Immune (food allergy, infection)

Coronavirus lockdown

How long natural immunity to coronavirus COVID-19 lasts, why are we hearing herd immunity doesn’t work & what difficulties have been experienced with past coronavirus vaccine research?

We are in a global lockdown, not knowing how long it will last for. Governments worldwide are preparing for the coronavirus pandemic to last up to 18 months. They expect that once the current suppression phase is relaxed, that the disease will re-emerge and infections will begin to rise again. The coronavirus pandemic is expected to come in multiple waves because, as they describe, a vaccine will be unavailable and natural herd immunity will not have been achieved (1, 2).

Threes modes of action exist. We know them as the do nothing, containment and the delay phase. In the industry they are called mitigation and suppression. The do nothing phase is catastrophic and not an option. Mitigation aims to slow but not necessarily stop the epidemic spread to reduce peak healthcare demand while protecting those most at risk of severe disease from infection. With the modelling showing scientists the virus is increasing exponentially, by moving into a suppression phase, health authorities are looking to reduce R (transmission rate), to close to 1 or below, meaning that each person with the disease can only infect 1 other per day. Suppression aims to reverse epidemic growth and maintain this situation indefinitely.

The major challenge with such rigorous suppression measures is that because the virus will start to spread again once relaxed, suppression measures would need to stay in place for the time until a vaccine becomes available. The time frame for a vaccine is 18 months away and that is a big if, hence the intention is to maintain this current lockdown for 18 months. What is being considered as the best case scenario is after the initial 12 week lockdown we may return to "intermittent social distancing" (2). Everyone is looking to China and South Korea to see if the disease re-emerges after suppression measures have been lifted. On the 16th March 2020 from Imperial College London scientists released coronavirus pandemic modelling which concluded that the UK could face an indefinite period of lockdown without a vaccine, concluding that the UK could be trapped in a coronavirus cycle that could continue for two years to November 2021 stating the only solution is a vaccine but admitting there is no guarantee that a vaccine will work (3).

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Herd immunity is the only option
As bitter a pill as this is seems by many to swallow, artificial immunity is not an option for this current pandemic. The UK government said Britain needs herd immunity to combat the spread of Covid-19 and acknowledged that no vaccine will exist for this current outbreak. Individuals, who are immune to a disease act as a barrier in the spread of disease, to slow or prevent the transmission of disease to others, hence alongside cocooning, can protect the vulnerable. The herd immunity level (HIL) is the percentage at which the disease may no longer persist in the population, putting an end to the pandemic. The UK chief medical officer and Sir Patrick Vallance FRS FMedSci FRCP and Government Chief Scientific Adviser (GCSA), states the herd immunity level for the coronavirus is 60%. The UK government scientists have acknowledge that previous natural exposure to SARS and MERs coronaviruses produce lifelong immunity and that this virus is responding similarly. The UK government are looking to test the population for people who have had the disease, hence have developed lifelong protection to coronavirus to then be able to relax restrictions in those people (4). Essentially what is now playing out is a race between the scientists and Mother Nature to see which protects the herd first.

To learn which countries are more accepting of the inevitably of COVID-19 to overwhelm health systems and the concurrent need to protect the economy read Coronavirus (COVID-19) Countries Adopting Herd Immunity

Natural immunity to coronavirus has been demonstrated
A study published in a 2007 Emerging Infectious Disease Journal on severe acute respiratory syndrome (SARS).(coronavirus is SARS-CoV-2 2019) found on average that patients produced SARS specific antibodies and that these remained in the blood for on average two years, and up to three, suggesting that immunity to the SARS virus may remain for two to three years. Bear in mind the annual influenza vaccine offers protection for only one year (5).

The antibody test
A test is being developed in the UK to test not only if you have coronavirus, but if you have had the coronavirus in which case you have produced antibodies to coronavirus and will be naturally immune for up to three years (6). This test will allow an army of the immune health care workers who have been identified as immune to be able to take the lead in the fight on the ground against the virus with no worry for their safety, even if the shortage of personal protective equipment continues (7).  On April 2nd 2020, the FDA approved the first COVID-19 antibody test, this tests will answers questions such as how many people are asymptomatic, better estimate the death rates and teach us how long natural immunity lasts. An Irish company Assay Genie, is going one step further and has created a coronavirus testing kit which can detect both the virus and antibodies in one drop of blood.

