Question to Dr. X: Is Dr. Vanden Bossche right about Omicron?
A scientific debate between Dr. X and Dr. G. Vanden Bossche about the article referred to in the link below.
Dr. X:
In my opinion, a worry but probably not. Before omicron there had been 50 million registered cases, probably at least 100 million in total counting asymptomatic. From December 1 to now, another 30 million registered cases, and 90 million asymptomatic ones. So more than 200 million Americans have had Covid. Probably 200 million have been vaccinated. Even though the vax efficacy is now low, it is still true that about 2/3 of the population has immunity, at least. This is reflected in the quite rapid peak and drop of the daily case numbers (see further below). Why did the omicron count peak on January 10? Omicron growth started in early-mid December, before the holidays. No sudden effective mass vaccination, no mass lockdown on January 10--no temporal event corresponds to this dramatic change then. What changed was the buildup of effective population immunity.
Given this large amount of population immunity, I am less concerned that much of anything will happen until an omicron-derived progeny strain begins to evade existing immunity. New cases have been declining strongly and thus will provide only a limited endemic resource for the development of strains that evade natural immunity, until population mixing conditions change to enhance interpersonal transfer, as occurs with school openings in fall seasons. We may see a fall-winter wave, but my expectation is that it will probably be like other fall respiratory illnesses. And now we know that it can be mitigated with good vitamin D intake and if need be treated with HCQ and other medications. Maybe other of the seasonal respiratory viruses will be amenable to that approach also.
Reply from Dr. G. Vanden Bossche:
Thanks for sharing your perspective.
Regardless of any predictions made, I would be interested in learning how asymptomatic cases are ‘diagnosed’ in the US. I would be interested in learning about the criteria defining an asymptomatic case. There can be no doubt, though, that many (most?) of Omicron infections are, indeed, asymptomatic and that a large part of the population is dealing with the virus without developing clinically significant symptoms. However, it’s important to distinguish between the effect of trained innate immunity and vaccine-induced immunity (VII). Whereas the former is beneficial to clearing the virus (and hence, contributing to reducing transmission and building herd immunity), the latter is having exactly the opposite effect. So, one shouldn’t count on VII when it comes to assessing the level of population immunity towards Omicron. It’s my understanding that VII is even interfering with the innate immune defense in that it suppresses training of the innate immune system (the current situation would compare to vaccinating somebody with a recombinant protein vaccine and live attenuated vaccine at the same time). I believe that this is why we’re currently seeing more disease (although not severe!) in the vaccinated as compared to the non-vaccinated part of the population. I also think that the predictions I am making become the more likely, the more we’re going to vaccinate younger age groups, especially children, for their innate Abs have lower affinity (and hence, cover a more diversified spectrum of self-like antigens such as those expressed on a number of glycosylated enveloped viruses). In addition, large scale vaccine booster campaigns and natural boosters (due to circulating Omicron) in vaccinated people could significantly contribute to dampening binding of innate B1a-derived IgM because of titers of non-functional anti-S Abs that are ‘abnormally’ high (due to antigenic sin, boosters primarily recall anti- Wuhan S Abs).
So, it may still take some more time before these effects come to bear at a population level. Last, it’s also important to realize that a single ‘pocket’ of high anti-Omicron seropositivity (due to multiple vaccine breakthrough cases resulting in disease) can be sufficient to entail natural selection of the type of variant I’ve been describing. Once that natural selection has taken place, it would be easy for this variant to become highly virulent in all subjects whose innate immune response is naïve or compromised. It would simply compare to a highly contagious virus like measles hitting a population that has no acquired and no trained innate immunity or whose innate immunity is compromised.
IMO, high immune pressure due to a ’local’ surge in disease cases (e.g., in areas of high population density and poor hygiene such as favellas, slums etc) may have contributed to natural selection of previous variants (e.g., beta, gamma, delta). So, whenever you end up with pockets of high immune pressure on viral infectiousness, regardless of the cause for enhanced susceptibility to disease, natural selection of highly infectious variants can take place. The highest form of infectiousness is reached in case the virus manages to strongly bind non-functional Abs as this phenomenon will lead to suppression of Abs produced by innate immune effector cells while also enhancing antibody-dependent viral entry. That is to say that the virus now becomes highly virulent and simply blows through the first line of immune defense in all those having high titers of non-functional Abs. This would not apply to those who’ve acquired such Abs upon recovery of natural disease as their innate immunity has been thoroughly trained, precisely as a result of the previous productive viral infection.
