Sophia Labarbera-Limone, a single mother of three, was one of the frontline workers that New Yorker’s clapped for at 7 p.m. every day early in the pandemic. A registered nurse with more than 25 years experience, she worked to fight COVID-19 at two of Staten Island’s city-run clinics.

Her pandemic tour began at the NYC Health + Hospitals Corporation Mariners Harbor clinic as the only nurse providing primary and pediatric care in a working class neighborhood on the north shore of Staten Island. As the primary medical provider for the Mariners Harbor public housing complex and surrounding area, she would teach the patients about how to take care of their chronic health issues, like cancer, diabetes and high blood pressure.

“We had a pediatric doctor and a primary care physician that I work very closely with. We worked through the whole pandemic. Initially, we didn't even have any PPEs,” she said.

Despite her daily exposure during the initial outbreak, the 44-year-old Labarbera-Limone said she didn’t contract the coronavirus until the start of 2021. When it cleared, she went back to work.

However, because of a serious allergic reaction to one of the mRNA vaccines that prevents her from getting a second dose, she may never work as a nurse again for the city. In a lawsuit filed Wednesday in the Richmond County Supreme Court, Labarbera-Limone and her lawyer Lawrence Spasojevich say the city has violated her civil rights by failing to find a reasonable accommodation for her medical conditions.

Labarbera-Limone is among tens of thousands, if not millions, who are partially vaccinated but also have some so-called natural immunity that they acquired after an infection. Aside from taking a single Moderna shot, she said that she has caught the virus three times. Medical records provided by her lawyer show a positive PCR test in February 2021 and another 7 months later.

This hybrid immunity — yielded from vaccination plus past infection — is generally considered by immunologists, multiple research studies and the World Health Organization to be stronger than the defenses created by vaccination or infection alone. Labarbera-Limone argues her body has enough immunity that she should be sufficiently protected and no risk to her patients.

Sophia Labarbera-Limone

But as politicians and business leaders urge people to return to offices, it's unclear how, or if, employers will consider natural immunity or hybrid immunity as sufficient protection compared to full vaccination and boosters. The shots are easy to validate with those handy vaccination cards, but there still isn’t a passport system for past infections.

The debates surrounding natural immunity, vaccine passports and mandates are also heavily contaminated with politics. Elected leaders like former President Donald Trump and Republican Sen. Rand Paul made public pronouncements early in the pandemic that suggested their COVID-19 infections had rendered them immune to the virus (though Trump ultimately got vaccinated).

Politics, however, were not a motivating factor for Labarbera-Limone. She is just among a small group of people who can’t take the COVID-19 vaccines without potentially getting sick.

I’m fully vaccinated for everything else. My children are vaccinated. I’m not an anti-vaxxer.
Sophia Labarbera-Limone

“I’m fully vaccinated for everything else. My children are vaccinated,” she said. “I’m not an anti-vaxxer. If I didn't believe in vaccines, I wouldn't be in a position administering vaccines.”

Adverse reactions with the mRNA vaccines are extremely rare — with serious allergic reactions happening only in five of every 1 million vaccine doses administered. That would be about 1,200 people out of 240 million Americans who’ve taken at least one dose of Pfizer or Moderna. The Johnson & Johnson vaccine would normally be recommended as an alternative in this scenario, but as a woman between the age of 18 and 49, Labarbera-Limone has a higher risk of the rare blood clots associated with that vaccine. Labarbera-Limone’s lawyer says she declined getting the Johnson & Johnson vaccine as an alternative, given she has a history of stroke.

Mayor Eric Adams, who has taken heat for easing vaccination requirements for professional athletes and performers while keeping them in place for municipal staff, said in February he’s open to considering natural immunity in his public health calculations, but his health advisors rejected that idea.

“I need to find out if this is a viable option. And if it is a viable option, we need to revisit it,” the mayor said during the winter. City Hall’s press office had no update on his statement.

Health experts interviewed for this story agree with the mayor’s medical advisors — that there is no point at which a regular infection could be used for an immunity passport. They say that there are far too many variables when it comes to natural immunity. The degree of protection and how long that protection lasts varies too widely among the population to be a reliable yardstick, experts say.

The omicron variant, meanwhile, has steadily moved through the New York population this winter and spring, causing record numbers of infections — and reinfections — as COVID restrictions disappear. This moment is a crossroads for partially vaccinated workers like Labarbera-Limone, or even unvaccinated people with a history of past infection. Some can’t work in person without all their shots, even though many vaccine and mask requirements in the city and state are no longer in place and the coronavirus is spreading mostly unchecked.

Currently, 97% of the municipal workforce is vaccinated. There have been 12,142 requests for a reasonable accommodation regarding the vaccine, according to the latest numbers from City Hall, which includes religious and medical exemptions. About 80% – 8,769 applications – have been denied. About 1,089 are still pending.

But all medical waivers are temporary, and health workers with these exemptions are not allowed to work with patients, according to Health + Hospitals.

Unable to fulfill her essential role providing direct patient care, Labarbera-Limone was allowed to stay employed temporarily by using her medical leave, but the city determined that she was no longer allowed to serve safely as a nurse.

“It is clear that protective measures alone are insufficient to permit [Labarbera-Limone] to continue in her role as a staff nurse providing direct patient care,” H+H lawyer Stephanie Siaw wrote in her answer to the Staten Island nurse's complaint.

A reaction

After former Gov. Andrew Cuomo mandated the doses for health care workers in August 2021, Labarbera-Limone became nervous about how her body would respond to the vaccines due to her past medical history. She had experienced a stroke in 2018. So she requested a medical waiver for the vaccine.

