You can have cases here and there more severe—especially with strain changes. But I've seen all those studies. The key issue is the obvious, glaring conditional probability. You cannot only study the re-infections you encounter—obviously sicker than population-wide.
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Replying to @zeynep @lisa_iannattone
Let me put it this way. There is absolutely no way to explain the epi curve you see in *every* country over time without accepting re-infections and breakthroughs are milder on average. No way. It's the same way droplets/contact only could not explain the epi data. Clear as day.
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Replying to @lisa_iannattone
Do the correct math on the seronegatives, and it's pretty clear. You can also see surges in high-vaccination places—even 20% remaining is lots of people. As you note, small numbers are big effects at scale. I see zero evidence to assume those countries ran out of seronegatives.
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Replying to @zeynep
We haven’t run out of seronegatives in highly vaccinated countries either. And yet the death curves look extremely different. If waves were just about finding the seronegatives, then it wouldn’t make such a huge difference whether countries were leaning on vaccines or infection.
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Replying to @lisa_iannattone @zeynep
And there’s this study on Iran that shows they likely did run out of seronegatives and the IFR increased over time. Please reconsider these broad suggestions that infection immunity is as good as vaccine immunity when the evidence isn’t there.https://www.medrxiv.org/content/10.1101/2021.10.04.21264540v1 …
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Replying to @lisa_iannattone
That study from Iran needs to fix the CFR. It doesn't match with what we've observed, and if you get the wrong CFR your estimates will be way off—same problem with that Manaus paper. Yes, we haven't run out of seronegatives, that is exactly my point.
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Replying to @lisa_iannattone
The force clearly driving hospitalization and deaths everywhere is remaining seronegatives. Sadly, sometimes the number isn't easily available and people can talk themselves into early herd immunity projections or severe re-infection stories. The epi is clear. Omicron, we'll see.
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That chart absolutely, positively does not compare infection vs vaccine-immunity. I give up, honestly, if you think that chart shows anything of the sort. Honestly feel like I'm arguing on how snacks can't cause so much superspreading, so one more tweet and then I'll leave this.
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Replying to @zeynep @lisa_iannattone
The question itself is important & that data isn't conclusive—obviously, avoiding infections via vaccines is best. But I can't really keep arguing things that are quite obvious from the epi data, are coherent, match the science. Like airborne spread, time will help understanding.
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