Natural immunity vs vaccination

The pandemic seems to have been on forever, but we still have much to learn about COVID-19, which is only a bit over 2 years old, an infant among human diseases.  So it is unsurprising to have different opinions and debates and changes in positions.  Even scientists and medical professionals don’t agree on everything or many things, no wonder the public is often confused.

Take Dr John Campbell, a very popular YouTuber on COVID-19 subjects, as an example.  From his background he knows medical stuff more than the intricacy of science.  Most what he says fits the mainstream consensus, but two “obsessions” of his, one about ivermectin, and one about natural immunity, merit mentioning.

The case for ivermectin is odd.  Hyped by many people including Campbell, there is no clinical evidence it works against COVID-19.  Research cited by Campbell is of questionable quality, rebutted by no less than other YouTubers, and it is clear that the canonical mechanism of ivermectin won’t do because the lung concentration of ivermectin isn’t high enough.  The only saving grace for ivermectin supporters is that ivermectin might work with a different yet unknown mechanism.  But if that argument is enough, what is stopping tens of thousands of other medicines from ever being COVID-19 drugs?

Campbell is not against vaccination, but he places a higher premium on natural infection and immunity than probably most scientists and doctors would, especially since Omicron.  Campbell bets that Omicron infects everybody to give everybody immunity, then everybody will be free of COVID-19 forever.  This position fits the inclination of a large section of the populace, is not necessarily wrong, but also not necessarily right, either.  Unlike popular beliefs, the medical community has evaluated natural immunity vs vaccination.  The latest data, from CDC, cited as evidence is https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm.  The study found that COVID-19 conferred protection a bit better than two-dose vaccination in CA and NY.  But the data were limited, might not apply to elsewhere, the Omicron variant, or any future variants. 

The first question is, which is safer?  There is no debate here, even if COVID-19 kills only 0.5% or fewer of the infected, and vaccines do have side effects.  And even if you survive, you may develop long COVID.  So if one has a choice of natural infection/immunity or vaccination, don’t do natural immunity, certainly not if you are old or have other health problems.  Even Campbell agrees on this.  If you get COVID-19 and clear it, consider yourself lucky, but it is never a better option population-wise.  Unfortunately, attempts to compare between natural immunity and vaccination often veer to arguing against mass vaccination. 

The second is the most important: is natural immunity really better?  Natural immunity has been suspected and recognized from animal and human studies by mid 2020 (April 9, 2020 blog), so it is not something scientists have ignored.   In 2020 two big unknowns are how long does immunity last, and what is the Ab threshold for protection?  Both questions have been answered reasonably well in 2021.  Immunity, natural or vaccine, drops after a few months, but protection against serious disease lasts longer than against infection.  The Ab threshold for protection is quite low, since different vaccines, i.e., mRNA, Ad, protein based, and inactivated virus based, are similarly effective at preventing serious outcomes even as they induce different levels of Ab in humans.   

These properties muddle the water of whether natural immunity is truly better than vaccination because a study must find people who are infected or vaccinated at the same time and compare how many are infected and their outcomes.  Furthermore, what variants they are infected and re-infected matter.  Few if any study has had that high level of resolution, so it is premature to conclude natural immunity is better, provided one survives first. 

On a slightly different note, the same shortcoming pertains when comparing different vaccines in different countries and clinical trials.  If a country, e.g., the US, is having a lot of cases at the same time people are getting the shots, the difference in infection between the vaccinated and unvaccinated will appear fast and vast.  But if the shots come earlier than the COVID-19 wave, the vaccines may seem less effective, simply because more time has passed since the shots.  But the protective power against serious disease is more alike.   