When she was denied, she agreed to take her jab, receiving the first dose of the Moderna injection in early October 2021.

Almost immediately Labarbera-Limone said she felt sick. She felt like her throat was closing up, her mouth went dry and she started breaking out in a red itchy rash. She had difficulty speaking.

“I had an anaphylactic reaction to it. My throat was closing in and I had hives. My heart rate was high and they had to give me treatment,” she said. “I had a fever and everything.”

Anaphylactic shock is easily treatable, but the experience can be traumatic. Her doctor at New York City Health + Hospitals, Alexander Ling, gave her a shot of prednisone and determined that the vaccine had triggered an allergic reaction. After 90 minutes, Labarbera-Limone recovered and they sent her home.

The experience shook her, she said, and when it came time to get her second dose, she couldn’t go through with it.

Her doctor agreed that another shot was not advisable.

Her doctor agreed that another shot was not advisable.

“It is my opinion that a second dose of Moderna SARS-CoV-2 vaccine is medically contraindicated for this individual,” Ling wrote in a letter reviewed by Gothamist. However, under the governor’s executive order, she had to complete her full course of vaccines by November 18th, 2021 if she wanted to keep her job.

Health + Hospitals doctors suggested that she get her second dose under medical supervision, but she refused.

“If you're allergic to penicillin, do you go back and get another dose of penicillin?” she said. “We don't prescribe it once you're allergic to a medication. That's the end of it.”

The Centers for Disease Control and Prevention also advises against getting a second dose for those who have a severe allergic reaction.

Should immunity passports be reconsidered?

Supervisors at Health + Hospitals agreed with Labarbera-Limone’s second application for an accommodation, saying her “medical condition supported an exemption for the second dose of the COVID-19 vaccine.”

However, that did not mean she would be able to return to her regular job working with patients. As someone who was not considered fully vaccinated she would not be able to perform patient-facing care.

“They said I’m a clinical nurse and I can never treat patients because I’m a danger to my coworkers and my patients,” she said. “I’ve had COVID three times.”

She had hoped that immune system defenses set up during her prior infections would allow her to work, but it’s still unclear if that’s safe for health care settings. Full vaccination – two doses of the vaccine – is the only way a medical staff may work with patients, under state and city guidelines.

Studies in Israel and in the U.S. have shown that infection can set up defenses that are as potent as vaccination, but natural immunity can be less consistent and may not last as long. Vaccination records can also be fed into passports, but there’s no approved test for gauging protection against infection after a prior bout of the disease.

Most health officials and scientists acknowledge that infection confers some immunity, but they say that there’s no easy way to determine how long it lasts which could vary widely from person to person.

Health care workers have increased risk in terms of our exposure. But we also have increased responsibility.
Dr. Eric Cioe-Peña, head of global health at Northwell

“There are so many challenges with natural immunity,” Dr. Bruce Y. Lee, a public health policy expert at CUNY and executive director of the research group PHICOR. “Number one is we don’t know how long it lasts. There’s quite a lot of variation in terms of people getting infected, when and how soon, compared to vaccines which have been extensively tested and followed, so you have an idea of how long these indicators of protection last.”

And requiring a vaccine for all nurses can help ensure that patients are protected, Dr. Eric Cioe-Peña, head of global health at Northwell. Breakthrough infections have become more common among vaccinated people due to the arrival of omicron. But the vaccines are known to shorten the window of time that a person is infectious, reducing their chances of spreading it to others.

“Health care workers have increased risk in terms of our exposure,” Peña, who practices at Staten Island University Medical Center. “But we also have increased responsibility. People that I’ve seen in the emergency department are much more medically fragile than probably most people you see in the course of their regular lives.”

Despite the fact that pandemic restrictions all over the city have loosened and death rates are low right now, it’s unlikely that the health policy on COVID-19 vaccine requirements for certain settings will or should change, Peña said.

“There’s a Hepatitis B vaccine that’s required for school, and it’s required if there’s a Hepatitis B epidemic in our community or not,” Pena said. He said not requiring the vaccine or relying on natural immunity is “the equivalent of kind of setting your rain gear on fire because it's sunny out today.”

Another COVID-19 wave is expected this fall, as well as vaccines that are updated to tackle omicron.

This is no comfort to Labarbera-Limone who says she just wants to get back to work as a nurse, her chosen profession for 20 years. During the December 2021 surge, the city suddenly granted her a temporary accommodation that allowed her to work from home, providing telehealth counseling for New Yorkers infected with COVID.

When cases began to wane this spring, she found temporary work sifting through resumes and interviewing nurses applying to the city health system, but that again was outside the role she was hired to do as a nurse.

The city is only required to extend a reasonable accommodation if it does not put an “undue burden” on the system.

“To protect our patients and our staff, and to comply with state law, all NYC Health + Hospitals employees were required to be vaccinated,” spokesperson Christopher Miller said. “A very small percentage of the health system’s 43,000 employees requested a religious or medical exemption, and NYC Health + Hospitals reviewed them and granted those that met appropriate standards. A COVID-19 vaccination remains the best way to remain healthy, and today all city employment requires a COVID-19 vaccination.”

On April 18th, the city determined that she could not go back to her role as a patient facing nurse and could no longer extend her an accommodation that didn’t burden the system so they fired her.

“What's most disturbing to me and upsetting is I've dedicated 20 years of my life, taking care of patients,” she said. “I've been spit on, I've been verbally abused. And now when something happened to me because of the vaccination that I was forced to get, I was told that my health doesn't matter.”