Cross-immunities at work again?

Health care workers may be less susceptible to COVID-19 infection than people in the communities they serve, according to surprising early data from an ongoing study at Hoag Memorial Hospital Presbyterian.

Of some 3,000 workers tested in May and June, only 1% had antibodies to the novel coronavirus in their blood, despite the fact that the Newport Beach hospital has cared for hundreds of COVID-19 patients.

That 1% is far lower than what has been found in wider communities. Some 4-6% of residents in Los Angeles, Santa Clara and Riverside counties had COVID antibodies when surveillance testing was done there over recent weeks and months.

“This is what surprises some people,” said Dr. Michael Brant-Zawadzki, principal investigator. “Despite the headlines you see saying health care workers are at higher risk of contracting the disease, we haven’t seen that. In fact, we’re seeing the reverse of that. The question is, why?”

Obviously some of this is PPE, mask-wearing, and the like.  But all of it?  Here is the Teri Sforza story, via Amihai Glazer.

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isn't this just

P(infection) | exposure

is lower for people in hospital settings (makes sense, and you could imagine the same thing being true for teachers/daycare who work with young children. unfortunately, at least early on, P(exposure) was much higher for healthcare workers

Obviously.

But, before we get the vaccine, everyone should volunteer to work in a covid hospital so as the reduce the likelihood of contracting the virus.

+1

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after months of reading all these studies and accounts, are common sense, self preservation and intelligence critical factors in avoiding illness?

Does New York have a much lower standard for those than the rest of the country/world?

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Seems obvious to me .. more studies likely available.

"Study links low national average IQs with infectious diseases"

https://medicalxpress.com/news/2010-07-links-national-average-iqs-infectious.html

As for New York, res ipsa loquitur.

Searching for statistical anomalies to make political hay out them is popular. You can't avoid being infected by a highly infectious virus because you are smart. The idea that hospital workers don't get it because they wear masks is intended to make you all wear masks but without telling you that hospital workers have effective PPE and not the home made cloth masks you get to wear. AND they throw them away rather than reuse them. AND they are trained on not touching them and how to take them off without getting themselves contaminated.

there is nothing political about the instinct for self protection, the ability to sense danger, to appreciate risky behavior. Give everyone the same gear, the same instructions and it does not change one's innate and learned behaviors. Just an observation, not a judgement.

"AND they throw them away rather than reuse them. AND they are trained on not touching them and how to take them off without getting themselves contaminated."

Actually, we keep and reuse them for quite a while since you cant be sure when a new shipment of PPE will come in. We UV sterilize ours. You wear your mask then sterilize. Up to 10 times. Also, a very high percentage of health care workers have no real training other than youtube.

Steve

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"Seems obvious to me "
""Study links low national average IQs with infectious diseases""

So South Korea did better than Germany because they are smarter?

France must be smarter, having done better than the U.S. Or thinking about it, the U.S. and France must be equally dumb, though still smarter than Sweden.

Or this is one of the dumbest ways to measure smart ever invented.

Actually France did worse than the U.S. But it is too soon to try to make these comparisons. Give it 18 months. SK will get their chance to show if being really smart makes you immune. eventually this virus will reach everywhere and it will more or less take the same toll everywhere. The mask and social distancing does NOT stop it.

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Last I checked Google, "IQ by country", South Korea was indeed smarter than Germany. Mongolia and Singapore were like 105 IQ, incredibly high, as was China (but they say China only sampled big cities).

So yes, Greece is smarter than Sweden, as they had only 10% of Sweden's C-19 cases.

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NYC does not have time traveling cargo craft to fully supply PPE to all health care workers in Feb, Mar, Apr.

From what I've seen, the workers at highest risk are using PAPR or flip down full face shields, which 6 months ago would have been available only for chemical or biohazard crew and special treatment centers.

Otherwise, physical distance, N95 respirator masks, hygiene are highly effective if used constantly.

Consider, BLM protests have not resulted in infections close to parties and evangelical church gatherings when minorities are expected to be at higher risk at the former than the low risk whites at the latter. Physical distance and protection lower risk of spread.

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I'm guessing this was an oblique insult flung at "MAGA" country? Careful, you might miss and hit someplace like the Rio Grande Valley instead.

It’s just prior_approval trolling.

Probably because Germany is now up to 900 cases a day and reports are coming in that mask usage and social distancing are falling rapidly

“failing rapidly”. are they?

i saw that click bait headline yesterday. the article was incoherent, but the gist was that the masks aren’t failing, but noncompliance is rising

Falling not failing.

