Prior infection and vaccine mandates

cow451 · Sep 21, 2021

tall73 said:
Here is an example that is playing out in my local area. I know a couple of employees at a nursing care center. The center has required vaccination for all employees. However, they do not consider prior infection with evidence of antibodies to be sufficient.

The employees noted numerous individuals who provided their resignation due to this requirement. Most have already been infected, as they were working during an outbreak before the vaccine was available.

The care center in question is already chronically under staffed, and sometimes cannot even find agency staff when needed, due to the worker shortage impacting the field generally, and in that area.

It seems to me that mandate is poorly thought out. If prior infection provides protection, why remove staff who could help the residents? This is especially the case when they were willing to risk their own lives to work during the pandemic and contracted the virus. If they have immunity roughly equal to the vaccine, and can demonstrate antibodies, why not allow them to continue, since it will be the residents who suffer if there is insufficient staffing?

How many pandemic-level diseases have been eradicated by "natural" or "herd immunity?

Odd that people that oppose the mandate are fine with having the antibodies that the disease produces but not the vaccine that does the same thing better. The mandates make sense. Otherwise one would need to contract COVID annually to accomplish the production of antibodies.

tall73 · Sep 21, 2021

cow451 said:
How many pandemic-level diseases have been eradicated by "natural" or "herd immunity?

Since no one in this thread proposed that we eradicate the disease by natural immunity, there is no need to answer. This is not an anti-vax thread. This is a thread looking at mandates that are requiring people who have already contracted COVID, and have substantial protection, to still undergo additional risks.

Odd that people that oppose the mandate are fine with having the antibodies that the disease produces but not the vaccine that does the same thing better.

Please review the data in the OP. It is disputed that the vaccines do better, as some studies show the opposite. Moreover, some studies show that those with prior infection have higher rates of adverse events, including hospitalization.

I understand from your previous posting that you have both contracted Covid and been vaccinated. I have no objection to people doing so if they want the additional protection. I am addressing those who don't wish to. It does not make sense to compel them to when they have protection on par with those who have been vaccinated.

The mandates make sense. Otherwise one would need to contract COVID annually to accomplish the production of antibodies.

Again, read the studies in the OP. There is evidence of long-term memory immune repose that could last "decades".

cow451 · Sep 21, 2021

tall73 said:
Since no one in this thread proposed that we eradicate the disease by natural immunity, there is no need to answer. This is not an anti-vax thread. This is a thread looking at mandates that are requiring people who have already contracted COVID, and have substantial protection, to still undergo additional risks.
Please review the data in the OP. It is disputed that the vaccines do better, as some studies show the opposite. Moreover, some studies show that those with prior infection have higher rates of adverse events, including hospitalization.
I understand from your previous posting that you have both contracted Covid and been vaccinated. I have no objection to people doing so if they want the additional protection. I am addressing those who don't wish to. It does not make sense to compel them to when they have protection on par with those who have been vaccinated.
Again, read the studies in the OP. There is evidence of long-term memory immune repose that could last "decades".

When a reliable test to certify that one has sufficient antibodies exists, you may have a case. It may be years before a scientific consensus could be reached. Otherwise there is no reason not to have mandates. But then there's the argument that could be made for any vaccine. I had to had another MMR as an adult when I was tested for measles immunity (required by my employer, BTW). So I got another vaccination. Did I really want to? No.

Now, in your scenario, if someone does not meet the established cutoff in an antibody test, does he/she still have to have the vaccination?

Many employers offer the option of weekly COVID tests as an alternative to vaccination. I think that is wasteful and silly. Why the gymnastics to avoid a vaccination mandate?

tall73 · Sep 21, 2021

cow451 said:
When a reliable test to certify that one has sufficient antibodies exists, you may have a case. It may be years before a scientific consensus could be reached. Otherwise there is no reason not to have mandates. But then there's the argument that could be made for any vaccine. I had to had another MMR as an adult when I was tested for measles immunity (required by my employer, BTW). So I got another vaccination. Did I really want to? No.

Now, in your scenario, if someone does not meet the established cutoff in an antibody test, does he/she still have to have the vaccination?

Many employers offer the option of weekly COVID tests as an alternative to vaccination. I think that is wasteful and silly. Why the gymnastics to avoid a vaccination mandate?

Given that other countries already factor it into passes, two health systems in the US have now granted exemptions for it, etc. I am sure there are ways to verify prior infection and antibody levels that are satisfactory.

