Will the government let the vaccine make any difference at all?

[Furtwangler]

Sorry for long post. It's great news that a Covid vaccine is in the pipeline, but aren’t we forgetting that there already exists a potent means of providing immunity against the disease - catching the disease itself? The government was, rightly, quickly discouraged from its initial ‘herd immunity’ plan, with ‘immunity certificates’ for survivors, but when they changed tack, they went to the opposite extreme and declared that those of us who'd had it were to be treated no differently from those who hadn't.

Consider this: if the Pfizer vaccine were to be given to health & social care workers tomorrow, we’d have 3 million people, 90% of whom would be protected against Covid for an unknown time period - and we don’t yet know if they wouldn’t transmit the disease, only that they wouldn’t suffer the symptoms - and 10% who wouldn't.

But we already have in the UK at least 6.5 million survivors of Covid-19 who, judging by the tiny numbers proven to have contracted Covid twice, are a lot better than 90% protected, and who, once they’ve had it, don’t seem to be still able to transmit the disease: how would the huge dip in Covid infection rates over the summer have been achieved if there'd been 6.5 million active infectors?

I look at it this way: if I were running a care home, I would be very interested indeed in which of my staff had had Covid. In fact, I’d pay for them all to have blood tests, so that I could deploy those with positive antibody tests to look after my most vulnerable clients. I know having had Covid doesn't make a person zero risk; but government and workplace regulations make no risk distinction at all between those who have had Covid and those who haven’t. My staff would all still be urged to use the NHS Covid app, and self-isolate on being notified, regardless of whether they have had Covid or not, on the basis that ‘it’s not known if having antibodies stops you getting the virus again’. No wonder there are compliance issues with track & trace.

So the advent of a large, Pfizer-vaccinated group of people should, under current health advice, make no difference whatsoever. They would, as a group, be LESS protected than the naturally immunised. The government has to not only deliver the vaccine; it's got to change its tune on what the immunised are allowed to do, and admit that they have been mismanaging that risk.

@Missmidden Cheers! I was beginning to feel a bit beleaguered. I wonder, has there ever been a pandemic in which naturally-acquired immunity has been so deliberately talked down? The very idea is bizarre: our bodies have evolved, over millions of years, a staggeringly effective mechanism by which they fight not only known antigens but entirely new ones. But our government tells us this is not to be trusted, not to be measured. Wait for the vaccine.

In the meantime, we must impose a strict levelling-down policy, by which no-one is permitted to obtain any advantage not available to the uninfected. The already infected must behave exactly as if they weren't, for fear that some may try to deliberately catch the disease in order to 'step up' to the advantaged position of the infected. It beggars belief.

We seem to manage all the other inequalities of our society fairly well: do we prevent some people getting richer for fear that others may try to get richer by unauthorised or risky means? No, we have laws to deal with theft and fraud. The fact that burglars might fall from roofs does not lead to bans on the acquisition of wealth on the grounds that the NHS might be overwhelmed by bone fractures.

@Lemons1571

You’re not factoring people’s behaviour into the plan. It would cause chaos. You’d get millions of people not isolating or social distancing on the basis of “I definitely had it in March so I’m not worried, well, I never got a test as they weren’t available but my cousins friends sisters dog works for the nhs and tested positive so I DEFINITELY had it”.

I agree completely- human frailty will cause immeasurable damage.

@jasjas1973 Totally agree. I welcome the vaccines, it would be irrational not to. They offer a high degree of protection with an unmeasurable degree of risk. I'm annoyed that this country's top health officials have peddled an irrational policy on natural immunity, causing unnecessary economic harm and emotional distress.

As for the risks of people deliberately catching Covid to get the advantage of immunity, given how strongly the risk of death increases with age, anyone much over 45 (and/or suffering with underlying disease) would be mad to try. For healthy people under 45, the overall death rates are below about 5 in 100,000.

So, provided people are properly informed on the relative risks, I don't have a moral problem with deliberate self-infection. Having said that, I doubt many would try; most of us would need the prospect of a very significant benefit - such as being reunited with a loved one who was dying - before we could overcome the strong instinct for self-preservation, which doesn't really deal in numbers.

@Furtwangler

Sorry for long post. It's great news that a Covid vaccine is in the pipeline, but aren’t we forgetting that there already exists a potent means of providing immunity against the disease - catching the disease itself? The government was, rightly, quickly discouraged from its initial ‘herd immunity’ plan, with ‘immunity certificates’ for survivors, but when they changed tack, they went to the opposite extreme and declared that those of us who'd had it were to be treated no differently from those who hadn't.

