[Immunity to SARS CoV-2 - strengths and weaknesses]

Area of Science:

• Immunology
• Infectious Diseases
• Vaccinology

Background:

• The rapid development of COVID-19 vaccines highlights the success of scientific collaboration.
• Understanding the nuances of virus- or vaccine-induced immunity is crucial for managing COVID-19 outcomes at individual and population levels.

Purpose of the Study:

• To analyze the current literature on human immunity to SARS-CoV-2 and other coronaviruses.
• To evaluate the reliability of different markers for assessing antiviral immunity.
• To determine the long-term protective effects of infection and vaccination against COVID-19.

Main Methods:

• Literature analysis focusing on high-quality clinical trials with patient outcomes as endpoints.
• Inclusion of case reports and series on individuals with inborn errors of immunity (IEI).
• Critical evaluation of surrogate markers like antibody titers versus clinical data.

Main Results:

• Antibody titers are unreliable indicators of local or systemic immunity to SARS-CoV-2.
• Antiviral immunity, particularly against infection and transmission, wanes significantly over time.
• Immunity confers robust protection against severe COVID-19 pathology and death, even as infection protection declines.

Conclusions:

• While protection against infection and transmission wanes, immunity remains robust against severe COVID-19.
• COVID-19 is transitioning towards an endemic state with seasonal peaks.
• The majority of individuals are expected to be protected from severe disease and death, similar to other human coronavirus infections.