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September newsletter

Do You Have Super Immunity?

Are you one of the few people standing that has not had COVID-19 yet? Chances are you that you actually HAVE had it…about 85% of the population has been infected with the coronavirus and 50% of those people either didn’t have symptoms and therefore never knew they were infected, or did have symptoms and just didn’t catch it on the test at the right time. If you are actually part of the 15% of the population that never contracted COVID-19, there are a few primary reasons why:

  • The first group of people in that 15% are those that are just lucky despite being exposed. They managed to miraculously dodge the virus at every turn, for two and a half years, despite persistent infection rates in almost every country in the world. The chance of you being in this category is less than 1%.

  • The second group of people who haven’t had COVID-19 yet are those that haven’t left their house much, have avoided gatherings and travel and in-person work, and have applied the utmost caution possible by embracing mask wearing, and COVID-19 vaccinations. This group is primarily comprised of those who are immunocompromised or high-risk due to age. If people in this group are infected, the severity of the infection is unknown--but could be quite significant due to the inherently vulnerable characteristics of this group.

  • The third group of people who haven’t had COVID-19 yet are those that have some sort of resistance to the virus. This means that something in their immune system is protecting them from contracting clinical recognizable COVID-19—it doesn’t mean they weren’t exposed or subclinically infected— it just means that their immune system was able to very efficiently stop the viral particles from replicating. Sub-clinical infections are those that produce no symptoms and cannot be picked up on even PCR tests, but produce an immune response in the body. In later variants of the disease (BA.4 +) , this type of super immunity to COVID-19 seems to occur mostly in those with blood type O (+/- seems to be less impactful than letter of blood type according to the most updated research). These people might also be those have had other types of viruses in the past which produced enough of a lasting immune response to fight against replicating SARS-Cov-2. I have previously postulated that the COVID-19 vaccine might help us from being infected against a host of other viruses. In fact, this theory which seemed a little unusual at first, is now finding supporting evidence through studies conducted at major academic institutions, including Northwestern. Those with blood type A seem to be most impacted by severe COVID-19 infections, and are also more likely to be reinfected. Thus, I would recommend finding out your blood type if you don’t already know it. With the omicron variant, blood type has a more central role in predicting those of us who will have trouble making and keeping protective COVID-19 antibodies.

If you think you have not had COVID-19 yet, your chance of becoming severely ill with infection drops considerably because you are likely in the group that has already had it and didn’t know it, had subclinical COVID-19 through small exposures which produced an immune response that is protecting you, or have natural defenses to COVID-19 through blood type or other prior infections that produce cross-immunity to COVID-19. Of course, all I am doing here is playing the odds and individual experiences may vary. If you HAVE already had COVID-19, and were not hospitalized or severely ill, the chance of you having a severe acute infection from a subsequent infection drops by up to 85% (this statistic does not include the impact of long covid on either the initial of subsequent infection--which may be substantial). This means, unless you are high-risk, your chances of you having a mild course of COVID-19 at this stage of the pandemic is the most likely scenario. Personally, having not had COVID-19 yet, I am not sure which category I fall into but if I had to guess I would say that I am probably in the dwindling group that has exercised enough caution to have escaped infection altogether due to avoidance and protective behaviors (read: not super immune). In order to confirm I have not have COVID-19, I was given an antibody test. There is a special test that can detect COVID-19 antibodies from infection only -even if you have been vaccinated. This test is called the IgG nucleocapsid protein antibody test and it must be ordered by a physician. This is DIFFERENT from the spike protein antibody test which detects BOTH antibodies from the vaccine and from prior infection. Thus, if you want to know if you have had COVID-19 because you never tested positive on rapid or PCR tests, then you need to be sure to order the nucleocapsid antibody test. It is a blood test and they offer it at LapCorp and Quest. Further, if you want to know how recently you have had COVID-19, you will want to order the quantitative version (how many antibodies) instead of the qualitative version of the test (yes v no antibodies). There is not always a direct correlation but generally higher antibodies will indicate a more recent infection. There are a small number of people who have no nucleocapsid antibodies and have had COVID-19, but that is really very rare. The New Bivalent Boosters By now you know that the FDA has approved a new booster — a bivalent booster —which is supposed to offer better protection against omicron in the form of more effective neutralizing antibodies, while still protecting against the original version of the coronavirus. This is so we can retain some protection against the more severe delta variant (which the original vaccine worked well against) in the event it decides to re-emerge. This new bivalent booster has not been tested on humans, however the original formula was modified by such a small amount (think changing out washer fluid in your car, instead of building a new vehicle) that experts assert it is synonymous to making the adjustments on the annual flu vaccines each year to match the type of flu virus variant circulating (we don’t perform new clinical trials each year for the flu vaccine). Moving forward with this strategy by tweaking the vaccine to match emerging variants instead of performing long and costly human trials allows us to better match our antibodies to the virus in a timely manner. In other words, it allows us to catch up with the virus and prevents us from enduring long and deadly viral surges. I have no doubt that the new bivalent vaccines are safe --both the Moderna and Pfizer versions, and it is likely--based on animal trials--that the new vaccines are also somewhat effective. That being said, this is the first time this type of vaccine has been tweaked and approved without a human trial and I am much less worried about safety than I am about efficacy. Animal studies and in-vitro testing (lab testing) provide an acceptable proxy for estimating effectiveness, and the vaccines did indeed show good neutralizing power in these tests. However, animal studies aren’t human studies and the true efficacy of these vaccines can only be measured by being trialed in a human population. My guess is that these boosters will only last for about 3-6 months, so it is important to time when to get them since the primary benefits diminish quickly. Because the original boosters are still doing a great job at preventing severe disease, hospitalization and death, in my opinion, it makes sense to wait a little to get the new bivalent one. Let me explain why. If you are not high-risk, and have had COVID-19 or been boosted in the last 6 months, I would recommend waiting for a few months or more to get the new booster. In terms of timing surges we are currently at the end of a very long surge--meaning community-based risk is likely at a low point and you will receive less benefit from a booster because your new, strong antibodies won’t have much to protect you from without exposure to the virus! Thus, I would consider the new booster once you are further out from either your last booster or your last infection (personally, I am waiting a full year to get re-boosted). Conversely, I WOULD recommend boosting if:

  1. You are high-risk or immunocompromised. If you are over 60, not only do your antibodies fade faster but you are more likely to develop severe disease if infected. This is why if you are in this age group, you are deemed high risk and this new booster IS recommended.

  2. You are engaging in a high-risk activity that you want to be fully protected for (travel, wedding, etc..).

  3. A new COVID-19 wave begins

Remember, the higher your antibodies are, the less benefit a new booster will provide. In a nut shell, the amount of time you end up waiting in-between boosters will be different for all of us depending on all of the varied risk factors in play in your life. But, if you are not high-risk and can wait a few more months for it, not only have will you have a higher chance of benefiting more from the booster, but you will also have the benefit of seeing some real-world data emerge on the new boosters showing how long they last and if there are any unforseen issues. As always, I hope this was helpful for you and I am wishing you all well as we transition into Fall. Come say hi to me on my Instagram, Facebook or Twitter @drjendunphy--or check out my website where I post new articles and blog about health topics that affect your mind and body:

Stay Safe and Healthy, Dr. Jen Dunphy

**I am not a medical doctor, but a doctor of public health (DrPH) and I am not giving any clinical advice. My job is to help interpret leading research and make sense of the probable implications. Please consult your physician for any medical advice. Thank you.

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