Consider this: if the Pfizer vaccine were to be given to health & social care workers tomorrow, we’d have 3 million people, 90% of whom would be protected against Covid for an unknown time period - and we don’t yet know if they wouldn’t transmit the disease, only that they wouldn’t suffer the symptoms - and 10% who wouldn't.

But we already have in the UK at least 6.5 million survivors of Covid-19 who, judging by the tiny numbers proven to have contracted Covid twice, are a lot better than 90% protected, and who, once they’ve had it, don’t seem to be still able to transmit the disease: how would the huge dip in Covid infection rates over the summer have been achieved if there'd been 6.5 million active infectors?

I look at it this way: if I were running a care home, I would be very interested indeed in which of my staff had had Covid. In fact, I’d pay for them all to have blood tests, so that I could deploy those with positive antibody tests to look after my most vulnerable clients. I know having had Covid doesn't make a person zero risk; but government and workplace regulations make no risk distinction at all between those who have had Covid and those who haven’t. My staff would all still be urged to use the NHS Covid app, and self-isolate on being notified, regardless of whether they have had Covid or not, on the basis that ‘it’s not known if having antibodies stops you getting the virus again’. No wonder there are compliance issues with track & trace.

So the advent of a large, Pfizer-vaccinated group of people should, under current health advice, make no difference whatsoever. They would, as a group, be LESS protected than the naturally immunised. The government has to not only deliver the vaccine; it's got to change its tune on what the immunised are allowed to do, and admit that they have been mismanaging that risk.

Once you have immunised the vulnerable we can go ahead with your plan to allow the non- vulnerable to catch it. That is the only way to 'protect the vulnerable' and let the others get in with their lives.

If you have vaccinated the most vulnerable why does it matter if they might still be infectious? Surely they will be passing it on it to people who won't get too ill or to those who have been vaccinated The problem is you need to vaccinate as near as possible ALL of the vulnerable. This does of course assume that vaccination confers immunity that lasts a reasonable length of time

@ClaireP20 @Lemons1571 What a low opinion you have of your fellow human beings. When you say it would cause chaos, I assume by 'it' you mean either a policy of herd immunity or dividing society into two distinct tiers, neither of which I've advocated.

I do believe that the population should be getting tested for antibodies with at least as much vigour as the govt is proclaiming antigen tests the best weapon against Covid. If we could gauge and track a person's level of immunity on an ongoing basis, we could allow them to avoid self-isolation after coming into contact with someone potentially infectious, with all its damaging economic consequences, because the risk of transmission in those circumstances would be very low. We could also allow them closer contact with ageing relatives. We could deploy healthcare workers with naturally-acquired immunity to care for the most vulnerable. None of this has anything to do with the risks of transmission of the virus by purely mechanical means, i.e. by poor hand hygiene, which apply equally to everyone.

If that's dividing society into two tiers, well, how do we describe the divisions in society that result from inequalities in wealth, from racism and sexism? Chasms? Yawning abysses? It goes off the scale.

You'd get millions of people not isolating or social distancing on the basis of "I definitely had it in March so I'm not worried, well, I never got a test as they weren't available but my cousins friends sisters dog works for the NHS and tested positive so I DEFINITELY had it."

You're saying there could be a situation where people make sketchy, improbable claims for immunity and those claims are then in some way accepted or seen as sufficient reason to avoid isolation. Of course, some people could say that and behave like that, but they can do that right now. The situation I'm advocating wouldn't tempt anyone to behave in this way any more or less than they're already inclined to.

I want a system of widespread and repeated antibody testing, with limited but important concessions for those who can show they have effective levels of natural immunity. If people were as irresponsible and selfish as you think they are, it would hardly be the existence of my limited immunity 'passes' that would cause them to behave that way, would it? Because their wacky, selfish claims wouldn't get them a pass. Only getting tested would. So, sorry: there's no cause-and-effect link between my idea and their behaviour. Not guilty.

It's always 'other people' who are stupid, selfish and feckless, isn't it? Never you. No, no, you would never behave like that, but you're quite sure 'millions' of other people definitely would. Yes, there are some stupid and selfish people in society. And there are clever, caring people who, in their wisdom, look down on 'millions' and pronounce them stupid and selfish.

