With COVID-19 variants lurking, we must prepare for the worst

Should those who have had a proven coronavirus infection also be vaccinated? The Centers for Disease Control and Prevention and World Health Organization say yes; others are not so sure. But the real question we must decide as a society is: Are we going to prepare for a potential infection from immune escape variants that are threatening our shores, or are we going to wait and see what happens, hoping for the best but not preparing for the worst? 

Similar to the flu, immunity to last year’s strain does not guarantee immunity to next year’s. Granted the reinfection may be lessened but unlike the flu, even a mild to moderate COVID-19 infection is of concern since this virus can have lasting effects on almost every organ of the body.   

Exact guidance is inhibited by the fact that no one knows what level of immunity will provide substantial protection for an infection, and even mild to moderate infection of this virus can pose significant harm. Just ask someone who has long-COVID. These concerns were probably a factor in requiring all 2021 Olympic athletes to sign a COVID-19 waiver along with undergoing daily testing and maintaining physical distancing. Athletes of all ages are wary of post COVID-19 myocarditis. Concerns regarding this virus are not a United States’ political conspiracy theory, they are worldwide and found among all nations. 

We do not have an available booster for the next variant. One of the problems is that there are several different ones and unlike the flu, last year’s virus did not go away. Comparing the length of protection an infection with SARS or MERS affords is not applicable to COVID-19 with the immune escape variants. The evolutionary success of mutations is dependent upon increasing transmissibility or allowing the virus to escape immunity. SARS-CoV-2 (the virus which causes COVID-19) is doing both.

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The plan is to boost your immunity to the wild type (original) virus to a much higher level. If you had COVID-19 with the wild type virus, this means also receiving the vaccine. There is currently ongoing research to see if one shot will suffice.

The answer to if natural versus vaccine immunity is better depends upon how one frames the question, and the level of required immune protection is not truly known. What is known is that mRNA vaccines are highly safe and elicit a large, highly specific response of viral killing antibodies. But their big advantage is mRNA vaccine safety, allowing them to be given twice. One can argue whether natural immunity or a single mRNA dosage is best at hitting the target, but if one has two chances, your odds are much better. 

The need for augmented immunity has been supported by both laboratory and field studies. Rafael Assis, et al., from UC Irvine, demonstrated that individuals who have received two doses of a mRNA vaccine will “rapidly induce a much stronger and broader Ab response than SARS-CoV-2 infection”. Field observations have also found two doses of the mRNA vaccine offer protection against the South African and even the Indian variant. 

Field observation studies raise real concerns regarding reinfections caused by these variants in those who have had their original infection by the wild type virus. During a March 18, 2021, Senate hearing, Dr. Anthony Fauci stated: “In the South African study conducted by Johnson & Johnson, they found that (unvaccinated) people who were infected with wild type were exposed to the variant in South Africa, the 351. It was as if they had never been infected before. They had no protection.”

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This observation is supported by the events which unfolded in Manaus, Brazil. In May of 2020, researchers reported in Science that the city reached herd immunity with 76% of its population being immune. But over the winter holidays, the city was crushed again by an even larger wave caused by the P.1 immune escape variant. One of the concerns was reinfections, Herd immunity apparently did not take place after the initial surge.

Concerns were heightened when a recent study of blood donors from Manaus reported to have found that 1 in 6 of those infected with the coronavirus were reinfected with the P.1 variant, suggesting reinfections are all too common.

Travel bans are being used by various countries to slow down the spread of variants into their nation and then use this time for preparation. In the case of the United States, we could use this time to expand genomic testing of immune escape variants to early on detect community spread, and for all to receive vaccines to the wild type virus to boost their immunity to a level which will prevent disease, hopefully even mild to moderate disease, by the immune escape variants. We have the knowledge to avoid another devastation by this virus.  Simply become vaccinated.     

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA. 

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