Peter Chow: The Stigma of the Unvaccinated

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An online community exists on Reddit, called the Herman Cain Award, dedicated to chronicling the deaths of those who have publicly declared their opposition to Covid-19 vaccines, mask rules and lockdowns on social media, often in aggressively belligerent and politically-charged fashion, only to subsequently fall ill and pass away at the hands of the Coronavirus themselves.

Herman Cain was a Republican who was an avid Trump supporter, was a COVID denialist who contracted COVID at Trump’s rally in Tulsa in June 2020 and died from it.

His media posts continued to call COVID a hoax even after he was dead.

The idea is to track the individual’s journey from COVID theory, so to speak, to COVID practice: what a person posted or commented about masks or shots, or those who advocated for either before getting sick, and how they and their community narrated their disease once they were ill.

If someone is merely hospitalized, the flair on that entry reads “Nominated.”

When they die, it changes to “Awarded.”

It is cruel, a site for heartless and unrepentant Schadenfreude.

What is sad is that many of the contributors mocking these COVID denialists are healthcare professionals whose rage is growing toward anti-vaxxers deliberately prolonging the pandemic out of an anti-social and deadly misunderstanding of their rights.

Health care providers are still struggling with how to handle unvaccinated patients.

About one in 10 lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

The trend is raising questions about the ethics of allocating a scarce resource to people who have chosen not to be vaccinated against the coronavirus.

“They are accumulating on a steady basis. So it’s very much a real thing,” says David Klassen, chief medical officer for UNOS.

“If there were more lungs available for transplants, I believe the numbers would be greater than they are,” he says.

In all, 238 people across the country have received lung transplants due to COVID-19 since the first such operations were tracked in August of 2020, according to the latest UNOS figures from October of this year.

Lung transplants for COVID patients rose tenfold between the first year of the pandemic and 2021, according to UNOS data, which also shows transplants for other top lung diseases, like emphysema, cystic fibrosis and pulmonary fibrosis, are down compared to prior years.

“It’s happening in the U.S.  It’s also happening in Canada.  There was just a paper out from Western Canada about this causing a huge surge in the number of lung transplants there.  It’s a big problem,” says David Mulligan, chair of the Yale-New Haven Health Transplantation Center.

More than 2,000 lung transplant operations are usually done each year in the U.S., costing around $1.2 million for a double lung transplant.

The rise in COVID-related transplants is forcing doctors to grapple with how to best manage who gets them, especially now that vaccines are widely available.

“When somebody contracts such severe COVID that they need a lung transplant, and they got it refusing to get a vaccine, it’s a really ethical dilemma,” says Mulligan.

“How can they just jump in and take a lung away from somebody who’s sick, but has been doing the best they can to take care of themselves and avoid getting COVID?”

Transplant centers weigh a lot of different factors when listing people who need an organ.

But social and behavioural factors — such as how people came to be sick — are not usually among them.

People who smoked can be eligible for a lung transplant, just like people who drank alcohol in excess can also be listed for a new liver if they’ve stayed smoke-free or sober for six months.

Not judging people’s past behaviour is fairly standard in medicine.

But future behavior, when it comes to transplants, is fair game, according to Olivia Kates, an assistant professor of medicine at Johns Hopkins.

“I think COVID-19 patients should be subject to the same expectation, that they should either be vaccinated or be able to demonstrate immunity to COVID-19 going forward, so that their next set of lungs is not subject to the same risk,” Kates says.

Some transplant centers have said patients will lose their spot on the list if they are not vaccinated against coronavirus.

Last month, a Colorado hospital system, UCHealth, stated it won’t provide transplants to patients who choose to remain unvaccinated.

There is no national, overarching policy on how to handle vaccine refusal when it comes to transplants.

The American Society of Transplant Surgeons recommends vaccination for anyone awaiting a transplant because the immune response is stronger if a patient gets the vaccine before, rather than after, their transplant.

People who live with donated organs must take immune-suppressing drugs for life in order to prevent their bodies from attacking and rejecting the new organs, making them more vulnerable to COVID-19 as long as it’s around.

In August, a family doctor in Alabama posted a sign refusing to see patients who are unvaccinated against COVID.

It’s not just an issue of ethics — it’s one of emotion too.

