(J. Harris: Wonderful Atlantic article; readable and makes sense.)
‘’…We know how this ends: The coronavirus becomes endemic, and we live with it forever. But what we don’t know—and what the U.S. seems to have no coherent plan for—is how we are supposed to get there… “Are we trying to prevent hospitalization? Are we trying to prevent death? Are we trying to prevent transmission?” Different goals would require prioritizing different strategies…‘’…Hard questions lie ahead, and the answers require political will. But first, we have to stop avoiding them. We need a goal….“We’re sleepwalking into policy because we’re not setting goals…We will never get the risk of COVID-19 down to absolute zero, and we need to define a level of risk we can live with……But the level of COVID-19 risk we can live with is also not an entirely scientific question. It is a social and political one that involves balancing both the costs and benefits of restrictions and grappling with genuine pandemic fatigue among the public…The U.S. still has too many unvaccinated elderly people—or rather, parts of the U.S. do….Exactly how hard do we want to work to help how many people….To prevent hospitals from being overwhelmed, the key group we need to vaccinate is really the elderly. The risk of hospitalization for an unvaccinated person over 80 is 25 times that for an unvaccinated person under 18… San Francisco and seven other Bay Area counties recently set three-pronged criteria for lifting indoor mask mandates: (1) Community transmission is moderate, as defined by the CDC, for at least three weeks, (2) hospitalization numbers are low and stable, and (3) 80 percent of the total population is fully vaccinated or eight weeks have passed since COVID-19 vaccines have been available for kids age 5 to We need a goal.
”...Available evidence shows that fully vaccinated individuals and those previously infected with SARS-CoV-2 each have a low risk of subsequent infection for at least 6 months. Data are presently insufficient to determine an antibody titer threshold that indicates when an individual is protected from infection. At this time, there is no FDA-authorized or approved test that providers or the public can use to reliably determine whether a person is protected from infection.
The immunity provided by vaccine and prior infection are both high but not complete (i.e., not 100%).
Multiple studies have shown that antibody titers correlate with protection at a population level, but protective titers at the individual level remain unknown.
Whereas there is a wide range in antibody titers in response to infection with SARS-CoV-2, completion of a primary vaccine series, especially with mRNA vaccines, typically leads to a more consistent and higher-titer initial antibody response.
For certain populations, such as the elderly and immunocompromised, the levels of protection may be decreased following both vaccination and infection.
Current evidence indicates that the level of protection may not be the same for all viral variants.
The body of evidence for infection-induced immunity is more limited than that for vaccine-induced immunity in terms of the quality of evidence (e.g., probable bias towards symptomatic or medically-attended infections) and types of studies (e.g., observational cohort studies, mostly retrospective versus a mix of randomized controlled trials, case-control studies, and cohort studies for vaccine-induced immunity). There are insufficient data to extend the findings related to infection-induced immunity at this time to persons with very mild or asymptomatic infection or children.
Substantial immunologic evidence and a growing body of epidemiologic evidence indicate that vaccination after infection significantly enhances protection and further reduces risk of reinfection, which lays the foundation for CDC recommendations.
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