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Feb 21 • 55 tweets • 25 min read
Here's some evidence contradicting the proposal that "hybrid immunity" (the immunity one develops from covid infection plus vaccination) can be "built up in the population" and is "good for future prospects." 🧵
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1/~50 'Q: What is hybrid immunity...
TL;DR:
"Hybrid immunity" may reduce future severe acute covid, but it doesn't greatly reduce transmission, so it produces viral evolution & immune dysfunction (which extend the pandemic) plus other acute & chronic illness, healthcare decline, economic decline, isolation, etc.

2/ "Hybrid immunity"...Graph showing that excess m...Excess mortality in the EU ...Bar graph of UK (ONS) Long ...
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Infection & vaccination do seem to confer some protection against transmission and severe acute outcomes. But evidence suggests that this immunity is limited and will not meaningfully impact the pandemic's future prospects.
∙ doi.org/10.1016/S1473-…
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4/ Figure 3 from linked study....
Hybrid immunity hasn't ended the pandemic so far. Most people have already been infected and vaccinated by now, but severe acute covid infections (not to mention #LongCovid) continue to *increase*, not decrease, as hybrid immunity prevalence increases.

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This is true of many jurisdictions around the world. The rate of severe acute (and chronic) infection is no longer creating just discrete waves, but also a rising overall tide.
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Countries continue to see high — and in many cases, rising — excess death rates, even after vaccination rates reached "herd immunity" levels (>70%) and after most of the population had likely been infected.

7/ Graph showing excess mortal...
Sweden, well known for embracing a hybrid-immunity strategy from the start, continues to see high death rates (not to mention innumerable #LongCovid cases), despite underreporting, & deaths are highly correlated w/ cases.
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The baseline excess death rate for the entire European Union has continued to increase since the beginning of the pandemic, despite (because of?) increasing rates of previous infection plus vaccination.

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 ec.europa.eu/eurostat/stati… Graph of excess mortality i...
While it is trivially true that infection with a pathogen produces immunity to that pathogen in survivors, depending on the pathogen, that immunity may be very limited in duration and scope.

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As a rule, an infection w/a coronavirus doesn't confer lifelong immunity to coronaviruses. "Four seasonal coronaviruses...cause about 30% of common colds" & "on average, each of us will get around 200 colds in a lifetime."
∙ theguardian.com/lifeandstyle/2…
∙ jamanetwork.com/journals/jama/…
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More specifically, covid infection does not prevent future covid infection.

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Reinfection can occur within a month of infection.
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Reinfection rates continue to increase.

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 Graph of % of infections th...
And immunity derived from infection appears to wane especially fast in children.
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15/ Image from linked tweet. T...
Infection may actually be increasing — not decreasing — chances of reinfection. For one thing, antibody imprinting/original antigenic sin from early exposure may dampen immune protection against later variants.

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What about immunity derived from vaccines? Like infection-based immunity, vaccine-based immunity reduces transmission but does not prevent it (& may even increase transmission in people without an updated vaccine).
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Vaccines do protect against acute hospitalization & death, but that immunity also wanes. That's why the initial 2-dose primary series required supplementation first by 1 booster & then by periodic additional boosters.
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(Note: immunity most likely wanes more readily after mRNA vaccines than after Novavax because #Novavax is a protein-based vax targeting epitopes that don't evolve, but even Novavax has had trouble with the latest variants; see antigenic drift, below.)

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Yet despite known immunity waning, the percentage of people keeping up to date with covid vaccination is decreasing with time.
∙ health-infobase.canada.ca/covid-19/vacci…
∙ covid.cdc.gov/covid-data-tra…
20/ Table showing declining US ...Table showing declining Can...
Part of the problem is antigenic drift: the higher the transmission rate, the faster SARS-CoV-2 mutates away from whatever immunity people may have gained from infection and/or vaccination.
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21/ "2. The new COVID soup...
Evolution appears to be outpacing immunity. By the time scientists have studied immunity against one variant, that variant has been supplanted by new variants that have already created immune escape.
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The absence of political will to dampen transmission has led to evolution so extensive that the Kraken/XBB.1.5 covid variant is as different from the original Wuhan strain as the original Wuhan strain was from SARS-1.
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23/ Antigenic distance diagram ...
While viral evolution could lead to benign "endemic" variants, that is not necessarily true.

