How Concerned Should We About Rising Cases? Johns Hopkins’ Makary Gives Sobering Assessment

Johns Hopkins Medical health expert Dr. Marty Makary sets the record straight on rising cases, mandates and vaccinations in this published response to the CDC and COVID Task Force Director Dr. Anthony Fauci, originally posted in the Wall Street Journal:

The news about the U.S. Covid pandemic is even better than you’ve heard. Some 80% to 85% of American adults are immune to the virus: More than 64% have received at least one vaccine dose and, of those who haven’t, roughly half have natural immunity from prior infection. There’s ample scientific evidence that natural immunity is effective and durable, and public-health leaders should pay it heed.

Only around 10% of Americans have had confirmed positive Covid tests, but four to six times as many have likely had the infection. A February study in Nature used antibody screenings in late summer 2020 to estimate there had been seven times as many actual cases as confirmed cases. A similar study, by the University of Albany and New York State Department of Health, revealed that by the end of March 2020—the first month of New York’s pandemic—23% of the city’s population had antibodies. That share necessarily increased as the pandemic spread.

Natural immunity is durable. Researchers from Washington University in St. Louis reported last month that 11 months after a mild infection immune cells were still capable of producing protective antibodies. The authors concluded that prior Covid infection induces a “robust” and “long-lived humoral immune response,” leading some scientists to suggest that natural immunity is probably lifelong. Because infection began months earlier than vaccination, we have more follow-up data on the duration of natural immunity than on vaccinated immunity.

Skeptics of natural immunity point to Manaus, capital of the Brazilian state of Amazonas, where reports in January suggested a wave of re-infections despite herd immunity. But the initial estimate of those infected was incorrect because it was based on antibody testing among those who donated convalescent plasma—an unrepresentative subgroup of the population. A follow-up study debunked the re-infection hypothesis and found only three confirmed re-infections in the entire state, whose population exceeds four million. Other studies have confirmed that re-infections are rare and usually asymptomatic or mild.

Some health officials warn of possible variants resistant to natural immunity. But none of the hundreds of variants observed so far have evaded either natural or vaccinated immunity with the three vaccines authorized in the U.S.

Should the previously infected be vaccinated? My clinical advice to healthy patients with natural immunity is that one shot is sufficient, and maybe not even necessary, although it could increase the long-term durability of immunity. A University of Pennsylvania study of people previously infected with Covid found that a single vaccine dose triggered a strong immune response, with no increase in that response after a second dose. A separate study from New York’s Mount Sinai School of Medicine concluded that “the antibody response to the first vaccine dose in individuals with pre-existing immunity is equal to or even exceeds the titers found in naïve”—never-infected—“individuals after the second dose.”

Dr. Fauci said last Aug. 13 that when you have fewer than 10 cases per 100,000, “you should be able to open up safely and clearly.” The U.S. reached that point in mid-May. It’s time to stop the fear mongering and level with the public about the incredible capabilities of both modern medical research and the human body’s immune system.

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