For that matter, we are not requiring demonstration of immune response from vaccination either, and we know not everyone produces a sufficient response.

The reluctance is because of additional risks, even beyond that of the usual risk of the vaccine per some studies, with much smaller benefits.

tall73 · Sep 21, 2021

cow451 said:
Odd that people that oppose the mandate are fine with having the antibodies that the disease produces but not the vaccine that does the same thing better.

Another aspect on the "same thing better" angle, the insistence of "full vaccination" also misses the point that in other countries they are often administering only one dose to people with prior infection. There may be drawbacks to two doses with those with prior infection.

Vaccinating people who have had covid-19: why doesn’t natural immunity count in the US?

Other studies suggest that a two dose regimen may be counterproductive.34 One found that in people with past infections, the first dose boosted T cells and antibodies but that the second dose seemed to indicate an “exhaustion,” and in some cases even a deletion, of T cells.34 “I’m not here to say that it’s harmful,” says Bertoletti, who coauthored the study, “but at the moment all the data are telling us that it doesn’t make any sense to give a second vaccination dose in the very short term to someone who was already infected. Their immune response is already very high.”

cow451 · Sep 21, 2021

tall73 said:
Given that other countries already factor it into passes, two health systems in the US have now granted exemptions for it, etc. I am sure there are ways to verify prior infection and antibody levels that are satisfactory.

For that matter, we are not requiring demonstration of immune response from vaccination either, and we know not everyone produces a sufficient response.

The reluctance is because of additional risks, even beyond that of the usual risk of the vaccine per some studies, with much smaller benefits.

If having the antibodies on board is not causing one any problems, the vaccine added will not, either. Neither the logic nor any significant data supports that at this point.

tall73 · Sep 21, 2021

cow451 said:
If having the antibodies on board is not causing one any problems, the vaccine added will not, either. Neither the logic nor any significant data supports that at this point.

Read my last post that calls that logic into question.

Also, posted earlier, but perhaps you missed it:

Vaccinating people who have had covid-19: why doesn’t natural immunity count in the US?

A large study in the UK and another that surveyed people internationally found that people with a history of SARS-CoV-2 infection experienced greater rates of side effects after vaccination. Among 2000 people who completed an online survey after vaccination, those with a history of covid-19 were 56% more likely to experience a severe side effect that required hospital care.

cow451 · Sep 21, 2021

tall73 said:
Another aspect on the "same thing better" angle, the insistence of "full vaccination" also misses the point that in other countries they are often administering only one dose to people with prior infection. There may be drawbacks to two doses with those with prior infection.
Vaccinating people who have had covid-19: why doesn’t natural immunity count in the US?
Other studies suggest that a two dose regimen may be counterproductive.34 One found that in people with past infections, the first dose boosted T cells and antibodies but that the second dose seemed to indicate an “exhaustion,” and in some cases even a deletion, of T cells.34 “I’m not here to say that it’s harmful,” says Bertoletti, who coauthored the study, “but at the moment all the data are telling us that it doesn’t make any sense to give a second vaccination dose in the very short term to someone who was already infected. Their immune response is already very high.”

From your link:
Former CDC director Tom Frieden, a proponent of universal vaccination, echoes that uncertainty: “We don’t know that antibody level is what determines protection.”

Dr. Frieden is one of the experts I keep track of for relevant information. As of today, he has not shifted his position. When and if the data is sufficient to convince him, let me know.

You could be correct that about future approaches. But what are we to do in in the interim ? Get vaccinated. The preponderance of the evidence goes with vaccination, IMHO.

tall73 · Sep 21, 2021

cow451 said:
From your link:
Former CDC director Tom Frieden, a proponent of universal vaccination, echoes that uncertainty: “We don’t know that antibody level is what determines protection.”

Dr. Frieden is one of the experts I keep track of for relevant information. As of today, he has not shifted his position. When and if the data is sufficient to convince him, let me know.

You could be correct that about future approaches. But what are we to do in in the interim ? Get vaccinated. The preponderance of the evidence goes with vaccination, IMHO.

Former CDC director Tom Frieden, a proponent of universal vaccination, echoes that uncertainty: “We don’t know that antibody level is what determines protection.”

Gandhi and others have been urging reporters away from antibodies as the defining metric of immunity. “It is accurate that your antibodies will go down” after natural infection, she says—that’s how the immune system works. If antibodies didn’t clear from our bloodstream after we recover from a respiratory infection, “our blood would be thick as molasses.”

