Are the unvaccinated at higher risk from BA.4 and BA.5?

You may have seen this and found yourself wondering if this is correct, whether the unvaccinated are at increased risk from BA.4 and BA.5, as neutralizing antibodies were found to be much higher in the vaccinated:

To answer that question, you first need to understand what they’re even looking at. At 23 days after a recent BA.1 infection, these South African scientists took blood samples from vaccinated and unvaccinated patients and looked at the ability of their antibodies to prevent infection of cells by the virus. What they found was that the antibodies of the vaccinated had about five times more neutralizing capacity.

What people seem to be missing however, is that this just doesn’t tell us anything very useful. To start with, they look at an unusual sample: Young adults, most of whom were hospitalized with a BA.1 infection. BA.1 infections are known to be very mild in young adults, as evidenced by the rarity of hospitalization from this variant. I don’t see how we can trust that these people, who were hospitalized with BA.1, are representative of the general population.

More important however to understand, is that it’s correct to say that immunity in the vaccinated can be largely boiled down to protection from neutralizing antibodies in blood. On the other hand, in the unvaccinated immunity against SARS-COV-2 looks very different.

In the unvaccinated a SARS-COV-2 infection induces an immune response in the location where the body encounters the virus: The mucous membranes of the upper respiratory tract. At the start of the pandemic, we saw cases of people who had no detectable antibodies in blood, but did have detectable antibodies in their tears or nasal secretions. If your body stops the virus before it ever enters your blood, you can have protection in your mucous membranes, without having protection in your blood.

Protection in the unvaccinated also involves different kinds of antibodies. As an example, a natural infection in an unvaccinated person generally leads to the development of antibodies against the nucleocapsid protein. These antibodies generally won’t prevent infection of a cell, but they do something else that helps your body deal with this virus: They help kill the infected cell, either directly, or indirectly by drawing other immune cells to the infected cell. Nucleocapsid antibodies are important to prevent replication of SARS-COV-2 in the brain. Unfortunately, the vaccine prohibits the development of nucleocapsid antibodies.

In the unvaccinated, immunity against SARS-COV-2 mainly takes the form of trained innate immunity. The Natural Killer cells are fast replicating white blood cells with a short lifespan, that kill SARS-COV-2 infected cells and massively replicate themselves when they are stimulated by encountering cells that are aberrant (either due to cancer, infection with a virus or other issues).

If we define immunity as “neutralizing antibodies in blood against the SARS-COV-2 Spike protein” then the vaccinated will almost always seem to be better protected than the unvaccinated. Of course this is not how the immune system in most people deals with rapidly mutating respiratory viruses of this nature. That’s why the reality on the ground never seems to reflect the optimistic discoveries from these studies, which would suggest the unvaccinated must by now be crippled or dead from constant reinfections.

To illustrate this point, look at the infection wave in 31% fully vaccinated South Africa:

And compare it to the wave seen in Portugal, where BA.4 and BA.5 first grew dominant after spreading from South Africa:

In South Africa the BA.4/5 wave is about half the BA.1 wave, with 7000 daily infections now in a population of 60 million people. On the other hand, Portugal, with a population of 10 million, is seeing 58,000 infections daily now over the past 7 days, with a BA.5 wave that is already starting to exceed their massive BA.1 wave. Keep in mind that Portugal is experiencing this wave in summer, completely different from last year, whereas South Africa is right now experiencing their winter.

When your observations in the lab seem to have no real resemblance to our observations in the real world, you should be asking yourself whether you’re really looking at the right thing in your lab, or whether you’re merely trying to confirm your own preconceived notions.

The question to ask ourselves, is what’s going to happen now. Is this the next chapter in the widely prophesied ADE/OAS apocalypse you have heard so much about by now? There is no good reason to believe that. The direction this pandemic is evolving is still towards an increasingly mild disease course, both for the fully vaccinated and the unvaccinated. Take a look at this graph:

If some unfortunate mutation happened now to BA.4 or BA.5 that suddenly led to a variant ten times as deadly as BA.2, it still would have a fraction of the infection fatality ratio that we saw during last winter. If anything, the current situation in Portugal serves as evidence against the OAS/ADE horror scenario: If we can see this widespread outbreak of infections in Portugal, without overburdened hospitals and people dying in the streets, then under what circumstances would we see a real crisis?

And you might say that these repeated infections are now going to decimate the fully vaccinated, but I would leave that hypothetical concern to the they/them Phd #diversityinpublichealth wokies who try to climb the academic hierarchy by inventing hypothetical horror scenarios that never seem to come to fruition, the Anthony Leonardi’s and Eric-Feigl Ding’s of this world, who are increasingly isolated and perceived as cranks even within their own academic community.

Leonardi’s main remaining allies in his increasingly desperate struggle to conjure a global catastrophe into existence are a Chinese nutritionist and a Canadian jeweler who recently deleted his account. Of course it’s theoretically possible that some sort of horror still strikes, but it would be very much against the trend.

Leonardi and the rest of the zero COVID wokies repeatedly rage against the “novelty is severity” idea, but so far this argument really seem to be holding up better than the “every successive infection is going to further kill off your T-cells and leave you vulnerable to more severe reinfections” idea proposed by Leonardi.

The evidence overwhelmingly points towards the boring and most intuitive theory proposed by Zeynep: Novelty is severity. With every new infection, your body has had to learn some new tricks, that will still work against the new infection. In addition, as this virus evolves in a direction to avoid going extinct, it has to learn to spread in a manner that does not anger the immune system. One way to do that of course is to cause so few issues in your host that your host doesn’t even bother developing an aggressive immune response against you

If there is some validity to the “reinfections are more severe” argument, you would expect to see the evidence of that emerge right around now in South Africa and Portugal, where people should now be getting reinfected in droves. So far, I’m not seeing anything.

The problem with Leonardi and the people who believe in his cult, is that they don’t look critically at the evidence they use to back up their apocalypse fantasies.

Here is the study in question.

But here’s the juice:

We identified 308,051 initial cases of SARS-CoV-2 infection diagnosed in VHA between March 2020 and
January 2022; 58,456 (19.0%) were associated with VHA hospitalizations. A second PCR-positive test
occurred in 9,203 patients in VA at least 90-days after their first positive test in VHA; 1,562 (17.0%) were
associated with VHA hospitalizations. An additional 189 cases were identified as PCR-positive a third time at least 90-days after their second PCR-positive infection in VHA; 49 (25.9%) were associated with VHA

Out of the 308,051 people infected, just 189 were infected a third time. The third infection has a higher hospitalization risk, but that’s pretty easy to explain: Healthy people don’t get the third infection to begin with, if you’re one of just 189 out of 300,000 people who get infected three times in such a short period, then you have an underlying immune problem and so of course the third infection has a higher hospitalization risk. You don’t need a Phd in T-cell immunology to figure that one out.

If this is the sort of terrible low quality evidence you need to rely on, to support your theory that reinfections are going to be more severe, then it serves as evidence against your theory, rather than as evidence in favor of it.

I would recommend everyone to look critically at what happens over the next few days in Portugal and South Africa. If the Messiah you were promised still does not arrive, then it’s really time to question whether your cult leader is sincere in his warnings or just eager to keep his cult of personality going.

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