonstrated, though SARS-CoV-2 naïve vaccinees had a 5.96-fold (95% CI, 4.85 to 7.33) increased risk for breakthrough infection and a 7.13-fold (95% CI, 5.51 to 9.21) increased risk for symptomatic disease. SARS-CoV-2-naïve vaccinees were also at a greater risk for COVID-19-related-hospitalizations compared to those that were previously infected.

Neanderthal has consistently posted data that doesn't coincide with the doomposters

Ok, sorry for picking on him. Sorry, Neanderthal!

jfc thank you Karl. i had very similar thoughts reading that.

somebody should tell this guy that “the immune system” is what vaccines use to fight disease, also. and yeah it works lol

Better than vaccines, in fact!

yeah, it was me nitpicking the source before i read it, anyway! sorry, i know that's annoying, too.

am i right, DJI, in thinking thinking that your point is that a lot of people (including me!) thought there was no evidence that natural immunity was as effective in preventing infection as the vaccine, but now there is evidence that it does provide lasting immunity? so maybe some people can step down from that hobby horse when it comes up? i'm with you, i hadn't really heard much about it til you posted the op-ed. i mean, i believe it's true to some degree, of course.

what i don't understand, though, is why knowing that there is immunity 2 years into a pandemic that will go on and on and on means much for the future when it's likely the antibodies will lose their efficacy over time? it gives people ammunition to criticize decisions that were made in fall 2020, but...i just don't think part of the argument is compelling? it all boils down to just "see? you CAN get covid and not get vaccinated afterward, and you'll be pretty much just as safe as someone who got vaccinated but hasn't had covid! and...that was true of the last 2 years, maybe, but it's not necessarily true for the future unless we want to just guess and hope we're right! haha, i don't know. it's just like, what does it matter?

I think The Immune System are playing Coachella this year, aren't they?

am i right, DJI, in thinking thinking that your point is that a lot of people (including me!) thought there was no evidence that natural immunity was as effective in preventing infection as the vaccine, but now there is evidence that it does provide lasting immunity? so maybe some people can step down from that hobby horse when it comes up? i'm with you, i hadn't really heard much about it til you posted the op-ed. i mean, i believe it's true to some degree, of course.

This is all I was trying to say. It's possible the immunity won't be as long-lasting as the vaccines., but I haven't seen info either way on that.

I have all these anxious friends and family who have told me that getting COVID is meaningless when it comes to immunity, and it's nice to see at least SOME evidence that this isn't true.

xp

agh - you can ignore what i wrote DJI! i'm not thinking straight this morning. i do have a point, i think, it's just not coming out right. i don't think there was anything wrong w/ you posting that op-ed or just thinking about the issue. i really got into it with my mom last year, because part of her reasoning for not getting vaccinated was that she already had it, and i just didn't see the evidence for that (despite believing it could be true or maybe even probably was true). but in retrospect that was one of her more logical reasons (some of the others involved new world order and apocalypse), so i shouldn't have given her such a hard time on that.

DJI I did look at the study. Here is what the CDC says.

"During May–November 2021, case and hospitalization rates were highest among persons who were unvaccinated without a previous diagnosis. Before Delta became the predominant variant in June, case rates were higher among persons who survived a previous infection than persons who were vaccinated alone. By early October, persons who survived a previous infection had lower case rates than persons who were vaccinated alone."

In other words, if you thought "I seriously thought vaccines were better until today," you were only off by a few months. It makes me very frustrated when editorialists make moves like, e.g., going off on Walensky for saying in October 2020 what was in fact true in October 2020. I think there is a perfectly good case for believing that the people at greatest danger from COVID right now are people who are unvaccinated and haven't been infected before. And I think this is a pretty decent number of people, unfortunately.

It should also be noted that people were highly skeptical when that Israeli study came out. That infection provides a degree of immunity has never been controversial, and that it would provide a degree of immunity comparable to vaccination has always been considered plausible. That it would confer immunity more than 10x as effective as vaccination raised eyebrows and indeed the California/NY results are incompatible with it.

I worry that mild cases of covid confer less immunity than serious cases

xp

i think that if it were the flu we were talking about, we'd have a hundred years of longitudinal data on natural immunity over the years, facing different variants, etc. with covid, we're talking a max of less than two years for any study, with several different variants dominating during that time and several different vaccines and booster options and red state/blue state differences in political and social mechanisms to reduce infections. knowing that in israel they had some kickass natural immunity during a certain period of time so far doesn't really matter much to me, in thinking about the next year and what to do in the near future, it's too early (imo)

I have all these anxious friends and family who have told me that getting COVID is meaningless when it comes to immunity

I have overanxious friends too and I get that this is annoying but this is not and has never been the stance of the CDC or the medical establishment generally. There are plenty of people getting COVID twice, sure, but it would be a bizarre medical phenomenon if infection didn't provide you some degree of protection against getting infected again in the near-term. The medical establishment advice has been "if you want to acquire immunity to COVID, it's better to acquire it via vaccine than via infection, because if you acquire it vaccine you a) don't get sick and b) don't risk getting the old people around you sick." I would say that has been and remains good advice.

