Why are we not hearing more statistical data about reinfections?

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swintie
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12:45p, 8/6/21
AG
I just read about the CDC's reasoning for asking us to "mask up" yet again, and I found it really interesting. For those that are on the late train (like myself), there was a pretty large outbreak in Provincetown, MA over the July 4th weekend where 75% of the infected people had previously been fully vaccinated.

I am not going to argue the merits of masks or vaccines or even argue whether someone being selfish by not following protocols. I'm hoping that this thread doesn't devolve into that.

I'm am hoping that either (a) someone knows the information I'm looking for, or (b) can help to explain the absence of this information. I am also not someone who considers himself a "conspiracy theorist" nut job, but the fact that we can never seem to get statistics on reinfection rates (vs breakthrough rates) makes me think that this is on purpose. Why?

I DO believe that this is important data that should not be ignored -- even if it is a fairly small sample. Why, then, can we not know how many of these infected were "reinfections without vaccine" or even "reinfections with vaccine?" For that matter, why aren't we getting ALL of our information that way? It seems like we should be putting all infections into one of FOUR bins, rather than one of TWO.

What gives? Are we just lazy reporters or are we trying to manipulate the public into thinking that natural immunity doesn't count?

Full disclosure: I am a political moderate, and I had COVID earlier this year. I chose to wait on getting the vaccine because (a) I know that I have some level of natural immunity, (b) I have a personal belief that getting your vitamins from broccoli and carrots is better than getting them from a pill, and (c) I wanted to understand the level of "reward" associated with the "belt and suspenders" approach vs. the "risk" associated with getting this again. As an engineer, I want real data. The lack of data here is scary to me because it smells like it is being hidden in order to manipulate public behavior.
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Zobel
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In reply to swintie • 1:16p, 8/6/21
AG
It's been an ongoing discussion here - there doesn't seem to be any good data out there to close the book one way or another. Based on what we think we know, it's probably safe to assume that as of now, infection from previous variants vs delta is probably better than the original mRNA vs delta.

The problem is one of getting good data. You have real bias problems, because there's age and behavior correlations with both vaccinated groups, groups likely to be previously infected, groups likely to be reinfected, and groups likely to present for medical attention or to have more severe disease in either case, as well as different exposure probability between communities that are more or less vaccinated.

The only way I think you can know for sure is to check for the presence of antibodies to the N protein and the S protein. If you have S and N, you've had covid before. If you only have S but no N, you were vaccinated but not exposed. But it doesn't seem like we're doing antibody testing at scale with some kind of follow-up study. Maybe we are, it'd be interesting for sure.
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ramblin_ag02
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1:25p, 8/6/21
AG
As said above, natural immunity is hard to track. If you just ask people, 90% of the US is convinced they had COVID in the winter of 2019-20 so every new infection is a reinfection. You can use previous testing, but many people didn't get tested the first time around, and that will underestimate reinfections. As Zobel said, you can try to do antibody testing to differentiate between natural immunity, no immunity, and vaccine immunity, but that's resource intensive and difficult. It's really just easier to track vaccinations status among people that test positive. I don't think there's anything nefarious about that.

As to whether natural immunity is better or worse than vaccine immunity, I don't think anyone knows. I also don't think it's a high priority in the medical community, because we know vaccine immunity is very good and easy to get. I also think they are trying to avoid a situation where a person had undiagnosed rhinovirus in Jan 2020, is convinced they had COVID, and now that person doesn't think they need a vaccine.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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BlackGoldAg2011
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1:29p, 8/6/21
AG
I think the reason the data is limited on re-infections is a compounding of several reasons.
  • I think there are probably some who are concerned that any positive news about natural immunity from previous infection is likely to limit distribution of the vaccine. This causes them to shy away from studying it so they don't have to hide anything because there is no study to hide. I think this group is probably small
  • I would guess that there are some choosing to not study this for pragmatic reasons. Acquiring natural immunity requires no action outside of living your normal life, so it is not something that medicine can "do" to help society kick the pandemic. So instead they focus their finite time and resources studying the effectiveness of the things they can "do" like vaccinate, limit spread, and treat infection, so they can focus their efforts on doing something to those actions that have the greatest positive effect, and then leave the "do nothing" data to work itself out since they have no control over whether or not that is implemented. I would guess this is a much large portion than the first group.
  • Finally, as zobel alluded to, this data is also much harder to collect and analyze. to get breakthrough infection data, you already have lots of people getting covid tests for lots of reasons, and it is really easy to ask them to self certify if they are vaccinated or not and trust that the answer will be accurate. not many people could not know for sure their vaccination status. however it is not as simple to ask people to self certify a prior covid infection and trust the data. to truly drill down on this type of study would really require serology testing which is much more invasive and would therefore limit your study size. There are studies that will provide this type of info like the Tx-cares serology study, but there just aren't as many, because this is the harder data set and resources are finite
these are just my guesses on the reasons for the limited data based on what i have learned over the past year and a half, so there is a realistic chance i'm way off, but it's what i have been assuming. But i, like many of us, would really love to see that data thoroughly studied, because that is likely a large portion of our collective societal immunity at this point.
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swintie
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3:06p, 8/6/21
AG
I thank all three of you for your very thoughtful responses.