And yes I agree, I doubt there are any reliable statistics on mask usage.

Oh jeez I gotta stop doing this on my phone

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Or it might land on target like the Trump rally Herman Cain attended, without mask, and picked up COVID. Karmic justice works in all ways.

And the other 154,999 Covid victims on American soil ... one may detect karmic justice in their deaths?

It's only karmic if they denied the danger, fought against measures to fight the danger, and denounced those who tried to fight the danger. Most people know enough not to pee on an electric fence.

Oh good. I was worried about people that die in car crashes, that they might be in karmic limbo. But sounds like if the denial is collective and effective, and measures to avert danger are the province of cranks, then the dead may rest in peace.

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There are at least two people who are having an immense amount of fun reading this thread.

Oh I think you always enjoy trolling, prior.

That goes without saying

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"Health care workers may be less susceptible to COVID-19 infection than people in the communities they serve"
-to the extent this is true it is probably due to lower age and fewer comorbidities. dont underrate the risk to health care workers.
also this meme that kids dont transmit the virus needs to be considered mostly speculative
meanwhile
the democrats and their leftist allies have quickly &socially engineered us into the biggest violent crime wave in mebbe 20 years

The study focuses on antibodies and infection rates, not deaths or debilitating diseases, so your comment about age and comorbidities is totally irrelevant. Similar faulty analysis probably underlies your gratuitous comment about democrats and leftists.

thats why the pharse "less susceptible to COVID-19 infection" is obfuscatory in this context.

That’s true. Point taken.

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Post here when it starts. (I could be wrong. Are you talking about Clinton repealing Glass-Steagall?)

have you really not looked at the violent crime stats for this year?
harvard sociologists are also suddenlyacutely uninterested in violent crime
we call it the nadler/pelosi/penguin effect

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This data seems really odd. Assuming it's not a statistical anomaly then I wonder what the process is?

As I understand it the hypothesis is that healthcare workers will have been exposed to a wider variety of previous viruses like common cold coronavirus, and this gives them "crossover immunity" to Covid 19, which means that they fight off the infection without producing specific antibodies.

In these cases, it is not clear what should count as an infection. If an exposed healthcare worker has very capable nasal mucus, which kills the inhaled Covid particles within ten minutes, does that count as an infection?

As a now retired internist of over 40 years, I never got sick caring for any patients. I quit in December and got Covid 19 in March. It could be that continued viral barrages from my patients kept my immune system on constant alert. It might also help that my nasal/bronchial mucous is for whatever ever reason more copious than all but one of my patients!

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Weren't those doctors out in CA who were early and vocal lockdown opponents talk about how the lockdown would wreck people's immune systems because they wouldn't be exposed to germs regularly? Isn't the t-cell immunity idea that exposure to corona- (or maybe other) viruses provided some people with immunity/resistance to SARS-cov-2 ?

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It could be what the paper says. T cell reactivity to other HCoVs protects them or maybe hospital settings are much safer now than we thought ( less intubation).
It’s hard to know with little information.
They would have to be tested for T cell responses vs controls to determine this.

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Hoag is an interesting place. Very rich, and usually pretty slack in demand. I'm not sure how that would shape things, but it's probably not overcrowded emergency wards, especially earlier this year, when OC lagged well behind LA or the Bay Area in cases.

(I used to go to Hoag when I was younger, before I switched to Kaiser. I find the HMO experience smoother, but it does come without the epic ocean views.)

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why can’t precautions explain all of the difference?

comparing the supplies, protocols and discipline with front line health care versus the general public are not even in the same universe

We've heard an awful lot about how health care workers were at a much higher risk and that many were getting sick and dying do to Covid19. Perhaps that was all just a media narrative, but it seems rather surprising that health care workers are at much less risk than the normal population.

Sure one assumes they do a better job with respect to precautions, but they are also in a working environment with a lot of positive patients.

They’re in an environment where there are more infected people around but on the other hand , they’re more protected , what’s the result of this is hard to know.

Early on in the whole world, more HC workers were dropping due to PPE and defensive protocol deficiencies.

In Lombardy they had big problems because they shoved anybody with symptoms into hospital wards with so so ventilation and precautions. Also ambulance drivers got infected.
I think it’s much better now.

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did the study mention whether they tested a range of health care jobs or strictly front line?

covid risk for non front line was likely quite low.

Yes it says :
" Study participants were recruited from the entire hospital employee workforce and the independent medical staff"
It's in Orange County CA and the prevalence in the local population at the time was quite low ( ~4.4%)
They weren't overwhelmed with patients.