Safety issues with fast-tracking the coronavirus vaccines

Difficulties experienced with past coronavirus vaccine research
Human coronaviruses (HCoVs), include severe acute respiratory syndrome coronavirus (SARS-CoV) with the current COVID-19 (2019-nCoV) also known as SARS-CoV-2 2019 novel coronavirus. The concurrent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak is also a coronavirus, hence a lot is known about previous attempts to produce a coronavirus vaccine (8). Even with previous coronavirus outbreaks, a coronavirus a vaccine does not exist. It may be possible to make as safe and effective coronavirus vaccine but it is sensible in gauging timeframes for a vaccination, to consider past difficulties experienced in coronavirus vaccine research.

Previous coronavirus vaccines have made the disease worse
Past coronavirus vaccines have been shown to carry a risk of what is known as vaccine enhancement, which is where instead of protecting against the infection, the vaccine can makes the disease worse (9). The Dean of the National School of Tropical Medicine at Baylor College of Medicine Dr Peter Hotez, says, “I understand the importance of accelerating timelines for vaccines in general, but from everything I know, this is not the vaccine to be doing it with,” Dr Hotez says that the way to reduce that risk of immune enhancement is to prove that is does not occur in laboratory animals (10). Antibody dependent enhancement (ADE) is a major obstacle in vaccine development. ADE occurs when non-neutralising antibodies are produced after vaccination and these bind specifically to viruses, but do not neutralise the virus. Previous coronavirus vaccines were shown to enhance the infectivity of the infection and aggravate the infection (11, 12).

Bioethics of coronavirus vaccine research
The coronavirus is an RNA virus and the current vaccine is called mRNA-1273 is a collaboration with The National Institute of Allergy and Infectious Diseases (NIAID) scientists and the biotechnology company Moderna, Inc., based in Massachusetts. The vaccine is being developed in the Kaiser Permanente Washington Health Research Institute in Seattle. Researchers are paying participants $1,100 to test the first potential coronavirus vaccine and an additional $100 for each in-person visit. The vaccine is being tested in only 45 healthy people. The vaccine is not being tested against a placebo, the gold standard scientific test, is only being tested on healthy people thus susceptible to healthy vaccinee bias which may lead to an overestimation of vaccine effectiveness and is unable to determine the safety in people on medications, nor has the vaccine been proven in animal trials to establish it is effective and safe (13, 14). In the UK volunteers are being paid £3,500 in be infected with coronavirus in a bid to find a vaccine (15).

Why are we hearing herd immunity is dangerous?
Herd immunity is currently our only strategy and I question whose payroll the scientists are on that dismiss it. In this day and age it is important to understand the psychological manipulation that is used by companies for profit to change our behaviour. No company is exempt from these tactics.

The coronavirus is vaccine is currently being fast-tracked and this is advantageous for vaccine makers. The World Economic Forum (WEF), based in Cologny-Geneva, Switzerland, is an NGO, founded in 1971. The WEF is funded by its 1,000 member companies, typically global enterprises with more than five billion dollars. The Vaccine Alliance Gavi was launched at the WEF Annual Meeting in Davos, with an initial pledge of $750 million from the Bill and Melinda Gates Foundation. Gavi aims to bring together key influencers from the public and private sectors to promote vaccines. In 2018, Gavi partnered with the WEF’s Centre for the Fourth Industrial Revolution, a collaboration aimed to maximise emerging technologies to accelerate Gavi’s vaccination initiatives globally (16).

Although vaccine developers usually test on animals before humans, there are no laws saying they must. In global response to the new coronavirus, The World Health Organisation (WHO) and scientists representing government-funded research organisations and pharmaceutical companies have agreed that the threat from coronavirus is so great that vaccine developers should move quickly into human trials, before animal testing is completed. Disregarding the fact participants are getting paid to partake in the trial, ethicists aren't so positive that the eventual benefits of rushing this unproven vaccine into clinical trials will outweigh the risks. In this case the Trump described this relaxation of FDA regulations today as “cutting the red tape”. Moderna, the company producing the vaccine, describes the relaxation as “good news for vaccine makers” (17). Pre-COVID-19 the European Pharmaceutical Market is projected to be worth 43.7 billon USD per year by 2020 and the African Pharmaceuticals Market forecast for 2020 is projected to be even greater at 45 billion USD (18, 19).

The American Centre for Disease Control announced a seven-step recipe on how to use the media to generate interest in, and demand for, flu (or any other) vaccination at the conference "Getting Ready for 2004-2005: Lessons (Re-) Learned [Including the Seven-Step Recipe for Generating Interest in, and Demand for, Flu (or any other) Vaccination]

The Recipe includes;
• Statements of alarm by medical experts and public health authorities
• Prediction of dire outcomes from influenza (or any other disease) 
• Continued reports influenza (or any other disease) causing severe illness affecting lots of people
• Repeated urging of influenza (or any other disease) vaccination (20)

Many experts continue to report that herd immunity is a dangerous strategy and that getting the disease will not guarantee immunity. There are degrees of truth to these statements. The world  is at great risk from COVID-19 and scientists globally are making speculative decisions which we can see are contrary. The truth is, that the results of these decisions will only be known as the pandemic plays out. In addition, the amount of immunity that you build up after being exposed to any virus depends on the strength of your own immune system, this may also apply to artificial immunity through vaccination.

