In hospital, Covid-19 has largely become a disease of the unvaccinated. The man in his 20s who had always watched what he ate, worked out in the gym, was too healthy to ever catch Covid badly. The 48-year-old who never got round to making the appointment.
The person in their 50s whose friend had side-effects. The woman who wanted to wait for more evidence. The young pregnant lady worried about the effect on her baby.
The 60-year-old, brought to hospital with oxygen saturations of 70% by the ambulance that he initially called for his partner, who had died by the time it arrived; both believed that the drug companies bribed the government to get the vaccine approved.
All severely ill with Covid. All unvaccinated and previously healthy. All completely avoidable.
Of course, there are people who have their vaccinations but still get sick. These people may be elderly or frail, or have underlying health problems. Those with illnesses affecting the immune system, particularly patients who have had chemotherapy for blood cancers, are especially vulnerable. Some unlucky healthy people will also end up on our general wards with Covid after being vaccinated, usually needing a modest amount of oxygen for a few days.
But the story is different on our intensive care unit. Here, the patient population consists of a few vulnerable people with severe underlying health problems and a majority of fit, healthy, younger people unvaccinated by choice. Watching the mix of patients coming in with Covid, it feels to me like hardly anybody has been vaccinated nowadays; of course, this is because the people that have been vaccinated are getting on with their lives at home. If everyone got vaccinated, hospitals would be under much less pressure; this is beyond debate. Your wait for your clinic appointment/operation/diagnostic test/A&E department would be shorter. Your ambulance would arrive sooner. Reports of the pressure on the NHS are not exaggerated, I promise you.
Furthermore, we have recently rolled out a new medication for patients without antibodies against Covid. It costs about £2,000 a treatment and is subject to a rigorous and time-consuming approval process for every case we treat. Guess which patients don’t have these antibodies (spoiler: it’s not the ones who have been vaccinated).
Most of the resources that we are devoting to Covid in hospital are now being spent on the unvaccinated.
Yes, vaccinations are unpleasant. They cause side-effects. They hurt. You may even still catch Covid afterwards. I have many colleagues who have felt awful after vaccination and a few who had to take a day or two off work. However, I have not heard of any who have been hospitalised with Covid afterwards or who have had severe side-effects. The approvals process was incredibly stringent and we now have an unbelievable amount of real-world data that these vaccines work. The science that has been applied here is nothing short of awe-inspiring to me. However, I realise that none of these rational arguments would change the mind of someone who is resolved against having it, although I suppose it may push someone who remains undecided.
As a respiratory doctor, I have spent my whole career treating people whose lung diseases have been caused by smoking, including long after they knew the risks. I have spent countless hours with people who blame themselves for ruining their health; I have thought a lot about our personal responsibility for our health and to what degree we should be held accountable for our choices. I personally – unlike some of my colleagues – have never felt any ambivalence about treating smokers without judgment in exactly the same way as people with diseases that are not seen as self-inflicted.
Enshrined in the way we protect patients’ autonomy is the recognition that others may reasonably make decisions we may see as irrational or wrong. We are all products of our upbringing, education and opportunities, and I have been hugely fortunate that in my case these have led me to make decisions I value. Who is to say I wouldn’t have made different choices in someone else’s shoes.
Translating this to the choice not to take the vaccine, however, I find my patience wearing thin. I think this is for a number of reasons. Even if you are not worried about your own risk from Covid, you cannot know the risk of the people into whose faces you may cough; there is a dangerous and selfish element to this that I find hard to stomach.
Some of my frustration is directed upwards, at the flagrant misinformation flourishing in certain places and the utterly woeful example that our leaders continue to set. I have never heard a reason not to take the vaccine that I have agreed with. Most of all, however, I am now beaten back, exhausted, worn down by the continuous stream of people that we battle to treat when they have consciously passed up the opportunity to save themselves. It does make me angry.
Despite this, I find the idea of NHS and care staff being forced to be vaccinated very difficult. I know that it is the right outcome, but I dislike the means of bringing it about. It is incredible to me that there is so much anxiety and falsehood around that this could possibly be necessary after the year we have all witnessed. How strong is the hold that this information has on people that it outweighs rational thought?
Maybe it’s just that others have not seen what I have recently, or do not believe it, but even now we have nurses on our Covid ward who have not been vaccinated. I just hope that we don’t end up losing yet more staff.
Fundamentally though, for me, it comes down to this. I can’t think of a single case offhand of a person who was previously fit and healthy who has ended up needing intensive care after being fully vaccinated. It may not stop you from catching Covid. But it can save your life when you do.
The writer is an NHS respiratory consultant who works across a number of hospitals