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- SARS-CoV-2 reinfections: Overview of efficacy and duration of natural and hybrid immunity - Pilz Feb 2022
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SARS-CoV-2 reinfections: Overview of efficacy and duration of natural and hybrid immunity - Pilz Feb 2022
Environmental Research 209 (2022) 11291 . https://doi.org/10.10167j.envres.2022.112911
Stefan Pilz a stefan.pilz at medunigraz.at, Verena Theiler-Schwetz a, Christian Trummer a, Robert Krause b, John P. A. Ioannidis c
a Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036, Graz, Austria
b Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz, 8036, Graz, Austria
c Departments of Medicine, Epidemiology and Population Health, Biomedical Data Science, and Statistics, Stanford University, Stanford, CA, 94305, USA
Seroprevalence surveys suggest that more than a third and possibly more than half of the global population has been infected with SARS-CoV-2 by early 2022. As large numbers of people continue to be infected, the efficacy and duration of natural immunity in terms of protection against SARS-CoV-2 reinfections and severe disease is of crucial significance for the future. This narrative review provides an overview on epidemiological studies addressing this issue. National surveys covering 2020-2021 documented that a previous SARS-CoV-2 infection is associated with a significantly reduced risk of reinfections with efficacy lasting for at least one year and only relatively moderate waning immunity.
Importantly, natural immunity showed roughly similar effect sizes regarding protection against reinfection across different SARS-CoV-2 variants, with the exception of the Omicron variant for which data are just emerging before final conclusions can be drawn. Risk of hospitalizations and deaths was also reduced in SARS-CoV-2 reinfections versus primary infections.
Observational studies indicate that natural immunity may offer equal or greater protection against SARS-CoV-2 infections compared to individuals receiving two doses of an mRNA vaccine, but data are not fully consistent. The combination of a previous SARS-CoV-2 infection and a respective vaccination, termed hybrid immunity, seems to confer the greatest protection against SARS-CoV-2 infections, but several knowledge gaps remain regarding this issue. Natural immunity should be considered for public health policy regarding SARS-CoV-2.
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Computer transcript - will have some errors, but costs only 5 cents/min instead of 80 cents/minute
:00:00.6 Dr. Campbell: I send, I think we are recording. Thank you very much for coming on this on this podcast, and also thank you for doing it in English, because if we're doing it in German, I think I might struggle quite a bit, so it's that step and you're a medical doctor, you're a doctor of research, your PhD, you're consultant for Endocrinology. I know you've got a special interest in in the infinitely complex disease of diabetes as well, you have a consultant in internal medicine or general practitioner, and I believe you're currently an associate professor in the department of medicine, endocrinology and Diablo... In graphs, in Austria? Yes, yeah. Good, and you did a PhD from the Department of Epidemiology and Biostatistics in Amsterdam, so been around you up quite a bit. So we want to talk about what we might call natural immunity, I guess, can you just sort of introduce this... What is this concept of natural immunity? What is it? How does it occur?
0:01:04.7 Dr. Piltz: I have the epidemiological feint perspective when I look at this, and the way I look at this is very simple, I just wanna look at patients who had Astin sections and then I wanna know our day protected afterwards, and how long are they protected? We can discuss for hours about immunology, I'm not an immunologist, because I think we have to focus clinical endpoints on clinical data, that is really what matters, and you see a lot of studies measuring antibodies, measuring T-sales pieces and whatever... What I wanna know is just, am I protected after infection, how efficient is this protection, and how long does this protection list, and there's a very simple questions, and that is what we wanted to address in our research.
0:01:54.8 Dr. Campbell: Absolutely. Let's go for it then, and I think we should say We've been overstating your paper for the past few days is quite excellent, it's available as a free download, so we'll put the link on and people can get it, and I must say I did find it very accessible that any intelligent lari think it could make sense of that. So let's start off with that then if someone is infected with size Coronavirus 2, they're going to develop some sort of immune response, just talk us through it, the type of immune responses to get how long it's going to last for me, it starts with the assessment of re-infection, because when we look at this, we want to know, do you get the re-infection and at what time to get a re-infection?