Critically, natural immunity has more uncertainty than vaccination.  Vaccination’s uncertainty lies in individuals responding to the same, uniformed vaccines differently.  Natural immunity shares the same variation, but has its additional, unique features: how much virus you got initially to become infected, and how sick you were, which also depends on whether and how much you got medical care.  This adds overwhelming amount of unpredictability to natural immunity.  Currently it is surmised that those who were modestly or seriously sick develop better immunity, so people who are infected with few or no symptoms might not realize they are carriers and might have little Ab or natural immunity.  These people could account for 10-50% of the infected, but are likely under-sampled by the CDC or other studies.  Thus, it is erroneously based on those data to conclude that natural immunity is better. 

The last question is, what is the best way to protect infection and re-infection, by Omicron, another variant, or future variants?  Omicron is more infectious than other variants mostly because it better evades human’s immune response, so will people get Omicron over and over once the immunity wears off?  How long are we protected against infection and against serious disease?  How do we get to the COVID-19 endgame with immunity?  Are we waiting for natural immunity, or vaccine booster?  Since we know immunity wanes (protection against serious disease should eventually drop as well), and we don’t know what future infection will bring, it will be foolish to roll the dice with and emphasize natural infection/immunity.

PS: Here is a history of 2009 pandemic origin, with eerie similarity to or lessons for COVID-19:  https://www.the-scientist.com/infographics/timeline-investigating-the-origins-of-the-2009-pandemic-69519?utm_campaign=TS_DAILY_NEWSLETTER_2022&utm_medium=email&_hsmi=203964027&_hsenc=p2ANqtz-9PEnTx85tmo-ZB_Bj1AK_X1xN0Ntpzqk73S-Qmh4r8NuuIDxnqKbnSDHfE8njqaIxll0C1LK_xwhsZWRehkf5DvY1zeQ&utm_content=203964027&utm_source=hs_email.

Maybe as good as it will ever get in the Western media about WIV and COVID-19

MIT Technology Review published an article on WIV on Feb 9, 2022 (www.technologyreview.com/2022/02/09/1044985/shi-zhengli-covid-lab-leak-wuhan/).  Together with columns by Michael Hiltzik at the LA Times, it stands as the best journalism on COVID-19 origin by the Western media.  MIT Technology Review is no brand-name, and Michael Hiltzik can be dismissed as being a columnist and expressing his opinions.  Hence this underscores indirectly but also abundantly the lopsided COVID-19 debate.

The new, lengthy article contains a lot of new information about WIV.  For example, beyond the “usual suspect” Shi Zhengli, it describes for the first time in the West two important junior researchers at Shi’s lab who had cultured bat CoVs and sequenced SARS-CoV-2.  The article reflects how dismal Nathan Robison’s interview of Alina Chan was (Jan 22, 2022 blog), which is far from the worst.  Along the way the article summarily confirms many points my previous blogs had made based on public records and professional knowledge (e.g., Dec 7, 2021 and Jan 22, 2022 blogs).  Some of the confirmations, in a matter-of-fact manner almost for the first time, are:

1. There aren’t many CoVs in WIV’s collections.  Estimated 2K at most, and perhaps 200 relevant to humans.  A drop in the bucket compared to Nature CoVs.

2. Almost all known CoVs at WIV exist as sequences, or computer files, only, never live viruses.  Every lab in the world knows how hard it is to isolate CoV from bat samples.  Only 3 viruses have been isolated, all SARS related, by one of the researchers mentioned in the article.

3. It is a common practice to grow bat CoVs at BSL-2 facilities in the world. 

4. Thus it is a red herring for the lab origin crowd to cry lab safety on the BSL-2 or BSL-4 issue.  There was never any problem with WIV biosafety.  The 2020 WP article about DOS cable on BSL-4 at WIV was misleading at best because it seriously lacked contexts and had no specifics on any accidents.

5. Shi’s lab has three dozen people, big but not so big (plenty of labs around the world have many more people).  Not exactly an enterprise of gigantic work to create SARS-CoV-2.

6. Furthermore, GOF was not technically possible with what WIV had.  Even with RaTG13, lab origin crowd’s favorite.  Scientists quoted by the article all agree on that. 