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As we've seen, vaccination does not prevent infection, and infection does not prevent reinfection. Therefore, vaccination plus infection does not meaningfully dampen transmission.

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We're seeing more and more cases of "failed" hybrid immunity.

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What about hospitalizations & deaths? The protection that infection (and therefore, also "hybrid immunity") offers against severe acute outcomes appears to be greater and more durable than the protection offered by vaccines alone.

27/ Figure repeated from tweet ...
Some PHOs used this information to deliberately increase transmission (to hasten "priming exposure" and "hybrid herd immunity"), and at least one PHO studied case numbers as they skyrocketed and celebrated the "success" of her mass infection efforts.

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The problem? In order to get "hybrid immunity," you need to get infected with covid.

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 XKCD "immunity" c...
Even people who appear to have gotten off lightly by experiencing a short & mild acute infection may have undetected lingering effects, including long-term damage to the very immune system infection was supposed to help.
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Instead of the immune system's crushing covid, covid may be crushing the immune system. Attempts to achieve hybrid immunity may instead produce immunity theft. (See @jvipondmd et al. below.)
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 (Click "show replies" for more)
Contrary to popular belief, in some cases (for some people/viruses), the acute phase of an infection does not end by clearing the virus from the body.

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Covid may chronically activate the immune system by viral persistence, viral reactivation, autoimmunity, etc.
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33/ Figure from @VirusesImmunit...
Seeking immunity through infection — and then repeated infection — is backfiring.

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 Meme of zombie crawling on ...
What about #LongCovid in general, apart from immune dysfunction? Getting vaccinated does not make you immune to Long Covid. Your chances of suffering with Long Covid may be only slightly reduced by vaccination.

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Nor does getting infected make you immune to #LongCovid. On the contrary, your chances of suffering with Long Covid increase with the number of infections you've had.
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36/ Figure with data from Bowe,...
Antigenic drift/viral evolution has not eliminated (or maybe even reduced) the incidence of #LongCovid.

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Overall, confirmed case fatality rates have declined significantly since the beginning of the pandemic (the greatest reductions occurring even before vaccines).

38/ Graph of various countries'...
But excess mortality remains high despite countries' reaching high levels of vaccination and infection.

39/ Graph showing that excess m...
"Hybrid immunity" may reduce acute-covid mortality per case, but that reduction is overwhelmed by huge case numbers & by deaths due to long-term covid complications (plus secondary effects like overwhelmed healthcare systems).

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And as suggested above, chronic morbidity (#LongCovid) rates have not greatly declined per case (with vaccines & different variants) and have increased overall (presumably, due to high case rates and worse outcomes with reinfections).

41/ Bar graph of UK ONS Long Co...
So what would a society look like if it relied entirely on infection plus (increasingly out-of-date) vaccination for pandemic management? Sure, we could anticipate reduced hospitalization & death rates from acute covid. But that pro is outweighed by the cons.

42/ Trojan horse meme, which I ...
With a hybrid-only approach we can anticipate:
1. Increased viral evolution rate w/ unknown consequences.
2. People constantly sick w/ covid & secondary infections.
3. Kids not learning in school because they and/or their teachers are constantly sick.

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4. Malfunctioning essential services & supply chains b/c workers are sick or dead.
5. Constant suffering of vulnerable people & their families (including kids) in long-term isolation.
6. Constant suffering of people w/ #LongCovid & their families/caregivers (including kids).