The (near) future will tell us the truth about all this. Anyway, I think my concerns are sufficiently substantiated to be highly alarming and calling for immediate action, particularly in countries with high vaccine coverage rates.
Reply from Dr. X:
I guess so. My thinking is parallel to yours. But delta came out of Brazil where it had a long endemic evolution in overcrowded slum environments rather than a sudden development from high selection pressure. I think it is worth keeping an eye on what you are warning about, and I am also 100% against vaccines for normal children and young adults, but even in Brazil omicron is disappearing and nothing new has started up (yet).
Reply from Dr. G. Vanden Bossche:
Overcrowding leads to high infection rates and to higher incidence of disease and hence, to higher immune pressure and natural selection of viral variants; however, it’s only when you generate population-level immune pressure (e.g., as result of mass vax) that naturally selected, more infectious variants will expand in prevalence (i.e., become dominant). We have already seen case rates dramatically decline just to give rise to yet another huge surge ( e.g.,Israël) as it may take the naturally selected variant some time to adapt to the population (i.e. to cross the fitness valley). But I am even predicting that in countries/ regions with high vaccine coverage rates, the number of Omicron cases will only decline temporarily and down to a level that is still far above the baseline. When it levels off, it’s basically just a matter of weeks before the new variant is fit enough to break through. Unless one can cut the chain of transmission, it’s difficult to imagine how one could prevent this virus from evolving on a background of sustained/ renewed immune pressure. IMO, the ´wait and see ´ attitude is a very risky one. I am even afraid that any compromise allowing vaccinations to continue to some extent will merely throw more petrol on the fire..Of course, given the current situation and the history of previous pandemics, I fully understand and accept that my assesment is considered highly questionable.
Reply from Dr. X:
You may be right, no countries are quite down to zero daily cases yet. US cases are dropping by 1/3 per week so it will take 6-8 weeks to get down to negligible numbers at the current rate. Canada is dropping by 26% per week and Israel by 29% per week, so they will take a little longer. That's the time frame to watch to see how much stays endemic. I would observe though that delta is essentially gone, that the buildup of immunity from omicron was enough to subdue delta in both highly-vaccinated and poorly-vaccinated populations.
I continue to argue that vaccinating children serves no beneficial purpose and puts them at risk. We have plausibility to say that omicron is cold- or flu-like and that it is going away on its own, thus no reason to vaccinate children. This message can resonate with people and we can get better mileage from this than from a more complicated argument about longer-term damage.
Reply from Dr. G. Vanden Bossche:
That delta almost disappeared is not due to immunity from omicron (as naturally induced population-immunity comes after viral dominance and not the other way around) but simply due to a competitive replication advantage of omicron. One could basically mimic this in cell culture by passaging a mixture of 2 viruses with different intrinsic infectiousness. After a few passages, one will end up with a supernatant that exclusively consists of the more infectious virus.
Unless innate immunity is restored in the majority of the population, one won’t see daily cases going down to zero. IMO, (natural or vaccine-mediated) boosting of vaccinal Abs is going to compromise innate immunity in vaccinees. So, part of the capacity that got restored thanks to Omicron’s resistance to neutralizing anti-S Abs will soon get lost due to high titers of non-neutralizing Abs that still bind with sufficient affinity to the virus to suppress binding of innate CoV-reactive Abs.
Staying tuned on the curves will help us to determine who’s wrong and who’s right, but unfortunately it won’t be changing the course of the pandemic. I agree that omicron will be going away on its own… but not without being replaced by yet another immune escape variant. As already mentioned, I am in deep fear that the latter will be able to not only break through acquired immunity (like Omicron) but also through the vaccinees’ first (innate) line of immune defense.
We have to make sure that we’re using the right argument to counter this madness. I am not sure that the ‘mildness’ of Omicron is the right argument. It’s an easy one but I’ve only recently learned about the ease with which experts in academia reject this argument (not sure you watched the video S. Kirsch recently shared; in the last 5 minutes, Dr Maldonado emphasized how important it is to vaccinate children in terms of prevention of infectious cases:
I would be especially interested in learning about the number of cases in young children (e.g., 6M-2y; 6M-5y). I would not be surprised that it is not insignificant. Do we have those numbers? Young children have high innate immune capacity but their innate immune effector cells are very immature/ naïve so they can easily be outcompeted by short-lived, low-affinity anti-S Abs they previously acquired upon asymptomatic infection. This could pose a problem in case of rapid re-exposure (which is likely to happen in case of a high infection rate). A relatively high incidence of cases in this age group (=?) might explain why PH authorities and their advisers (e.g., Dr Maldonado) are so motivated to get the children vaccinated. But again, I would love to see those figures as they may get diluted when counting all cases in the 0-18 y old age group.