Agreed, we don't know that antibody level demonstrates protection. But that is partly because levels start high with an acute response, and then level off to a lower, but usually consistent level as one of the reports in the OP noted. So a particular level of antibodies does not guarantee immunity. And there are more than just antibodies at play in regards to protection.

However, the CDC hasn't said much on the studies showing real world populations that did have protective effects. Nor have I seen them address the studies that suggest higher risks, or some negative impacts to two doses for those with prior infection.

It seems more like messaging to make sure they don't impact those who have not been infected getting the vaccine then following the studies. Other countries are looking at these factors.

When Fauci was asked about the study out of Israel showing greater protection for natural immunity he said he doesn't have a firm answer yet and they need to discuss it. He also wondered what the durability was and said the study didn't address that. Well, the study did somewhat address that as they found it more durable.

Now when you say we don't know what the future holds so we should get the vaccine now, that doesn't make sense. They admitted when they recommended vaccination for those who had prior infection they didn't have much data on it.

Now we are getting data that there are higher risks of adverse events, that prior infection even without vaccination is rather protective, and that two doses may be counter-productive. They need to reassess. And Fauci stated they hadn't done that yet.

If there is data that natural infection is protective they should prioritize the doses for countries that have no doses, etc. so that they can try to get the pandemic under control, which involves more than just the US.

cow451 · Sep 21, 2021

tall73 said:
Former CDC director Tom Frieden, a proponent of universal vaccination, echoes that uncertainty: “We don’t know that antibody level is what determines protection.”

Gandhi and others have been urging reporters away from antibodies as the defining metric of immunity. “It is accurate that your antibodies will go down” after natural infection, she says—that’s how the immune system works. If antibodies didn’t clear from our bloodstream after we recover from a respiratory infection, “our blood would be thick as molasses.”

Agreed, we don't know that antibody level demonstrates protection. But that is partly because levels start high with an acute response, and then level off to a lower, but usually consistent level as one of the reports in the OP noted. So a particular level of antibodies does not guarantee immunity. And there are more than just antibodies at play in regards to protection.

However, the CDC hasn't said much on the studies showing real world populations that did have protective effects. Nor have I seen them address the studies that suggest higher risks, or some negative impacts to two doses for those with prior infection.

It seems more like messaging to make sure they don't impact those who have not been infected getting the vaccine then following the studies. Other countries are looking at these factors.

When Fauci was asked about the study out of Israel showing greater protection for natural immunity he said he doesn't have a firm answer yet and they need to discuss it. He also wondered what the durability was and said the study didn't address that. Well, the study did somewhat address that as they found it more durable.

Now when you say we don't know what the future holds so we should get the vaccine now, that doesn't make sense. They admitted when they recommended vaccination for those who had prior infection they didn't have much data on it.

Now we are getting data that there are higher risks of adverse events, that prior infection even without vaccination is rather protective, and that two doses may be counter-productive. They need to reassess. And Fauci stated they hadn't done that yet.

If there is data that natural infection is protective they should prioritize the doses for countries that have no doses, etc. so that they can try to get the pandemic under control, which involves more than just the US.

Where is the data? It isn't there yet. So, today, we go with what is there today.

And where is the data that people will give up their blood for antibody testing? I see no evidence that Americans of the "I don't want to" anti vaxx stance will be any more inclined to go along with this as a mandate, either.

And any immunity, from illness or vaccine, will eventually wane. Then what?

tall73 · Sep 21, 2021

cow451 said:
Where is the data? It isn't there yet. So, today, we go with what is there today.

How could he say they have to discuss the study if it was not there yet?

Moreover, the studies regarding adverse events, etc. are out there as well. And they were referenced in that article.

And where is the data that people will give up their blood for antibody testing? I see no evidence that Americans of the "I don't want to" anti vaxx stance will be any more inclined to go along with this as a mandate, either.

It would be an exemption to the current mandates, as we see with two health systems already. It would not be a mandate on its own.

But yes, I think some would prefer a stick in the finger to a vaccine, as the latter has more demonstrable risk. And since some have already sued for the right to do so, such as the military cases referenced earlier, the successful suit by the university professor cited earlier, etc. apparently some want to do that.

And any immunity, from illness or vaccine, will eventually wane. Then what?

Yes, but some wane quickly and some after decades. So far indications are that this could last quite a while.

