Comment by Pyramus | Hacker News Reader

Comment by Pyramus | Hacker News Reader

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> There is every reason to expect that natural immunity (derived from a previous infection) is better (than that conferred by a vaccine), simply because the immune system will recognize the entire virus and not just the spike cell.

No - we do not have "every reason" to expect, quite the opposite. As a starter, for many infectious diseases (incl. viral diseases) vaccine-induced immunity is better, see e.g. the commentary and examples here [1].

Regarding SARS-CoV-2, the picture is a lot more subtle. Directly from German virologist Christian Drosten:

"If you look closely at the data in the studies, the situation is much more complicated. What one should say and be aware of is vaccination, which provides a relatively constant protection, which is very well described in studies. You actually pretty much know what you have. While there is a greater spread in the case of infection. Quite simply, we get different amounts of virus in the infection. Some have a silent infection that they don't even notice, others have a symptomatic infection. And you have to be aware that in such studies, which are primarily based on PCR test results, there will always be a certain emphasis on symptomatic courses. That means saying that if I know I have survived an infection and it was confirmed by PCR testing, then that also implies that I had symptoms, otherwise I would hardly have had a PCR test at the time. So then I had a symptomatic course. I think that for this situation you can now say very well, whoever had the whole thing symptomatically, will be well protected afterwards, almost like a vaccination." [2]

The study you picked in its current pre-print form does not adequately address this obvious selection bias, nor does it address the inherent survivorship bias. I´m not a medical expert though, so we will see if it passes peer review.

In any case, please do not perpetuate the myth that natural immunity is superior per se. If you had a symptomatic infection plus a PCR test, you are likely well protected, very similar to (mRNA) vaccination. If your infection is more than 6 months old, get a booster.

[1] https://twitter.com/ENirenberg/status/1412865782862725125

[2] https://www.ndr.de/nachrichten/info/coronaskript334.pdf page 7 (via Google Translate)

Can you link to studies mentioned in your quote ? - "If you look closely at the data in the studies, [..]"

Also, you seem to be rightfully cautious that the situation is fluid, but also calling natural immunity being better a 'myth'. This may just be the word you chose, but myth to me is something that is complete BS. Are you also intending to use it that way?

> Can you link to studies mentioned in your quote ? - "If you look closely at the data in the studies, [..]"

See e.g. papers mentioned here: https://g-f-v.org/2021/09/30/4411/

> myth to me is something that is complete BS

I chose myth to describe the pattern of something that seems correct for seemingly obvious reasons but is actually incorrect for more complicated reasons.

In particular the black and white belief that natural immunity is superior because

a) it is 'natural' (this is a such a great example of extrapolating from a kernel of truth and can have interesting notions packed into it, like the superiority of divine creation and/or nature),

b) the vaccine only encodes the spike protein (one of the reasons the spike protein was chosen is because it is more robust w.r.t. to variation relative to other components of the virus).

I see these "arguments" often politicised with terms such as 'gold standard immunity'.

Your claim that natural immunity superiority is a myth is based on which scientific principles? Please throw all the science you can at me, I am genuinely interested.

Also, I'm curious if you read the studies you're linking to?

This is literally the conclusion from link #8

>This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity.

Please re-read what I wrote: It's BS to call natural immunity superior for the reasons of being "natural" or because "vaccines only encode the spike protein".

There is no black and white argument why natural immunity should be superior - it can be worse, similar or better than vaccine-induced immunity. It all depends on the amount of viral particles you were exposed to in the first place.

Any study that compares natural immunity to vaccine-induced has to deal with a selection bias (as stated in the quote by somebody who is a professional at designing such studies).

Let me know if that clears things up.

>There is no black and white argument why natural immunity should be superior - it can be worse, similar or better than vaccine-induced immunity. It all depends on the amount of viral particles you were exposed to in the first place.

Logical arguments for a position don't equate to empirical truths. Data is preferred over argument/opinion.

