And then the question is, should you as a vaccinated healthy person mind getting infected in the sense that it can shield you maybe even more from future variants or is this a dangerous game to play?

It's probably still worth trying to reduce the amount of virus in circulation, even if individual risk is low. There's someone in another thread talking about being on immunosuppressants, for example.

I don't think it's a binary condition either, we can do things that are more effective and less costly (like cutting down on large, indoor, adult social gatherings) and not do things that are less effective.

I think it's all about timing. Right now in Oregon our hospitals are full. So the less people getting infected right now the better.

If I remember correctly, the number of vaccinated people who get infected and require hospitalization is quite low.

You remember correctly:

More than 99% of recent deaths were among the unvaccinated, infectious disease expert Dr. Anthony Fauci said earlier this month on NBC's Meet the Press, while Walensky noted on Friday that unvaccinated people accounted for over 97% of hospitalizations.

https://www.npr.org/2021/07/16/1017002907/u-s-covid-deaths-a...

As of April 2021, the CDC "unvaccinated" definition includes people who are thirteen days after their second vaccine, https://www.cms.gov/files/document/qso-20-38-nh.pdf

> Fully vaccinated” refers to a person who is ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine. “Unvaccinated” refers to a person who does not fit the definition of “fully vaccinated,” including people whose vaccination status is not known

That is wild. The situation in UK is nowhere near '99% unvaccinated suffer terrible outcome'.

On 20th August, Public Health England published a report that is quite a bit more balanced. From Table 5, pp 22-23, Delta cases:

    overnight inpatient admissions (inclusion#)

    all ages
    unknown                      99
    <21 days post dose 1        260
    ≥21 days post dose 1        689
    ≥14 days post dose 2      2,204
    unvaccinated              4,033

    <50 age group
    ...
    ≥14 days post dose 2        366
    unvaccinated              3,044


    deaths within 28 days of positive specimen date

    all ages
    unknown                      16
    <21 days post dose 1         14
    ≥21 days post dose 1          5
    ≥14 days post dose 2        679
    unvaccinated                390

    <50 age group
    ...
    ≥14 days post dose 2         27
    unvaccinated                 72

For all adults percent fully vaccinated is 75%, whereas for <50, percent one dose vaccinated is somewhere between 60-75%

https://assets.publishing.service.gov.uk/government/uploads/...

https://www.bbc.com/news/health-55274833

This may be explained by Simpson's Paradox. Something similar happened in Israel, if you look at the raw case numbers for the current wave, it looks like the vaccine only has a ~67% efficiency:

https://www.covid-datascience.com/post/israeli-data-how-can-...

The UK and Israel both have very high vaccination rates of older people, and lower fully vaccinated rates of younger people. Someone who is 75 most likely has a much weaker immune system than someone who is 25, to the point where someone who is 75 and fully vaccinated may have a much harder time fighting the virus than someone who is 25 and unvaccinated.

The data from Israel if broken down by under and over 50s, shows the vaccine efficiency is 92% for under 50s and 85% for over 50s. Israel mainly used Pfizer though, where as the UK mainly AstraZeneca, so there could also be differences there.

Of course Simpson's is heavily at play, of course especially when lumping <25s with >75s. Not sure I see how one can get from the (UK) data to statements like 'more than 99% of recent deaths were among the unvaccinated', which seems off by at least an order of magnitude.

The number of people possibly infected by a vaccinated person as an asymptomatic or mild symptomatic carrier and who may require hospitalization is still ambiguous. I will continue to err on the side of caution, tho I have little worry for myself personally.

That's what I've been proposing for a few months. Get the vaccine and then get the delta variant a few weeks later to crush it and then be super immune for future variants that jet off of that one.

Do you have evidence that this is the best course of action?

Well the obvious problems with it is that it's hard to tell you've been infected and you need to quarantine for the entire duration until you are sure you've been infected and have recovered.

Apart from that, if the protection from a vaccine is temporary then there's no reason to believe your immune system will learn anything from an infection it can already handle. That part of the immune response takes a while and may never succeed if the virus is long gone before then.

Who knows if you getbDelta while vaccinated and you crush it shortly afternentry if your immune system makes any changes or not.. this requires an immunologist to answer.

The whole point of my strategy would be that perhaps Delta is a precursor to a, let's say, Zeta variant that has almost complete evasion to the vaccine. Let's say in January or something.

So what you're doing is giving your body a high chance to crush the Delta and gain some cross-immunity towards the future evasive variant.

Whereas if you just relied on the vaccine, it might not even work well in January.

Obviously this is just conjecture, but I think a real possibility.

The vaccine is highly effective at preventing severe disease requiring hospitalization, but nothing is 100% (after 6 months, Pfizer is 97% effective at preventing severe disease) -- I'm not going to deliberately expose myself to something that could put me in a hospital.

And no point, really. If I'm going to force myself to have the disease to build up immunity, why not just wait until I'm accidentally exposed (which may not happen)?