I too hope that there isn't anything nefarious about the lack of information here. It may be years before we really know which provides broader and longer lasting immunity.

I guess I feel like I am a member of an important demographic that is not given any credit whatsoever. My choice not to get vaccinated (yet) is looked down upon as being "selfish" and "not caring about the greater good". I understand that there is not much of a "downside" to getting vaccinated. I also believe that there is not much "upside" either (at least for my and my wife).

My personal beliefs about sickness might be a bit wacky to most -- I would rather let my body fight off infection the "hard way" than to "cheat" my immune system of the opportunity to respond in a natural way. You can either get an "A" on the test by knowing the material, or you can get an "A" on the test by getting the previous semester's questions and knowing how to answer. You can decide for yourself which is a better long-term strategy.

I believe that our bodies are the most amazing and complex control system in the world. I also believe that we (as humans) tend to overestimate how much we understand about this system. I am always worried about unintended consequences when we insert ourselves into that control loop.

Again, I'm not a nut. This isn't a religious or political stance. It isn't really a hard stance at all -- I'm just sort of tired of being made to feel like someone who is "self-centered" because I haven't seen enough evidence that would cause me to change my behavior.

Thanks, everyone...
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Zobel
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In reply to swintie • 3:22p, 8/6/21
AG
I think that there's this common misconception that vaccines somehow are like a replacement or a competition for your immune system. They aren't...the immune system works ridiculously well already, way better than anything we could come up with.

The reasons vaccines work is because they use this existing system. Literally all the mRNA vaccines are doing is sending a "production order" to your cells ribosomes to make the exact same* spike protein that is on the outside of the virus.

The cells make copies of the spike, and they it get stuck on the outside of the cells the same way it is stuck to the outside of the virus, using the same attachment point (transmembrane anchor). Your body responds to that foreign spike the same way it would if it saw it on the outside of a virus, and that memory is what enables your immune system to rapidly respond when it encounters the virus for real.

*There are minor changes. The spike protein on the virus has shape that changes after it attaches / fuses to the cell. The protein by itself can can tend to "spring" to the post-fusion shape. Scientists discovered back in 2017 on the MERS spike that if you substitute two amino acids in at a certain "joint" in the protein, you can hold it in the right shape like a splint. Then when your body sees it, it will see it in the same shape that the virus will be. There are other changes to the mRNA that don't change the resulting protein, and some other stuff. You can read about it here, it's pretty cool.
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swintie
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In reply to Zobel • 4:14p, 8/6/21
AG
Zobel said:
I think that there's this common misconception that vaccines somehow are like a replacement or a competition for your immune system. They aren't...the immune system works ridiculously well already, way better than anything we could come up with.

The reasons vaccines work is because they use this existing system. Literally all the mRNA vaccines are doing is sending a "production order" to your cells ribosomes to make the exact same* spike protein that is on the outside of the virus.
I agree and believe that the work that has been done in this area is amazing. I don't have a problem at all with the science behind the vaccines, and I don't believe there is much (if any) concern with negative consequences.

I believe that it is a no-brainer for anyone over 40 or having ANY type of pre-existing condition (including moderate obesity) to get vaccinated if they have not both (a) tested positive for COVID-19, and (b) had moderate enough symptoms to know that the infection triggered a lasting immune response. For me, both of those conditions were met, so the decision is not as obvious.

I may be steering this in an undesired direction, but I'm not completely on board with the idea that healthy children and young adults need to be vaccinated at all. There is something to be gained by letting your body fight off infections. I haven't had a flu vaccine in my life. I also have not had the flu in over 30 years. Why? I believe (possibly naively) that my body's natural response to having the flu when I was younger has made me much more resistant to all the different variants that have come along over the years. I also do other things to make my immune system stronger (eating well, exercising, etc.)

