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October 9 — Here is an FAQ answering this question and other questions The Day has heard recently.
What natural immunity to COVID-19 do people get from a previous infection, and why can’t natural immunity be used to opt out of vaccine and testing warrants?
Doctors and researchers generally agree that people who have already been infected with COVID-19 and who have also been vaccinated are the most protected. But science is still evolving on the degree of immunity conferred by a previous infection – which may depend on the severity of the infection and the variant of the coronavirus circulating – and the duration of protection.
“It has been very difficult to determine how the vaccine and natural immunity compare,” said Dr. Shira Doron of Tufts Medical Center at NBC10 Boston last month. Centers for Disease Control and Prevention spokeswoman Kristen Nordlund recently told NBC News: “We hope to have additional information on protecting vaccine immunity over natural immunity in the coming weeks. “
In a study published on August 6, the CDC looked at adults in Kentucky infected with the coronavirus in 2020 and people who were or were not re-infected in May or June of this year. The study found that unvaccinated people were 2.34 times more likely to be re-infected.
One of the limitations listed by the authors is that “people who have been vaccinated may be less likely to get tested. Therefore, the association of reinfection and no vaccination may be overestimated.”
This is the opposite of a limitation that Emory University biostatistician Natalie Dean shared about a different study: People previously infected may be less likely to get tested than people who have been vaccinated because they think that they are immune.
She told the journal Science about a study published in August by Israeli researchers and based on the database of a healthcare organization that has around 2.5 million Israelis.
Comparing more than 32,000 people who received their second dose of Pfizer or were infected in January or February, one model found that the risk of developing symptomatic COVID-19 was 27 times higher in those vaccinated than those who had already been infected, and the risk of hospitalization eight times higher. But the latter was based only on eight hospitalizations in people fully vaccinated and one of a previously infected person.
Using a model that included people infected in 2020, the researchers found evidence of a decrease in natural immunity, but the risk of symptomatic illness was still seven times higher for people vaccinated but never infected.
This study has not yet been peer reviewed, and the medRxiv preprint server cautions that medical research “has not yet been evaluated and therefore should not be used to guide clinical practice.”
Dr Richard Martinello, medical director of infection prevention for Yale New Haven Health, said more studies will need to be done to confirm the results. He said we’ve always known that people develop immunity after infection, but the question is whether it’s good enough.
Researchers at the Yale School of Public Health analyzed data from close relatives of the COVID-19 virus to model the risk of reinfection over time. They said reinfection “under endemic conditions would likely occur between 3 and 63 months after the peak antibody response, with a median of 16 months”.
“Those who have been naturally infected should get vaccinated. A previous infection alone may offer very little long-term protection against subsequent infections,” said lead author Jeffrey Townsend. This study was published in The Lancet Microbe on October 1.
A study from the Cleveland Clinic published in June, which was not peer reviewed, found that 99.3% of employee infections between December 16 and May 15 occurred among those who were not. not vaccinated and not previously infected. During those five months, COVID-19 did not occur in any of the 2,579 previously infected people, including 1,359 unvaccinated people.
Some Connecticut organizations responded to questions about why they chose not to allow past infections as an exemption from vaccination and testing mandates.
“The science on immunity against natural infection with COVID is evolving. Some people develop very strong immunity and some do not,” Public Health Ministry Commissioner Dr Manisha Juthani said in a report. -mail. “Vaccination after receiving COVID reliably produces immunity, which is why we continue to recommend getting vaccinated despite having had COVID. This recommendation may change over time as we assess more people. scientific data. “
Martinello said Yale New Haven Health does not view natural immunity as an exemption because natural immunity is not as consistently established as immunity conferred by a vaccine.
A professor at the University of California’s Irvine School of Medicine challenged the UC system’s vaccine mandate, saying it was immune to a previous infection, but a federal judge upheld the vaccine requirement in a ruling September 30.
The Michigan hospital system, Spectrum Health, said last month it would grant an exemption from its employee vaccination mandate to people who have a PCR test or an antigen test positive for COVID-19 plus a test for COVID-19. antibody positive in the past three months, The Detroit News reported.
Some other countries accept a certificate of recovery in addition to proof of vaccination or a negative test: For the EU COVID digital certificate and the Green Pass in Israel, a certificate of recovery is valid for six months.
