Michael Abrahams | COVID-19 and the value of natural immunity

Last week, the Centers for Disease Control and Prevention released data from California (the most populated state in the United States) and New York concerning infection and hospitalisation rates during the Delta surge last year. The study included over one million participants divided into four cohorts:

- Unvaccinated with no prior history of COVID-19 infection;

- Vaccinated with no prior history of COVID-19 infection;

- Unvaccinated and previously infected;

- Vaccinated and previously infected.

Not surprisingly, persons who were unvaccinated with no prior history of COVID-19 infection fared the worst, and were the most likely to contract the infection and to be hospitalised for illness resulting from it, while the vaccinated and previously infected fared best, affirming the value of being vaccinated during this pandemic. There is no doubt that vaccines have saved lives and helped to keep people out of hospital. The evidence for this is unequivocal.

But the study also revealed something else of importance: the value of natural immunity. It found that during the Delta surge, among infected individuals, people who were unvaccinated and previously infected fared better than those who were vaccinated with no prior history of infection. To be honest, to say they fared better is an understatement. Their level of protection from infection and hospitalisation was significantly superior. The data showed that natural immunity from previous infection was 2.8 times as effective in preventing hospitalisation, and 3.3 to 4.7 times as effective in preventing COVID-19 infection when compared with vaccination alone.

BIG THING

Natural immunity really is a thing. A big thing. A prior infection with COVID-19 not only significantly lowers your risk of a subsequent infection, but also your risk of becoming severely ill if reinfected. So, an inconvenient truth for the vaccinated is that if you have received vaccination against COVID-19, and have no prior history of infection, there will be many unvaccinated people around you, specifically those who have had prior infection, who are better protected than you are.

This is one of the reasons why mandatory vaccination is not only unfair, but unscientific. For example, if you became fully vaccinated six months ago, you are likely to be less protected than an unvaccinated person who contracted COVID-19 and recovered from it last month. However, possessing evidence of vaccination may enable you to enjoy benefits your unvaccinated but protected counterpart will be denied. It makes no sense.

Recently, the University Hospital of the West Indies (UHWI) issued a press release informing the public of a restriction of their activities as a result of our fourth wave, driven by the Omicron variant. The release also appealed to persons who recovered from COVID-19 to donate plasma to assist with the management of hospitalised patients ill with the infection.

This request is an affirmation of the value of natural immunity. The plasma is useful because it contains antibodies to SARS-CoV-2, the virus that causes COVID-19. The majority, over 70 per cent, of Jamaicans are unvaccinated. Most of our infections occur in unvaccinated individuals. So, the request for plasma has been extended to a population of people, the majority of whom are unvaccinated. So, here is another inconvenient truth: the plasma from an unvaccinated person may save the life of a vaccinated one. It is a fact that the overwhelming majority of patients hospitalised for COVID-19 are unvaccinated. But there is a small minority who are vaccinated, usually with significant comorbidities.

The demonstrated value of natural immunity, however, does not suggest that if you are unvaccinated you should deliberately attempt to acquire the infection. To do so would be unwise. The severity of disease after contracting COVID-19 is unpredictable, being influenced by a multiplicity of factors, including the variant of the virus involved, the amount of viral particles encountered at the time of exposure, the strength of the immune system, and the presence or absence of certain comorbidities. Czech singer Hana Horka did just that, and succumbed to the disease.

ABSENT OR DOWNPLAYED

Surprisingly, although natural immunity is powerful, is has been conspicuously absent or downplayed in the narratives of international and local health authorities. The dismissal of the phenomenon, coupled with censorship of those who place importance on it, such as the banning of the hashtag #naturalimmunity by popular social media platform Instagram, have helped to fuel distrust and hesitancy.

We must also be aware that minimising the role of natural immunity during this pandemic is not benign and does have grave consequences. In his Wall Street Journal article, ‘The High Cost of Disparaging Natural Immunity to Covid’, Dr Marty Makary, a professor at the Johns Hopkins School of Medicine, stated, “Vaccines were wasted on those who didn’t need them, and people who posed no risk lost jobs.”

The recognition of the value of natural immunity must be up front and centre, along with the push for vaccination during COVID-19 conversations. Unfortunately, there has been a type of irrational binary thinking, suggesting that you are either for vaccination or natural immunity. If you truly follow the data, you will appreciate both, as over 140 studies have validated the protective effect of natural immunity.

If we want to maximise saving lives during this plague we must be honest. We must decide if we are going to follow the science, be influenced by politics, give in to popular opinion or arrogantly stick to our own narratives, even when their flaws are revealed.

It would be in the best interest of our brothers and sisters to follow the science. Science, including medical science, has never been static. It is constantly evolving. As research is carried out and we collect evidence and correlate data, algorithms, diagnostic criteria and treatment protocols change.

The findings of the plethora of research on natural immunity dictate that we reassess our approach to mass vaccination. It is clear that the ‘one size fits all’ approach warrants re-evaluation, as well as the use of antibody and other tests to evaluate immune status.

We owe it to our fellow human beings.

Michael Abrahams is an obstetrician and gynaecologist, social commentator and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on Twitter @mikeyabrahams.