One ICU doctor let his anger spill onto the pages of the LA Times and another, an emergency medicine doctor put it this way: “Welcome to the new Pandemic of the Unvaccinated: the patients we love to hate.”

The thing is: none of this is new.

Behavioural choices of patients have bothered doctors for years.

As justified as we may feel to be angry at unvaccinated patients, research has demonstrated that our attitudinal hang-ups compromise their health and only cause more harm.

Health professionals have a generally negative view of patients with substance use disorders, viewing them as manipulative, dishonest, violent and poorly motivated to improve their health – just lesser than.

These self-fulfilling negative views make patients feel stigmatised, judged, disempowered and lead to worse treatment outcomes.

So much so that in 2015, life expectancy in the U.S. decreased for the first time in over two decades.

Fatal opioid overdoses were so common that they actually dragged down life expectancy.

Buprenorphine-naloxone (Suboxone) seemed to be an answer to opioid dependency — a drug that could be prescribed in primary care offices to treat opioid addiction by stimulating a partial response from the same receptors for oxycodone, heroin, and fentanyl.

Studies showed this drug not only decreased deaths due to drug overdose, but decreased deaths from any cause as well.

But doctors didn’t prescribe it.

Only 3% of primary care physicians went out to get certified to prescribe Suboxone.

And of the physicians who were certified, many were prescribing far below their full capacity.

So, widespread access to life-saving opioid addiction treatment remains scarce, especially for rural communities.

Surveys of certified and non-certified physicians found that physicians were unwilling to prescribe more because of a lack of belief in the treatment, because of a perceived lack of time, and a perceived insufficient amount of reimbursement to make it worth their while.

The problem is that these are myths of prescribing Suboxone, that excuse away the fact that providers allow their prejudice to prevent life-saving care.

It’s not just in substance use disorders.

The health impacts of weight bias against obese patients are well documented.

Lung cancer stigma arises when patients who smoke are blamed for their disease and leads to increased depression, poorer quality of life, delays to seek treatment and may be one reason for why lung cancer receives a fraction of funding despite being a leading cause of cancer death worldwide.

It’s difficult not to blame the unvaccinated.

Their choices and actions spread the disease and make another mutation, perhaps a completely vaccine-resistant one, more likely.

Unlike smokers, drinkers and the obese, the unvaccinated are endangering not just themselves but also those around them.

They also pose a more specific threat to health care personnel than drug addiction, smoking or obesity.

Data from the World Health Organization (WHO) show that 115,000 healthcare workers died from COVID-19 between January 2020 and May 2021, a figure that WHO said may well be at least 60% lower than the actual number of victims.

Since the start of the pandemic, 56 health care workers have died in Canada from COVID-19.

Doctors, nurses and health care workers also have elderly parents, immunocompromised friends, and children who need to be back in school.

The personal choices of patients, which physicians often struggle to understand, have never affected their personal lives as they do now.

But this is medicine.

This may not be the scenario he imagined, but these feelings are what William Osler, father of medical residency training, had in mind when he addressed new doctors in his 1889 essay, Aequanimitas.

Osler advised physicians to maintain imperturbability, the “calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness.”

Maybe that clearness and calmness is guiding administrators in the case of transplants because they’re precious scarce resources — organs — that may be wasted if transplanted into a patient who eventually succumbs to COVID.

Medical school doesn’t teach what equanimity looks like when one must choose between patients’ lives.

Or between patients’ lives and our own.

Whatever the decision is, it must be guided by imperturbability.

The unvaccinated patient is the addicted person, the overweight patient, the smoker in the waiting room.

Our antipathy toward them endangers their health, maybe their lives.

The unvaccinated will not be convinced with stigma.

They will be convinced with integrity, sincerity, and love.

Stigmatization has never been an effective health intervention.

And that’s exactly what these reflexive responses to the unvaccinated are.

It’s not righteousness, as if righteousness ever helped in an examining room.

These days, maintaining grace and an open heart to the unvaccinated is the most ethical practice a physician can undertake.

8 COMMENTS

  1. Very lazy rebuttal Francis. At least answer my question.

    If unvaccinated people seeking healthcare when infected deserve shame and stigma what do vaccinated people deserve upon infection seeking the identical treatment?