7. The S protein is not the sole determinant of disease by CoVs.  So the much-hyped furin site in S, lab origin crowd’s the other favorite, is even less telling, because for WIV to make SARS-CoV-2, they now not only had to mutate S, but also other parts of the CoVs, which to this day still have unknown significance to disease.  Related to 6, and in the words of Angela Rasmussen of the University of Saskatchewan in Canada, it would have been “a feat of unprecedented genetic engineering.”

8. Many rural people have Ab against SARS-related CoVs, indicating long-time and prior exposures.  Contrast to common beliefs but natural for scientists to understand, it is never a given that COVID-19 originated in Wuhan.

9. Peter Daszak really was not that powerful in the WHO team the lab origin gangs make him out to be.

10. The WIV debate persists simply because the lab origin crowd don’t believe what Shi/WIV/China says.  There is no way to satisfy them, due to WCEV (May 1, 2020 blog).  They have no evidence, and they ask questions not because they want scientific answers.  These people and their actions are the epitome of neo-racism.

But for anyone with an open mind, you can look at public records and scientific literature, prior to 2020 and since, to determine whether there is any indication Shi/WIV was doing anything they said they were not doing, which might lead to SARS-CoV-2, or anything Shi/WIV said that was not unreasonable but was contradicted by any evidence.  Answer: Nil.  Then compare Shi/WIV’s record with lab origin crowd’s.  The contrast is day and light.  It is a big wonder that the lab origin theory still has a speckle of credibility, if not for the fact that WCEV infected more people than SARS-CoV-2 in the West, and human bodies don’t clear WCEV automatically.     

Nonetheless, there are a few questions or problems with the article.  MIT Technology Review is not a household name, and the article’s timing is badly off.  There have been bits and pieces from MIT Technology Review before, but the current, complete article publishes mostly months- or even years-old information.  Why didn’t it come out, say 6 months ago, when it could have made a bigger impact and Michael Hiltzik was the only one at MSM writing good columns?

The worst part is the article also blames Chinese misinformation and not being transparent, a preemptive cover against pro-China bias in the West (in fairness the article includes responses from Chinese scientists).  For one, it is curious that transparency is treated implicitly as an all-or-none phenomenon.  If so, is the US transparent?  Does the US government tell or show you everything, or do you find everything from the US government truthful and immediately throughout the pandemic (or other events)?  If not, is the US transparent or not?  Regarding China, what is not transparent?  If there is something found wrong later, is it possible that it was due to confusion about dealing with a brand new virus and disease and still learning, or no one having all the information in real-time? Even Einstein made scientific mistakes, but being wrong doesn’t mean hiding something.

The article cites the 2003 SARS as an example, but the popular storyline spread by the media is off.  The article mentions a doctor at Beijing revealing more patients in Beijing than officially admitted at the time, but misses the nuance that it was unclear at what level the information was withheld.  And haven’t we seen plenty of such examples in the US during COVID-19?  More importantly, SARS started in Guangdong months earlier, and by the time Beijing had it, China and the whole world already knew about the disease. 

About Chinese misinformation, the West likes to accuse Chinese foreign ministry of blaming the US for making COVID-19.  This article is careful in only saying that China “insinuated” the possibility, which is the lightest accusation by any Western media outlet.  But the article never tells you countless US officials from Trump down have claimed WIV/China made COVID-19 earlier, while no Chinese government officials have made the other assertion.  And the foreign ministry spokespeople merely argued in rhetorical tweets and in response to Western journalists: you say China doesn’t have transparency or allow access, but China has already allowed visits to WIV, so when will the US allow visits to so-and-so?  Before 2020 WIV was (still is) a research and education institute that publishes in scientific journals and cooperates internationally.  Foreign scholars come and go all the time.  Circling back to transparency, does the so-and-so facility in the US operate the same way, and how much do we know about what it does?  Is it fair to apply different standards? If the MIT Technology Review article reminds its audience of the US side, it would have been more objective, balanced, and better.