>Any study that compares natural immunity to vaccine-induced has to deal with a selection bias (as stated in the quote by somebody who is a professional at designing such studies).

Do you have any evidence that the study you linked to is biased? If so, why even link to it?

In any case, I think this thread is not going anywhere, so I will just let you have the last word.

I also wonder whether the reason the "natural vs vaccine" immunity question may not have a great, direct answer is it wasn't asked until covid-19.

When I was asked about this by a 'vaccine skeptic', I said having the vaccine after an infection was clearly a huge benefit over having just the vaccine or just the infection - so do it. I've also seen a study where the super rare, problematic responses to the vaccine seemed to be the same symptoms someone would experience with an infection sans the vaccine - only the effect would be dramatically worse with an infection. (Sorry I can't offer sources at the moment - moments from sleep.)

Of course it was asked before COVID-19: there's no point in taking a vaccine for a disease you already had because the vaccine is not more virus-like than the virus itself. By definition there is no event closer to infection than infection; for the body, a vaccine is always a trial run. Hence things like chickenpox parties. There wasn't raging debate about this because it's obvious and uncontested.

It's quite sad to see people now claiming it's some kind of novel scientific question about natural immunity vs not. This is basic, high school level biology. It's not advanced stuff and the people claiming otherwise are invariably using bad science to do so. For example, claims that infection doesn't stop reinfection are often based on studies with so few cases of reinfection that it'd fall below the noise floor for almost any testing system. The belief that these events are real relies on yet more bad science (the belief that mass testing has an FP rate of zero).

The reality is that natural immunity is suddenly being questioned because "vaccine zealots" are desperate to suppress any messaging that might discourage people from taking it. They've lost all perspective, which means they're making claims that are contradicting biology considered so basic and important that it's literally taught to children in school. Then they sit around looking confused, wondering why suddenly so many "anti-vaxxers" and "skeptics" came out of the woodwork.

> By definition there is no event closer to infection than infection [...] Hence things like chickenpox parties.

Glad you mention chickenpox. Could you help me understand why the protein vaccine is much more effective than the attenuated virus vaccine? Following your argument there should be nothing better than the virus vaccine, because it is closest to infection?

It's not more effective, is it? The mRNA vaccines have proven to have zero efficacy after only a few months, at least for the goal they were judged against in the trials. They don't reduce the rate of infection at all. Even Boris Johnson has admitted that now.

Actually it is good to be vaccinated even if you have already had a disease. This confers greater immunity than the infection or just the vaccine.

Whether or not the vaccine or natural immunity is better protection isn't as clear as suggested either, generally the vaccines will give more reliable resistance.

Please read: https://www.nebraskamed.com/COVID/covid-19-studies-natural-i...:

"Natural immunity can be spotty. Some people can react vigorously and get a great antibody response. Other people don't get such a great response," says infectious diseases expert Mark Rupp, MD. "Clearly, vaccine-induced immunity is more standardized and can be longer-lasting."

No it isn't. That's extremely bad advice, please don't tell people to get vaccinated if they don't need to. The vaccines can have nasty side effects and if you've had the disease you are hardly at any risk of being reinfected, let alone actually suffering disease. The data on this is quite clear, there are many studies that look at the testing data to find this.

Example: https://www.medrxiv.org/content/10.1101/2021.03.06.21253051v...

"Out of 149,735 individuals with a documented positive PCR test between March 2020 and January 2021, 154 had two positive PCR tests at least 100 days apart, reflecting a reinfection proportion of 1 per 1000"

So that's really incredibly low. Note that this paper, like so many others, assumes a false positive rate of zero: with such a low number of reinfections they could easily just be testing errors and thus the reinfection rate can easily be even lower still.

Remember - COVID is a mild disease for the vast majority. Having been infected reduces your chance of infection so low that it takes you from a very low chance of having serious problems to "you need scientific notation to express the probability of having problems". Vaccines can only make things worse for those people, not better.

