Tuesday, September 7, 2021

New Studies Find Evidence Of 'Superhuman' Immunity To COVID-19 In Some Individuals September 7, 2021 Michaeleen Doucleff

 

New Studies Find Evidence Of 'Superhuman' Immunity To COVID-19 In Some Individuals

An illustration of antibodies attacking a coronavirus particle.

Christoph Burgstedt/Science Photo LIbrary /Getty Images

Some scientists have called it "superhuman immunity" or "bulletproof." But immunologist Shane Crotty prefers "hybrid immunity."

"Overall, hybrid immunity to SARS-CoV-2 appears to be impressively potent," Crotty wrote in commentary in Science back in June.

No matter what you call it, this type of immunity offers much needed good news in what seems like an endless array of bad news regarding COVID-19.

Over the past several months, a series of studies has found that some people mount an extraordinarily powerful immune response against SARS-CoV-2. Their bodies produce very high levels of antibodies, but they also make antibodies with great flexibility — likely capable of fighting off the variants of coronavirus circulating in the world but also likely effective against variants that may emerge in the future.

"One could reasonably predict that these people will be quite well-protected against most — and perhaps all of — the SARS-CoV-2 variants that we are likely to see in the foreseeable future," says Paul Bieniasz, a virologist at the Rockefeller University who helped to lead several of the studies.

In a study published online last month, Bieniasz and his colleagues found antibodies in these individuals that can strongly neutralize the six variants of concern tested, including delta and beta, as well as several other viruses related to SARS-CoV-2, including one in bats, two in pangolins and the one that caused the first coronavirus pandemic, SARS-CoV-1.



"This is being a bit more speculative, but I would also suspect that they would have some degree of protection against the SARS-like viruses that have yet to infect humans," Bieniasz says.

So who is capable of mounting this "superhuman" or "hybrid" immune response?

People who have had a "hybrid" exposure to the virus. Specifically, they were infected with COVID-19 in 2020 and then immunized with mRNA vaccines this year. "Those people have amazing responses to the vaccine," says virologist Theodora Hatziioannou at the Rockefeller University, who also helped to lead several of the studies. "I think they are in the best position to fight the virus. The antibodies in these people's blood can even neutralize SARS-CoV-1, the first coronavirus, which emerged 20 years ago. That virus is very, very different from SARS-CoV-2."

In fact, these antibodies could even fight off a virus engineered, on purpose, to be highly resistant to neutralization. This virus contained 20 mutations that are known to prevent SARS-CoV-2 antibodies from binding to it. Antibodies from people who were only vaccinated or only had prior COVID infections were essentially useless against this mutant virus. But antibodies in people with the "hybrid immunity" could neutralize it.

These findings show how powerful the mRNA vaccines can be in people with prior exposure to SARS-CoV-2, she says. "There's a lot of research now focused on finding a pan-coronavirus vaccine that would protect against all future variants. Our findings tell you that we already have it.

"But there's a catch, right?" she adds: You first need to be sick with COVID. "After natural infections, the antibodies seem to evolve and become not only more potent but also broader. They become more resistant to mutations within the [virus]."

Hatziioannou and colleagues don't know if everyone who has had COVID-19 and then an mRNA vaccine will have such a remarkable immune response. "We've only studied the phenomena with a few patients because it's extremely laborious and difficult research to do," she says.

But she suspects it's quite common. "With every single one of the patients we studied, we saw the same thing." The study reports data on 14 patients.

Several other studies support her hypothesis — and buttress the idea that exposure to both a coronavirus and an mRNA vaccine triggers an exceptionally powerful immune response. In one study, published last month in the New England Journal of Medicine, scientists analyzed antibodies generated by people who had been infected with the original SARS virus, SARS-CoV-1, back in 2002 or 2003 and then received an mRNA vaccine this year.

Remarkably, these people also produced high levels of antibodies, and — it's worth reiterating this point from a few paragraphs above — antibodies that could neutralize a whole range of variants and SARS-like viruses.

Now, of course, there are so many remaining questions. For example, what if you catch COVID after you're vaccinated? Or can a person who hasn't been infected with COVID-19 mount a "superhuman" response if they receive a third dose of vaccine as a booster?

Hatziiannou says she can't answer either of those questions yet. "I'm pretty certain that a third shot will help a person's antibodies evolve even further, and perhaps they will acquire some breadth [or flexibility], but whether they will ever manage to get the breadth that you see following natural infection, that's unclear."

Immunologist John Wherry, at the University of Pennsylvania, is a bit more hopeful. "In our research, we already see some of this antibody evolution happening in people who are just vaccinated," he says, "although it probably happens faster in people who have been infected."

In a recent study, published online in late August, Wherry and his colleagues show that, over time, people who have had only two doses of the vaccine (and no prior infection), start to make more flexible antibodies — antibodies that can better recognize many of the variants of concern.