0:02:37.1 Dr. Piltz: The first problem that we have, when can we talk about reflections, and usually the definition is that we can only talk about the re-infection three months after your first infection, because many patients have viral chatting for several weeks and months. And that is the first thing we have to consider when we talk about this, and... Well, if I am allowed to start how I called... You stop me. We'll start with that. Well, at the end of 2020, I was not discussing with my wife about covid 19, I always ask her, what is the measure as... What I'm allowed to do and what not, and we couldn't believe that at that time, at the end of 2020, there were virtually no data available for natural service reflection risk in those already infected, and I am convinced that this is very important for two reasons for two main reasons, and the first one is being, of course, the more people are infected and if they are protected, we can bet a predictive Forecourt of this covid 19 pandemic, and that's very important in particular in these days. And the second reason was to go into this research direction is when we started with vaccine campaigns, when we started with vaccination, we had to shore of vaccines the beginning of these campaigns, and it was extremely important to prioritize the vaccines to have the most efficient use of vaccines, and at that time it was important to know about natural immunity, and that's why we started to look at this in Austria, because I still believe we could have saved many more lives with vaccines if we have prioritized within the same risk groups according to the previous infection status and...
0:04:23.0 Dr. Piltz: Well, what I did in the beginning was very simple. In Austria, it was very lucky to have access to the Austrian National Data that were released by Francia and I could collaborate with this team, and we had a very simple concept, we looked at individuals in Austria, where does Ascot infection the first wave? And then we re-assessed this group of previously infected patients six to eight months later, and we compared their infection risk with the rest of Austria, and we found a 91 protection against re-infection in this group, so we had a huge effect size. Really have a huge effect as for protection against re-infection with SAS cut, and this was after six to eight months, so we already... At that time, this was one year ago when we released this regional study, we knew that natural immunity lasted for at least six to eight months, and there was no sign of waning in our studies, so we knew we could expect that naturally immunity lasts quite long and at the moment with more studies coming up with more studies confirming about this effect size of 8, 18, 90% for natural immunity, in terms of protection against re-infection, we see longer and longer follow-up periods, and we do have data now from the United States, there was the group I came and Roth Berg and they published that even more than 30, 90 days after your first infection, you do have a significant protection in the range of 87%, so we know naturally immunity, you get a high protection against re-infection and also can severe disease, and this is lasting for more than one year, and from the evidence we have, there is only, if at all, a moderate waning immunity of over one year, and it will last more than one year.
0:06:26.1 Dr. Piltz: That is also what we know and that's a particular importance when we look at the next season, so those were... In fact, the this season, they will also have some kind of protection, a very good protection against re-infection the next winter, and this really matters, and if I may continue, I think that at the moment with the Omicron wave, we see that is protection, also natural immunity, really works because you see we have a lower proportion of hospitalizations and of that, and you know in the beginning there was a discussion, maybe Omicron is such a mild disease, it's not that severe as the other variants, but we know right now that the major reason why Omicron is so mild. Is not that Macomber SE. It is because we have such a high immunity in the population, of course, it's vaccine in Houston and its natural immunity, and we have countries where we see going, this number numbers going down in terms of hospitalization, and that's where we have a high vaccination uptake, but also countries take Africa or South Africa, or we don't have that, and we see these numbers going down, so I think we are at the moment with this working together of vaccines and a natural immunity, somewhere at the end of this, of this covid 19 pandemic and this are really, really important use for everyone and we should be happy...
0:07:54.3 Dr. Piltz: Very, very happy about this. Yeah.
0:07:56.0 Dr. Campbell: Yeah, absolutely. Then the first to encourage me when I learned that in the 2002-2003 Sakharov Rus one outbreak, people still have neutralizing immunity and clinical protection, that 17 years later in 2020, so you're saying we're getting like 87% protection after 390 days. What's kind of your best estimate about the longevity, and you think it could be years or into a decade or more, like the original silver into... What do you think...