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7. Increased hosp'n & death from covid-induced immune dysfunction, other #LongCovid, accidents caused by cognitive dysfunction, lack of protection of vulnerable people, inadequate medical care b/c of essential service & supply chain disruptions, etc.

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 cbc.ca/news/canada/br…
8. Loss of experts with specialized knowledge due to death & #LongCovid.
9. Declining economic productivity due to worker absenteeism & unemployment from acute & Long Covid and due to Long Covid cognitive dysfunction & decreased learning in schools.

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10. Ballooning social security rolls with a declining number of workers able to support the newly disabled.
11. Increased prevalence and severity of eugenics ideology (largely due to #10 above).

Etc.

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Health officials have focused on "mild" case fatality & acute hospitalization rates instead of on the more important metrics of excess deaths, Long Covid cases, healthcare system failures, supply chain disruptions, school & work absence rates, viral evolution rates, etc.

48/ "Hybrid immunity"...
(Another important but oft-ignored metric is vaccine injury rates. Perceived secrecy & obfuscation lead to misinformation & disinformation & death.)

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So-called hybrid immunity to covid has not — and will not — build up an "immunity wall" of herd immunity. Our escape from this pandemic will come from developing vaccines that produce sterilizing immunity and from enacting airborne protections to minimize transmission.

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Our best accelerated chance for the former is probably an unbiased (free from corporate & political lobbying and from conflicts of interest) Operation Warp Speed for nasal vaccines and other vaccines that promise to produce mucosal immunity.

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Our best accelerated chance for the latter is probably for a small jurisdiction to enact very modest policy aimed at protecting and including vulnerable people.

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Also, we need to urgently #TreatLongCovid & similar illnesses. Millions of people & their loved ones — including many people just like you, & including many children, & including me — are suffering terribly every second of every day from infectious-onset chronic illness.

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More from @dreamy_run

Dreamy Run Profile picture
Sep 16, 2022
🧵. @TheLancet has just released a major report "on lessons for the future from the COVID-19 pandemic." In it, the authors roundly criticize a widely held, historical misconception about viruses and SARS in particular —
1/6
doi.org/10.1016/S0140-…
— the misconception that viruses are primarily transmitted through close-range large droplets. The authors concluded that reluctance to overturn this centuries-old error & acknowledge #CovidIsAirborne has led to untold suffering during the pandemic.
2/6
Unfortunately, the authors failed to discredit the other major widely held, historical misconception about viruses — the misconception that immune systems immediately clear viruses from the body, so as long as you survive the acute phase, you're home free.
3/6
Read 6 tweets
Dreamy Run Profile picture
Sep 15, 2022
Let's see if I can enumerate the problems revealed by this study coathored by the chief public health officer of B.C.

(1)The person in charge of keeping the public healthy instead removed health protections.

(2)She manipulated this "protection variable" as part of a real-world experiment.

(3)Participants were denied informed consent.

(4)Participants did not even know they were in a study.
(5)To the extent participants were informed about risks, the experimenter was dishonest, claiming that the manipulation would not produce any meaningful effects (e.g., schools are safe, so masks don't make a difference), while the experimenter's own data suggested otherwise.
Read 24 tweets
Dreamy Run Profile picture
Feb 7, 2022
A 2013 lecture by Dr. Paul Cheney has been getting some Twittention lately. It's a goldmine of info re: #MECFS & the PEM variety of #LongCovid. For people who don't have the spoons to watch (or read) the whole thing, I've pulled out a few nuggets.

Stress & chills:
"[In ME] the body adapts to a low-energy state. It has to, because if it tries to stay at a high-energy state, it generates too much oxidative stress, which is deadly. So it adapts to a low-energy state. How do you think the body creates a low metabolic rate?"
"The answer is that it downregulates thyroid function. So the lowered thyroid function – get this – is not the problem. It’s the solution. ... Admittedly, that’s going to produce stuff like being cold, because that’s what it’s like to be at a low metabolic rate."
Read 25 tweets

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