The reason there is doubt about naturally acquired immunity in this case is that the virus is a coronavirus. Other coronaviruses that cause illness in humans include viruses that cause the common cold and immunity doesn't last long in those cases. Scientists are studying how long natural immunity lasts but I think we are right to be cautious.

I'm sure they will also study how long vaccine derived immunity lasts.

It's a nice idea to have antibody testing but is it practical? The government can barely cope with what they're doing currently. I don't believe they could manage it.

There's a study that has just been published (yet to be peer-reviewed) that indicates longer-term immunity against SARS-COV-2 is probable. I came across this last night:

www.nytimes.com/2020/11/17/health/coronavirus-immunity.html?campaign_id=154&emc=edit_cb_20201117&instance_id=24206&nl=coronavirus-briefing&regi_id=137046435&segment_id=44752&te=1&user_id=a9973fe749f72c70b0bd403f474eb9b7

www.biorxiv.org/content/10.1101/2020.11.15.383323v1

I agree it's frustrating for people who likely have immunity now against this virus to not have this recognised, but there would have to be a lot more antibody testing done, and as a PP has said, the govt are having trouble providing enough antigen testing as it is. I think the logistics of trying to manage this would be beyond them, sadly.

You undermined your argument by stating that the drop in the summer was due to natural immunity, nothing to do with the membrane around the virus being less protective in sunlight. There is also the problem that the rapid increases now show that natural immunity is insufficient to prevent major problems for the NHS.

It would be possible to argue - with as much (in other words little) justification that the high levels now show the previously infected are being sloppy about the rules and transmitting the virus.

The truth is that we dont know if either or both the naturally immune or the vaccinated will still transmit the virus and restrictions therefore have to remain in place until beds used drop. They are still rising.

As for your argument about people not seeking to become infected - we've seen the reports of university covid parties. The young are foolish. Parents are already being forced to risk their childrens future (we dont know what the disease does long term) by sending them to schools where infection is rife. They might decide to risk their children even more with covid parties.

If you want to be treated differently you need studies showing that if infected you dont transmit the virus - feel free to volunteer for one.

I agree with you OP. There are tens of millions of people in the world who’ve had COVID and I’ve only read about a handful who’ve had it twice. I would think that’s as good or better than the vaccine trial of ~600 infected at 90% unvaccinated, when it comes to risk.

Perhaps the vaccine will be able to work on different strains of covid instead of just one? Not sure if there is enough difference between covid strains, for the immune response to need to distinguish them. Just speculating in case anyone wants to inform me!

Regarding anti-body testing, I thought this was not reliable after a couple of months, as the antibodies usually fade after 8 weeks or so? It would be good if there were a test for T cell memory or other immune mechanisms that would work longer term.

It's interesting too reading the thread on here about hospitals- a lot of posters are saying the main problem with bed capacity is the lack of staff who are in self isolation due to exposure (either them or their kids). It seems we may be in a bit of a circle - we have implemented these isolation rules to slow spread and protect hospital capacity but hospital capacity is then reduced because of these rules!!! I think medical staff at least shouldn't have to repeatedly isolate if they can show they have had antibodies at some point.

Furtwangler I looked up the SAGE article which finally acknowledges that immunity plays a role in pandemic dynamics:
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/935238/potential-trajectories-covid-190next-6-months-s0848-291020.pdf

I’ve just been trying to plug this argument on a schools thread (where a few noted that they were seeing less cases in local schools than a few weeks back- gosh, why might that be?!) but am met with a lot of heads in the sand......

@Kinsters I think you're right, the testing system is already stretched. But maybe that's because the govt has gone all-out for antigen testing and won't even talk about antibody testing except to say - wrongly - that it's not reliable, or repeat the mantra of 'people can get it twice.'

If we'd done more antibody testing, that would have helped take some of the load off antigen testing - there'd be little point testing people with natural immunity more often than, say, a cautious every three months. Most people I know who've had a swab test have had several, so we're testing the same people multiple times.

It would also reveal the true level of infection spread - and therefore natural immunity - in the country. Anecdotally, I believe there are significant numbers of people who've had it but don't know. My 3 DCs all tested positive for antibodies, and they had very few or no symptoms, and didn't believe they had it.