0:08:29.0 Dr. Piltz: I mean, I'm focusing on clinical data, so we don't have the clinical data for many years, and there's always some uncertainty around this data we have fires, we have confounding in epidemiological studies, but from immunological studies, from antibody data and also what you mentioned from measuring other parameters of immune system, we could estimate, we could expect it less for several years, so this is what we can really, really assume for national immunity, and you mentioned we also have other coronaviruses that are also endemic in our population, and these do not cross a lot of harm to us, because we have our first infection is when we are child, so in three, four or five years old, and then we could re-infect and re-infect and Reinert and we build up natural immunity and it doesn't do harm, and some colleagues of mine... There's great science papers about that, they assume that what will remain from sources first infection as a child, he has a young child, and then we get... In fact, that are... In fact, that... And when we're old, and in 10 or 20 years, we will have many old people, but they have open, infected, infected, infected and Tamil times and build up their natural immunity.
0:09:49.7 Dr. Piltz: And the good thing about cascades that the first infection as a child is very, very mild, so also compared to the flu, that's a very mild infection, and we're very lucky that this is the case, and this will probably remain in a few years ahead from now, but of course, these are on the estimations based on the data that we have, and it's never black and white, white picture, but I think that the data on natural immunity are very, very important in particular, because we know at the beginning of 2022, we can estimate that probably... More than half of the world's population has already be infected with sucrose, what we know when we're watching this data on World meter and all the this reports on national infection data, we know that we do not capture... We do not capture most of the infections and we know if we have a very perfect test strategy, we may detect every second infection, but for low-income comes the surveys or there are mid-analysis estimating that you detect one infection for 62 occurring in such countries. So more than half of the worlds population seems to be infected right now, they have a good production, a very efficient protection, and this is long lasting, so these are extremely good news, and therefore I think these days coming to an end of this covid 19 pandemic, and yeah, the question is, of course, how do I test all this and how to change the measures against covid 19 and how to balance the costs, efforts and time that we put into the fight against covid 19.
0:11:37.6 Dr. Piltz: I think vaccines were very, very important and a very, very effective and this was really great that we have time available and also vaccinated three times, so I'm a big fan of that, but natural immunity has to be considerate, and that's very important, and that's why I'm very happy to have to interview with you.
0:11:57.4 Dr. Campbell: Yeah, so the practical implications of this are, the way I see this, it's almost like a generating active immunity on top of the immunity we already have from the vaccines, so like you... Thankfully, I've had three doses of vaccine when I'm infected with... On my Cron, I haven't known been infected whether... Yeah, but when I am, I'll be protected yet still, even though and protected from the vaccine, am I right in saying that the Omicron will give me a big immune boost as well?
0:12:28.0 Dr. Piltz: Yes, of course. I think we have solid data from this, they are great data from Israel, from Qatar, and also from the US, and just yesterday from the UK, serene siren study was publishing in diagonal of medicine, and they all show that his term hybrid immunity, so persons who received a vaccine and two had an infection either before or after the vaccine, that seems to be the best form of protection against... As of Jan, against covid 19. And I just quote a paper from yesterday in the New England, and there they write, well, our finding of greater protection associated with infection, acquired immunity to vaccine immunity, so it should be not a battle between vaccine in Usenet and the natural immunity. Although the data that we have from observational studies seem to suggest that when you compare to doses of an MRNA vaccine with natural immunity, it seems to be equal even if not better for natural immunity, and this is very great news for the world.
0:13:36.9 Dr. Campbell: HighTower was data from New York and California on that from the CDC. The people who'd had natural infection without vaccination actually had better protection than people who have two doses of vaccine, because the other factor there is that we know that the protection from the vaccine was... It goes down. So do you think that the natural immunity is going to last for much longer than the vaccine-induced immunity...
