Viewpoint: What Doesn’t Kill You Mutates and Tries Again

The cost of COVID-19 to employers can be insurmountable. First, as there is increasing reluctance of a portion of their employees to become vaccinated, other employees and potential employees are reluctant to work because of an unsafe workplace. Vaccine mandates have become politically charged but instead should be viewed as vital to the opening of our economy. If a foreign army was invading our shores and we needed to raise an army, few would call a draft “unpatriotic,” but when the evader is a virus, vaccines, not enlistments are needed.

Many will state mandates only make sense if vaccines will assure the prevention of infection and spread, if they cannot do this, then they do not work and should not be mandated. Actually, the

Kevin Kavanagh, MD

opposite is true. A vaccine which does not provide near 100% assurance against infection can still significantly reduce your chance of contracting an illness, but more importantly they will decrease spread and thus, provide community protection. The less effective a vaccine is, the more important it is for all to be vaccinated and bolsters the need for mandates.

To end the pandemic, the virus must spread to fewer additional people than the number who are currently infected. Thus, as the infected recover or die, the number of those spreading the virus progressively decreases. Epidemiologically stated, the R0 becomes less than 1.

Thus, we are unlikely to return to a normal workforce without near universal vaccination.

However, there are 2 other major problems that the lack of vaccination produces.

First it has been well shown that those who are hospitalized and/or die from COVID-19(2) are largely those who are not fully vaccinated. I suspect that this relationship will narrow as vaccine immunity wanes and the “fully” vaccinated, especially considering the Delta variant, will need to obtain a booster. In the case of Omicron, 2-dose vaccine immunity has been severely mitigated with a more than 25-fold reduction in neutralization, necessitating the need for a booster dose. The timing of the booster may be changed. The United Kingdom is considering recommending giving the booster 3 months after the second dose.

Contracting COVID-19 not only places key work personnel at risk of being laid off for many weeks, if not permanently, but also exposes the company and our society as a whole to a staggering rise in health care costs. The average cost of each COVID-19 hospitalization for non-insured or out-of-network patients rages from $51,000 to $78,000. Hospital costs for complex cases (on the ventilator or in the ICU) ranges from $132,000 to $472,000. Co-Pays (without waivers) for privately and employer-insured patients average $3,800 per hospitalization.

In Kentucky, my home state, the uninsured/out-of-network cost of treating just the current 305 COVID-19 patients in Kentucky would be projected at over $75 million.

The unvaccinated make up the lion’s share of the hospitalizations and associated costs. The Kaiser Health Foundation estimates that from June through August 2021, preventable COVID-19 hospitalizations among unvaccinated adults cost $5.7 billion. The cost of this pandemic may soon become unaffordable, possibly necessitating the following of Singapore’s lead in limiting health care coverage for those who have not become vaccinated.

Finally, the pandemic is placing a horrible toll on the functioning of our health care system. In many regions of our country, health care delivery has effectively collapsed with rationing of care and necessitating the canceling of non-urgent surgery. As aptly stated by Vishal Khetpal, “People who do not have to die are dying.” The looming surge from the Omicron variant may well have a lower case-fatality-rate but its high infectivity will further strain our health care system and fill our hospitals. Vital care for many will not be delivered, expanding the true toll of the COVID-19 pandemic.

COVID-19 is endemic, it has found animal hosts and is not going away. We must start wearing high-quality masks, upgrade indoor ventilation and become fully vaccinated. If you have had a vaccine, obtain a booster as soon as you are eligible; if you have had an infection obtain a vaccine (just consider it a booster). We have the knowledge and tools to beat back this virus, but first we must stop listening to false prophets and embrace mainstream public health.