How do school nurses treat students with symptoms of COVID-19?
School nurses here rely on advice from the DPH, the state Department of Education, and the Ledge Light Health District.
DPH and Department of Education Addendum 5, which has been revised several times, states that a person who shows symptoms of COVID-19 but has not had close contact with a person who is positive for the coronavirus must stay home, notify the school immediately and get tested.
If at school, “students must remain masked, respect strict physical distancing, be evaluated by the school nurse or the school medical adviser (if available), stay in the isolation room ( under adult supervision), until they are collected to go home. Parents should be asked to see a health care provider and have the student tested. “
Students who test negative can return to school after 24 hours without fever, or can return without test results if a health care provider “provides documentation with another specific and confirmed diagnosis.”
The addendum presents different protocols for close contact, which depend on vaccination status and whether or not symptoms are present.
Annie Ryan, a nurse at Nathan Hale Arts Magnet School in New London, said about two weeks ago she had to send 17 children home in two days.
“I explain it to the parents,” she said, “and some of them understand, and some of them are screaming in your face, like, ‘Why did you send my child home, because he just had a cold? ‘”
Ryan is president of the union representing nurses of the Visiting Nurse Association of Southeastern Connecticut, which supplies nurses to schools in New London, Waterford, East Lyme and Groton.
Maria Kostopoulos, a nurse at Clark Lane Middle School in Waterford, said that one main symptom or two secondary symptoms are enough for her to support a child at home. She said the main symptoms are fever, chills, loss of taste or smell, an uncontrolled cough and shortness of breath.
Secondary symptoms include sore throat, congestion, runny nose, nausea, headache, and fatigue.
“The symptoms are very vague, so it’s hard to know who to send home and who not to send home,” Kostopoulos said, “so it’s okay if you know the medical history of these children. allergies? “
“It’s multifaceted, and it’s about dealing with families when they’re fragile and scared, and you don’t know what their situation is at home,” she said. Sending children home is a hardship for parents, especially if they have to wait a few days for a scheduled test and then a few days for results.
Kostopoulos said what is striking is that school boards “can adopt policies in their own way, with a little bit of discretion,” so protocols vary from city to city.
“I don’t think there is one size fits all (approach),” said Lyme-Old Lyme Superintendent Ian Neviaser. He added, “It really depends on the specific situation. We do not, per se, require the student to provide a negative COVID test in every situation, as that would in some cases be a bit ridiculous. If a child has one. symptom and it goes away immediately, the chances of them having COVID are pretty slim. “
Where can I get tested?
The Ledge Light Health District offers free COVID-19 testing four days a week in four locations, for symptomatic and asymptomatic people, with no appointment required.
The tests take place Tuesdays from 3 p.m. to 7 p.m. at the municipal building in the town of Groton, Wednesdays from 8 a.m. to 11 a.m. at the Waterford Public Library, Thursdays from 4 p.m. to 7 p.m. at the social services of Stonington and Fridays from noon to 5 p.m. at the New London Senior Center.
Uncas Health District and UCFS Healthcare offer free drive-thru tests at Dodd Stadium in Norwich on Mondays, Tuesdays, Thursdays and Fridays from 3pm to 7pm.
Thanks to Yale New Haven Health, people can get tested at Lawrence + Memorial Hospital in New London or at the Mohegan Sun. To make an appointment, visit covidtesting2.ynhhs.org or call (833) 275-9644. Martinello said that when people get tested because they are sick, results come back within 24 hours more than 99% of the time.
The CVS test schedule is available at bit.ly/cvscvdtst, but not all sites offer rapid tests or tests for asymptomatic people, and appointments may not be available on the same or next day.
What if I lose my COVID-19 vaccination card?
There are a few options for obtaining proof of vaccination, such as contacting your vaccinator to request a copy. If you have been vaccinated through Yale New Haven Health or Hartford HealthCare, you can log in to MyChart or MyChartPLUS respectively to download your vaccination record.
You can log into the Vaccine Administration Management System, or VAMS, if you have scheduled your appointment this way.
Immunization records are also available from the CT Immunization Information System, or CT WiZ, by visiting bit.ly/ctwizportal or by calling (860) 509-7929.
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