Down the road we may know more and realize the need for more vaccination. And by then we may even have vaccines that target more than one protein so that we get better protection against variants. But in the meantime if there is evidence that those with natural immunity are showing equivalent or better protection than vaccines, they shouldn't have to submit to potentially greater risks than those who are naive to the virus, for very small benefits.

Those extra doses could go to places where people don't have access to even one dose.

If breakthrough cases and reinfections continue (even rarely in those both vaccinated and infected), then we are likely to all continue to be exposed in any case. The hope is that the prior exposures will give some protection, or that the disease may eventually moderate.

Subduction Zone · Sep 21, 2021

TLK Valentine said:
Just FYI, I've had Covid twice. Antibodies only accomplish so much.

I had it once, and then got vaxxed. My infection was before the vaccines. When my housemates son came down with it he was visiting her. She seemed to have gotten it too. She was not confirmed, but was ill. Me? I was fine. Though I did mask up whenever I left the house to do what had to be done.

Vaccines are not perfect either. And the good news if one is vaccinated and does get it that one is much much safer than if one did not get the vaccine. It not only prevents many from getting the disease, those that do are far less likely to die.

TLK Valentine · Sep 21, 2021

Subduction Zone said:
I had it once, and then got vaxxed. My infection was before the vaccines. When my housemates son came down with it he was visiting her. She seemed to have gotten it too. She was not confirmed, but was ill. Me? I was fine. Though I did mask up whenever I left the house to do what had to be done.

Vaccines are not perfect either. And the good news if one is vaccinated and does get it that one is much much safer than if one did not get the vaccine. It not only prevents many from getting the disease, those that do are far less likely to die.

Tell me about it: I got COVID, got vaxxed, and then got COVID again (much milder the second time)

I've got no luck at all.

cow451 · Sep 21, 2021

tall73 said:
How could he say they have to discuss the study if it was not there yet?
Moreover, the studies regarding adverse events, etc. are out there as well. And they were referenced in that article.
It would be an exemption to the current mandates, as we see with two health systems already. It would not be a mandate on its own.
But yes, I think some would prefer a stick in the finger to a vaccine, as the latter has more demonstrable risk. And since some have already sued for the right to do so, such as the military cases referenced earlier, the successful suit by the university professor cited earlier, etc. apparently some want to do that.
Yes, but some wane quickly and some after decades. So far indications are that this could last quite a while.
Down the road we may know more and realize the need for more vaccination. And by then we may even have vaccines that target more than one protein so that we get better protection against variants. But in the meantime if there is evidence that those with natural immunity are showing equivalent or better protection than vaccines, they shouldn't have to submit to potentially greater risks than those who are naive to the virus, for very small benefits.
Those extra doses could go to places where people don't have access to even one dose.
If breakthrough cases and reinfections continue (even rarely in those both vaccinated and infected), then we are likely to all continue to be exposed in any case. The hope is that the prior exposures will give some protection, or that the disease may eventually moderate.

Lots of "coulds".

How frequently do the non-vaccinated need to show "immunity"?
When does all the extra labwork become cost prohibitive to essentially achieve what will be achieved with two vaccinations annually? Even if most of your projections pan out, is it really effective to do all the testing and monitoring in order for the "I don't want to" proponents to buy into public health safety efforts?

cow451 · Sep 21, 2021

TLK Valentine said:
Tell me about it: I got COVID, got vaxxed, and then got COVID again (much milder the second time)

I've got no luck at all.

Now that you have superior immunity, you may skip vaccinations and join the bullet-proof club. Oh, wait..... your system doesn't retain immunity as well as most ..... sucks for you. Maybe you just need a third episode of COVID. :swoon:

tall73 · Sep 21, 2021

cow451 said:
Lots of "coulds".

Yes, because all aspects of the virus are still being studied, including how long protection lasts from vaccines, etc.

How frequently do the non-vaccinated need to show "immunity"?

How often do the vaccinated? We don't know if any particular vaccinated person has had a proper immune response.

So far studies show longer protection from natural immunity.

When does all the extra labwork become cost prohibitive to essentially achieve what will be achieved with two vaccinations annually?

The timing of boosters, etc. is still an open debate for vaccination as well. In the same way they need to continue monitoring the usual duration of natural immunity.

As to cost-prohibitive, they can simply require the employee to provide the data in lieu of a vaccination record. Since it is an exemption they can allow the employee to demonstrate the results.