I'm sure the FDA will approve the Pfizer vaccine soon, and the vaccine mandates will come soon after that. At that point, this debate will be a moot point. I just hope that my children were exposed when my wife and I had this (they never had symptoms and were never tested) so that I can feel like I haven't cheated them out of an opportunity to get stronger.


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eric76
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In reply to swintie • 4:16p, 8/6/21
AG
swintie said:
I just read about the CDC's reasoning for asking us to "mask up" yet again, and I found it really interesting. For those that are on the late train (like myself), there was a pretty large outbreak in Provincetown, MA over the July 4th weekend where 75% of the infected people had previously been fully vaccinated.
Provincetown reportedly has one of the highest vaccination rates in the country -- well above 75%. As such, a 75% infection among the fully vaccinated does not mean that the vaccinated are at higher risk of getting covid.

I don't know what the actual rates are, but suppose, for example, that 90% are vaccinated and 10% are not vaccinated. Then that would mean that the 10% who were not vaccinated were getting 25% of the infections. Thus, those who were not vaccinated would have been at far higher risk of being infected than those who were vaccinated.
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swintie
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4:23p, 8/6/21
AG
Eric --

I agree with you completely, but that wasn't the itch I was trying to scratch at. I think that P-town data is very interesting, and says more about the role of the vaccinated (and previously infected) as carriers than it does about anything else.

My itch was that nobody has said anything about the previously infected at all -- as if this demographic (which gets bigger and bigger every day) doesn't exist or doesn't count. How many of these "breakthrough" infections were of the "belt and suspender" variety? How many of the non-vaccinated infections were reinfections? That's what I want to know.

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eric76
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In reply to swintie • 9:05p, 8/6/21
AG
swintie said:
Eric --

I agree with you completely, but that wasn't the itch I was trying to scratch at. I think that P-town data is very interesting, and says more about the role of the vaccinated (and previously infected) as carriers than it does about anything else.

My itch was that nobody has said anything about the previously infected at all -- as if this demographic (which gets bigger and bigger every day) doesn't exist or doesn't count. How many of these "breakthrough" infections were of the "belt and suspender" variety? How many of the non-vaccinated infections were reinfections? That's what I want to know.
That makes sense.

I had covid in May 2020. In October, I had the same exact symptoms I had in May and to the same degree other than my sense of smell going haywire for an afternoon. I didn't get tested so I don't know if I had it again.

I did get in an argument with a PA. When she told me I should be tested, I told her that it wouldn't matter because by the time the results came back, I would already be out of isolation if they were positive. She said that isolation would start from when I was tested and I answered back that the CDC and the TDHS go by test date only if there are no symptoms and it was already about 9 days from the first symptom I had that might have been of covid.
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Gordo14
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In reply to ramblin_ag02 • 9:57p, 8/6/21
ramblin_ag02 said:
As said above, natural immunity is hard to track. If you just ask people, 90% of the US is convinced they had COVID in the winter of 2019-20 so every new infection is a reinfection. You can use previous testing, but many people didn't get tested the first time around, and that will underestimate reinfections. As Zobel said, you can try to do antibody testing to differentiate between natural immunity, no immunity, and vaccine immunity, but that's resource intensive and difficult. It's really just easier to track vaccinations status among people that test positive. I don't think there's anything nefarious about that.

As to whether natural immunity is better or worse than vaccine immunity, I don't think anyone knows. I also don't think it's a high priority in the medical community, because we know vaccine immunity is very good and easy to get. I also think they are trying to avoid a situation where a person had undiagnosed rhinovirus in Jan 2020, is convinced they had COVID, and now that person doesn't think they need a vaccine.
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Reveille
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In reply to ramblin_ag02 • 10:04p, 8/6/21
AG
ramblin_ag02 said:
As said above, natural immunity is hard to track. If you just ask people, 90% of the US is convinced they had COVID in the winter of 2019-20 so every new infection is a reinfection. You can use previous testing, but many people didn't get tested the first time around, and that will underestimate reinfections. As Zobel said, you can try to do antibody testing to differentiate between natural immunity, no immunity, and vaccine immunity, but that's resource intensive and difficult. It's really just easier to track vaccinations status among people that test positive. I don't think there's anything nefarious about that.