Unfortunately our society has completely lost all rationality over vaccines. Your so-called infectious disease expert is a great example of that. Firstly, he's dead wrong that vaccine-induced immunity is longer lasting. It lasts months at most, which is why even vaccine-pushers have given up claiming it stops you getting COVID. And antibody titers are not the end goal here! The goal is to avoid getting sick. They've completely substituted the means for the end, which is the sort of contempt-worthy irrationality that makes people reject the vaccination programme.

> The vaccines can have nasty side effects and if you've had the disease you are hardly at any risk of being reinfected,

This is wrong, the vaccines are safe and effective - much moreso than getting reinfected with COVID-19. As a former medical professional who works with medical professionals today, you are completely misguided. Please don't repeat this stuff.

The vaccines were released to the public barely a year ago. There is no way to know exactly how safe or effective they are, supposing they are. We just don't have the data yet. What we have, however, is an aggressive censorship of any information or person critical of the vaccines.

This is wrong. We know how the ingredients of the vaccine interact inside the body and we know they leave the body pretty rapidly. We have a good idea of the side effects as over 6 billion doses have been administered worldwide.

Parent's comment will not cease to amaze me: We are going through a pandemic that has cost more lives in the US than the Spanish flu (absolute numbers) and there are still folks running around proclaiming that

> Remember - COVID is a mild disease for the vast majority.

If you had told me in 2019 that we will experience something like it in our lifetime I would not have believed you.

COVID is in fact mild for the vast majority. That is a simple fact, and not one that can be dismissed with strange non-population adjusted comparisons. Actually nobody really knows how many people died from the Spanish flu, so I really wonder where you heard that idea. Wikipedia says:

"Estimates of deaths range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in human history."

NB: The high estimates come from epidemiological modelling so should probably be ignored as such modelling has no legitimacy. But even for the USA alone, there's no agreement on how many died, especially as many people (especially in the USA) seem to have been killed by aspirin overdoses rather than the flu itself. At the time aspirin was new and considered a miracle cure. Doctors panicked prescribed doses that we now know are far, far too high. From a paper published in 2009:

https://www.sciencedaily.com/releases/2009/10/091002132346.h...

High aspirin dosing levels used to treat patients during the 1918-1919 pandemic are now known to cause, in some cases, toxicity and a dangerous build up of fluid in the lungs, which may have contributed to the incidence and severity of symptoms, bacterial infections, and mortality. Additionally, autopsy reports from 1918 are consistent with what we know today about the dangers of aspirin toxicity, as well as the expected viral causes of death.

The motivation behind the improper use of aspirin is a cautionary tale, said author Karen Starko, MD. In 1918, physicians did not fully understand either the dosing or pharmacology of aspirin, yet they were willing to recommend it. Its use was promoted by the drug industry, endorsed by doctors wanting to “do something,” and accepted by families and institutions desperate for hope. “Understanding these natural forces is important when considering choices in the future,” Dr. Starko said. “Interventions cut both ways. Medicines can save and improve our lives. Yet we must be ever mindful of the importance of dose, of balancing benefits and risks, and of the limitations of our studies.”

> Whether or not the vaccine or natural immunity is better protection isn't as clear as suggested either, generally the vaccines will give more reliable resistance.

Yah, perhaps it'd be best to talk about mean and variance.

For COVID-19, it looks like natural infection provides a somewhat better neutralizing titer of antibodies than vaccination on average. But there's a much larger variation in the response than vaccination provides. The people with the lowest responses are in the natural infection group, too.

> I said having the vaccine after an infection was clearly a huge benefit over having just the vaccine or just the infection - so do it.

Yes --- amazingly so. We don't have wonderful data for SARS-COV-2 yet, but some number of recipients of mRNA vaccines who are survivors of the original SARS apparently have strong antibody responses to all coronaviruses. https://www.nejm.org/doi/full/10.1056/NEJMoa2108453

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