I continue to argue that the biggest threat is the high infectivity rate that will (indirectly) lead to continued immune escape. I hope I am wrong and that the infectivity rate will spontaneously drop so that we can claim herd immunity. However, this would entirely go against my understanding of how the virus evolves in a massively vaccinated human population. If I were in charge, I would definitely opt for a mass antiviral chemopropylaxis program in highly vaccinated countries. That mass vax drives expansion of highly infectious SC-2 variants can no longer be denied, on the contrary (one of the more recent publications on this topic: https://pubs.acs.org/doi/10.1021/acsinfecdis.1c00557). Dramatic consequences of immune escape would not be limited to certain age groups. And they won’t take much time to manifest (remember how it took only very few months for dominant Delta to turn into dominant Omicron, a variant which is very different from any previous variant!).
When I see what’s happening in Canada, I am even more of the opinion that we need to come with arguments that truly point to the imminent risk the mass vaccination program poses to all of humanity. The power of the alliance we’re up against is just indescribably immense….
Of course, I do understand your pragmatic perspective, it’s just that I am afraid it will be too easy to counter, now and in the near future.
Reply from Dr. X:
Cases in young children are highly asymptomatic so real case numbers are not knowable. There may be some data on symptomatic cases, but during omicron with the advent of home testing, those numbers won't be accurate either.
As far as I understand, children are not the main vectors and much more often get infected from older household members than the other way around. And for omicron, it doesn't really make a difference because it is cold-like in them. Thus I see no motivation to damage children by vaccinating them that has no potential benefit. Maldonado is wrong because cases are not the metric of the omicron wave. Hospitalizations and mortality, not cases.
I understand the competition issue, but you have to address why both delta and omicron have been declining, with no apparent intervention substantial enough to cause that. The only mechanism that I can see is herd immunity--they have saturated their marketplaces.
Reply from Dr. G. Vanden Bossche:
Below are the number of cases as reported by age group (week 47-50, so this is omicron; UKHSA)
The number of cases in the age group under 18 is still pretty high (of course, data are biased due to a number of confounders but these are the data that are officially reported). This is what may motivate Maldonado and others to vaccinate children. However, vaccinating children and boosting vaccinees is what is in my opinion going to be very problematic in terms of causing more cases of disease and, therefore, peaks of high anti-S seropositivity.
In my previous email, I explained that the decline in infectious delta cases is simply due to a competitive replication advantage of omicron in the current context of immune pressure exerted by the majority of the population (i.e., the vaccinated). Omicron peaks are now waning due to resistance of Omicron to vaccinal Abs. This allows innate Abs produced by IgM-secreting plasma cells to regain full functionality and enable elimination of virus-infected cells. This, indeed, contributes to herd immunity (as it always does after a peak of infection has been reached). The point I am making is that this sterilizing immunity conferred by this first line of immune defense will not suffice to establish herd immunity (‘too little, too late’!) This is because anti-S Ab titers in previously primed vaccinees will rapidly rise as a result of natural boosts (by circulating Omicron) and continued mass vaccination. The recalled Abs (directed at Wuhan-S spike!) cannot neutralize Omicron but may still be able to attach to the virus and thereby dampen the vaccinee’s protective innate immune capacity. IMO, this will soon prevent Omicron from strengthening herd immunity as peaks of disease and seropositivity in the vaccinated population will cause more and more S-directed immune pressure on Omicron. So, we cannot rely on Omicron for generating herd immunity. We need to massively implement antiviral chemoprophylaxis in highly vaccinated countries.
Of course, the conclusion is always to stop mass vaccination instead of extending it to additional age groups (i.e., children)….
Reply from Dr. X:
Here's updated info attached (table 13, p44; the highest ages now similar to middle ages which vaxxed are now 3x unvaxxed).
I am not convinced that "Omicron peaks are now waning due to resistance of Omicron to vaccinal Abs." Vaccinal Abs would have been higher in December than January but omicron was increasing in December.
Dr. G. Vanden Bossche:
The higher the vaccinal Abs, the more the innate immune capacity is suppressed and hence, the lower the beneficial impact of Omicron’s resistance to vaccinal Abs on reducing transmission of a highly infectious variant. Reduction of viral transmission should, therefore, become more apparent when vaccinal Abs wane. I guess that’s what happened in January and resulted in improved viral clearance.
