Reaching immunity: A path forward

As we continue on a six-week decline in cases, hospitalizations and deaths across the country, Americans are growing restless, demanding to know when life will resemble some level of pre-COVID-19 normalcy.  

Following the surge that resulted from holiday gatherings, the country is seeing the result of growing immunity and decreased indoor gatherings, witnessing a 73 percent decline in new cases since January. 

This week, the Food and Drug Administration (FDA) granted a third vaccine candidate the emergency use authorization (EUA) to be shipped out to various locales across the country. The single-dose Johnson & Johnson vaccine further adds to the robust vaccine effort with approximately 2 million doses being administered daily and over 82 million doses already given.  

While the magnitude of such efforts is enormous, the current pace would take another six to nine months to vaccinate 70 percent of the U.S. population, the approximate threshold to reach protective “herd” immunity.  

However, the country will reach a level of protection well before then.

Natural immunity will likely reach 55 percent of Americans when documented COVID-19 infections with seroprevalence studies and other modeling are extrapolated. Ultimately, the quickly expanding vaccine-induced immunity adds to the existing natural immunity that has been building since Jan. 21, 2020, when the first U.S. case of COVID-19 was reported. The combination immunity from vaccinations and exposure, some predict, will result in the country reaching protective immunity by sometime late spring, a conclusion not refuted in a recent interview with former FDA Commissioner Scott Gottlieb.

Despite the evidence of growing immunity, our nation’s leaders are slow to adapt and lead the country into this new period of the pandemic. 

During a White House press briefing last week Dr. Anthony Fauci said, “There are things, even if you’re vaccinated, that you’re not going to be able to do in society… For example, indoor dining, theaters, places where people congregate.” He further went on to say that unless the majority of people are vaccinated and viral transmission is “way down,” he continued to recommend mask-wearing because of the continued unknowns about immunity. 

But are these data-driven recommendations or dogma?

Looking forward, we now have two populations: the immune and the non-immune. While there are still questions as to how long immunity will last and if the immune are able to transmit the virus to others, we cannot ignore the evidence in front of us propelling us to move forward as a society. 

A recent study found that natural immunity from SARS-CoV-2 is present eight months after a person is infected. Another study noted that the immune response to COVID-19 is comparable to the original SARS in the early 2000s. Deductive reasoning suggests there may be some level of long-term immunity to SARS-CoV-2 that can last for several years, as occurred with SARS.  

While it’s nearly impossible to confirm long-term immunity from a virus that has only been circulating the globe for a little over a year, we have much more data regarding the ability to transmit the virus after gaining immunity. Viral load is linked to the severity of illness and its transmissibility. Since the vaccines have a 100 percent efficacy in preventing hospitalization and death, it can be deduced the vaccines result in low viral loads if a vaccinated person is still able to carry the virus after exposure. Thus we can assume the transmission risk of a vaccinated person is quite low. Further adding to the optimism about low transmission, early data from Moderna,  AstraZeneca and Johnson & Johnson suggest a level of protection following vaccination against asymptomatic infection. Johnson & Johnson reported a 74 percent reduction of asymptomatic infection at 71 days, giving further credence to the theory of decreased transmission ability. 

Rising immunity points towards emancipation in the next few months as another 2 million people begin developing immunity each day. More Americans have received the vaccine than have been diagnosed with SARS-CoV-2 infection by now.  

Most states have based whether they reopen on percent positivity levels since May 2020. This was after the World Health Organization (WHO) suggested reopening measures begin when the percent positive cases remain below 5 percent for at least two weeks. Fast forward to now, newly reported Johns Hopkins data shows the seven-day average percent positivity in the United States is below 5 percent. Currently over half of the U.S. states are reporting less than 5 percent positivity and soon many more are to follow, yet restrictions remain. 

Closures are becoming anti-science as the number of the people immune expands, so states should look to liberate restrictions on gatherings such as theater, dining, events, among others. While the establishment should always try to maximize outdoor space and promote self-selective masking and distancing, they should not be denied the ability to open if such accommodations do not exist and transmissions levels remain low. 

When individuals with immunity begin gathering together, self-selective masking can suffice to further decrease risk, as there has yet to be conclusive data demonstrating cloth masks to have anywhere near the effectiveness at preventing COVID-19 as seen with immunity. But this should not come in the form of an immunity passport because this may lead to discrimination and equity issues, in addition to the many variables that would render the passports inaccurate. 

While we may see a small rise in cases following spring break, especially as the circulating variants continue to threaten small waves, by May, the majority of the country should remain below 5 percent positivity.  

Cases will continue to rise and fall as the virus undergoes further mutations and the world builds global immunity. Because of this, we will need to modify recommendations based on locale the way Asian cultures have been doing for decades. 

The more people who get vaccinated, the better positioned the country will be.

Nicole Saphier, MD., is an assistant professor at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, Fox News medical contributor and bestselling author of “Make America Healthy Again.”