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The High Cost of Disparaging Natural Immunity to Covid

Reproduced from the Wall Street Journal

Pub­lic-health of­fi­cials ru­ined many lives by in­sist­ing that work­ers with nat­ural im­mu­nity to Covid-19 be fired if they weren’t fully vac­ci­nated. But af­ter two years of ac­cru­ing data, the su­pe­ri­or­ity of nat­ural im­mu­nity over vac­ci­nated im­mu­nity is clear. By fir­ing staff with nat­ural im­mu­nity, em­ploy­ers got rid of those least likely to in­fect oth­ers. It’s time to re­in­state those em­ploy­ees with an apol­ogy.

For most of last year, many of us called for the Cen­ters for Dis­ease Con­trol and Pre­ven­tion to re­lease its data on re­in­fection rates, but the agency re­fused. Fi­nally last week, the CDC re­leased data from New York and Cal­i­for­nia, which demon­strated nat­ural im­mu­nity was 2.8 times as ef­fec­tive in pre­vent­ing hos­pi­tal­iza­tion and 3.3 to 4.7 times as ef­fec­tive in pre­vent­ing Covid in­fec­tion com­pared with vac­ci­na­tion.

Yet the CDC spun the re­port to fit its nar­ra­tive, ban­ner­ing the con­clu­sion “vac­ci­na­tion re­mains the safest strat­egy.” It based this con­clu­sion on the find­ing that hy­brid im­mu­nity—the com­bi­na­tion of prior in­fec­tion and vac­ci­na­tion—was as­so­ci­ated with a slightly lower risk of test­ing pos­i­tive for Covid. But those with hy­brid im­mu­nity had a sim­i­lar low rate of hos­pi­tal­iza­tion (3 per 10,000) to those with nat­ural im­mu­nity alone. In other words, vac­ci­nat­ing peo­ple who had al­ready had Covid didn’t sig­nif­i­cantly re­duce the risk of hos­pi­tal­ization.

Sim­i­larly, the Na­tional In­sti­tutes of Health re­peat­edly has dis­missed nat­ural im­mu­nity by ar­gu­ing that its du­ra­tion is un­known—then fail­ing to con­duct stud­ies to an­swer the ques­tion. Be­cause of the NIH’s in­ac­tion, my Johns Hop­kins col­leagues and I con­ducted the study. We found that among 295 un­vac­ci­nated peo­ple who pre­vi­ously had Covid, an­ti­bod­ies were present in 99% of them up to nearly two years af­ter in­fec­tion. We also found that nat­ural im­mu­nity de­vel­oped from prior vari­ants re­duced the risk of in­fec­tion with the Omi­cron vari­ant. Mean­while, the ef­fec­tive­ness of the two-dose Mod­erna vac­cine against in­fec­tion (not se­vere dis­ease) de­clines to 61% against Delta and 16% against Omi­cron at six months, ac­cord­ing to a re­cent Kaiser South­ern Cal­i­for­nia study. In gen­eral, Pfiz­er’s Covid vac­cines have been less ef­fec­tive than Mod­er­na’s.

The CDC study and ours con­firm what more than 100 other stud­ies on nat­ural im­mu­nity have found: The im­mune sys­tem works. The largest of these stud­ies, from Is­rael, found that nat­ural im­mu­nity was 27 times as ef­fec­tive as vac­ci­nated im­mu­nity in pre­vent­ing symp­tomatic ill­ness.

None of this should sur­prise us. For years, stud­ies have shown that in­fec­tion with the other coro­n­aviruses that cause se­vere ill­ness, SARS and MERS, con­fers last­ing im­mu­nity. In a study pub­lished in May 2020, Covid-re­cov­ered mon­keys that were rechal­lenged with the virus didn’t get sick.

Pub­lic-health of­fi­cials have a lot of ex­plain­ing to do. They used the wrong start­ing hy­poth­e­sis, ig­nored con­trary pre­lim­i­nary data, and dug in as more ev­i­dence emerged that called their po­si­tion into ques­tion. Many, in­clud­ing Rochelle Walen­sky, now the CDC’s di­rec­tor, signed the John Snow mem­o­ran­dum in Oc­to­ber 2020, which de­clared that “there is no ev­i­dence for last­ing pro­tec­tive im­mu­nity to SARS-CoV-2 fol­low­ing nat­ural in­fec­tion.”

Many clin­i­cians who talk to other physi­cians na­tion­wide had have long ob­served that we don’t see re­in­fected pa­tients end up on a ven­ti­la­tor or die from Covid, with rare ex­cep­tions who al­most al­ways have im­mune dis­or­ders. Mean­while, pub­lic-health of­fi­cials reck­lessly de­stroyed the ca­reers of every­day Amer­i­cans, ral­ly­ing to fire pi­lots, truck driv­ers and oth­ers in the sup­ply-chain work­force who didn’t get vac­ci­nated. And in the early months of the vac­cine roll­out, when sup­plies were lim­ited, we could have saved many more lives by giv­ing pri­or­ity to those who didn’t have recorded nat­ural im­mu­nity.

The fail­ure to rec­og­nize the data on nat­ural im­mu­nity is hurt­ing U.S. hos­pi­tals, es­pe­cially in rural ar­eas. Mul­ti­Care, a hos­pi­tal sys­tem in Wash­ing­ton state, fired 55 staff mem­bers on Oct. 18 for be­ing out of com­pli­ance with Gov. Jay In­slee’s vac­cine man­date—and that was in ad­di­tion to an undis­closed num­ber of staffers who quit ahead of the vac­ci­na­tion dead­line. The loss of work­ers con­tributed to a full-blown staffing cri­sis.

It got so bad that the hos­pi­tal sum­moned staff who were Covid-pos­i­tive to re­turn to work even if they were sick, ac­cord­ing to an in­ter­nal memo ob­tained by Ja­son Rantz of KTTH ra­dio. The memo stated that “pos­i­tive staff with mild to mod­er­ate ill­ness” could work, so long as they wear ap­pro­pri­ate per­sonal pro­tec­tive equipment, don’t take breaks with oth­ers, and agree to stay home “if symp­toms worsen.” Man­agers were rec­om­mended to as­sign Covid-pos­i­tive staff to Covid-pos­i­tive pa­tients and vac­ci­nated pa­tients, but not im­muno­sup­pressed pa­tients.

The Cen­ters for Medicare and Med­icaid Ser­vices took the hos­pi­tal man­date na­tional by de­cree­ing that all med­ical fa­cil­i­ties un­der its ju­ris­dic­tion re­quire vac­ci­na­tion for em­ploy­ees, in­clud­ing those with nat­ural im­mu­nity. The Supreme Court up­held the rule on Jan. 13, the same day it is­sued a stay against a sim­i­lar man­date from the Oc­cu­pa­tional Safety and Health Ad­min­is­tra­tion, which OSHA for­mally with­drew Tues­day.

Con­necti­cut has sus­pended its vac­cine man­date for state em­ploy­ees, and Star­bucks is re­hir­ing em­ploy­ers fired for be­ing un­vac­ci­nated. Other states and busi­nesses should fol­low their lead. Politi­cians and pub­lic-health of­fi­cials owe an apol­ogy to Amer­i­cans who lost their jobs on the false premises that only un­vac­cinated peo­ple could spread the virus and only vac­ci­na­tion could pre­vent its spread. Sol­diers who have been dis­hon­or­ably dis­charged should be restored their rank. Teach­ers, first re­spon­ders, and oth­ers who have been de­nied their liveli­hood should be re­in­stated. Every­one is es­sen­tial.

Dr. Makary is a professor at the Johns Hopkins School of Medicine

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