As to whether natural immunity is better or worse than vaccine immunity, I don't think anyone knows. I also don't think it's a high priority in the medical community, because we know vaccine immunity is very good and easy to get. I also think they are trying to avoid a situation where a person had undiagnosed rhinovirus in Jan 2020, is convinced they had COVID, and now that person doesn't think they need a vaccine.


Excellent explaination! I completely agree. Everyone with a cold insist they already had COVID-19 regardless of antibody testing.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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unmade bed
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In reply to ramblin_ag02 • 11:50p, 8/6/21
ramblin_ag02 said:
As said above, natural immunity is hard to track. If you just ask people, 90% of the US is convinced they had COVID in the winter of 2019-20 so every new infection is a reinfection. You can use previous testing, but many people didn't get tested the first time around, and that will underestimate reinfections. As Zobel said, you can try to do antibody testing to differentiate between natural immunity, no immunity, and vaccine immunity, but that's resource intensive and difficult. It's really just easier to track vaccinations status among people that test positive. I don't think there's anything nefarious about that.

As to whether natural immunity is better or worse than vaccine immunity, I don't think anyone knows. I also don't think it's a high priority in the medical community, because we know vaccine immunity is very good and easy to get. I also think they are trying to avoid a situation where a person had undiagnosed rhinovirus in Jan 2020, is convinced they had COVID, and now that person doesn't think they need a vaccine.


This is a really good answer to the OPs question.
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jopatura
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12:06a, 8/7/21
AG
In the beginning, reinfections were only counted the first time if they had tested positive both times more then 90 days apart and both samples had been DNA sequenced appropriately to tell that it came from a different region.

Those were extremely high barriers to cross to be considered an "official" reinfection. The international traveler out of Colorado was the only reinfection for a long time, even though there were a couple of cases in Dallas and elsewhere that made the news anecdotally.

I haven't necessarily seen any new guidance that makes me think the CDC has changed that criteria.
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Not a Bot
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10:12a, 8/7/21
AG
The Provincetown "outbreak" has been completely misrepresented. When you have such a high population in a given area that is vaccinated, it is more likely that each case would be among a vaccinated person than an unvaccinated person.

The town is highly vaccinated. There were about 60,000 people in town over that time period, many in close quarters. There were only about 900 or so confirmed cases. Only seven hospitalizations. Zero deaths. The vaccines appear to have largely prevented severe disease.

Unfortunately the CDC and other government agency messaging has been terrible through all of this. They have been focusing on cases, cases, cases, cases, cases without truly reflecting on percentage of cases that result in hospitalization. The entire messaging around the vaccines should have been focused on hospitalization and severe disease reduction. They appear to be working very well in that regard.
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eric76
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In reply to jopatura • 1:14p, 8/7/21
AG
jopatura said:
In the beginning, reinfections were only counted the first time if they had tested positive both times more then 90 days apart and both samples had been DNA sequenced appropriately to tell that it came from a different region.

Those were extremely high barriers to cross to be considered an "official" reinfection. The international traveler out of Colorado was the only reinfection for a long time, even though there were a couple of cases in Dallas and elsewhere that made the news anecdotally.

I haven't necessarily seen any new guidance that makes me think the CDC has changed that criteria.
If someone is reinfected with the same strain, how would you confirm that it is an actual reinfection and not a continuing infection that never went away?

It seems natural that "confirmed reinfections" require a separate strain and that they might not always have a blood sample of the first infection to compare them.
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eric76
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In reply to Not a Bot • 1:19p, 8/7/21
AG
Captain Positivity said:
The Provincetown "outbreak" has been completely misrepresented. When you have such a high population in a given area that is vaccinated, it is more likely that each case would be among a vaccinated person than an unvaccinated person.

The town is highly vaccinated. There were about 60,000 people in town over that time period, many in close quarters. There were only about 900 or so confirmed cases. Only seven hospitalizations. Zero deaths. The vaccines appear to have largely prevented severe disease.

Unfortunately the CDC and other government agency messaging has been terrible through all of this. They have been focusing on cases, cases, cases, cases, cases without truly reflecting on percentage of cases that result in hospitalization. The entire messaging around the vaccines should have been focused on hospitalization and severe disease reduction. They appear to be working very well in that regard.
Where the concern is treating the ill, then the focus is naturally on those who are in critical need of being treated, but for purposes of epidemiology, they should be tracking cases, not hospitalizations.
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