0:14:05.0 Dr. Piltz: I mean, the data on this are quite clear from epidemiological studies, so with the vaccines you have opposed, you have a very, very good protection in the first few months after that, but you have a relatively steep, deep decline afterward sent for natural immunity. We've seen many studies that it's really very, very stable and only moderately waning over this time, and well, of course, no data from the CDC, and I think this is very important that this data come up, but it's sad that this data haven't been published previously because many countries did not anyhow, like the US, consider previous infection in terms of any measures against covid, but when we compare it, the course of the immunity after vaccines and after infection, we see it after infection, it's really very, very stable from all the studies we see, is it clinical studies, or is it starts to mature antibodies or other parameters of the immune system, and that are very... Very good news for all of us. So
0:15:12.9 Dr. Campbell: For someone like me that's been vaccinated, my vaccine immunity is waning quite rapidly now, because it's maybe four months since my last facing, so that's going down quite rapidly, and I know that armories likely to give me absolutely minimal disease unless I'm really unfortunate. And that's going to give me a boost which could last for years or a decade, so the way I see it is my vaccines have given me this opportunity to be safely infected with Oneonta the longer term, as we move into indemnity, as my thinking reasonable there do you think
0:15:49.8 Dr. Piltz: It's, of course reasonable, but it's very difficult for me as a doctor, as Dr, working as a university hospital to make any recommendations for this, but of course, we can break it down to simple terms, I think we will get infected, so almost everyone will get an infection, and the question is, when is the best time to get your infection, and that's probably quite a few months after you receive the accents, and we know that the protection for the vaccine will go down a year, we are more after... And we'll make it clear. Dr. Fitton myself, I'm not giving medical advice. We're not too hot to do...
0:16:28.5 Dr. Campbell: Thank you, this is a really an academic discussion, he is not better striving for you, I am not prescribing for you, this is an academic discussion that you may happen... It defined interesting because I know you as an individual.
0:16:42.3 Dr. Piltz: But I also want to add, when we look at the moment that many studies that are released at look at vaccine efficacy and has natural immunity, we always have to consider the absolute risks. So when we started with the first vaccine studies, the risk, the background risk was very high, and the 90% production is about this decrease, but when the absolute risk is very low for death and for hospitalization, even a 90% reduction from that starting point is only a minimal difference. So we have to be very cautious with interpreting studies, what we have to ask what is the absolute worst or risk of dying of hospitalization, or what are kind of clinical end point we have... And as we see with the oricon wave that the Apple risk of mortality and of hospitalization decreases in the whole group, we have to ask the question, Do we have to rethink the risk and benefit ratio also vaccines in the future, this will be very, very challenging because the more immunity we build up in the population and the less severe infections will mean we can expect this also after this, in this Omicron wave, the more we have to ask about the risk benefit ratio of vaccines and what we have to consider what has not been paid so much attempt attention as I would have liked it to be, is the deep radiant of the risk increase with age.
0:18:17.7 Dr. Piltz: So we know that even if you are unvaccinated is a very young healthy woman, you have a lower risk when you get infected with a soft-diced 19 versus an older person who is vaccinated, and we have to consider, doesn't incorporate this also in our strategies in terms of content.
0:18:39.3 Dr. Campbell: I got vaccinated, it was absolutely 100% clear that my chances of delivering for another year on this planet were much greater if I were to be vaccinated and I'm quite all, but if we take someone of your age group, the risk is much less so we have to look at the absolute risk, which really is your risk of being hospitalized or dying as a citizen of the entire country, not comparing it to a subgroup H Grove out of particular infection is the absolute risk. That's important, and I think what we can say with some certainty is that the risk benefit analysis of vaccination has now changed against vaccination. Now, this is not an anti-vax statement by any means. But the benefit that a vaccination might give me now with the LaPlace amount of immunity we have and somewhat reduce pathogenicity of Omicron... Yes, has changed the balance of that equation, it's something that needs to be... To be reconsidered and because what we always do in healthcare, you know this better than I do, you're always saying, Well, this could help this patient, but what is the risk? It's always this benefit risk, so a patient is very likely to die, we might carry out a very high risk procedure because it's their last chance, I've defiled people many times, and that's a very high risk procedure, but the alternative were certain death, whereas when we're dealing with it, with a more subtle intervention, we have to look at that now that risk benefit analysis much, much more carefully.
0:20:09.6 Dr. Campbell: What is that? Right, did you agree with that, that?
