A Letter to the Unvaccinated

An ICU team at Providence Little Company of Mary treats a patient suffering from COVID-19. The recent surge is almost entirely among people who remain unvaccinated. Photo by Alex D. Hakim M.D.

Redondo Beach Child Development teacher Sarai Cuevas receives a COVID-19 inoculation in March, when vaccinations first became available. Manhattan Beach Firefighter Tyler Wade administers the vaccine. Looking on at the Beach Cities Health District’s AdventurePlex are Los Angeles County Supervisor Janice Hahn and Redondo Beach Schools Superintendent Steven Keller. Photo by Kevin Cody

by Anita Sircar, MD, MPH, DTM&H

Editor’s note: Dr. Sircar is an infectious disease specialist who spent the last two decades studying and treating viruses, internationally. She returned to the South Bay to be with family just before the pandemic arrived. She works at three area hospitals. At one point, she worked 155 days straight. In August, she wrote this essay, which ran as an Easy Reader cover story and also appeared in the LA Times. It went viral, worldwide. 

Mr. N sat at the edge of his bed gasping for air while he tried to tell me his story, pausing to catch his breath after each word. The plastic tubes delivering oxygen through his nose hardly seemed adequate enough to stop his chest from heaving. He looked exhausted.

He had tested positive for COVID-19 10 days ago. He was 46 years old, mildly hypertensive, but otherwise in good health. Eight days ago he started having severe fatigue and cough and went to see his doctor who started him on antibiotics. It did not work. Fearing his symptoms were worsening, he started taking some hydroxychloroquine he found on the internet.  It did not work. He was now having shortness of breath with even the most routine of daily activities, such as walking from his bedroom to his bathroom or putting on his shoes. He had no energy, no appetite. He was a shell of his former self. He finally made his way to a facility where he could receive monoclonal antibodies for the outpatient treatment of COVID-19. It did not work.

Mr. N finally ended up in the ER with dangerously low oxygen levels, exceedingly high inflammatory markers and patchy areas of infection all over his lungs. He could not breathe. His wife, his 10-month-old and his five-year-old were all COVID positive at home. He and his wife had made the decision not to get vaccinated.

Last year, a case like this would have flattened me. I would have wrestled with the sadness of how unfair life was. Battled with the angst of how unlucky he was to suffer so badly. This year, I struggled to find sympathy. It was August 2021, not August 2020. The vaccine had already been available in the U.S. for eight months now, free of charge to anyone who wanted it, on every street corner, in every city, in local drugstores and supermarkets next to the ice cream aisle. Cutting edge, revolutionary, mind-blowing, lifesaving, vaccines were available and people still didn’t want them. 

I took a deep breath outside his hospital door before going in, battling down the anger and frustration I felt bubbling up. I had been at this for 17 months straight now, all day, every day. I had taken care of hundreds of COVID patients. We all had. There were no breaks long enough to recover from what we had been through. For those of us who didn’t leave after the hardest year of our professional lives, compassion, and even hope, were now in short supply.

I walked into his room shouting through my N95 mask, and the noise of the HEPA filter and introduced myself. I asked him calmly why he decided not to get vaccinated.

“Well, I’m not an anti-vaxxer or anything,” he said. “I was just waiting for the FDA to approve the vaccine first. I didn’t want to take anything experimental. I didn’t want to be the government’s guinea pig and I don’t trust that it’s safe.”

“Well,” I said, “I can pretty much guarantee we would have never met had you gotten vaccinated because you would have never been hospitalized. All of our COVID units are full right now and every single patient in them is unvaccinated. Numbers don’t lie. The vaccines work.”

This was a common excuse as to why people had not gotten vaccinated. Ironically, treatments such as antibiotics, monoclonal antibodies and hydroxychloroquine were all in fact “experimental” without much evidence to support their use. None were lifesaving. The only proven, life saving “medicine” we had in a year and a half of this pandemic was a vaccine that people didn’t want.

“Well,” I said to him, “the medication I am going to treat you with, remdesivir,  only recently received FDA approval and has not been studied or administered as widely as COVID-19 vaccines. Over 353 million doses of COVID vaccine have been administered in the US and over 1.3 billion worldwide, without any evidence of overwhelming, catastrophic side effects. Not nearly as many doses of remdesivir have been given or studied in people, and its long term side effects are still unknown. Do you still want me to give it to you?”

“Yes,” he said, “Whatever it takes to save my life.”

It did not work.

Mr. N died nine days later from a fatal stroke that left him paralyzed on an ICU ventilator, leaving behind his 37-year-old wife and two young children. We, the care team, reconciled this loss by telling ourselves, he made the personal choice not to get vaccinated, to not protect himself or his family. We did everything we could with what we had to save him. This year, this tragedy, this unnecessary, entirely preventable loss, was on him.

The burden of this pandemic now rests on the shoulders of the unvaccinated. On those who are eligible to get vaccinated, but choose not to.  A decision they double down on by declaring “vaccination is a deeply personal choice.” But never in memorable history has anyone’s personal choice impacted what happens to the world as a whole as it does right now. When hundreds and thousands of people continue to die, when the most vulnerable members of society, children, cannot be vaccinated, and the weight of the responsibility to protect them lies on us, the luxury of choice ceases to exist.

If you believe the pandemic is almost over and you can ride it out or hide it out, without getting vaccinated, you could not be more wrong. This virus will find you.

If you believe, I won’t get my children vaccinated because I don’t know what the long term effects will be, it matters little if they aren’t alive long enough for you to find out.

If you believe, vaccinated people are getting infected anyway, so what’s the point, the vaccine was built to prevent hospitalizations and deaths from severe illness, so instead of fatal pneumonias, those with breakthrough infections have only a few days of a bad cold, well then it’s already proven itself. The vaccinated are not dying from COVID-19.

SARS CoV2, the virus that causes COVID-19 has mutated countless times in the span of this pandemic for one sole purpose, to survive. It has changed, adapted and shifted to become anything it needed to be or had to be to survive. It remains a threat today because of its willingness to do what it takes to stay in this world.  Stacked up against a human race that has resisted change every step of the way from wearing masks, to social distancing, to community lockdowns, and now to lifesaving vaccines for fear of disrupting a daily routine, it is easy to see who will win this war if people don’t change right now.

The most effective thing that you can do today to protect yourself is to GO GET VACCINATED. It’s the best thing to do for you, your loved ones, and the world at large.

It may not be the easiest decision to make, but it is the right one.

And it will work. ER

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