    You signed up for a vaccine that lived up to none of its claims and yet your dumbfounded that some people don’t want to take it. I almost took it but decided to wait. You still spread, you still get sick, you still end up in the hospital, you can absolutely still die.

    What part of this vaccine do you have think appeals to young healthy people who can think for themselves?

    Why are the protected so scared of the unprotected that refuse to take the protection that didn’t protect the protected?

    • unfortunately someone has led you to believe that what you think matters, or that people owe you a response when you demand it. it doesn’t and they don’t. this kind of delusion and self importance is precisely what leads someone like you to think they know better than the scientific community fighting this horrible epidemic.

      the very fact that you think the vaccine is to protect YOU demonstrates that you don’t understand (or care). thankfully you are part of a very small but very loud minority that is truly doing all of this to themselves. and I’m here for it with popcorn.

  2. Francis if unvaccinated people seeking healthcare when infected deserve stigma and shame then vaccinated people seeking the identical treatment would deserve what exactly?

    Calling Ivermectin horse dewormer is such an injustice to a drug that has radically improved millions of lives long before covid 19 showed up. When your using a drug that won a Nobel prize in 2015 as a pejorative clearly your not forming any of your own opinions or ideas. Echoing left wing media doesn’t put you on moral high ground.

    I’m 40, fit as hell, train every day, eat clean, supplement heavily with vitamins and have zero co-morbities associated with covid complications. I can only wonder if your one of those guys eating garbage, never exercising and doesn’t care what goes into his body but suddenly proclaims his virtuosity because he took a vaccine that lasts all of 6 months.

  3. There is no excuse nor any logical reason not to cooperate and get the shots. It is simply the right thing to do. If it was a pneumonia shot for example I would say you have the right to refuse it as your decision does not affect me medically. But…your lack of compassion for your fellow man by not getting the shots DOES affect me and others. Just please….get the shots.

  4. Just a few things for Doctor Chow from a guy in the middle politically, reads both sides, well informed but still unvaccinated.

    How do you feel about the fact that a fully vaccinated person brought omnicron to North America? Unvaxxed can’t fly so logically a fully vaccinated person is responsible.

    Next, on what day, hour and minute did we transition from a traditional pandemic to a pandemic of the unvaccinated? Seems like a left wing talking point more than a scientific fact.

    Next, your claim that the unvaccinated are driving variants is as unlikely as it is likely. It’s been argued both ways and by people much more educated than you or I. Never in human history have we vaccinated in the middle of a pandemic so your simply guessing.

    Furthermore, this vaccine targets a specific spike protein which from an evolutionary perspective seems to make it more likely a virus would mutate around that singular protection.

    Your argument against my natural immune system driving variants doesnt apply to other corona viruses so why here??

    If you really want to change mindsets doc how about sharing some common ground. Tell people to exercise, lose weight, drop sugar, supplement with vitamins, take high doses of vitamin D especially as winter comes.

    Your trying to help people and I respect that but your writing style screams that you live in a far left echo chamber. You need to find some balance to your writing as some of it has become overly predictable and ripe with the same old left wing talking points.

  5. they’ve earned every bit of stigma and shame.

    they are society’s weakest link.

    and when they do fall ill they seek the very medical expertise they’ve spent the last 2 years railing against, an irony that is lost on no one except themselves.

  6. “fall ill and pass away at the hands of the Coronavirus themselves.”
    That statement right is is the type that is largely responsible for causing the dangerous polarizing of opinions during this pandemic.
    It’s been proven, beyond debate, that there have been many many deaths labeled covid after the patient was declared covid free. It’s also been acknowledged by health professionals and hospitals across Ontario that covid death statistics include deaths that were not related to covid & asymptomatic but tested positive post-mortem. Media outlets including CBC & CTV have all reported this.
    It’s the political maneuvering, complete lack of transparency, shock news reporting by media and the social media echo chamber effect which have led to this harmful divisiveness.
    Many many questions with no answers. For instance, people have asked why when were warned so early about the omicron variant in Africa that borders were allowed to remain open again? The government sat on their hands and just like the first cases of covid – here we are with the new variant scattered across Ontario.
    If new variants are so incredibly dangerous, as we’re told, why are borders the last thing to action? Why are lockdowns and restrictions the first?
    It makes about as much sense as bailing out an overflowing sink while leaving the water running. Even the town fool knows better.

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