I don't think it's conclusive enough to draw sharp inferences. Perhaps they have better immunity, perhaps they are actually less exposed ( since better protected) being at work than anyone else out there

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The data was collected for the period May and June. Coronavirus cases in Orange County were modest until the end of June and then spiked. I'm not disputing Cowen's heterogeneity argument (not this time anyway), I'm just pointing out the data during the period studied. Sure, it could be the T-cell response, or it could be just the lower volume of cases. I thought Tik Tok was a video-sharing social media, but it's actually the obsessive-compulsive approach to the coronavirus.

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"Obviously some of this is PPE, mask-wearing, and the like. But all of it?"

Why not?

That hypothesis is hard to test precisely. The T cell hypothesis is more testable. Health care workers T cell response vs controls.

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Seems to me we're going to learn a lot about common cold over the coming years.
There should be study of people who are consistently in high-stress and travel situations. Amongst youth music festival communities there is a phenomenon known as "wook flu", which a post-festival respiratory bug and a general post-high-activity malaise. I think we would see very low covid amongst those who have had wook flu a few times.

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One assumption here is that health care workers by the nature of their occupation receive more biological exposure to all viruses than the average person. This seems more like a hypothesis of its own than a given. The nominal purpose of OHSA regulations, exam gloves, N95s etc is to make this not be true. Perhaps even with these precautions, the average exposure is greater, but shouldn’t this be proved first?

What about other groups with (1) higher than average exposure and (2) little to no attention to PPE? Eg, janitors, garbage men, perhaps teachers and teacher’s aides, home health care workers? Shouldn’t we find a similar effect there?

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Several points:

Reported Data: It is odd that they did not break out the study results based on occupation within the hospital -- they sampled from the entire hospital workforce. Were there differential results among doctors, nurses, orderlies, administrators, etc.? We don't even have an idea of the total numbers of each category in the entire tested sample, much less a knowledge of possible differences across employment categories. Such data could surely help one generate hypotheses to explain the overall pattern.

T-Cells vs. B-cells vs. Innate Immune Response: They make a big deal about the possibility that higher T-cell cross reactivity might have been at play. Okay, possibly. But why would they limit such speculations to T-cells? I would expect also (or alternatively) a greater degree of antibody (B-cell) cross-reactivity that (a.) would be sufficient to mitigate the infectivity of the virus but (b.) still not be specific (or numerous) enough to produced a positive result on the Covid antibody assay. I can't imagine that enough is known to exclude that possibility. Also, why no mention of possible differences in innate immune response?

Although the results were striking, I'd still want to know: 1) How the antibody tests in question performs relative to the test used in the reference population, to decide if the raw numbers are even comparable; (2) whether the prevalence of antibodies in the reference population actually corresponds closely to that of the *local* community where the hospital is located, again to determine if the raw numbers are comparable.

It does seem quite possible that the entire

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Could variolation be playing a roll? Could variolation be what causes viruses to cause less severe illness over time.

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I don’t see why PPE and appropriate safety precautions can’t explain it all. I know a lot of healthcare workers, and from the very beginning of this thing, they all took this disease very seriously because they were seeing it with their own eyes. Not only did they use PPE and good safety protocols in the workplace, but they were also very diligent about PPE and social distancing outside of the workplace.

That is 100% of the answer, just good biosecurity and PPE compliance.

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Does it mean we can stop pretending they're heroes? Or have we already done that? It was cool for a week or too, but I haven't seen much of that contrived BS for a while now.

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To tie this to crossimmunity, we would have to know that people with preexisting cross immunity don't develop antibodies in response to exposure at same rate as other people (or that the antibodies fade sooner). If antibodies decay at same rate for everyone, the lower seroprevalence could just mean the healthcare workers were exposed earlier on average than the broader population.
Anecdotally, a healthcare worker I know in NY says there were lot of cases at her institution before the hospital made PPE widely available to staff, and very few after.

> If antibodies decay at same rate for everyone, the lower seroprevalence could just mean the healthcare workers were exposed earlier on average than the broader population.

Except that antibodies do seem to persist for longer.

From
SARS-CoV-2 infection induces sustained humoral immune responses in convalescent patients following symptomatic COVID-19
https://www.medrxiv.org/content/10.1101/2020.07.21.20159178v1

"IgG-S/N titers showed an intermediate contraction phase, but stabilized at relatively high levels over the six months observation period."

and

"Analysis that terminated their observation period earlier than in our study, but extrapolated a long-term trend based on the contraction phase without considering or determining the memory/consolidation phase, bear the inherent risk to come to over-pessimistic conclusions concerning the durability of humoral immune responses after SARS-CoV-2 infection."