The whole point of my strategy would be that perhaps Delta is a precursor to a, let's say, Zeta variant that has almost complete evasion to the vaccine.

Let's say in January or something.

So what you're doing is giving your body a high chance to crush the Delta and gain some cross-immunity towards the future evasive variant.

Whereas if you just relied on the vaccine, it might not even work well in January.

Obviously this is just conjecture, but I think a real possibility.

Unless, of course, Zeta has almost complete evasion to natural immunity too. Then you've intentionally exposed yourself to Delta for no reason.

I'll stick with my strategy of getting the vaccination (including a booster when eligible), and taking reasonable precautions against exposure.

If it comes from the lineage of the prevalent strain... there's no way that it would not have cross-immunity after 6 months.

It seems like the article is saying that vaccine immunity is actually more robust that natural immunity though.

Good point, edited to clarify.

Beyond just this study, which doesn't give the whole picture of immunity, I think there is conflicting evidence. Given that vaccine effectiveness seems to be going down in Israel, I think there are legitimate concerns about the robustness of vaccine-based immunity - but the question is always "relative to what?". If it ultimately sets you up similar to or better than natural immunity from an infection (which also wanes, as we get, e.g., colds over and over throughout our lives), that's the best you can hope for.

For spike proteins. Not for the other targets you get with natural immunity.

> For spike proteins. Not for the other targets you get with natural immunity

From the article: "the new evidence shows that protective antibodies generated in response to an mRNA vaccine will target a broader range of SARS-CoV-2 variants carrying 'single letter' changes in a key portion of their spike protein compared to antibodies acquired from an infection." The study discussed in the article unequivocally states that vaccine-induced immunity is more robust than that from infection.

> unequivocally states that vaccine-induced immunity is more robust than that from infection.

It absolutely does not make such a strong claim - a more accurate takeaway is that vaccination using the current mRNA based formulations induces an immune response highly targeted toward the S protein RBD. This has not been conclusively proven to provide better or worse protection than immunity acquired through natural infection.

> At first glance, the RBD targeting of the vaccine sera neutralization might seem likely to increase susceptibility to viral mutations, but the rest of our results SUGGEST that this MAY not be the case.

> We found that the specificity of the mRNA-1273 vaccine-induced RBD-binding antibody response often narrows over time. In contrast, the infection-elicited RBD-binding antibody response often broadens over time

> The vaccinated individuals in our study were relatively young (18–55 years) and healthy, whereas the convalescent individuals were older (23–76 years, median 56) with a range of comorbidities (13).

> Additionally, we did not examine effects of mutations or deletions to the N-terminal domain of the spike protein, which can also affect neutralization by vaccine sera (7).

> Our experiments assayed binding of antibodies to isolated RBD expressed by yeast, and so cannot capture mutational effects on trimer conformation or antibodies with quaternary epitopes

> Evidence from multiple experimental studies showing that single RBD point mutations can lead to resistance to neutralizing convalescent plasma from multiple donors suggests that specific single mutants may be able to evade spike-targeting vaccinal immunity in many individuals and rapidly lead to spread of vaccine-resistant SARS-CoV-2. [1]

[1] Risk of rapid evolutionary escape from biomedical interventions targeting SARS-CoV-2 spike protein https://pubmed.ncbi.nlm.nih.gov/33909660/

The quote you're highlighting is specifically referring to 'single letter' variants of the spike protein. Immunity from infection gives a wider variety of protections beyond just the narrow targeting of the spike protein.

The RDB portion of the spike protein is the part that allows the virus to latch onto your cells. We therefore expect strong limitations on how much this portion of the virus can change while still remaining infectious.

If that's the case, then they should retract and work towards understanding why their methodology failed so miserably.

The data from Israel shows an order of magnitude better immunity from prior infection than the vaccine.

Individuals with a combination of history of COVID and vaccination appear to have exceptionally strong protective immunity that has been described as "bulletproof." As published in Nature [1] and analyzed by JAMA [2], individuals who had been infected (even those with mild disease) and vaccinated had over 50 times more neutralizing antibody activity than those who were unvaccinated. This level of protection was more robust even than that seen in fully vaccinated individuals.

[1] https://www.nature.com/articles/s41586-021-03696-9 [2] https://jamanetwork.com/journals/jama/fullarticle/2782139

It would be interesting to know the order of events in the population studied (vaccination first or infection first?) and whether it seems to matter for the ultimate level of immunity achieved.

Here's a pragmatic question - do we need large amounts of people who have natural (non-vaccine) antibodies to donate their blood? To put it more crudely, is there a way that everyone at large can benefit from their (unfortunate) suffering?

I know someone who has been donating for exactly this purpose (he's a bar owner, and apparently was told by his doctors that he had an extraordinarily high antibody count). Unfortunately, the results from all of these kinds of treatments thus far has been less than hoped for.