Dr. X:
The vax Abs have been moderate at best against omicron.
Dr. G. Vanden Bossche:
Vaccinal Abs have, indeed, no neutralizing activity towards Omicron. However, non-neutralizing Abs can still attach (with lower affinity) to antigenic sites within the N-terminal domain
Dr. X:
I think it is more likely that omicron in its very widespread asymptomatic and weakly symptomatic infections generated its own herd immunity in the context of the combined pre-omicron infection- and vaccine-based immunities.
Dr. G. Vanden Bossche:
Herd immunity implies dramatic reduction in viral transmission. This can only happen by sterilizing immunity. It’s not possible that pre-omicron immunity acquired upon recovery from disease caused by delta generated sterilizing immunity towards Omicron in the vast majority of the population, which is vaccinated. In addition, it is clear that vaccine-induced immunity does not confer sterilizing immunity and, therefore, cannot contribute to herd immunity either. Furthermore, if the mild course of omicron would not be related to immune control, very relevant changes in genes responsible for intrinsic virulence of the virus would have been reported. As this is not the case*, only diminished suppression of CoV-reactive Abs produced by innate effector cells can explain its mildness and why cases start to decline when titers of vaccinal Abs wane.
*Meanwhile, I'm actually still skeptical about Omicron's alleged mildness. There are several recent reports that seem to contradict that claim - e.g., deaths are apparently still increasing in S. Africa:
Big spike in hospitalized children in the UK
and this is what I read this couple of days ago in the NYTimes:
https://www.nytimes.com/interactive/2022/01/09/us/omicron-cities-cases-hospitals.html
Dr. X:
Vax immunity contributed a little, post-Covid immunity also contributed, but the huge omicron spread was determinative.
Dr. G. Vanden Bossche:
Huge omicron spread will lead more rapidly to a surge in S(omicron)-directed immune pressure than it will actually generate sufficient innate immune capacity in vaccinees. That’s why I am seriously worried about the current situation (‘the calm before the storm’?).
Dr. X:
The main question is to explain why the same UK thing is not being seen in the under-18s. Perhaps it is that the vaccines actually work to reduce symptomatic infection in those ages--even though that is unimportant for their health, and maybe counterproductive for dealing with future strains.
Dr. G. Vanden Bossche:
I tend to agree with your analysis: Especially in children innate Abs are known to be largely untrained (and hence, only having low affinity); vaccinal Abs could, therefore, more strongly bind to SC-2 (no competition whatsoever from innate Abs); this could explain a relatively stronger protection from symptoms in this younger age group. On the other hand, transient, low affinity anti-S Abs titers that result from previous asymptomatic infection in unvaccinated children would have a relatively stronger suppressive effect on naïve innate Abs and, therefore, make unvaccinated children more susceptible to disease upon re-exposure to the virus. Again, the solution is not to vaccinate these children but to reduce the infection rate in the population. That’s at least what I would strongly recommend.
Reply from Dr. X:
One problem is if you can explain an observation in opposite ways (antibodies doing the job, or not doing it but T-cells doing it, etc.) then the explanation has little explanatory power.
Dr. G. Vanden Bossche:
I am not sure I understand what this means
Dr. X:
Maybe it's my immunology naivete, but it seems to me that the balance of neutralizing vs non-neutralizing antibody effects etc. are difficult to make definitive statements about before the actual events happen.
Dr. G. Vanden Bossche:
In that case, I am always trying to educate myself on new insights people acquire on these matters in an attempt to better understand the immune pathogenesis as it evolves as a result of the evolutionary dynamics of the pandemic
https://www.journalofinfection.com/article/S0163-4453(21)00392-3/fulltext (in French: https://bit.ly/3h7WDVM)
Dr. X:
I want to see how the theories actually pan out in the population behaviors.
Dr. G. Vanden Bossche:
I understand the typical scientific behavior but also found that conventional epidemiology may come too late when it comes to preventing disasters. Molecular epidemiologists have made alarming predictions already a long time ago but - for some reason – they’ve kept silent, which – of course – isn’t very helpful either:
Dr. X:
If we do get a rebound massive wave after omicron, we will be in deep doodoo, because we really have nothing to use except HCQ, IVM etc. that have so much resistance.
Dr. G. Vanden Bossche:
That’s exactly why we need to turn the tide, not just attempt to mitigate it as it won’t suffice
Dr. X:
South Africa peaked December 15 and is still declining with no evidence of something new occurring, so maybe we will be lucky.
