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In regards to getting sick at a higher rate, it starts to get complicated when a population is partially vaxinated. For instance let’s say that exactly 50% of people are vaxinated in a sample. If say 100 vaxinated and 100 unvaxinated people get sick then people are getting sick at an equal rate weather vaxinated or invaccinated. I.e. 50% of infections happened in each 50% group.
Likewise say 75% were vaxxed, and then 75% of infections were in vaxxed. Then that means vaccination status did not impacted the rate of infection, but was correlated to percent of population in each group.
Now let’s say that in or 50/50 vaxxed/unvaxxed population that 75% of people who got sick were vaxxed and 25% unvaxxed. That would imply that vaxxed are getting infection at higher rates compared to unvaxxed. In this example at 3x the rate.
if the vaccine was 100% effective then in our 50/50 population 100% of infections would occur in unvaxinated and 0% in vaxinated.
So to know what that infection rates mean, you must know the baseline vaccination rate in the population to make sense of it.
I don’t know what the actual vaccination rate of the population that study was derived from so it’s not possible to say if or how much vaxxed can unvaxxed people get the infections.
Hope that makes sense.
As far as ADE, it can be that either the rate of infection is higher and/or the severity of illness is greater. The point of ADE is that the virus is more efficient in the presence of antibodies and/or the associated immune response than it would be in the absence of antibodies and/or vaccine induced immune response.
As far as no ADE because viral titers were just as high in vaxxed vs unvaxxed, maybe and maybe not. As I described ADE is any enhancement of the virus in either ability to infect or degree of severity. There needs to be more rigorous study to determine that.
The concern here is that antibodies should be able to neutralize/sterilize against the pathogen. Meaning people should not be getting infected. ADE often happens in the setting of antibodies that are not neutralizing. So the very fact that people are getting sick after vaccination means that the risk of ADE is increased because the antibodies are not neutralizing. That’s why I said it’s a red flag and possible early warning sign of ADE.
Also, even if ADE was not present today does not mean that it can’t pop up as time goes on. Your immune response is not static but evolves over a period of time. There are different antibodies (e.g. IgM, IgG) as well as different cells like T-Cells and also chemicals such as the complement cascade that increase or decrease in different phases of immunity. ADE can be a delayed observation because the immune response is not static but morphs over time.
Here is a very in depth paper about ADE and different possible mechanisms with Covid. It’s pretty medical jargon dense, but has tons of interesting information in it.
Antibody-dependent enhancement and SARS-CoV-2 vaccines and therapies - Nature Microbiology
Mechanisms of antibody-dependent enhancement of disease and mitigation strategies for SARS-CoV-2 vaccines and therapies are discussed.
www.nature.com
On a different note, and something that I find very concerning, is that during Covid our definition of sick and disease has been radically changed - and this is terrible.
In the past someone was considered infected who presented with symptoms, and then there was confirmatory tests performed demonstrating presence of some pathogen.
Often we run confirmatory tests. For example if you go to your doctor with a sore throat they will do a throat swab called a rapid strep, that tests for the presence of a specific protein on strep bacteria. If it’s positive then a culture is sent out to see if they can grow and isolate the strep bacteria.
The typical pattern was therefore symptoms, preliminary diagnosis, confirmed diagnosis.
With viruses it’s a little trickier because it’s hard to culture and isolate them compared to bacteria. But it was similar in that people presenting with symptoms were tested with antigen tests. It was the presence of flu symptoms and confirmatory tests.
With Covid we are changing things. You are diagnosed with Covid if any trace of Covid is detected in your sample. You don’t need any symptoms or signs whatsoever of infection. Ever.
We are talking about screening totally healthy people without any symptoms. If your test is positive, you are deemed sick, and removed from the population. Golfers are removed from the tour, olympians are removed from competition. A positive test is enough to demand someone be removed from participation in society.
A positive test does not mean you are actually infected. It just means that there is viral material detected in your sample. This viral material could be dead viruses, contamination, microscopic traces of virus that never causes infection in the person, etc.
Covid diagnosis should be symptoms PLUS positive tests. Otherwise people will repeatedly test positive overtime and be removed each time because they have Covid, never develop symptoms, and in reality never have had a Covid infection to begin with
I would recommend that anyone who has had a positive Covid test in the past get an antibody test. If the antibody test is negative, I would take that to mean you were never infected and do not have immunity. The antibody tests are much more reliable for the determination of immunity and past infection than the PCR test is for diagnosis of Covid infection.
Something interesting that happened last year, there were a bunch of people with positive Covid tests at one hospital in Phoenix, months later the started testing for antibodies to Covid….and well less than 50% of people came up positive, I don’t remember the exact number but is was quite low.
It was interesting because a bunch of people said they didn’t believe the antibody tests. However I think the reality was that the majority of these people were never infected, had false positives, and therefore never developed antibodies.
The point of this long discussion, detecting some microscopic quantity of viral material (especially by a ridiculously sensitive test such as PCR that can detect genetic evidence of even one or a few virus particles) is not equal to a viral infection. This is a total turning medical history on its head in how we define infectious disease.
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