I think what I'm seeing and what the study linked to by @CrunchyCarrot is seeing is, evidence that the natural immune response is pretty effective. Of course it's going to fade. Of course the numbers getting Covid for the second time will increase at some point, at which point there may be a chorus of told-you-so but no matter, the opportunity to construct a rational response strategy will have been comprehensively missed because our politicians care far more about PR opportunities than anything else.

@alreadytaken
You undermined your argument by stating that the drop in the summer was due to natural immunity, nothing to do with the membrane around the virus being less protective in sunlight. There is also the problem that the rapid increases now show that natural immunity is insufficient to prevent major problems for the NHS.

Except, that wasn't my argument. I said:
we already have in the UK at least 6.5 million survivors of Covid-19 who, judging by the tiny numbers proven to have contracted Covid twice, are a lot better than 90% protected, and who, once they’ve had it, don’t seem to be still able to transmit the disease: how would the huge dip in Covid infection rates over the summer have been achieved if there'd been 6.5 million active infectors?

I wasn't saying the drop in the summer was DUE TO natural immunity; given that only around 10 percent possessed it, how could it be? I was suggesting that if natural immunity didn't prevent a person being able to (catch the disease a second time and) transmit the disease onwards to his or her lockdown companions, then surely that would have significantly spoiled the rather spectacular effectiveness of the lockdown. So - say I - the fact that the lockdown WAS clearly effective suggests that natural immunity wasn't spoiling it by allowing reinfection and transmission. I don't know that, of course, it's just an inference, I think a reasonable one.

You go on to say,
It would be possible to argue - with as much (in other words little) justification that the high levels now show the previously infected are being sloppy about the rules and transmitting the virus.

Well, yes. If you reject my inference and say that the lockdown's effectiveness could have been achieved despite 10 percent of people being potential second contractors and transmitters of Covid, then that could be true, because lockdown limited the number of people they could infect, while the relaxation of lockdown, the return to schools and workplaces, has allowed them to infect many more people.

Having said all that, the facts about the difference in vulnerability of viruses' membranes in warmer and colder weather seem entirely reasonable to me, so the consequences of possible second infections and transmissions might well be dwarfed by this factor.

Does natural immunity prevent transmission, or merely prevent disease? This researcher
www.theguardian.com/commentisfree/2020/aug/19/covid-19-immunity-natural-defences-eliminate-virus-data
believes we eliminate the virus after 2 weeks and there is 'no strong evidence for reinfection'.

Why do you say things like 'the young are foolish'? I know plenty of thoughtful, non-foolish young people; this is just perpetuating stereotypes. News cameras get pointed at youngsters having 'Covid parties' (and who called them that? Journalists?); they're never pointed at those just getting on with their lives and following the rules.

Do some research for yourself on the difference between adult brains and teenage brains - risk-taking is higher in the young because of the way brains develop.

This is a disease with unknown long term effects. What we do know is that it gets into every organ in the body. The latest research shows it gets to the testes and damages male fertility - possibly only temporarily but that is too soon to know.

Volunteer to be reinfected if you wish, with no idea whether subsequent infection will be worse (initial reports suggested the damage to the body was cumulative but you can hope it wont be, no-one has done any proper study yet). The government is trying to get herd immunity on the quiet, without any idea of what that actually means for those infected.

@DougRossIsTheBoss

Up to now we have not known enough about natural immunity. Does it work? If so for everyone or only some? How long does it last? We have been gathering data.

But how are we talking already about 95% efficacy from vaccines, etc and we are only loosely 'gathering data' about immunity after natural infection.

There needs to be proper studies conducted timely on the latter also, surely. Otherwise it seems a bit as an afterthought.

I understand the point you are making op. There is some immunity in London at least as we were hit hard in the spring and don’t seem to be as hit hard this time. Anecdotally my London trust had huge numbers with Covid back in the spring. We all had antibody tests in June and 23% had antibodies, that’s 2,300 people in our trust. This time very few have caught Covid. I know no one at work that has it right now and that reduction must be helped by a quarter of staff having antibodies, it would be illogical to think anything else ( there may obviously be some I am unaware of).
I think the high numbers in the midlands, north etc reflect the lower number of infections in these populations in the spring time and so the lower population immunity they were able to build up in the spring.
But having said that I am not sure Gov policy can be built around natural immunity as there will be plenty of people that think they had Covid in March but didn’t. And you would have to give antibody tests to 66 million people which seems a waste of time/ resources. I think the PM is absolutely right to be self isolating despite his “abundance “ of antibodies ( but I get the point you are making)