Dr. G. Vanden Bossche:
The numbers are far from reaching the original baseline; from what I can see the virus has now started to cross the ‘fitness valley’. Haven’t we seen this before (Israel etc.)?
Reply from Dr. X (cont’nd):
...It is estimated that over 85% of all children aged 5 to 11 will have had prior SARS-CoV-2 infection by the end of January 2022 (reference 5), with roughly half of these infections due to the Omicron variant. Natural immunity arising from prior infection will contribute towards protection against future infection and severe disease.
Reply from Dr. G. Vanden Bossche:
I guess I’ve seen too many predictions based on poor understanding of the vibrant dynamics of both the virus and the immune system during a pandemic. All of the models used thus far have wrong. That herd immunity cannot be reached in the presence of high infection rates has already been shown by the Manaus case (2020-2021; 2 major peaks within 6 months).
It doesn’t matter whether high infection rates are caused by overcrowding combined with poor hygiene (favellas) or by dominant circulation of a highly infectious variant combined with suppressed innate immune defense. As long as infection rates are high (even when declining), serum anti-SC-2 antibody titers are unlikely to serve as a correlate of individual protection or as a metric for herd immunity. It all comes down to what is defined as ‘natural immunity’. Most people think natural immunity can be assessed by measuring post-infection anti-SC-2 Ab titers. I continue to argue that what counts most is innate immunity. IMO, lack of understanding of what is triggering innate immune training in the unvaccinated on one hand and what’s causing suppression of innate immune protection in vaccinees on the other, is where we may lose this battle.
Reply from Dr. X:
How does innate immunity change over the course of an epidemic wave. Something is changing that flips the spread from increasing to decreasing. The classic model has been the relative exhaustion of susceptibles vs the force of transmission.
Reply from Dr. G. Vanden Bossche:
That’s exactly what ‘training’ does (via epigenetic changes that enable reprogramming of innate immune effector cells). However, Abs that specifically bind to SC-2, even though no longer able to neutralize the virus, have exactly the opposite effect. Prof. Fantini (see links I fwd’ed in previous email) explains how Abs that are directed at the N-terminal domain of S (so not at the neutralizing antigenic sites within RBD) bind to the N-terminal part of S via multivalent interactions. This is exactly the same mechanism used by innate Abs for binding to the surface of the virus. As binding of both types of Abs is, therefore, determined by their avidity, they can mutually compete for binding to SC-2.
You can use the keyword ‘training’ in the following article (published on TSNews) to learn more about training of innate immune cells:
Below follows an excerpt from my answers to the Qs raised during a recent parliamentary hearing; it is also dealing with innate immune training:
“Q: What do you think is the difference between the natural immunity that will work in the long run and the vaccines?
A: In contrast to immunity induced by C-19 vaccines, in natural SC-2 infection effector cells of the innate immune system are stimulated (e.g. B1a cells and NK cells). These alone may be sufficient to eliminate the virus and consequently make the infection symptomless or at most mild: https://pubmed.ncbi.nlm.nih.gov/33391280/ : 'Different Innate and Adaptive Immune Responses to SARS-CoV-2 Infection of Asymptomatic, Mild, and Severe Cases'
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7202830/: ‘The immune system of children: the key to understanding SARS-CoV-2 susceptibility?’
B1a cells produce polyreactive IgM that play a key role in containing the virus in the early stages of infection. This has been demonstrated in several publications -see literature in the link above: https://www.voiceforscienceandsolidarity.org/scientific-blog/why-the-ongoing-mass-vaccination-experiment-drives-a-rapid-evolutionary-response-of-sars-cov-2 as well as: https://pubmed.ncbi.nlm.nih.gov/15633017/ : 'Inherent specificities in natural antibodies: a key to immune defense against pathogen invasion') for, among others, another enveloped and glycosylated respiratory virus (i.e. Influenza) that, like SC-2, causes an acute infection that comes to a standstill itself ('acute, self-limiting'). The pathogen exposure-induced training and adaptation of these IgM-producing cells to more antigen-specific IgM memory B cells has so far not been investigated very much: (https://www.frontiersin.org/articles/10.3389/fimmu.2020.595535/full : ‘Immunoglobulin M in Health and Diseases: How Far Have We Come and What Next?’). However, it is likely that, just as has been demonstrated for NK cells and for other mediators of the innate immune system, innate B1a cells also undergo such reprogramming and fine-tuning (i.e., 'training'): ‘The cellular basis of trained immunity and heterologous protection against secondary infections resides in the functional reprogramming of innate immune cells, which were first observed in invertebrates.’ In: Trained Innate Immunity, Epigenetics, and Covid-19; https://www.nejm.org/doi/full/10.1056/NEJMcibr2011679. And so, the advantage of natural SC-2 infection lies mainly in the training and acquisition of a kind of memory by the innate immune system that is thereby able to control and eliminate SC-2 variants (!) with ever-increasing efficiency in the future. Vaccine antibodies have a much higher affinity for SC-2 than innate polyreactive antibodies (the difference in binding mechanism is also described under: https://www.voiceforscienceandsolidarity.org/scientific-blog/why-the-ongoing-mass-vaccination-experiment-drives-a-rapid-evolutionary-response-of-sars-cov-2). Based on their high affinity, antigen (Ag)-specific vaccine antibodies therefore offer an advantage when the virus to be controlled can be recognized clearly by those antibodies. However, this is not the case with current C-19 vaccines because they are directed against an S(pike) protein that is increasingly different from that of the circulating variants. As a result, these antibodies are barely functional, while inborn antibodies, which, because of their multispecific nature, could recognize and eliminate these variants (in synergy with NK cells), are sidelined.
