Cathy Cloud wants an antibody test, not a vaccination.
Last week, Cloud, a Galveston resident, was having a tough time finding a place that would test her blood for COVID antibodies, she said.
She wanted a test that would prove to relatives she was protected against the virus. That proof would allow her to see family members who have avoided her because she’s unvaccinated, she said.
Cloud was diagnosed with COVID-19 in early August, she said. Despite getting “really, really sick,” going to an emergency room to seek monoclonal antibody treatments and losing 11 pounds over 15 days because she wasn’t eating, she said she now felt “fabulous” and had no interest in getting vaccinated.
“It wasn’t the worst thing I’ve ever had in my life,” Cloud said.
Cloud plans to rely on natural immunity gained by surviving COVID. She’s not the only one with that plan.
As the COVID pandemic approaches its 20th month, exact answers about how well natural immunity conferred by infection works to prevent reinfection remain elusive. Although experts now say previously infected people might be protected, many still consider vaccinations the best protection and the best path to take.
Detailed COVID statistics released by the Galveston County Health District indicate vaccines and natural antibodies offer protection against serious cases of COVID. But comparing the protective abilities of the two isn’t easy and is a matter of ongoing research.
And based on what’s known today, the weight of evidence says people should be vaccinated rather than risk getting sick and letting natural immunities develop.
“You’re risking hospitalization,” said Dr. Dean Blumberg, an associate professor and specialist in pediatric infectious diseases at the University of California–Davis. “You’re risking death. You’re risking a severe disease. My recommendation is don’t take that risk.”
WHAT THE NUMBERS SAY
In Galveston County, which is emerging from a summer wave of infections that set records for cases and COVID- related hospitalizations, health district information indicates people who previously were infected with COVID-19 are more protected against the virus than unvaccinated people.
Every Friday, the Galveston County Health District reports the number of known breakthrough cases — when someone gets sick after getting a full course of vaccinations — and the number of reinfections, those cases when someone is diagnosed with COVID again more than 90 days after an initial infection.
Based on the county’s most recently reported numbers, it appears people in both groups are unlikely to be infected by the virus. If they are infected, they are unlikely to suffer serious consequences.
In the numbers released by the health district, breakthrough cases among the vaccinated occur at a lower rate than reinfections occur in the previously infected.
People who have breakthrough cases also are hospitalized at a lower rate. About 1 in every 10 reinfection cases has resulted in a hospitalization, according to the health district. In breakthrough cases, hospitalizations have happened in about 1 in every 25 cases.
But there is one rate in which that trend appears to be reversed. People with reinfections are dying at a lower rate than people with breakthrough cases.
Of the 52,387 COVID diagnoses identified in Galveston County residents since March 2020, only 476 were identified as reinfections, about 0.91 percent, according to the health district. Only two deaths were reported among reinfected people, about 0.4 percent.
Of the 181,101 people who have been fully vaccinated in Galveston County, 1,513 have been reported to later test positive, about 0.84 percent. Of the local breakthroughs, 17 people have died, a 1.1 percent rate.
Galveston County Local Health Authority Philip Keiser cautioned against jumping to conclusions based on the district’s reporting. The number of known reinfections is three times smaller than the number of breakthroughs, making it hard to draw direct conclusions on rates, Keiser said.
“We have a limited dataset,” Keiser said. “It’s a very small number. From a statistical point of view, your ability to measure that ratio with precision is not as high as when you have 200,000 people.”
There’s also a deficit in other types of information, he said.
“It’s not just infected/not infected, or vaccinated/unvaccinated,” Keiser said. “It’s how many days out from vaccination are you because we know the ability to protect wanes over time. You also need to know the total number days of exposure, and that’s constantly changing every day. You’ve got three moving targets.”
WHAT EXPERTS SAY
A low reinfection rate hasn’t changed public health officials’ stance on whether the unvaccinated and yet-to-be infected should be vaccinated.
“It’s an interesting question because for many diseases natural immunity might be better than vaccine-induced immunity,” Blumberg said.
“For COVID, if you measure the immune response for people who are fully vaccinated, the preponderance of studies find that immune response is stronger, more consistent and longer-lasting following vaccination.”
It’s also not advisable to hope natural immunity will protect you because natural immunity requires getting infected and sick, which carries a risk of serious health repercussions and death, he said.
Among Galveston County residents confirmed with COVID infection since March 2020, 1 in every 33 has been hospitalized and 1 in every 100 has died, according to the health district.
With the vaccines and natural infections, it’s still unknown how long immunity will last. But there’s evidence that vaccines protect better than natural immunity, experts said.
“We know natural immunity is limited,” said Dr. Richard Rupp, the assistant director of the Sealy Center for Vaccine Development at the University of Texas Medical Branch. “Healthy people start getting reinfected as soon as six months after their initial infection. There is a good chance that natural immunity will only protect for three to five years.”
That chance is based on how long natural immunity lasts in people who have caught other types of coronaviruses, such as the common cold.
The virus adversely affects immune systems in ways vaccines don’t, and people who are vaccinated have higher antibody levels than do people who were previously infected, Rupp said.
There also is a potential benefit for previously infected over the vaccinated. When a person is infected, the immune system develops antibodies against more than just the spike proteins, which the Pfizer and Moderna vaccines teach immune systems to copy and train to fight against the real virus.
Theoretically, a natural immunity might be broader and help a body fight against future variations of the virus, Rupp said.
The U.S. Centers for Disease Control and Prevention on its website acknowledges contracting COVID-19 might offer some natural protection, particularly in the first 90 days after infections.
Rupp and the CDC have the same stance on getting vaccinated over hoping to be naturally immune: It’s not worth the risk.
“Each infection carries the risk of myocarditis, blood clots, lung damage, long-haulers and death,” Rupp said. “We tend to only count death, but who really wants blood clots, heart damage, lung damage, prolonged fatigue or brain fog?”
Rupp and Blumberg said there’s one other benefit of vaccination for people who, like Cloud, already have been infected. Getting vaccinated after an infection might provide a super-immunity against the virus because the infection essentially primes a person’s body to receive the vaccine, they said.
But like so many things with the COVID virus, the super-immunity theory is still being studied, Rupp said.
Keiser said Monday about 100,000 county residents might still be vulnerable to infection because they’ve neither been vaccinated nor recovered from infection.