Medically reviewed by Susan Kerrigan, MD and Marianne Madsen
It’s been quite a year. As the COVID-19 pandemic swept the globe, we have all had to get used to new norms and practices. Social distancing, frequent hand washing, and face coverings were no longer overly cautious actions by the few but standard daily routines for everyone. Thankfully, there is light forming at the end of this particular tunnel. The coronavirus vaccine “train” is now gathering speed, hopefully bringing virus immunity to the masses.
But does everyone need to get the vaccine? What if I’ve already had COVID? Isn’t it the case that you build up antibodies that will prevent you from getting the virus again?
The short answer is yes and no. It is correct that as you recover, you build up antibodies that will give you a limited period of natural immunity.
However, The Centers for Disease Control (CDC) believes that, while reinfection cases are rare, there is insufficient data currently available to determine if the antibodies your body created will give you long-term immunity from reinfection.
There is also the question of what level of antibodies you have in your system. According to the World Health Organization (WHO), if you had a severe infection, your antibody levels will be much higher than if you had a mild case or are asymptomatic.
Does that mean that I’m just as likely to get it again?
Not necessarily. A study conducted by the National Cancer Institute did show evidence that the natural immunity created by the antibodies can reduce the chance of reinfection over a limited period of between 3-4 months.
This appears to be the current thinking on how long the antibodies remain effective against the virus. It also may be crucial in understanding how to administer the current limited supply of the vaccine.
How the vaccination may help raise your natural immunity
Some recent studies that are awaiting peer review have appeared to prove that the vaccine can act as a significant boost to any natural immunity. In one study, previously infected patients who received either the Pfizer or Moderna vaccine saw their antibodies rocket by between five- and ten-fold after the first jab. The study also indicated that the antibodies produced were more effective at providing immunity against both previous and emerging COVID strains.
One jab or two?
Suppose the studies are correct in suggesting that a previously infected patient’s antibody level increases even five-fold after one shot of the vaccine. In that case, the question arises: Do they need a second dose?
In another paper awaiting peer review, researchers have suggested that one dose may be sufficient. The study results show that antibodies in previously infected patients following their first dose are equal to or greater than those in uninfected people after their second dose. Another study awaiting verification goes even further and suggests that a second dose has little or no effect on previously infected patients’ antibody levels.
Dr. Anthony Fauci, the President’s Chief Medical Advisor, addressed the issue of giving only one dose to everyone as a general policy in his White House press briefing on February 8, 2021. He believes that the process of researching and verifying data could take many months until it is deemed reliable. By that stage, the point may be moot as vaccine production will have been ramped up.
Vaccination for Long-Haulers
If you have already had COVID but are still experiencing lingering symptoms much later, you may be a long-hauler. These are the people who just can’t seem to get over the virus. A surprising (but so far mostly anecdotal) finding is that people who have these persistent symptoms get better after they get vaccinated. Akiko Iwasaki, an immunologist at Yale, has three hypotheses that are being investigated to determine how this startling finding may work: (1) Boosted by the vaccine, T cells could eliminate a lingering viral reservoir, (2) persistent virus fragments may be eliminated by the heightened immune response caused by the vaccine, and/or (3) if the immune response was inappropriate to being with, the vaccine may cause a diversion of autoimmune cells to fight the long-lasting symptoms.
There may be evidence to suggest that giving only one dose to a patient who previously had COVID might be sufficient. However, there has been no data to indicate that you will not need the vaccine if you were diagnosed with COVID or found to be asymptomatic. The CDC has currently made no distinction between people who have or have not been infected, and the official recommendation for everyone is to get both doses. However, they have indicated that if you have had COVID-19 within the last few months, you can choose to wait to get the vaccine in light of the limited current supply. Of course, this is with the knowledge that your antibody level may be dropping the longer you wait. If you’re a long-hauler, getting vaccinated may help with your lingering symptoms.
References
- CDC: Using Antibody Tests for COVID-19
- WHO: Coronavirus disease (COVID-19): Serology, antibodies and immunity
- Real-world data suggest antibody positivity to SARS-CoV-2 is associated with a decreased risk of future infection
- NIH: Two Studies Show COVID-19 Antibodies Persist for Months
- Antibodies elicited by SARS-CoV-2 infection and boosted by vaccination neutralize an emerging variant and SARS-CoV-1
- Robust spike antibody responses and increased reactogenicity in seropositive individuals after a single dose of SARS-CoV-2 mRNA vaccine
- Poor antigen-specific responses to the second BNT162b2 mRNA vaccine dose in SARS-CoV-2-experienced individuals
- Press Briefing by White House COVID-19 Response Team and Public Health Officials
- Washington Post: Some long-haul covid-19 patients say their symptoms are subsiding after getting vaccines
- Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States