Apart from the advantage of training the innate immune system, natural infection - in contrast to vaccination - avoids immune escape because the peak of the virus load is already eliminated before antibodies are generated (thanks to the innate immune system). In this way, the antibodies do not put the virus under immune pressure whereas this is the case when people are vaccinated in the middle of a pandemic and build up antibodies while they are under full siege by the virus (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250780; https://pubmed.ncbi.nlm.nih.gov/15633017/).
The effect of natural SC-2 infection is therefore - even independent of the better quality and diversity of the antibodies generated - clearly more efficient and stable than that of vaccine-induced immunity (i.e., because of sterilizing immunity, training of innate cellular immunity and low risk of immune escape). This may also explain why natural immunity achieves a more sustained and stronger protection against SC-2 than vaccine-induced immunity (see links below), even after administration of a booster (and even after a third dose, protection against severe C-19 disease seems only short-lived). Even CDC has since conceded the superiority of natural immunity (see top of next links):
https://childrenshealthdefense.org/defender/cdc-natural-immunity-trumps-vaccine-immunity/
https://bit.ly/34SzPqJ
https://thepulse.one/2021/11/23/130-research-studies-affirming-the-power-of-natural-immunity-to-covid/
https://brownstone.org/articles/79-research-studies-affirm-naturally-acquired-immunity-to-covid-19-documented-linked-and-quoted/
https://www.nature.com/articles/d41586-021-01557-z
https://www.sciencedirect.com/science/article/pii/S2352396421002036
Meanwhile, it has also been shown that there is sufficient reason to believe that even after mild natural infection, robust, long-term protection against SC-2 can be induced, and this even at very low serum concentrations of acquired, antigen (S)-specific antibodies. And so, again, this study points to the ‘hidden’ protective power of natural SC-2 infection: https://www.nature.com/articles/s41586-021-03647-4.pdf ”
You’re absolutely right: something is flipping the equation upside down and that ‘something’ which leads to ‘relative exhaustion of susceptibles’ is the innate immune response, not the acquired Abs. The latter correlate well with protection when induced in a prophylactic way, but not when induced while the population is fully under attack from the virus (i.e., during a pandemic).
During a pandemic, naturally acquired Abs do neither serve as a correlate of protection nor as a metric for assessing the level of herd immunity. That is why I am always saying that the effectiveness of the vaccine when used in the middle of a pandemic is fundamentally different from the vaccine efficacy as determined in clinical studies. Shifting viral infectiousness and, therefore, viral infection rates and fueling thereof by population-level immune pressure leads to diminished vaccine effectiveness and erodes the vaccinees’ innate immunity whereas repeated exposure to several different variants and lack of competition from vaccinal Abs is what strengthens the innate immune response of the non-vaccinated…. No wonder that vaccine effectiveness now turns out be negative…..Food for thought…?
Reply from Dr. X:
Ok, I'll think about it. Thanks, great discussion—
Reply from Dr. G. Vanden Bossche:
Great. Thanks for all your patience.
Now this is a great example of a scientific discussion. Many thanks for sharing.
This is EXACTLY what the humans of earth have been denied during this. A respectful back and forth discussion on science and educated opinions. Thank you both for doing that.
Dr X I have to do a review of what I just read but it doesnt matter if I agree with you or Dr. Geert. Thank you for being a professional and I respect that.