Reasons for vaccine failure
Two reasons exist causing vaccines to fail, these are known as primary and secondary vaccine failure. Primary vaccine failure is defined as the failure to mount a protective immune response (failure to produce antibodies) after vaccination, whereas secondary vaccine failure describes when vaccine effectiveness wanes and the disease re-emerges (21). Primary vaccine failure may occurs for reasons including age, obesity and exposure to persistent organic pollutants (POPs). It must be noted again in turn that our natural immune system may also be less likely to amount an immune response for similar reasons. Vaccine failure in the elderly is termed immunosenescence (22). Primary vaccine failure has been demonstrated in obese individuals. Obesity adversely affects the immune system and data suggests that obesity increases the likelihood of a poor vaccine-induced immune response (23). Primary vaccine failure occurs in approximately 2–10% of healthy individuals who simply fail to mount an antibody response to routine vaccines (24). Primary vaccine failure has also been observed in children exposed to persistent organic pollutants (POPs) (25). A number of persistent organic pollutants (POPs) are detected at high concentrations in blood samples of the United States population, with more than one tenth of the US population having POPs at concentrations in the top 10 % (26). A genetic basis has also been indicated in primary vaccine failure (27).

The consequences of lockdown on our liberty
The BBC news reported on the 19th March that Belgium are fining its citizens found exercising €3000 to 4 months in jail for breaching lockdown laws. Australia has introduced $50,000 fines to six months’ jail, with states and territories have different penalties for breaching the 14-day quarantine self isolation rules (28). On March 20th reports arose that the German province of Bavaria is fining its citizens €25,000 for non compliance of social isolation laws. French police alone handed out over 4,000 fines of between €135 up to €375 on one Wednesday only (28). A new low was reached On the 28th March with the French police handing out the same fines to the homeless (29). Britons have been urged to inform on the neighbours (30). India's strict lockdown of 1.3 billion people is forcing migrant workers facing hunger to walk home (31). Rubber bullets are being used against shoppers South Africa (32). Irish boxer Connor McGregor made calls for the military to help enforce Ireland's coronavirus lockdown on his fellow citizens (33). Batons and tear gas were used on Kenyans queuing for ferries (34).

Public health law should be considered, necessary and proportionate. As a libertarian I can never agree with lockdown measures that infringe rights and place the lives of the poor and vulnerable at risk. I can never agree with police brutality and martial law. I can never agree with humanity being made to fear one another as I see in people pulling their masks up around my children . I believe we should be looking at countries adopting a proportionate, libertarian approach and measuring how they are doing, rather than dismissing them as irresponsible. We are better than this. The humane strategy is the strategy Mother Nature has provided to keep us on this planet for the last 200,000 years, the strategy of shielding the sick and old and allowing the healthy to do our job and act as hosts to the virus until the herd immunity level is achieved and the herd is protected.

