This commentary is by Dr. Turner Osler, a career academic trauma surgeon at the University of Vermont Medical Center turned research epidemiologist.
Over the last year and a half of this pandemic, I’ve spent a good deal of time reading, researching and writing about Covid. It almost seemed as though I’d spent my career getting ready for the pandemic. Medical school, a career as an academic surgeon, a lifelong researcher, and now a congenial group of fellow researchers with similar interests — it all came together as Covid crashed over the world.
On a personal note, over the pandemic all of us — my wife, our 26-year-old son sheltering with us, and I — were able to scrupulously adhere to Covid protocols: unnecessary trips out of our house minimized, most errands were run by our less at-risk son, carefully fitted N95 masks worn for every non-family interaction, our lives were “Covid optimized.”
After all, I understood this stuff, and our son understood that any missteps might kill his older mother and father. And besides, it would only be necessary until we were all safely vaccinated.
And then, with unprecedented speed, almost perfectly effective vaccines became available; it seemed the story might be almost over. Yes, the rest of the world was still on fire, but at least in the United States freezers were well stocked with vaccines, and in Vermont in particular, folks were lining up to be vaccinated. Everyone in our household was soon vaccinated, and we all breathed a sigh of collective relief. We’d made it.
And then, almost as though we were playing our parts in a Greek tragedy, reality intruded. Two weeks ago, our fully vaccinated son made a weekend trip to New Jersey to see his college mates. They happily went to restaurants and even bars. But, although they felt freed at last, it also felt to them, well, odd. As one of my son’s friends observed as they packed into a bar, “Boy, we’re really testing these vaccines to the max!”
Our son returned home a couple of days later, looking a little unwell, but it wasn’t until 3 a.m. that we understood just how unwell when we were awakened by a thud from the bathroom where we found him unconscious on the floor. The next day, a PCR Covid test confirmed he indeed had Covid.
The feeling of disappointment was crushing. By scrupulously observing safe protocols, we’d kept Covid at bay for a year and a half, only to have a monumental fail in the last inning. Because our son was vaccinated, we weren’t concerned that he would require hospitalization or die, but there was the risk of myocardial involvement or long-haul syndrome. It was hard to guess when Covid would be done with us.
I felt a particularly acute sense of failure. I study this stuff, and I can’t even protect my family. I should have known that New Jersey’s vaccination rate (48%) made New Jersey a poor choice for a reunion destination; Vermont, with its 82% vaccination rate, would have been much better. But I, too, was lulled by the seeming security offered by vaccination.
From the outset, we’ve known that the vaccinated can still become ill with Covid, an event now called “breakthrough Covid”; our son is just one more example. Fortunately, breakthrough infections are not common.
In the original trials of the Moderna and Pfizer vaccines, although hospitalizations were uncommon and deaths rare, as many as 5% of vaccinated patients became ill; illness was slightly more common following the J&J vaccine. So, while the protection provided by our vaccines against illness is not absolute, protection against serious illness and death is nearly absolute.
The Delta variant may make infection more common, but seems not to increase the risk of death. Because we have so few breakthrough cases to study, little can be said about the risk for further Covid-related problems such as long-haul syndrome.
So, Covid isn’t over for the vaccinated.
And Covid is most assuredly not over for the unvaccinated. Across the United States where rates of vaccination are low, Covid is surging. The director of the CDC has described this as “a pandemic of the unvaccinated” because Covid deaths are now overwhelmingly confined to the unvaccinated; over 99% of those now dying of Covid are unvaccinated. Because vaccine is available to any U.S. resident, all Covid deaths are now a matter of choice.
It turns out that death by choice is a thing in medicine. Over a long career as a surgeon, I cared for a few patients who refused treatment and died as a result. As long as I was sure these patients understood their options, I was able to respect their choice; after all, it was their life.
I feel quite differently about Americans who choose to forgo vaccination and subsequently die of Covid, because these decisions seem to be based on deliberate misinformation and political affiliation, rather than personal values. Maps of the Covid vaccine hesitancy and 2020 presidential voting are virtually superimposable, and individually Republicans are six times less likely to wish to be vaccinated than Democrats (30% R vs. 5% D). While Republicans have historically been more vaccine-averse than Democrats, this immense disparity is new.
To be clear, every Covid death is now an unnecessary death. And oddly, our unusual political climate guarantees that almost all of the people who die will be Republicans.
Our current vaccines are among the most effective ever created, and are now available without charge to everyone in America. This is a spectacular success for the virologists, vaccineologists, public health officials, and physicians and nurses who worked tirelessly to stem this pandemic.
It remains for our Republican pundits and politicians to convince their followers to get vaccinated, and our social media platforms to banish Covid disinformation because this is our only way out of the pandemic. Every day of hesitation kills hundreds more Americans.
Every week, as many Americans are dying of Covid as died on 9/11. The medical/vaccination community has done all it can. The Republican political class and social media platforms must now act, and act now. Why are they waiting?
