Healthcare workers are recommended to be first in line for COVID-19 vaccines once they're authorized, but many have already been infected -- leading to a debate about whether they should give up their place in line.
Joel Zivot, MD, an anesthesiologist and critical care doctor at Emory University in Atlanta, tested positive for COVID-19 in August and has since recovered. He believes it makes sense to give up his spot in the vaccine line for someone who has never had the virus, based on early results regarding longer-term immunity.
"As far as I understand, the people who have become sick with COVID have some immunity, and the immunity might be long-lasting," he told 番茄社区.
In fact, Zivot thinks healthcare workers -- previously infected or not -- should not be first priority at all.
Those at the highest risk of spreading the virus, those who might be tipping ICU capacity over the limit, are the ones who should be first in line for immunization, he said. Healthcare workers are typically not in that category, he said, as they seem to do a good job of protecting themselves and are not the target "highest risk" population.
"It's a bit like, who are the lifeboats for?" Zivot said. "It should be the people who are at the most risk, not the strongest swimmers."
On the other hand, Sapna Kudchadkar, MD, PhD, a pediatric intensivist who had COVID-19 in March, said that she expects all healthcare workers will be offered the first vaccine whether or not they've been infected -- and she wants to be on that list.
"I would definitely advocate to be vaccinated myself," Kudchadkar, an associate professor of anesthesiology and critical care at Johns Hopkins, told 番茄社区. She believes there's not enough evidence about antibody persistence to confidently say recovered patients are protected.
Still, knowing that she's had sufficient antibody levels to donate convalescent plasma, she said she would be happy to step back, allowing healthcare workers who have not been infected to be vaccinated before her.
But as a healthcare professional regularly exposed to the virus, the assurance that she would no longer be a threat to her family -- if a vaccine can genuinely offer that -- is a major pull for getting immunized as soon as possible.
"It's likely that my fourteen year-old, healthy child is going to be lower on the list for vaccination," Kudchadkar said. "But I know if I am vaccinated, and I'm the highest risk in my family, then it lifts a lot of anxiety."
Experts disagree when it comes to interpreting the evidence regarding lasting immunity and the need for vaccination among healthcare workers (or anyone, for that matter) who've already been infected.
Cases of reinfection have been documented; they appear to be rare, but the true rate remains unknown. For starters, second infections won't be recognized as such if the first was never detected.
Likewise, an asymptomatic reinfection may go unnoticed, yet the individual may still transmit it to others. It would not be good if that person happens to be a healthcare worker.
At the same time, the vaccine trials thus far have not examined whether the shots prevent infection, only clinical illness.
Biomarker data suggest that immunity to SARS-CoV-2 from infection lasts , but "I don't think we know enough yet about the degree to which [prior infection] confers immunity," Arthur Caplan, PhD, director of the division of medical ethics at NYU Langone Medical Center, told 番茄社区.
Previously infected individuals might need an immunity boost, Caplan said; delaying immunizations for healthcare workers who were infected early in the pandemic may not be safe.
While it's expected that hospitals and large health systems will mandate vaccines for employees, it's not likely until a product is licensed, Caplan added.
On the other hand, Deepta Bhattacharya, PhD, an immunologist at the University of Arizona, said that "natural immunity seems to be quite effective."
Months after infection, various components of immunity -- not only antibodies, but T cells (which might indicate longer-lasting immunity) and B cells -- seem to be in place, Bhattacharya said. "It looks like at least some amount of it is going to last for years," he told 番茄社区.
Understanding this potential for long-lasting immunity, Bhattacharya said it may be reasonable to delay vaccination for recovered COVID patients.
"Given that at the very beginning, we are really expecting demand to far outpace supply, I think it does make some sense to prioritize people who have not been infected already," Bhattacharya said. One remaining question, though, is how to confirm who has actually been infected, he said.
Down the road, Bhattacharya added that there is benefit for previously infected people to get the vaccine as an immunological booster. In the meantime, whether or not someone who has been infected gets vaccinated will be a matter of state health department guidance and individual decision.