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Understanding Why Breakthrough Covid Occurs

Summary:
This article (MedPage Today) popped up in my In-Box and I believe it is a good average – person on the street (high school education?) read if you want to understand “why,” why getting vaccinated is not a failsafe solution, You still have to socially distance, stay out of bars even if the owner is an ass, wear facemasks amongst other people, etc. so as not to catch Covid. The MedPage Today article explains why you should be vaccinated even if the vaccine is not the 100% impenetrable Covid – proof – jacket many people believe it should be. Checkout the multiple comments made by doctors, nurses, etc. too. This article was a well-received by medical personnel. We Can All Benefit From Helping Patients Understand Breakthrough COVID | MedPage

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This article (MedPage Today) popped up in my In-Box and I believe it is a good average – person on the street (high school education?) read if you want to understand “why,” why getting vaccinated is not a failsafe solution, You still have to socially distance, stay out of bars even if the owner is an ass, wear facemasks amongst other people, etc. so as not to catch Covid.

The MedPage Today article explains why you should be vaccinated even if the vaccine is not the 100% impenetrable Covid – proof – jacket many people believe it should be.

Checkout the multiple comments made by doctors, nurses, etc. too. This article was a well-received by medical personnel.

We Can All Benefit From Helping Patients Understand Breakthrough COVID | MedPage Today, Gary C. Steven, MD, PhD August 27, 2021

Introduction

Or the way am I posting this commentary??? The recent change in masking guidance from the CDC and reinstated public health measures from local and state governments have been met with frustration and defiance, with people understandably questioning why they got vaccinated if they have to go back to masking and distancing anyway. The answer is in the degree of exposure to SARS-CoV-2, and the explanation lies in the way vaccines work.

We (the doctors) can help our patients (us) understand this with three talking points:

This follows what I know to date and is difficult for me to explain. I am hoping to clear up some misunderstanding by quoting the doctors version of this which I am sure Joel and also Daniel Becker would agree on it.

Three Points

  • The antibody levels in the bloodstream are completely helpless at preventing infection.

Neutralizing virus particles from the environment is the sole responsibility of the vaccine-induced antibodies in our respiratory, GI, and ocular secretions or our “frontline” defensive antibodies in our saliva, tears, nasal secretions, and pulmonary mucus.

When exposed to airborne virus particles, antibodies attach to the spike protein of SARS-CoV-2, physically preventing it from latching on to the ACE2 receptor on the surface of our respiratory epithelium and gaining entry to those cells to cause an infection. This is all we have.

If we are exposed to so many virus particles that all the antibodies in these secretions have attached themselves to virus particles; we continue to expose ourselves to new particles faster than we transport more antibodies into these secretions, our antibody defense gets overwhelmed, we inhale or come in contact with more virus particles than we are able to neutralize, and we become get infected.

  • Circulating antibodies help to contain the infection

Once infected, the virus takes over the machinery of our cells to make more virus particles and release them. The circulating vaccine-induced antibodies latch on to these newly minted particles preventing them from infecting adjacent cells and from being exhaled.

One of the Delta variant’s strong suits is its ability to reproduce itself so rapidly our antibodies do not slow it down much. We see infected, vaccinated people shedding virus similarly to unvaccinated folks.

  • Our vaccine-induced T-cell immunity limits disease severity

The third element of the response to the vaccine you do not hear much about is the induced T-cell immunity. This arm of the immune system kills off our own infected cells which are a lost cause anyway and will need to be replaced. This limits the extent of disease. (To my limited knowledge, pre-vaccine T-cells would over react and flood the lungs).

That is why the vaccines remain effective at limiting the severity of disease, and the reason why we do not see many vaccinated people among the hospitalized even as the number of vaccinated people infected with the Delta variant increases. This is also why it is critical to get vaccinated. The vaccines are extremely effective at preventing severe illness and death from COVID-19.

It is not in the T-cell job description to go after viruses themselves. Vaccine-induced T-cells do not provide protection against getting infected; they only mitigate severity once infected.

Conclusion

More and more vaccinated people are getting infected because they are interpreting vaccination as carte blanche to return to pre-pandemic life without restriction and are exposing themselves to massive viral loads that overwhelm their immunity. 

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