So a third dose of the vaccine would presumably give those antibodies a boost and push the evolution of the antibodies further, Wherry says. So a person will be better equipped to fight off whatever variant the virus puts out there next.

"Based on all these findings, it looks like the immune system is eventually going to have the edge over this virus," says Paul Bieniasz at the Rockefeller University. "And if we're lucky, SARS-CoV-2 will eventually fall into that category of viruses that gives us only a mild cold."

Delta-Fueled Infections Are Moving Through Rural, Southern Oregon 'Like A Buzz Saw' August 29, 2021 ERIK NEUMANN

 PUBLIC HEALTH

Delta-Fueled Infections Are Moving Through Rural, Southern Oregon 'Like A Buzz Saw'

A team at Asante Rogue Regional Medical Center in southern Oregon prepares to intubate a COVID-19 patient.

Michael Blumhardt/Asante

If you live in one of the rural communities tucked into the forested hillsides along the Oregon-California border and need serious medical care, you'll probably wind up at Asante Rogue Regional Medical Center. It serves about nine counties on either side of the border.

The Asante system encompasses three hospitals in the Rogue Valley — in the cities of Ashland, Medford and Grants Pass. All three intensive care units are 100% full of COVID-19 patients, according to staff.

"We've had two deaths today. So it's a very grim, difficult time," said Dr. Michael Blumhardt, the ICU medical director, on a recent Tuesday in August.

In contrast to earlier phases of the pandemic, the Asante hospitals are now treating COVID-19 patients in their 20s, 30s, 40s and 50s, according to Blumhardt.

"We're seeing clusters of families being admitted. We had a father and an adult daughter admitted to the intensive care unit, and he passed away, right before, I had to put the daughter on life support," he said.

Overall, vaccination rates in many states look pretty good. But zoom in, and you'll see a checkerboard effect with huge differences from county to county. Oregon is no different. In and around metro Portland, two-thirds of all residents are fully vaccinated. But rural counties aren't even close to that; many have vaccination rates less than 50% or even 40%. Jackson County, in southern Oregon, is home to the largest number of unvaccinated individuals in the state. That's pushing the local hospitals to the limit.

Asante's Blumhardt blames the current surge on the highly transmissible delta variant but also on widespread rejection of the coronavirus vaccine in this area.

"This is far more severe for this region than the prior COVID waves," he said. "The delta virus is passing through the region like a buzz saw."

Inside the Asante ICU in Medford, Chelsea Orr, a registered nurse, is closely monitoring patients.

"We're taking care of a lot of ventilated patients here that are super sick," Orr said.

What feels different about this stage of the pandemic, she added, is the incredible loss of life.

"It's been really hard. We're working harder than we've ever worked before and still losing," Orr said.

Another ICU nurse, Justin McCoy, agrees.

"I've been an ICU nurse for 10 years. I've never seen anything like this," McCoy said. "It's really terrible seeing these patients who can't breathe. That is a very difficult thing to watch. It's really terrifying for them, and it's really difficult for us to see day in and day out."

Blumhardt said the vast majority of patients at Asante are unvaccinated.

"We admit nine unvaccinated to every one vaccinated individual," he said. "So clearly the vaccine is protecting against hospital admission."

Jackson County is recording record numbers of coronavirus infections. Within weeks, many of those people may worsen and need hospital care. Unfortunately, a new forecast from Oregon Health & Science University predicts that by Labor Day, the state will face a shortfall of 400 to 500 staffed hospital beds.

Blumhardt said smaller hospitals in Oregon have been trying to transfer their sickest patients to Asante, but so far they've had to turn away around 200 people because they don't have the beds or the staff.

Even though Asante has already postponed some surgeries, staffers are simply worn out, said emergency room physician Courtney Wilson.

"I think people are frustrated," Wilson said. "It feels discouraging that we have had a vaccine available for a really long time in this community and we have a really low vaccination rate here."

This month, Oregon Gov. Kate Brown sent National Guard troops to overwhelmed counties to help with nonclinical tasks, such as cleaning hospital rooms, moving medical supplies and traffic control. Some 150 soldiers were dispatched to southern Oregon. Medical leaders at Asante and Providence, the other hospital system in Rogue Valley, have teamed up to ask the state to set up a 300-bed field hospital. The state has also finalized a contract to deploy hundreds of medical "crisis teams" of nurses, respiratory therapists and paramedics from medical staffing companies to overwhelmed hospitals.

"I don't know how we're going to get everybody taken care of. That's the bottom line," Blumhardt said. "We're all hands on deck at every level of the organization."

Residents of Jackson County are starting to respond to the crisis. The rate of new vaccinations here has grown and is now about twice that of the Portland area. But thousands of people still need to be vaccinated to catch up.

This story was produced as part of NPR's reporting partnership with Jefferson Public Radio and Kaiser Health News.

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