Well, since the immunology focus at the moment is primarily on neutralizing antibodies, I assume alexactly that - neutralizing. Which translates into steralizing because it should not allow for productive infection.
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Als antwoord op @_b_meyer @viropractor
How would you know if survivors have sterilizing immunity, or simply protected from disease without massive longitudinal PCR testing? They’re clinically indistinguishable.
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Als antwoord op @stgoldst @viropractor
Clinically - yes, biologically - no
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nAbs is one thing, immunity something else - and for COVID-19, we just don't understand immunity. All these studies are focusing too much on nAbs and too little on e.g., role of T-cells and non-neuts. Yes, I'd like to see long-lasting nAbs, but we don't know if they're required.
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I completely agree.
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The worst interpretations of these papers conclude that "immunity doesn't exist in most people" (because, lack of neuts). If that was the case, we'd see report after report about reinfections by now - and we don't. So it works, but how long is an open Q (and it's more than neuts)
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Another limitation of these nAb studies is a lack of consistency in time of sampling. I think Florian showed that if you wait, a lot of people with low or no nAbs will end up seroconverting. The point about a lack of re-infections is huge and seems to be widely ignored.
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I don’t think the lack of reinfection is ignored. I think it’s an absolutely massive relief. There’s clearly some protection from reinfection. The questions are how long protection lasts, if it’s duration corellates with severity of primary infection and if T cells are helping.
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It's ignored in the sense that it's rarely discussed in papers claiming there's minimal protective immunity.
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Another point to consider here - all these studies focus on IgG, but because COVID-19 is caused by both upper and lower airway infection, antibody isotype matters - upper airways isn't protected by IgG, it's IgA. Lower down, it's IgG.
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Relatedly, that also complicates vaccines, which are typically injected - 1st gen versions likely won't lead to sterilizing immunity because the upper airways aren't as well protected. Maybe 2nd gen vaccines could include inhalers to better induce IgA?
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I definitely think that's something to think about it. IPV/OPV example is informative here in terms of protective against disease vs sterilizing, related to site of inoculation and isotype.
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Someone should definitely make a FluMist-style inhaled vaccine.
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