> In the case of highly vaccinated individuals, especially if they did not experience productive natural infection prior to vaccination, we should be prepared for the possibility that the illness will unfold as follows:

Because their immune system will have very little capacity (at either the cell-based innate immunity level or the adaptive immunity level) to control the virus, they will probably quickly become overwhelmingly infected, in the upper respiratory tract (URT), lower respiratory tract (LRT), and possibly other internal organs. They might have very high viral loads in all of these locations. Unfortunately, they will not be able to rely on usual immune mechanisms to control the virus—e.g., NK cells (natural killer cells, which are a key component of the cell-based innate immune system) or on effective utilization of their adaptive immune system. The acute viral phase of their illness may therefore quickly become extraordinarily severe (within 1-3 days) and may last more than the usual 7-10 days.

Bear in mind that it is quite possible that the cytokine storm triggered by the highly virulent variant in high risk highly vaccinated individuals (if they have time, opportunity, and the wherewithal to mount such a storm) will be more massive and explosive than has ever been seen in many adult ICUs.

Management of most healthy unvaccinated patients will likely be much less difficult. They will be better able to handle the highly virulent variant and will be less likely to develop cytokine storm. Although the “highly virulent variant” will, indeed, be highly virulent in high risk heavily vaccinated individuals (because the immune status of heavily vaccinated individuals has been altered by the mass vaccination campaign and they have been depending on virulence-inhibiting PNNAbs, which the highly virulent variant is able to overcome), the “highly virulent variant” will not be as virulent in healthy unvaccinated individuals (because their immune systems will be intact and able to respond in a normal way, and they have not been depending on virulence-inhibiting PNNAbs). As explained earlier, the immune status of heavily vaccinated individuals has become abnormal and is now quite different from the normal immune status of healthy unvaccinated individuals.

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