0:20:12.2 Dr. Piltz: I totally agree with this. I think this... But these are very challenging discussion is a future... And in particular, when it comes to children, when we know most of the children are so many children have already been infected and the risk is quite low, so there... It's very hard to say. Is it justified or not? That's a very challenging discussion. I want to... So I don't wanna give any recommendation regarding the...
0:20:36.8 Dr. Campbell: No, we're not prescribed, we're not doing that, but we know in my country at least 85% of children have got antibodies, and of course they've got antibodies, that's the absolute minimum that will enjoy some degree of protection because in many of the anti-bodies would have dropped below the 42-9 meme detection limits, some will be way below that, but of course they also love their memory be and T-Cells, which has we've been sharing is probably going to give immunity for some years, which is remarkably good news, but it's great to hear you saying this because I set him on to my camera and talk to myself quite a lot, making YouTube videos, but good to talk to someone, to talk to someone who's... Who's been re-actively researching this field... That is brilliant. What do you think about the idea of testing people for antibodies or other forms of immunity before we advise vaccination, do you think seem so far we've done a one-size-fit, sordid, you mentioned this at the start of this, that we were vaccinating everyone where they did have the immunity or not, therefore, potentially not using vaccines Toto the best of their potential, do you think we should be doing antibody tests before we do vaccination to take off the way this one-size-fits-all sort of program we have now...
0:21:52.4 Dr. Piltz: There have been many discussions about this, I think we still do not have the evidence that this really brings us benefits, it may seem logical on the first... On the first side, but we bring a lot of complexity into this topic and our whole strategy, we are safe to consider the cost... No test has a perfect... Is perfect. In terms of sensitivity and specificity, and I think at this stage, I'm not a fan of doing this. We probably would have needed the studies showing that this is effective, is effectively working. I think it's probably too late to incorporate such a strategy, it might have been of use in the beginning, but right now, I think you mentioned it, so many people already do have immunity, but of course it's worth considering, but from my point of us... My personal opinion, I think it brings too much complexity, cost sense On intertidal to have the best tests, so laboratory tests, they can be for positive or negative and so on, and you have costs, and I think cost is something we really have to reconsider these days because we have put so much costs and efforts identified against covid 19 and we have to think, Is this really cost effective what we're doing at the moment, because we spend so much money into all of this, and is this money better used for other topics like smoking, hypotension, or dollar and so on.
0:23:28.7 Dr. Piltz: We have to bring everything into perspective in the context and see where our efforts and our money best spend to produce the best results, and that is a question we have to ask in 2022 or things... Yeah, yeah.
0:23:42.4 Dr. Campbell: You're right. We're certainly not going to an or disease is to research in my lifetime, and I don't think you are going to in pathology in your career either as we move to endemic and patients are going to be potentially re-infected with this every season potentially. Do you think there's going to be an ongoing risk to people with diabetes, obesity, hypertension, chronic lung disease, heart disease, all these comorbidities are gonna be a longing threat to them, or
0:24:12.0 Dr. Piltz: Is there immunity... Go to sort of reduce the risk. Do you think the risk is definitely reduced, this is what we see in terms of relative risk, we have such a huge risk reduction, it's never black and white and told you in the beginning, so some sort of risk and may remain but it should not have that impact that it had in the beginning, because we already saw this medication of this artisan mic, so in the future waves there may be huge numbers of infections, but there will not cost the harm that we have seen in the beginning of Hispanic. The problem is, when we come to the end of hypodermic, according to my knowledge, we don't have a crystal clear definition, what is the end of this comedic? I didn't find it and with on different number and said, now we are coming to an end, but I think we have to rethink the balance between efforts, costs, time, attention, we spend on it, this compared to other very important topics and according to my opinion, we are... At the end, these days of the covid 91 pandemic, this does not mean that there is no harm with sastre in future years and decades, there may be people that the harm but is fire us, but it should not have that much attention and we should not spend so many money efforts into this into this topic.
