Eric Topol Profile picture
Feb 13 13 tweets 4 min read
We've learned a lot about Prior Covid ("Natural Immunity") over the past year, but the US/CDC continues to negate the abundant evidence for it providing any protection
erictopol.substack.com/p/ground-truth… w/links
And there's substantial new data, I'll review🧵here /1
Last week, the large J&J 1- shot, placebo-controlled trial w/ >2,000 participants who had Prior Covid published @NEJM
Vaccine effectiveness vs moderate/severe disease
Prior Covid 90%
J&J Vaccine 56%
Yet 1-shot J&J vaccine = "fully vaccinated" @CDCgov
Nothing for Prior Covid /2
Neutralizing antibodies after Prior Covid are present out to 16 months in 214 people (graph)
And another study showing persistence of memory B cells at 15 months /3
Over 7,000 UK health care workers with Prior Covid and assessment of IgG antibodies that were anticipated to last 1.5 to 2 years /4
The January 2022 CDC MMWR for California and New York State showed remarkable protection of Prior Covid, unvaccinated vs hospitalization, during the Delta wave /5
The new UK study, November 2021 to January 2022, the largest comparison of Omicron and Delta for hospitalizations and deaths, among 1.5 M people
Prior Covid, unvaccinated, hazard ratio, 95% CI
Hospitalization 0.55 (0.45, 0.63)
Death 0.18 (0.06, 0.57) /6
The protection afforded by Prior Covid was substantially reduced with Omicron, as evidenced by the jump in reinfection in the UK (previously quite rare) /7
And the drop in vaccine effectiveness vs symptomatic infection in Qatar, as published this week, from ~90% (prior variants) to 56% (Omicron) /8
All studies for Prior Covid have issues w/r to survival bias (people who died not included), heterogeneity of antibody,cellular immune response levels and their durability.
Getting Covid obviously doesn't protect #LongCovid, unlike vaccines which have shown protective benefit /9
There is unequivocal synergy of hybrid immunity (combined Prior Covid and 1 or more vaccine doses) in more than 25 studies pre-Omicron, and several with Omicron, for the augmented immune response /10
The CDC should reboot its "vaccination card" to a digital "immunity certificate" and give credit to confirmed Prior Covid, that is equivalent to at least a 1-dose vaccine /11
Vaccine mandates, without long overdue recognition of Prior Covid's protection, unnecessarily fuels divisiveness.
The US is only 64% "fully vaccinated" compared w/ many countries at 80%+. Recognition of Prior Covid can help build our immunity wall, which should be the priority
I meant to add this report (it's in the full post) from >52,000 health care workers at Cleveland Clinic health system which showed lack of symptomatic infections in the Prior Covid, unvaccinated group, at 1-year follow up, through the Delta phase

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More from @EricTopol

Feb 9
Today >3,400 Covid deaths reported in the United States, a 7-day average exceeding 2,600 lost lives.
This likely represents the current wave peak; 80% of the US pandemic peak when there were no vaccines. Compared to 20% in countries with high % vaccination and booster rates Image
OTOH at least we're seeing a rapid descent of hospitalizations to the 100,000 level Image
Read 4 tweets
Feb 7
🆕 Omicron [O] and Delta [D] outcomes for hospitalizations, deaths and by vaccines in > 1 million O and ~450,000 D cases in England
papers.ssrn.com/sol3/papers.cf…
—75% reduced hospitalization risk for O vs D
—For O, Booster >70% protection vs hospitalizations and deaths across all ages
2 and 3 dose vaccine effects vs hospitalization (both AZ and mRNA)
and
Prior Covid, without vaccination, had moderate protection (HR 0.53) vs hospitalization for Omicron, and high protection vs death.
Children age < 10 had infrequent hospital admissions and the incidence did not differ significantly between Delta and Omicron
Read 4 tweets
Feb 4
New: Assessment of an Omicron-specific booster vs Moderna original (vs ancestral) booster in macaques: no difference
"An Omicron boost may not provide greater immunity or protection compared to a boost with the current mRNA-1273 vaccine"
biorxiv.org/content/10.110… Image
Interesting to note that the same was seen for the Beta variant with the Pfizer vaccine, original vaccine booster vs Beta-specific booster, which led to abandoning that strategy.
3rd shots of the original vaccines are performing far better than expected 👍
A very good thread on the new Omicron-specific booster study and the overarching issue by @erlichya
Read 4 tweets
Feb 4
New @CDCgov
Reduction of death by vaccination and booster by age, per 100,00 people, vs unvaccinated, relative, with absolute data below
covid.cdc.gov/covid-data-tra…
Age 65+
2 shot 92% reduced
3 shot 99% reduced
Age 50-64
2 shot 95% reduced
3 shot 99% reduced
By age: cases and vaccination/booster status
As cases were rising steeply in December with emergence of Omicron, booster vs 2-shot was associated with 50% or more reduction of cases across the 3 age groups
And much higher % drop for vaccination vs unvaccinated
Which goes along with this new data posted showing booster had vaccine effectiveness of >60% vs Omicron infections
covid.cdc.gov/covid-data-tra…
Read 5 tweets
Jan 31
New @FT
"Almost half of the US Covid hospitalisations this winter could have been averted if the country had matched the vaccination coverage of leading European countries"
ft.com/content/03aa46… by @mroliverbarnes @jburnmurdoch @JamieSmythF
US lagging European peers by vaccine doses and boosters, especially notable in age 60+
"On December 20, 30% of people in the US over-65 had gone six months since receiving a second dose, compared with just 2% in Portugal; 5 per cent in England; and 7% in Denmark."
Graphic that shows differences in vaccination waning for US vs England, Denmark and Portugal, age 60+
Read 5 tweets
Jan 28
Brief update on Omicron, and its BA.1 and BA.2 lineages (sisters)
1. Origin—the 3 theories for how this hyper-mutated version of the virus evolved
nature.com/articles/d4158… @nature
2. A great annotated graphic by @firefoxx66 of @nextstrain conveying the antigenic distance of Omicron's BA.1 and BA.2 from prior variants
nextstrain.org/ncov/gisaid/gl…
3. The BA.2 variant is spreading widely, throughout many countries in Europe and Asia, out-competing BA.1, indicating higher transmissibility. But the good news from yesterday's @UKHSA: vaccination + boost is holding up quite well; there's no indication of more immune evasion
Read 7 tweets

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