I'm not extrapolating to "everyone should just get herd immunity" or anything. I'm just trying to get and share accurate information that might be outside of my/our media bubble.

Meanwhile, here's data from Oklahoma, which has been releasing some of the most fine-grained data

https://www.publicradiotulsa.org/local-regional/2021-09-24/covid-reinfections-have-jumped-300-since-may

and you can see the same phenomenon remarked in that CDC study; as Delta becomes dominant, the immunity advantage of vaccination over reinfection shrinks. But by contrast, in May you see almost 10x the rate of infection among previously infected people. Once Delta is fully dominant in September, previously infected people are still twice as likely as vaccinated people to get infected.

Now there are all kinds of potential confounds here! And in the California/NYC study too. All I'm saying is that there are a lot of studies that say a lot of things, they paint a confusing picture because life is authentically confusing, and people like to write op/eds picking and choosing those studies that support the position they prefer. I get why they do that but I don't like it.

My nervous friends are all vaccinated. I'm guessing vaccinated+boosted+previously infected is still better than just vaccinated+boosted, but I don't see that data...

Despite the fact that I think that op/ed is pretty bad, I do think the question is worth asking of whether people with documented previous infection should be treated similarly to vaccinated people from the point of view of "can they go in a restaurant," etc. To the extent that the goal of the policy is to mitigate transmission in those spaces, the answer is at least maybe yes. To the extent that the goal of the policy is to encourage vaccination, obviously no. And if you do go that route, you obviously create a perverse incentive for people who don't want to get vaccinated to purposefully go out and get sick (thus increasing transmission and straining the medical system.)

I agree.

whether people with documented previous infection

in the USA producing documentation of infection would present a problem for a large number of people. our lack of a nationwide health system is a major obstacle to any systematic approach to public health.

…otm

My point above was that Marty Markary is not an expert and for someone as mild mannered as Ashish Jha to call him out, when he never does that, is telling.

Any conclusions Marty draws should be taken with a grain of salt because he is not an expert within infectious diseases and has been dead wrong many times before.

Like eephus says, I don't think anybody's downplaying immunity through infection, particularly if paired with vaccination. But studies have mostly come back showing that immunity through vaccination IS more durable, and even if it turns out not to be in some contexts, it's far safer to get vaccinated than intentionally expose yourself to it, which people ARE doing.

Likewise, immunity through infection WITHOUT vaccination before or after is definitely much less durable than if you get vaccinated before or after infection. If the CDC makes it sound like you getting the Vid once = "you're good", nobody will get vaccinated, plus it's also not true.

My friend who is vaxxed and boosted had had COVID *four times* since 2020. Yes, mostly different strains, and never "severe", but it shows that the belief if "I got it, I'll never get it again" is...not sound.

I mostly don't want to amplify somebody who wrote an op-ed arguing AGAINST masking kids in school last August, which Marty did.

But studies have mostly come back showing that immunity through vaccination IS more durable

Not sure about durability, but it seems like previous infections provide better protection against Omicron than vaccines:

By the week beginning October 3, compared with COVID-19 cases rates among unvaccinated persons without a previous COVID-19 diagnosis, case rates among vaccinated persons without a previous COVID-19 diagnosis were 6.2-fold (California) and 4.5-fold (New York) lower; rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19.

My friend who is vaxxed and boosted had had COVID *four times* since 2020. Yes, mostly different strains, and never "severe", but it shows that the belief if "I got it, I'll never get it again" is...not sound.

I mostly don't want to amplify somebody who wrote an op-ed arguing AGAINST masking kids in school last August, which Marty did.

I get it, but this is a bulletin board full of vaxxed-up, reasonable, non-brainwormed people. We don't need to protect anyone here.

Sorry I should have broken up those two quotes so it didn't look like you were replying to the CDC.

Not sure about durability, but it seems like previous infections provide better protection against Omicron than vaccines:

The study you quote ends in November 30 and took place in the US, so it's about delta, not omicron.

oh right.

xp Which means we really don't know what the situation is now. And we probably won't know for a while. That's annoying I know but it is what it is.

Seems like we won't really know about durability for a few years.

Of course, the big question, as always, is "when is this basically as dangerous as a flu or a bad cold for most people?" It's not "when will nobody ever catch it again?" And it sounds like if you are vaxxed and/or have already had COVID, we are getting close to that situation, but things could change.

I saw someone make the point recently that misinformation proceeds usually not via outright lies but via partial information, and that's pretty much my take on the WSJ editorial.

I think you can argue that "infection" provides better future protection than "vaccination" but also believe in vaccines ... because there's a massive risk to the former.

I can't track the evidence for these things (though in the UK it does seem that having Covid without a vaccination is related to ending up in Intensive Care Units).