0:25:37.5 Dr. Campbell: What are we going to do carry on doing mass testing for the entire population for the next 10 years, this is gonna remain anemic to that there's gonna be after to be a time when it's cut off, so the way I see this, there was a time when the only immunity on the planet to save CO2 was natural immunity, then when there was a time when we had a vaccine immunity, and now that's leading into a time of hybrid immunity, and unless we're gonna keep vaccinating people forever and ever, which again, it's just not really practical or desirable, we could go on to a period of indemnity where all of the immunity... It is natural. In fact, we have to get to that stage, don't we, at some point in five or 10 years time into the future, people are gonna have very high levels of unity to size Coronavirus to, but that will all be naturally induced unless we carry on vaccinating that is all going to be naturally induced them, I'm just so pleased to hear your optimism that you... That's going to lead to an... 'cause that's been the way my thinking is developing, but it's really good to hear now, in terms of future variants, am I right in thinking that people that have developed immunity to Delta, they've got lots of breakthrough infections with a Macron, so Delta didn't provide good protection against a micron, but my understanding is that Macron does provide some protection against...
0:27:07.8 Dr. Piltz: Pretty good protection against Delta is not what you understand... To break it down, what we have with the epidemiological data, we see no huge differences between all those variants that we had, we had to alter the better the delta, the Omicron, and we always have to think about when we have natural immunity, we're exposed to the whole virus, so to all parts of the virus, we are exposed versus with the vaccines, we have only part of the virus that we're exposed to, our immune system reacts to with the virus infection, with Ascot, we have all parts of the virus, and even if it changes there are some other parts where immune system is primed and it's protecting us, so there are no... Huge difference is also with Omicron because just a few days ago, a group from Qatar, they looked at the natural protection against Omicron, and what they've seen as well, you're more likely to get re-infection, but your protection against death and hospitalization in particular, can tributes is the same, it's about the same. So you're more likely to get the infection probably with some future variants like with Omicron, after your first infection was another variant, but you're very well protected against severe disease, and that is what we've seen with the oricon variant, at least in CTA, that are also very, very good news for the first.
0:28:37.4 Dr. Campbell: So my understanding is there's at least 24 epitopes in the virus... Am I right in thinking? So to 24 antigenic components, the body recognizes as forms the body, generating 24 different, slightly different types of antibody to those 24 epitopes.
0:28:57.3 Dr. Piltz: I mean, I'm not an immunologist, I have to be honest. I want to stick with what I know. That's fine, it's fine to expertise, and of course, I know that the response to the virus and have been wonderful discussions and papers from this also from a guy from Osteen grama, he's an expert in that, but of course, the immune system is exposed to every part of deft of the virus as a careers immune reaction at many, many different antibodies, and of course, if you have problems with the spike protein and it can enter, it can cost infection, there are other parts of the immune system that work, but we should not only think about and discuss about antibodies, because also for natural immunity, there is a study from the UK showing that when you have the primary infection with Salcedo, and even if you had no anti-Iris measure it, you even had a high protection against re-infection. So it's not only about The Antipodes, definitely not, and we had so many discussions, so many news reports on antivirus studies and people asking for the antivirus, but there's much more than that, it's all an incomplete picture of immune response, you can say, but...
0:30:18.5 Dr. Piltz: I'm not an immunology, and I do not want to pretend to be one... There are so many smart people there. I looked at epidemiology and that's why... No.
0:30:28.8 Dr. Campbell: That's great. Is fascinating to hear you say that people with essentially non-detectable antibodies still very high levels of protection, and we assume that's all these B and T-cells and probably doesn't other mechanisms that humanity hasn't discovered yet. The immune system is an amazing thing, but the message I'm getting there is you are epidemiological optimistic, the Omicron infection is going to basically give us fairly good levels of protection against any likely future size Coronavirus to Varian.