 

Endgame of COVID-19

The question of how COVID-19 will end has been asked since Jan 2020.  It must be stressed that the endgame depends not only on virus properties but also on human society responses.  As a combination of those two factors, the first prediction that COVID-19 had the same trajectory as SARS was quickly squashed by late Feb 2020.  With vaccines coming out in Dec 2020 the 2^nd hope was that COVID-19 would end in 2021.  Vaccines indeed work, but the relaxation of COVID-19 measures, anti-vaccination movement, the uneven distribution of vaccines globally, and the emergence of COVID-19 variants push the pandemic well into 2022.  In Feb 2022 comes the third prediction of COVID-19 endgame that new Omicron variant could immunize enough people for COVID-19 to become endemic, much like the common cold.

This 3^rd prediction is plausible.  Combining vaccination of the population with the high transmission but less severity of Omicron, enough surviving people will have immunity against COVID-19 in 2022 and beyond.  Practically that is how infectious diseases have always progressed throughout human history: with time going by, there will be fewer people to infect.  Omicron might speed up the process, but COVID-19 will go downhill eventually regardless. 

But shall we bet on it for 2022, or is there anything people should do to prepare for the unpredictable future?  There remain two major unknowns.  The first is: will new, more dangerous variants arrive?  The second: how long does immunity last, and will people get infected and sick with the virus again and again?  These two issues will take months to resolve.  At this point one thing is certain: all vaccines protect severe diseases and serve as the last line of defense for humans.   

Even with these unknowns, many countries including most Western countries are phasing out or abandoning their COVID-19 restrictions.  A huge question is what will China do?  China’s COVID-19 policies have only become stricter and stricter since Jan 2020.  A consequence is that China’s COVID-19 cases and deaths are miniscule compared to most other countries.  Another is economy doesn’t run as well as it could have, for example, travels especially international travels have been severely curtailed, a big missed opportunity for China.  Tens of thousands of foreign students left China in Jan-Feb 2020 and then have been prevented from going back ever since.  Undergraduates have taken online courses and graduated, but graduate and professional students don’t have that option.  Some transferred, but inevitably many wasted a significant amount of time.  Chinese authorities might have hoped that they could come back when oversea COVID-19 situations improved, but things have only got worse, not better, since the summer of 2020, so no student or tourist entry for almost two years now.  In a sense China could have offered a safe heaven for many foreigners in 2020 and 2021, which is good for everybody including China, but that golden opportunity is gone in 2022.  To be fair, China is only one of the many countries that ban most foreign entry since 2020.  On a general note, China should welcome more foreigners in the future.  They may or may not like life in China, but they will see and find firsthand Chinese and Chinese society not much different from the rest of the world.  Their own experience will be the best weapon against WCEV.

With several major events on schedule in 2022, there won’t be any dramatic changes in China until the summer at the earliest.  But China is likely looking at other countries for clues and lessons at the same time.  Obviously for answers to the two questions above.  If there are no new variants by June, for example, there is certainly room for changes.  Also, how well other countries cope with COVID-19?  If the case numbers in, say, the US and UK, are 5K instead of >100K per day, international travel can be relaxed significantly.  Clearly it depends on the three big unknowns above and whether things go as wished.  Once China decides to loosen, it will do it in phases, so it won’t go back to a new “normal” for at least 3-6 more months.   

What will the new “normal” in China look like?  It depends on what the world learns about COVID-19 during the next several months, and don’t expect complete relaxation. On international exchanges, more flights will be allowed, fewer testings prior to departure but likely vaccination requirements, quarantine for a shorter time.  Domestically, once an infection is detected, shorter isolation time for fewer people, and no more lockdown of a whole city.  This is made possible because of a high vaccination rate in China, a good COVID-19 surveillance and response system, and a better understanding of a presumably lesser disease.  It will strike a moving balance between disease prevention and normal human life. 

PS: Maybe as good as it will get in Western media, at least MSM (She’s at the center of the covid lab leak controversy. Now she’s telling her story. | MIT Technology Review).