The Avoidable COVID-19 Disaster

“It’s time to think about hospice,” I said.

Ms. “Jones” was eighty-two and in good health, apart from a recent fall-related fracture. She’d developed a cough and then trouble breathing and was soon diagnosed with COVID-19 pneumonia. We knew things might not go well, considering her age. But at first, she seemed ok.

She needed a little oxygen, 2L/min at first. We gave remdesivir (an antiviral) and dexamethasone (a steroid), and that works for most of our patients. But not Ms. Jones. Over 10 days, her oxygen levels plummeted. We bumped her from 2 L/min to 100% oxygen at 60 L/min. Still, her saturations, which should have been 99-100%, drifted down into the eighties, predicting that she would soon become somnolent, breathe less effectively, and die, despite every measure we deployed against her disease.

I’ve seen this numerous times. COVID-19, for some reason, has been associated with shocking hypoxia I had considered unsurvivable, and some patients have little shortness of breath even as they near death. The first patient of mine who died of COVID-19 didn’t feel short of breath when she saturated 90, 85, then 80%. The next day I was shocked to see her oxygen saturation had been documented to be 50%! I’d never seen such a thing; now it’s unsurprising. And, of course, I’ve seen death from respiratory failure more times than I can count. But this felt different. This was preventable.

Ms. Jones had refused to get vaccinated for COVID-19.

Like much of the country, we are suffering a delta surge, although not nearly as bad in some places. Florida is seeing hospitalization rates 9 times New York’s. A third of hospitalized patients have COVID-19. In parts of America, it’s worse than the winter surge (remember winter? Last year’s surge began in November, which will be here in three months). Locally, every single patient my friends or I have taken care of was unvaccinated.

After declining vaccination, I had a patient get COVID-19 because they listened to strident radio hosts and thought recommendations to mask and vaccinate were “tyranny.” So many of these citizens are fiercely patriotic, in their own way, so often a militaristic “I’ll take a bullet for my country!” way. How about just a vaccine? Just a little jab, safe and effective? Wear a mask? No? Ok.

And we have hundreds of thousands of Americans who accept numerous mandatory vaccinations as preconditions for work and school protesting because they’ve been asked to take a vaccine that is highly effective at preventing misery, hospitalization, and death for them, their loved ones, and their fellow Americans. This is manufactured rage.

I had a patient admitted to the hospital with COVID-19 pneumonia who’d declined vaccination because she worried about the infinitesimal risk of clots after vaccination with the Johnson and Johnson vaccine (less than one in a million). She got COVID-19. COVID-19 causes blood clots. She got a clot from her COVID-19. This is an example of poor risk assessment. Humans aren’t calculators, and this is common, like when people are afraid to fly but willing to drive—although generally, people are willing to drive or fly. Why are we refusing life-saving vaccines?

I’ve discussed vaccination with friends of friends by Facebook who quite literally believed, or said they believed, that every death, stroke, or other health event documented by VAERs after COVID-19 vaccination was due to the vaccine. “But we were targeting sick, elderly, and immunosuppressed people for vaccination. Can a vaccine make those people immortal?” I asked. They replied, “these are the CDC’s own data; read it and weep,” with a *shrug* emoji.

We had a patient with respiratory failure from COVID-19 who kept saying vaccines were unnecessary, the risk was overblown, and that it would all go away with organic food. We see people online and on the news claiming vaccines contain liquid microchips or make you magnetic or change your DNA. They have all “done my own research,” and what they found from conspiracy theorists, Russian bots, disinformation profiteering sites like Mercola.com, and scared relatives trumps Ph.D. scientists, physicians, surgeon generals, and epidemiologists with lifetimes of experience. Disinformation went viral. The Dunning Kruger effect went viral.

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Then we have people who won’t vaccinate now because the vaccine doesn’t completely stop spread by vaccinated people. It feels like a “touche! I told you so” moment. But the vaccines are highly effective, preventing up to 96% of hospitalizations even in the elderly. The problem with COVID-19 spread by vaccinated people is that unvaccinated people are generating and spreading more dangerous variants, which vaccinated people may pass on to unvaccinated people. Those people run high risks of serious illness. 99.5% of COVID-19 deaths are now among the unvaccinated. What would we make of someone saying, "So you admit seatbelts aren't 100% effective? Ha, I cut mine out of my car."

This whole mess could have been avoided. All Americans—particularly our leaders and journalists—could have used this occasion to unite us against a common foe, to encourage masking and vaccination to save each other from illness and economic strife. This would have been a great moment for “Feel free to ask what your country can do for you, because (good news!) it’s the same thing you can do for your country—protect yourself and others!” Instead, safety got politicized because our system feeds off discord. Lies became fact because we seek information from unqualified or malicious people instead of experts. Facebook doesn't care if you're qualified or honest.

Perhaps when enough people have suffered a personal loss or survive COVID-19 and are willing to add their voices to those urging vaccination, or we read enough headlines along the lines of “Radio host who spread vaccine disinformation dies of COVID-19,” enough citizens will get vaccinated that we can halt the spread and generation of variants, and get back to our lives. Perhaps as we approach 620,000 dead—one and a half times the American toll from WWII—we will take a deep breath, listen to experts, protect ourselves and vulnerable neighbors, and end this.

“You know, my son’s getting vaccinated today,” Ms. Jones said after we finalized her end-of-life plans.

“That’s wonderful,” I said, thinking her family had taken notice, and some good would come of her death.

“His employer-mandated it,” she said. “He’s mad.”