In his ongoing fight with Fauci, Senator Rand Paul has oversimplified science

It is well known that Sen. Rand Paul of Kentucky often disagrees with infectious disease specialist Dr Anthony Fauci.

Recently, the two clashed in a Senate hearing when Paul, a Republican, objected to mask recommendations for people who have had covid-19 or who have been vaccinated against it.

During the hearing, Fauci, Chief Medical Advisor to President Joe Biden, objected to Paul’s characterization of wearing masks as “theater.” Caution is in order, Fauci said, as scientists study the new variants currently circulating in the United States and other countries.

Paul, a trained ophthalmologist, continued the feud a few days later, calling out Fauci in a tweet, highlighting a study that he said “shows that vaccines and naturally acquired immunity effectively neutralize variants of COVID.”

The tweet linked to a study posted online on the JAMA Network, a family of medical journals.

We reached out to Paul’s office for additional sources for his tweet, but did not receive a response.

So we asked the experts: Are covid variants effectively neutralized by vaccines or the natural immunity conferred on people recovering from the disease?

In short, the research cited by Paul shows good blood levels of neutralizing antibodies against at least some of the current variants after infection or vaccination. But that’s not the whole story.

Mehul S. Suthar, an author of the study Paul cited, said the results are encouraging but should not be taken as comprehensive: “Our interpretation is that our study examines one aspect of the immune response, antibodies. “

Small samples. Big questions.

Neutralizing antibodies are important because they can block the ability of a virus like the one that causes covid to infect cells. But the body also has other defenses. T cells, for example, can be stimulated by infection or vaccination, Suthar said, although the study was not designed to examine them.

For the study, the researchers collected blood samples from 40 people who were in hospital with or had recovered from covid. From the National Institutes of Health, they also received blood samples from 14 people who had received the two doses of the Moderna vaccine, said Suthar, an assistant professor at the Emory University vaccination center.

Then they ran tests on those samples against the original SARS-CoV-2 virus and three variants, including the one dubbed B.1.1.7, which first appeared in the UK and is now circulating widely in the UK. United States.

They wanted to know: Did the antibodies produced by being infected or vaccinated neutralize B.1.1.7?

“We are lucky with B.1.1.7 that our antibodies seem to work well against this virus,” said Suthar.

However, as with any study, there are caveats. On the one hand, the results were based on a small number of samples. And the analysis did not include other worrisome variants, such as those that emerged in South Africa and Brazil, which limits the ability to draw general conclusions.

Finally, antibodies are only one measure of potential protection against disease. Laboratory research measuring antibodies indicates that some immunity is created by both disease and vaccination, but the strength and longevity of that protection – effectiveness in the real world – is a separate question. This is in part because the ideal level of neutralizing antibodies needed for protection is not known and other immune protections, such as T cells, are not being measured.

Also, in the real world, other factors – such as which variant a person is exposed to and the presence of other mitigating factors, including masks and good ventilation – can make the difference.

“Part of why real-world data is so important is to look at the big picture of immunity,” said Gigi Gronvall, senior researcher at the Johns Hopkins Bloomberg School of Public Health. “Additionally, with the level of community transmission of the disease, I would be concerned that there will be more variants that emerge.”

The nuance counts

Paul’s tweet – aimed at what he sees as an overly cautious approach on the part of public health experts – does not capture that kind of nuance, nor does it refer to studies of other emerging variants.

“General claims made by non-scientific experts aren’t going to help,” Gronvall said.

Dr Jesse Goodman, professor of medicine and infectious disease specialist at Georgetown University, agreed.

“It is wrong to declare victory and say that there is no problem with the variants and that everyone previously infected will be fine,” said Goodman, who was chief scientist for the Food and Drug. Administration under the Obama administration.

Viruses naturally mutate when they replicate. So it’s no surprise that the coronavirus did. Several variations appeared, including those from California and New York.

Laboratory tests on blood samples from participants in vaccine trials in South Africa have shown lower levels of neutralizing antibody production, likely related to the variant circulating there.

The difference between the lower levels measured in these samples is not yet known.

The levels are still high and could “effectively neutralize the virus,” Fauci wrote in a Feb. 11 editorial in JAMA.

Even so, clinical trials used to test covid vaccines before they were approved for emergency use showed less efficacy when tested in areas where the South African variant was in circulation.

“We expect vaccines and past infections to provide significant protection against closely related variants,” Goodman said. “But as they become more genetically different – like that of South Africa – that protection may diminish.”

The primary goal of vaccines is to prevent hospitalization and death, and all vaccines used in the United States appear to significantly reduce the risk of hospitalization and death from covid, research shows.

“Even though current vaccines may not be perfect, they seem to prevent more serious results,” Goodman said.

Don’t assume, as Paul’s tweet suggests, that recovering from a covid or getting vaccinated means zero risk of infection.

On the one hand, reinfection is rare but can occur.

Goodman pointed to a recent study in Denmark showing that a small percentage (0.65%) of people who tested positive for covid in the spring fell ill again.

“People shouldn’t assume that even though they had received the vaccine or had already been infected, there is no future risk,” Goodman said.

Even though no vaccine is 100% effective, Hopkins’ Gronvall said not to use this as an excuse to avoid inoculation.

“The vaccines look great,” she said. “Get one when you can.”

Our decision

Paul is correct that the JAMA study showed that a previous vaccination or infection developed, based on a small sample of people, to help neutralize the virus. However, he omitted important details that make his position oversimplify a complicated issue.

The study only considered one variant – the one that emerged in the UK – and did not include an analysis of other types currently in circulation, nor the potential for additional variants that might emerge. Furthermore, the type of antibody studied is only a protective factor against the disease, and it is not clear exactly what these levels of neutralizing antibodies measured in a lab experiment may mean in the real world.

So, for these reasons, we are evaluating the senator’s statement as half-true.