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Occam's razor would point towards the most obvious least complex answer.

So, their PPE and procedures on the job work well and their better training and practices keep them safe when their not working.

they're

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+1

PPE and less intubation should be the null hypothesis. Evidence of other types of immunity would start to shift my priors

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"Obviously some of this is PPE, mask-wearing, and the like. "

May be obvious. But it may also be wrong.

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D'oh!!!

Hoag is my local hospital and they cleaned up their biosecurity when medicare stopped paying for nosocomial infections (hospital induced infections) like I got there about 15 years ago from an IV line after a 4X bypass that cost 2 extra days in the hospital and cost me a lot of extra problems. They are very good and just proper biosecurity with everyone wearing masks and outer garments. Just plain old good biosecurity works and masks are a big part of that.

This just means their internal reproduction rate for this virus R(o) is down around 0.01 instead of the typical hospital at 0.05. In either case, the transmission rate is insignificant, and if the general public had this rate by mask and PPE use the virus would go away.

For citizens PPE you need to sanitize your equipment and that can be done with an oven and a home dryer.

https://www.dropbox.com/t/pH1zEnDEYfkRaAOX

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California didnt have that much Covid during that period so not surprised. You need to look in the NYC metro area. We are just outside the area and have had a lot of Covid. In our area we think the Ab positive rate is about 5%, but our hospital staff has a rate less than 2%. I dont really think this is due to some protective effect but rather because we take precautions seriously. Among the 200 staff in my department we have had 0 known infections. None of my people are going to bars. Everyone wears masks.

Steve

What SARS-CoV-2 infections we did have when to that hospital. It is probably the best in the county.

It is all about precautions and being consistent in biosecurity.

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Has anyone worked on electrical wiring and also watched a skilled electrician work on electrical wiring? You would be a damned fool not to turn off the circuit breaker, but a trained electrician is used to reasoning about electricity and its dangers, so they treat hot wires one way and cold wires another. They can keep two wires separated at a distance while extracting a piece of electrical tape with their other hand to prevent the wires from shorting together. In really hairy situations, they'll turn off the breaker, but they've internalized the rules, so they usually don't have to bother.

Medical workers are like this too. Even with minimal PPE, as when their employers threaten to fire them if they use PPE, they keep track of infected surfaces, what they have touched, who has been breathing where, where liquids are flowing an so on. A friend of mine used to work in a biolab, so she automatically tracks what touched what, so her cuffs never touch the kitchen counter top.

Sure, there may be some level of hormesis with low level exposure. People who grow up with sand flies get milder cases of kala azar. Odds are though, it isn't immunity so much as training and practice. We know maybe halfway past "j" in jack shit about the immune system. The presence of antibodies can mean anything, even that health care workers get more exposure to the common cold.

P.S. Please, spare me the intelligence thing. Individual intelligence maybe gets you an extra hour or two. Societal intelligence is why people in the developed world live longer.

That seems very reasonable to me. These people are aware that if they are not careful they are likely to kill someone's grandmother. Or many grandmothers. Also, they are very aware that even if they don't develop a life threatening infection coming down with COVID-19 can be an extremely unpleasant experience. Finally, while I don't know how this works, they may have a strong financial motive to stay uninfected. Will they be paid if they are sick for a month? If they have a slow recovery, or never fully recover, how will that affect their future earnings?

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Obviously, common sense is at work. Something severely lacking in urban areas controlled by Democrats.

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Seems like behavior works. Masks work. Distancing works. The upshot: With ubiquitous vigilance, we can beat this, without a vaccine, and without shutting down the economy. Wear a mask, and even goggles. Avoid crowds. Prefer home, and when not at home, prefer the outdoors. This isn't rocket science, people. And this isn't complicated enough for 1% of the ink given to it.

Australia never had a New Zealand style lockdown and appears to have eliminated the virus from the general population in 3 of 5 states. One state looks like it has it well under control (fingers crossed) and one state -Victoria -- has hundreds of new cases everyday. The resurgence in Victoria was due to state government incompetence, but there has been a lot of incompetence with the response in Australia, so I guess we shouldn't be too surprised by this.

A major reason things have become so bad in Victoria is reduced fear. People no longer cut back on human interaction as they did when restrictions were first introduced. This doesn't mean we can't beat the virus, but it does mean we have to ramp up our efforts to obtain the same effect.

+2. Yep. Fear is critical. Reason without an emotion or motive to fuel it runs out of steam pretty fast. With ubiquitous vigilance, we could be back to 85% normal in a month.

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