0:31:05.1 Dr. Piltz: Yes, I think we can be pretty sure. It's never 100%. We do not know about the future, it can always happen that a new Verint and so on is coming up, but from the past, we had this different variance, so we had many different variants already, and always in the beginning, there were some reports where we have no protection after natural immunity, there's no protection with the vaccines, it's more severe and we have a bigger problem than before, it was always the same, or with each of the waves we had, and always, it turned out afterwards that the protection was about the same as about similar Mahar different, we have to admit that, but it was not a completely different story, and so I would ask why should it be different... Completely different in the future, we already had this different waves with different variants, and the immune system, natural immunity always work. So why should it be different in the future...
0:31:58.2 Dr. Campbell: That makes perfect sense. Is there any tips you could give me to increase my personal and unity... I mean.
0:32:04.6 Dr. Piltz: Of course. Healthy, healthy.
0:32:06.4 Dr. Campbell: Please do I need all the home...
0:32:10.5 Dr. Piltz: Healthy lifestyle.
0:32:12.9 Dr. Campbell: You have to be in good condition. In a good, healthy condition, doing sports, doing... Keeping your body weight in a reasonable range and looking at nutrition, and I've been working along with vitamin d and so on, so we talk hours about this, but I think I'd like just a little bit on vitamin d, if that's okay. I mean, my understanding is that if you have a vitamin d deficiency, that's certainly going to lead to immunodeficiency... Is that basically correct?
0:32:46.8 Dr. Piltz: I mean, I wanna come to the RCD data that we have a first, we have the background for vitamin d, that it has an effect on all the immune cells, all the immune as that you have a receptive of vitamin d, So if this is of no sense that nature would have made a big mistake because you have the system of vitamin d, and there are studies before the iconic that have shown us in randomized placebo control trials that when you supplement vitamin d versus placebo, you have to reduce risk of respite or a tract infections, and this was met analysis of RCT, so the highest evidence level that we can show, and based on this, there's quite good evidence that you have a protection as a preventive measure if you are deficient in vitamin, you supplement it against respiratory infections. So that are very good news for vitamin d, and of course it has enormous effects on our immune system, and there are also some evidence for autoimmune diseases for vitamin d. Yeah.
0:33:56.7 Dr. Campbell: We could talk for hours on this side, there's a lot optimum level to Rainford basic list. So if you're deficient, you're going to get more respiratory one is, but if you've got a good level and your top it up even further, that's probably not going to give you additional protection is that...
0:34:11.3 Dr. Piltz: That is status of course, correct, you can... Everything that has an effect, you can overdose, so that is also with vitamin d, but when you're severely deficient and you supplement this or you increase vitamin d by natural food or by sun exposure, and you can really improve your vitamin d status. And this has an impact also on immune system...
0:34:31.8 Dr. Campbell: Yes, yeah. So the easiest part of the improvement to the immune system is the easiest to get... Yeah, if someone's very deficient, you can... You can just give that a bit... A bit of a boost. Yeah, brilliant. So sound so much for that, you certainly can be in order and reassured me, Annas, lute, brilliant. Is there anything else that we should really cover that you think that things have missed, and
0:34:56.7 Dr. Piltz: I think it was really a pleasure for me to talk to you and if... I also have this opportunity, you have such a big audience. And thank you for that. I really appreciate this.
0:35:07.8 Dr. Campbell: Tower put links to staff and paper with others, it should be mentioned as a net hot, but the thing I really liked about this paper, this is readable, you don't have to be a doctor or an epidemiologist to read this, the average intelligent retreat can really make sense of that and just cram full of fascinating arguments for the... Well, we have no option. We have to go down the natural immunity route, and I just agree with that. Absolutely, completely. Thank you so much and thank your family for giving us a break from you... Are you working nice tonight. Yeah, you're working tonight. Or today, I'm not working on it at a time was my wife and my son, and I think you emailed me about 113191, you're at work, so I think you've been working pretty late, and I guess you've had a pretty busy period. Wonder, Stefan, thank you. And if you ever wanna come back... Of course. More than welcome, wonderful to have you. Fascinating stuff and great to get it from a clinician who's got the scientific background as well, so... It's wonderful, thank you.
0:36:18.0 Dr. Piltz: Okay, thank you, ichthyo.
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Some later answers
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VACCINation, VACCINations, VACCINes, VACCINe, VACCINated, etc.
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