What about natural immunity? A thread.

I'm not a virologist or vaccinologist. I'm addressing this issue as someone whose career has been focused on plasma cells, the cells that make antibodies, for over 20 years. 👇
1) When first exposed to an antigen, virus or vaccine, the immune system produces a primary immune response. On exposure to same antigen again, it produces a better, bigger, and more durable secondary response. Basic immunology. microbiologynotes.com/differences-be…
Sometimes the first infection gives a long enough exposure to the antigen to stimulate the secondary response. Sometimes it's not. Depends on the virus and duration of infection.
So even if someone had COVID, it's better to get the vaccine also to ensure a better, durable secondary immune response. More IgG producing cells, more long lived memory cells.
Given the rate of reinfections we are seeing, it is worrying that COVID doesn't seem to produce an enduring immune response in everyone.

It's possible that 2 vaccine doses given too close to each other may also not produce a durable secondary response. (Why some need boosters).
2) If someone has not yet had Covid, then between getting immunity from the vaccine versus virus, even if the virus induced response is for argument sake better, it is much more risky to acquire immunity that way. It is far safer to get it through a vaccine.
3) Testing for antibodies and then deciding who to vaccinate and who not to is not realistic when we have 70 million eligible left to vaccinate in the US.

4) The virus is also mutating. The more infections we have, the more risk of mutants. Hence the push for vaccinations.
5) There are side effects with the vaccines as there are with any medicine. But truly serious ones are very rare compared to risk of COVID related complications or death. 215 million people have been vaccinated in the US. 3.75 billion people in the world: Almost half the world.
6) There will always be people who doubt the efficacy of vaccines because they hear someone got severe Covid despite vaccines and therefore why bother. Actually vaccines reduce your risk of severe Covid by 90%. They work: Randomized trials and Real world data.
More here on clarifying doubts about vaccine efficacy.
So yeah whether you had COVID or not better to get vaccinated. This is the advise I have given my own family.

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More from @VincentRK

12 Oct
I hope that the fourth time is the charm.
This time around a lot more people have immunity than in previous waves. So there is more reason to hope.

>215 million have received one dose of vaccine. >400 million doses administered. Probably a third to half the country has had COVID.
Worries that threaten hope: First worry is that 60-80 million are still very susceptible. A second worry is duration of immunity; but this should be quite good and long lived at least in terms of protection against severe disease. A third worry is potential rise of a new mutant.
Read 4 tweets
11 Oct
The US had crossed over 400 million doses of COVID vaccine administered.
We have get the rate higher. But this is a great accomplishment. Under 10 months. ourworldindata.org/covid-vaccinat…
This has been accomplished even though I think the extent of anti vaccine misinformation has been the highest in the US. Public health leaders have tried their best to convince the hesitant.

We have 70 million eligible people left to reach.
Read 4 tweets
9 Oct
What proportion of the US has some immunity to COVID— where the immune system is not totally caught by surprise?

215 million have received at least 1 dose of vaccine.

40-60 million of the rest likely have had COVID.

That still leaves 60-80 million who are very susceptible.
The true number at risk of severe COVID is hard to estimate because some people who have been vaccinated or have had COVID may not have adequate protective immunity due to underlying comorbidities like cancer or other immunosuppressive disorder.
The unvaccinated include 50 million not yet eligible for vaccination. If a vaccine approval comes, this number will come down.
Read 4 tweets
4 Oct
Study of 3.4 million people @aboutKP @TheLancet

Vaccine efficacy against infections:
- First month post: 88%
- 5 months post: 47%

But vaccine efficacy against hospitalization (Figure):
- First month post: 87%
- 5 months post: 88 %

thelancet.com/journals/lance…
No significant difference in rate of decline in vaccine effectiveness between delta and other variants.

Vaccine efficacy against hospitalizations 93% for delta and 95% for other variants.

thelancet.com/journals/lance…
Bottomline is that some drop in efficacy against infections is seen over time, but protection against severe illness remains constant. Vaccines are working great in this study as in multiple others which have demonstrated the same thing.

#GetVaccinated
Read 7 tweets
4 Oct
Top 10 drugs for Medicare Part D spending in 2019. The list and the $ amounts are worrisome:

1 is used for a cancer that's 1% of all cancers.
2 are expensive blood thinners more convenient, but only marginally better than older drugs.
4 are diabetes drugs.
Insulins should not be on that list. It's 2021.

A drug that's a cousin I thalidomide, that has been used for over 15 years to treat a cancer that's only 1% of all cancers should not be on the list.

I don't think new oral blood thinners should be so highly priced.
Medicare does get back some money back for these drugs as rebates so we don't know the exact dollar amount which Medicare actually spends. But the spending is high regardless.
Read 4 tweets
4 Oct
We have 280 million people eligible for COVID vaccines in the US.

The first 140 million got fully vaccinated ASAP. The final stretch will be the hardest.

See the rocket take off and then slow to a crawl.
I thought some people may be reluctant. But not this much: 95 million eligible but not yet fully vaccinated.

30 million of these have had one dose. So I am hopeful they will get fully vaccinated soon.

That leave 65 million eligible people who have not had even one dose yet.
Out of these even if one third has some degree of immunity from prior COVID, it still leaves 40 million eligible people completely susceptible. That is a lot of people.

Which is why we cannot relax yet. What we can do below:
Read 6 tweets

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