1. Christina Maxouris C. US government is preparing for coronavirus pandemic that could last up to 18 months and 'include multiple waves of illness' 2020 [
2. Forum WWE. 3 charts that helped change coronavirus policy in the UK and US. 2020.
3. Lintern S. Coronavirus: World holds its breath and looks to China for clues on what pandemic does next. The Independent. 2020 Mar 18.
4. Desk N. Coronavirus may become an annual event, says Government’s chief scientific officer. The Global Herald 2020 Mar 13.
5. Wu L-P, Wang N-C, Chang Y-H, Tian X-Y, Na D-Y, Zhang L-Y, et al. Duration of antibody responses after severe acute respiratory syndrome. Emerging infectious diseases. 2007;13(10):1562-4.
6. Johnston L. Coronavirus breakthrough: £1 test could be game-changer as outbreak grips UK. The Express. 2020 Mar
7. Daly M. Can New Test Help Build an Army of Immune Medical Workers? Daily Beast. 2020 March.
8. Zhou Y, Hou Y, Shen J, Huang Y, Martin W, Cheng F. Network-based drug repurposing for novel coronavirus 2019-nCoV/SARS-CoV-2. Cell Discovery. 2020;6(1):14.
9. Bolles M, Deming D, Long K, Agnihothram S, Whitmore A, Ferris M, et al. A double-inactivated severe acute respiratory syndrome coronavirus vaccine provides incomplete protection in mice and induces increased eosinophilic proinflammatory pulmonary response upon challenge. Journal of virology. 2011;85(23):12201-15.
10. Steenhuysen J. As pressure for coronavirus vaccine mounts, scientists debate risks of accelerated testing. Reuters 2020.
11. Smatti MK, Al Thani AA, Yassine HM. Viral-Induced Enhanced Disease Illness. Frontiers in microbiology. 2018;9:2991-.
12. Yip MS, Leung NH, Cheung CY, Li PH, Lee HH, Daeron M, et al. Antibody-dependent infection of human macrophages by severe acute respiratory syndrome coronavirus. Virology journal. 2014;11:82.
13. Dunne A. You could get paid $1,100 to test the first potential coronavirus vaccine: Business Insider; 2020 Mar 
14. Remschmidt C, Wichmann O, Harder T. Frequency and impact of confounding by indication and healthy vaccinee bias in observational studies assessing influenza vaccine effectiveness: a systematic review. BMC Infect Dis. 2015;15(1):429.
15. Mullin G. Viral Load Volunteers to be infected with coronavirus for £3,500 in bid to find vaccine. The Sun 2020 Mar 09.
16. (WEF) WEF. Vaccine Alliance launched at Davos celebrates 20 years, saves 13 million lives 2020 
17. Boodman E. Researchers rush to test coronavirus vaccine in people without knowing how well it works in animals. The Stat. 2020 Mar 11.
18. Portal TS. Value of selected medical pharmaceutical markets in Europe in 2015 and forecast 2022 (in billion euro) [Internet]. 2018 
19. Newsire CP. African Pharmaceuticals Market, Forecast to 2020 Assessing Market Potential with a Focus on Kenya and Nigeria 2018
20. CDC GNAdMR. Increasing Awareness and Uptake of Influenza Vaccine "Getting Ready for 2004-2005: Lessons (Re-) Learned [Including the Seven-Step Recipe for Generating Interest in, and Demand for, Flu (or any other) Vaccination]2004.
21. Bonanni P, Gershon A, Gershon M, Kulcsár A, Papaevangelou V, Rentier B, et al. Primary versus secondary failure after varicella vaccination: implications for interval between 2 doses. The Pediatric infectious disease journal. 2013;32(7):e305-e13.
22. Grubeck-Loebenstein B, Della Bella S, Iorio AM, Michel j-p, Pawelec G, Solana R. Immunosenescence and vaccine failure in the elderly. Aging clinical and experimental research. 2009;21:201-9.
23. Painter SD, Ovsyannikova IG, Poland GA. The weight of obesity on the human immune response to vaccination. Vaccine. 2015;33(36):4422-9.
24. Wiedermann U, Garner-Spitzer E, Wagner A. Primary vaccine failure to routine vaccines: Why and what to do? Human vaccines & immunotherapeutics. 2016;12(1):239-43.
25. Granum B, Haug LS, Namork E, Stølevik SB, Thomsen C, Aaberge IS, et al. Pre-natal exposure to perfluoroalkyl substances may be associated with altered vaccine antibody levels and immune-related health outcomes in early childhood. Journal of Immunotoxicology. 2013;10(4):373-9.
26. Pumarega J, Gasull M, Lee D-H, López T, Porta M. Number of Persistent Organic Pollutants Detected at High Concentrations in Blood Samples of the United States Population. PLOS ONE. 2016;11(8):e0160432.
27. Jacobson RM, Poland GA. The genetic basis for measles vaccine failure. Acta paediatrica (Oslo, Norway : 1992) Supplement. 2004;93(445):43-6; discussion 6-7.
28. Wahlquist C. Police have fined 20,000 people in four days for not complying with the rules. The Gardian. 2020 Mar 19.
29. Brock P. Coronavirus: France's homeless 'fined for not staying indoors' during COVID-19 lockdown Euronews. 2020 Mar 20
30. Wright J. Britons urged to Snitch on their Neighbours. The Mail Online. 2020 28th
31. Bisht A. Chaos and hunger amid India coronavirus lockdown: Aljazeera News; 2020 Mar 27 [
32. Burke J. South African police fire rubber bullets at shoppers amid lockdown. The Gardian. 2020 Mar 28.
33. McGregor C. Conor McGregor calls on military to help enforce Ireland's coronavirus lockdown. The Gardian. 2020 Mar 28
34. News A. Kenya police under fire over 'excessive force' as curfew begins 2020 Mar 28

 

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