Column: The Costs of the Pandemic

If a man arrives in the emergency room with a hole in his right temple, a 9 mm Glock pistol clutched in his cold, almost dead hand, and a note pinned to his chest stating, “I want to die,” he will be transfused, placed on a ventilator [breathing machine] and rushed to surgery.  His choice will be ignored, and society will pay dearly for efforts to override his expressed wish. The cost is not only monetary, in terms of dollars required for the care he receives, but it is also social, in terms of resources diverted from people who prefer to live.  American medicine long ago addressed the question of whether or not to spend money, time, and talent on people who willingly and knowingly participate in high risk activities, such as intravenous drug use, suicide attempts, unprotected sex with strangers, sky-diving, driving in New York City, etc.  The answer was a resounding, “Yes.” We treat medical problems, regardless of how or in whom that problem arose.

Most of us do not think about who pays for this care. We may not have the best healthcare system in the world [and we do not], but we certainly have the most expensive. To address one of the people funding this largesse, you need only look in the mirror. You are paying through taxes, insurance premiums, or more subtle mechanisms. The ’wholesale’ cost of a day in an intensive care unit (ICU) is thousands of dollars.  If you are as weary as I of discussing the unnecessary deaths and disability of people who have refused or hesitated to get Covid-19 vaccinations, turn your attention to the avoidable cost of healthcare for which you must pay. This is simple arithmetic. Many, if not all, of those dying from Covid-19 and many of those who contract Covid-19 because they did not get vaccinated  spend days or weeks in ICUs. The cost of that ICU care alone for the tens of thousands unvaccinated who will be affected will be billions of dollars.

Do not dismiss this as an inevitable expense, money that would have been spent on treatments for other conditions. On the contrary, this is an expense above and greatly beyond that which must be spent for all the other medical problems that doctors, nurses, and other healthcare workers must routinely manage.  There are no fewer heart attacks, strokes, cancers, infections, and broken bones occurring during this pandemic. The cost of Covid-19 care is an unbudgeted expense. The cost to manufacture, ship, and inject the vaccine for a thousand people is less than the cost of care for one patient hospitalized in an ICU for one week.

Of course, we should feel the same concern for and extend the same compassion to the unvaccinated person who is hospitalized with Covid-19 as we do for the man with the self-inflicted bullet wound to the brain, but I would argue that the suicidal man is more a victim than the vaccine rejector. Both have self-inflicted problems, but the man with the bullet to the brain undoubtedly had a mental illness that interfered with his finding an alternative to self-extinction. The vaccine rejector cannot claim any such mental defect. He or she was provided information from numerous sources for the better part of a year, sources most of which had no vested interest or political agenda, originating inside and outside the United States, providing evidence of vaccine safety and efficacy, and these informed adults opted to forego protection for themselves, as well as for those in contact with them.

One in six of the United States contingent to the Tokyo Olympic Games went there without being vaccinated. Advocates of free choice [unless it involves sexual or reproductive issues] insisted that these athletes, trainers, and politicians could not be forced to get vaccinated. That would be true if they had not chosen to travel to Tokyo. Japan had the option to require vaccination against Covid-19 for anyone entering the country, but it decided to let the games begin. Assembling thousands of people from all over the world during a pandemic obviously carried enormous risks, but no one was forced to come. Every participant could have chosen to stay home and miss the opportunity of a lifetime.

To suggest that vaccinations could not have been mandated is not true. I am old enough to remember being required to get a smallpox vaccination before travelling to London to shop for ugly ties and taste horrible food. That was a time when smallpox had already been largely eradicated. 

I have heard many explanations for why the American athletes refused vaccinations, but I doubt that any one of them would have refused the shot if it meant missing the Olympics. In the middle of a pandemic, the Olympic committee claim that it could manage the spread of a disease that most governments had failed to eradicate was laughable. Top athletes are being excluded if they test positive for the virus or have been in recent contact with someone who has tested positive. Every day this event resembles the Hunger Games more than it resembles the Olympic Games.

This is another cost of a pandemic mismanaged. The fundamental error was the assumption that this crisis would resolve itself, like most that get publicized. It was mischaracterized as an event of little consequence. It is still being treated by some politicians and news outlets as an opportunity to pander to the multitude who are distrustful of science, medicine, and ‘big’ government. These misinformers have most recently heaped praise on billionaires in space (or at least almost in space) while depicting efforts to protect school children from Covid exposure as an unnecessary extravagance.  They insist that children are not at risk as pediatric cases and deaths in the U.S. have started to climb. They insist that Americans should not have confidence in the vaccines available until the FDA issues a final approval, instead of an emergency authorization, for vaccine use.  They are apparently unaware that the FDA issues “conditional’ approvals on many of the drugs it reviews and requires additional years of studies before those agents are given a final approval. The FDA issues emergency approvals only after the drug or vaccine manufacturer has provided overwhelming evidence of safety and efficacy and only in medical emergencies.

Obviously many Americans enjoy gambling.  In this case, the vaccine rejectors believe the odds are on their side. Unfortunately, if they have chosen poorly, we all end up covering their losses.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.