#MSCOVID19 – the fourth wave


Barts-MS rose-tinted-odometer: ★★★ (a blueish-green Thursday; looking forward to being a weekend warrior  #0d98ba )

My heart sank when I saw the latest COVID-19 UK case numbers. Here we go again? I don’t think so simply because the vaccines are working as well as the protective immunity induced by wild-type SARS-CoV-2 infection. I just wish the Government would take a pragmatic approach to the science and allow people who have been vaccinated (double-dose) and with confirmed previous SARS-CoV-2 infection to get back to normal. 

It is clear from Israel that people who have had COVID-19 are as immune as vaccinated people to (re)infection with the virus. This will almost certainly apply to the circulating variants that as yet are not immune escape variants, i.e. capable of reinfecting large numbers of people who are meant to be immune to SARS-CoV-2. 

The biggest concern with the current Indian or Delta SARS-CoV-2 variant is that it is more transmissible and more virulent, which means people who are not vaccinated are taking a big risk. This is very relevant to the East end of London where the vaccination rates in adults are below 50% because of significant vaccine hesitancy in the local population. We are therefore at high risk of a significant fourth wave of infections, which will have implications for our hospital and other services, including the MS service. We really need some respite from fighting and dealing with COVID-19 so that we can get back to normal or at least near normal. So please think carefully about resisting vaccination; you are not only putting yourself at risk but are impacting the health of others.

Please remember that COVID-19 and SARS-CoV-2 are going nowhere soon and will almost certainly become endemic, i.e. the virus and its variants will remain with us forever. So if you have not been vaccinated you will at some point in time get exposed to SARS-CoV-2 and get COVID-19. The risks of COVID-19 and its consequences, including long-COVID, are orders of magnitude worse than the risks of the vaccine. Therefore please #GetVaccinatedASAP. In my opinion there really are very few reasons to say no! Do you agree?

Goldberg et al. Protection of previous SARS-CoV-2 infection is similar to that of BNT162b2 vaccine protection: A three-month nationwide experience from Israel.  medRxiv preprint doi: https://doi.org/10.1101/2021.04.20.21255670.

Worldwide shortage of vaccination against SARS-CoV-2 infection while the pandemic is still uncontrolled leads many states to the dilemma whether or not to vaccinate previously infected persons. Understanding the level of protection of previous infection compared to that of vaccination is critical for policy making. We analyze an updated individual-level database of the entire population of Israel to assess the protection efficacy of both prior infection and vaccination in preventing subsequent SARS-CoV-2 infection, hospitalization with COVID-19, severe disease, and death due to COVID-19. Vaccination was highly effective with overall estimated efficacy for documented infection of 92·8% (CI:[92·6, 93·0]); hospitalization 94·2% (CI:[93·6, 94·7]); severe illness 94·4% (CI:[93·6, 95·0]); and death 93·7% (CI:[92·5, 94·7]). Similarly, the overall estimated level of protection from prior SARS-CoV-2 infection for documented infection is 94·8% (CI:[94·4, 95·1]); hospitalization 94·1% (CI:[91·9, 95·7]); and severe illness 96·4% (CI:[92·5, 98·3]). Our results question the need to vaccinate previously-infected individuals.

Conflicts of Interest

Preventive Neurology




General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice. 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • There may however be a case for offering the vaccine to those suffering from long covid. Those with long covid seem to experience recovery following vaccination even though they’ve already had Covid. Perhaps the anti-spike antibodies can reach the virus in places the “natural” virus antibodies can’t?

  • Why not make vaccination compulsory? Or introduce vaccine passports and prevent non-vaccinated people from going into public spaces?

  • Immunogenicity of Ad26.COV2.S vaccine against SARS-CoV-2 variants in humanshttps://www.nature.com/articles/s41586-021-03681-2

    CD8+ T cells contribute to survival in patients with COVID-19 and hematologic cancerhttps://www.nature.com/articles/s41591-021-01386-7

    are these kind of studies confirming a potentially decent level of protection for CD20 patients – sorry to post again about it but in went bit quiet about this topic

    • Yes, it is clear that people on anti-CD20 therapies with no B-cells recover from COVID-19. The recovery is based on innate and mainly CD8+ cytotoxic T-cell responses. In fact, there was data presented at the American Academy of Neurology meeting showing just this. Therefore, I see no reason why the vaccines won’t stimulate these cellular responses as well. These studies are currently being done by several groups and the data will be available soon. This is why I keep saying #GetVaccinatedASAP some immunity is better than no immunity. You can always get a booster vaccine later when the timing is right.

      • Tx for the answer ProfG – and as we got at least an ELISPOT confirmation that there was a “significant” t-cell reaction (most likely from vaccine) I hope there is some level of protection and the tail risk of severe covid pretty low – nevertheless we stay careful!

      • If this India (Delta) variant seems to be able to partly get past the vaccine, is 40/60% more transmissable than the Kent variant one was and cases are rising rapidly (doubling every 8 days I think), then should Ocrevus users be back to shielding?

        What kind of risk in normal times comes with Ocrevus in terms of what the immune system can’t fight off? What precautions are people told to take?

        You say some immunity is better than no immunity ( I agree) so get both jabs (I agree)……….but if Covid can be bad for people not on Ocrevus, surely it must be more risky for those that are on it?

        never mind the risks of #longcovid on top of MS….

        • For some of these studies the great risk is with the lower efficancy of antibodies however the T cell response target alpha, beta, gamma and I bet delta variants

        • I think the mRNA vaccines look reasonably effective against delta, AZ loses more but is still a lot better than nothing.

          That’s all for normal people not on anti cd20, of course.

          • The RNA virus vaccines produce higher-antibody levels than the adenoviral vaccine and as you need more antibody to deal with the variants this is why there is a differencein protection however they adenoviral vaccines get there. As said before the T cells seem to get these variants….but did you know there are variants that T cells dont respond to very well…what shall we call them…Untouchable as the current vaccines dont target nucleocapsid where the T cell variants may lurk

  • I am very proud of the 25-29-year-olds; not much vaccine hesitancy.


    The health service chief executive said the figures appear to have “blown out of the water” the suggestion that younger people might not want to be protected by vaccination.

    As eligibility extended to people aged 25 to 29, a total of 1,082,596 first and second dose slots were snapped up across the day online and by phone, around 45,000 an hour on average and more than 750 every minute, over the full 24 hours.

    The daily total for the National Booking Service on Tuesday means around four times as many slots were booked compared with the day before and the same day last week.

    People in this age group are being texted in stages this week to book their jab, with the initial surge Tuesday morning prompting 100,000 bookings an hour between 7am and midday, and labelled a ‘Glastonbury-style’ rush for jabs, by NHS chief executive Sir Simon Stevens.

    • “I am very proud of the 25-29-year-olds; not much vaccine hesitancy”….Vaccine passsports and holidays aborad are quite tempting;-).

  • I think you might be fighting a losing battle. I know of a few people who categorically will not get the vaccines. These are people who have a university education and would normally be classed as rational and sensible people. It’s almost got to the point that friendships are been fractured because of it. No accounting for human behaviour I guess!

  • I’m sorry to hear about the low uptake in East London and sincerely hope this doesn’t impact you badly. Uptake where I live in Somerset has generally been fantastic with the exception of local resistance in Glastonbury (anti vaccine, anti mask, anti everything). Ironic to hear the uptake surge of for ages 25 to 29 compared to Glastonbury Festival tickets!

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