Record numbers of new COVID-19 infections are filling up the nation’s hospitals and morgues just days before the U.S. Food and Drug Administration is likely to approve the first coronavirus vaccine for emergency use. But there’s a perverse silver lining to this lethal spike in infections: Every American who catches and recovers from COVID has a chance of retaining some degree of immunity for months or even years—all without the help of an expensive, difficult-to-distribute vaccine.
Those millions of former COVID patients and their lingering antibodies and T-cells could contribute to the population-level immunity that might signal the end of the current pandemic. In a weird and tragic way, America’s massive failure to slow COVID infections pre-vaccine could actually help speed up post-vaccine immunization efforts by reducing, potentially by tens of millions, the number of Americans who need shots.
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Seeking so-called herd immunity by way of mass infection has, of course, been roundly criticized as a grotesque approach to the pandemic—even if the U.S. government has sometimes seemed to embrace such a strategy. Still, if vaccine-assisted population-level immunity is the finish line, then natural immunity among a large number of COVID survivors is a potentially huge head start.
“The final goal is to develop an immune response with an appropriate level of antibodies,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast. “Any way those appropriate levels of antibodies comes about—whether naturally or by vaccine—counts.”
But health officials might not be able to take advantage of this existing immunity when they finally start administering vaccinations. Owing to the failure of U.S. testing protocols, officials don’t know with any degrees of granularity who has had COVID.
A year into the pandemic, there have been about 15 million confirmed COVID infections in the United States resulting in at least 283,000 deaths. But some scientists believe there could be at least three times as many undetected infections. The actual number of Americans with some potential degree of natural immunity, then, could be 60 million or more—and lately the official number has been growing by around 150,000 per day.
That’s a big deal. Epidemiologists estimate that around 70 percent of a population needs immunity in order to end a pandemic. That means 229 million Americans need antibodies or T-cells in order to beat COVID in some meaningful way nationally. Owing to the possibly huge number of undetected cases, and the catastrophic toll of infections and deaths in a uniquely dysfunctional pandemic response, it’s possible the U.S. is already over a quarter of the way there.
Natural immunity might not last forever, of course. There have been documented instances of COVID survivors getting infected a second time, although in early cases examined by researchers, the reinfections appeared to mostly be mild.
Antibodies and T-cells fade over time, at which point the immune system might retain a “memory” of the novel coronavirus and how to defeat it. Or it might not. We simply don’t know yet. “There’s a lot we’re going to have to watch in terms of how rapidly serology levels decline,” Redlener said, using the scientific term for antibodies and T-cells in blood serum.
Still, there’s ample evidence that natural immunity to the coronavirus is fairly durable over time. “If natural infection did not lead to a high degree of protection, many more reinfections would be expected,” a team led by Brad Spellberg, chief medical officer at the Los Angeles County and University of Southern California Medical Center, wrote in a November commentary
The upside of potentially widespread and lasting natural immunity is obvious. “It’ll reduce who needs vaccination,” Pierre Mourad, a University of Washington bio-engineer, told The Daily Beast.
While Mourad and other experts advised that even people with natural immunity eventually get vaccinated, just in case, if COVID survivors were the last to get dosed, it could help to stretch initially limited supplies of vaccines.
“People who know they have been previously infected, they may want to wait a bit and allow others who have not been infected to get in front of them, so to speak, in the line,” Jeffrey Klausner, a professor of medicine and public health at UCLA who previously worked at the U.S. Centers for Disease Control, told The Daily Beast.
Vaccines from New York pharma Pfizer and Moderna in Massachusetts—both of them genetically engineered “messenger-RNA” vaccines requiring two doses per person—are on the cusp of getting approval from the FDA for emergency distribution.
Production is well underway. The federal government dropped $2 billion to pay for the first 100 million doses of Pfizer’s vaccine and $1.5 billion for Moderna’s first 100 million doses. As many as 20 million doses, enough for 10 million people, could ship before the end of the year, though Pfizer has scaled back its own production expectations for this calendar year, thanks to supply-chain problems. The CDC is recommending states administer those initial doses to the most vulnerable groups, including frontline health workers and nursing home residents.
The CDC did not immediately respond to a request for comment for this story.
By spring, everyday people should be eligible to get a vaccine at low or no cost at their local pharmacy, officials have said. Leaving aside potential spoilage, the first 200 million doses that the feds have already paid for could inoculate 100 million Americans through early summer.
Add in the millions of Americans with possible natural immunity, and the country could be well on its way to population-level immunity by mid-2021.
Of course, this assumes health officials can identify who has natural immunity and encourage them to step to the back of the line for vaccination—without jeopardizing efforts to prioritize vaccination in communities that have borne the brunt of the pandemic.
“It’s logistically very difficult to screen people for prior infection,” Klausner warned. Most people with COVID are asymptomatic. Seemingly healthy people with no symptoms would need to volunteer for antibody and T-cell testing, by the tens of millions, in order to identify even a fraction of the Americans with natural immunity.
Those people who showed some sign of a COVID immune response would then need to voluntarily opt out of vaccination until some indeterminate point in the future—say, late 2021. Given the massive death toll and preexisting vaccine skepticism within some communities of color—thanks to a legacy of racist medical studies carried out by the U.S. government—such an effort could backfire.
Managing the widespread testing and messaging that would be necessary to pull off a strategy of this type could also be beyond the capability of today’s CDC, which experts say has fallen into a state of disrepair under the Trump administration.
Klausner said the CDC should assign an agency medical officer to congressional districts—all 438 of them—in order to advise local communities and manage complex public health efforts. In the absence of that kind of national leadership, local officials can only guess at how best to contribute to a national vaccination effort that doses the right people in the right order so as to reach population-level immunity as fast as possible. “They’re confused, they’re uncertain,” Klausner said.
Federal management of vaccination efforts could change dramatically with President-elect Joe Biden’s inauguration in January. But between now and then, experts say, officials would do well to make the most of past failures by taking into account natural immunity when they distribute precious doses.
If they do not, it wouldn’t be the first time in the year-old pandemic that America’s leaders have wasted a chance to save lives.