They have antibody tests in my area for 15 bucks that get results rather quickly. And employee could do that every few months if need be and submit the results.

Even if most of your projections pan out, is it really effective to do all the testing and monitoring in order for the "I don't want to" proponents to buy into public health safety efforts?

Not wanting to take on elevated risks for very minimal benefit is not just "I don't want to."

tall73 · Sep 21, 2021

cow451 said:
Now that you have superior immunity, you may skip vaccinations and join the bullet-proof club. Oh, wait..... your system doesn't retain immunity as well as most ..... sucks for you. Maybe you just need a third episode of COVID.

Sounds like it all worked fine, as he had a mild case the second time.

cow451 · Sep 21, 2021

tall73 said:
Y We don't know if any particular vaccinated person has had a proper immune response.

How do we know the "naturally" immune have a "proper response"

So far studies show longer protection from natural immunity.

Like this one?
The data is clear: Natural immunity is not better. The COVID-19 vaccines create more effective and longer-lasting immunity than natural immunity from infection.

and, of course, the Israel study ....

The researchers also found that people who had SARS-CoV-2 previously and received one dose of the Pfizer-BioNTech messenger RNA (mRNA) vaccine were more highly protected against reinfection than those who once had the virus and were still unvaccinated.

As to cost-prohibitive, they can simply require the employee to provide the data in lieu of a vaccination record. Since it is an exemption they can allow the employee to demonstrate the results.
They have antibody tests in my area for 15 bucks that get results rather quickly. And employee could do that every few months if need be and submit the results.

The people I know are not interested in having to pay anything because they have been getting it free so far.
And they are still predominately in the "I don't want to" category.

cow451 · Sep 21, 2021

tall73 said:
Sounds like it all worked fine, as he had a mild case the second time.

I'm sure the poster would gladly have a third round, given how safe and effective getting COVID will be.

tall73 · Sep 21, 2021

cow451 said:
How do we know the "naturally" immune have a "proper response"

And of course, that was the point. We don't know if either had an immune response if we don't test for it. But you are only looking at one side of the question.

Like this one?
The data is clear: Natural immunity is not better. The COVID-19 vaccines create more effective and longer-lasting immunity than natural immunity from infection.

That is not a study but a commentary on several studies. You will have to point out which ones you think make your point.

In one study they found in some mild cases there was not an antibody response. They did note this tended to be among younger people. It is unclear why you think this would rule out antibody tests as they would not test positive for antibodies.

In another they found antibodies fade over time after infection. That is expected as you go from acute to memory response. They note it doesn't necessarily mean there is no immune benefit:

Decline in SARS-CoV-2 Antibodies After Mild Infection Among...

Whether decline in SARS-CoV-2 antibodies increases risk for reinfection and disease in humans remains unknown. Humoral immunity to primary infections from a novel virus might not be as durable or strong as that to secondary infections, but memory B-cell and T-cell responses might reduce the severity of illness with repeat exposure or infection.

The article also notes that no country has managed to control the outbreak with natural immunity. True, but none has been able to control it even with high vaccination rates and boosters, such as Israel. However, we are seeing less deaths due to reduced severity both from prior infection and from vaccination.

The study indicating 2.34 greater protection for those who receive vaccination after prior infection, is granted, but look at the risk to begin with. The risk for those with prior infection is low, whether or not they get the vaccination afterwards. So if the chance is minute to begin with, then reducing it to an even better minute chance is great. But it may not be worth the additional risks. Reinfection certainly happens, but is rare. And the Israel study found even with Delta it was more rare than breakthrough cases with vaccination.

and, of course, the Israel study ....

The researchers also found that people who had SARS-CoV-2 previously and received one dose of the Pfizer-BioNTech messenger RNA (mRNA) vaccine were more highly protected against reinfection than those who once had the virus and were still unvaccinated.

Agreed, and noted earlier in the thread. But the protection even without the dose was greater than those who were only vaccinated. I don't think it is good to fire people who don't want to take on additional risk for a small additional benefit, when their protection already exceeds that of the vaccinated.

And also note they gave one dose. But the requirement here is for two.

The people I know are not interested in having to pay anything because they have been getting it free so far.
And they are still predominately in the "I don't want to" category.

I can't account for your acquaintances. But I posted cases of those willing to take on the expense of being tested.

EDIT: I went back and added response to more of the studies in your article.

Prior infection and vaccine mandates

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