I’ve been seeing a new riff on COVID immunity from Vaccine Refuseniks the last few weeks. It’s a peculiarly uninformed notion that herd immunity is only achieved when 70% of the population has been infected. The obvious extension? We should end all restrictions, throw away the masks, and let the virus burn through the population.

Not to put too fine a point on it, that’s horse hockey.

Immunizing the Herd

What our Holy Grail of herd immunity requires is that 70%+ of the population have COVID antibodies. It doesn’t matter whether the antibodies come from infection and recovery or vaccination. But by far the preferred way to acquire antibodies for COVID immunity is by vaccination. 

Many COVID immunity Poo-Pooers will say, “I/My Brother/My BFF Chauncey had COVID! It’s no worse than the flu!” Or my personal favorite, “I had COVID and I’ve had worse hangovers!”

However, a lot of people suffered more than a hangover. A lot more. 

As a self-professed Stats Geek, this would be the moment to point out the difference between data and anecdote. Anecdote would be You/Your Brother/Your BFF Chauncey. Actual data, drawn from a population of 32 million known cases of COVID in America, tells a much more sobering story.

More Than The Flu

We know from the first wave of COVID in the early spring of last year that about 26% of infected people required some level of hospitalization. Although we’ve gotten better at treating people outside of hospitals since then, it continues to be a large number. 

Within this 26%, some demographic cadres were hit much harder. For those over 75, hospitalization ran 44%-50%, with high mortality. This ran to 40% for persons of any age with preexisting conditions like renal, neurological, and cardiovascular diseases; chronic pulmonary problems; or diabetes. To put this in perspective, these conditions afflict north of 50 million Americans. 

Of all hospitalized persons, 9% end up in an ICU. For those with pre-existing conditions, that number rises to 13%. And that’s where too many people die.

Yeah, there are a lot of hospitalizations from COVID. This last week, about 40,000 Americans were in hospitals with COVID. By comparison, Israel, a nation with 2.7% the population of the USA, has 254. That would be a quarter the per capita rate in the USA. 

I should probably mention Israel has an aggressive vaccination program, with 55% of its population fully vaccinated and with COVID immunity as of 23 April. The Israelis also had zero COVID deaths that day, for the first time in 10 months.

It’s the Vaccines, Stupid

Yes, vaccines work. They create COVID herd immunity without all the suffering of actual infections. And they do not modify your DNA or implant 4K microchips in you. I hit 14 days since my second Pfizer dose as I wrote this and have yet to receive my first bicep-text message from Bill Gates or George Soros. Although wouldn’t that be super cool? 

What I want to consider, however, is what chronically high levels of hospitalization are doing to America’s healthcare infrastructure. Yes, healthcare is as much infrastructure as expensive canals that almost no one ever uses for anything except water skiing in a very long straight line. And I will knife fight anyone who says otherwise.

The Washington Post published a really disturbing article last week about the number of doctors, nurses, and other healthcare workers who are leaving the profession. They’re burned out, terrified, shell shocked. You can’t watch this much sustained suffering and death without being affected. 

The even scarier part is that most of our healthcare workers haven’t even experienced the rising tide of post-traumatic stress many will face long after the pandemic subsides. We know from sad experience that vets, for example, often don’t manifest the worst of their PTSD until months or years after they’re removed from combat stressors.

This Is Only the Beginning

Some of the worst fallout from the COVID pandemic won’t be felt for some time after it ends when hundreds or thousands of doctors will leave the profession. Some will take their own lives or sink into addiction and debilitating depression. They’ve been on the forward edge of the pandemic battle for 16 months now. We know all too well from vets what to expect in the years ahead and we’re woefully unprepared for it.

All this will come at a time of rapidly increasing demand for doctors due to the inexorable Greying of America from aging Boomers and Gen Xers. The Association of American Medical Colleges projects we’ll be short as many as 141,000 primary care and specialist physicians by 2030. 

Doctors are not quick to produce. We would need to start some of those 141,000 in medical school this August to produce any additional primary care physicians by 2028. This assumes there are additional seats in medical schools and residency slots. Which there aren’t.

The only other way to get more trained doctors quickly would be to import them. The US has been doing a lot of that for decades, but we’d have significantly to ramp up the immigration inflow of foreign doctors. At a time of disturbingly high anti-immigrant sentiment, this may not be politically viable. Of course, even the most virulent nativist might not mind a foreign doctor if they’re the only one in the county.

The Incredible Fragility of For-Profit Healthcare

Beyond the crippling stresses the pandemic has placed on healthcare personnel, COVID has revealed the hidden costs baked into our mostly private, for-profit, fee-for-service driven healthcare system.

Hospital corporations have very effectively applied to healthcare all the tricks of the commercial sector. Offshoring vendors in search of cost-cutting? Check. Internationalizing supply chains? Yep. Just-in-time inventorying? You betcha. Administrators learned how to exploit the Big Data produced by the healthcare sector to keep just the right amount of bed space, equipment, and supplies on hand to minimize the cost of otherwise unproductive assets. 

It almost goes without saying that this is the foreseeable and natural result of reliance on a for-profit system for our healthcare. There are exactly two ways to increase profits—increase revenue and/or reduce costs. We’re all familiar with the unceasingly rising health insurance premiums on the revenue end. “Right sizing” hospitals, staff, and equipment gets at the cost end.

Although American healthcare is wildly expensive by international standards, in normal times it functions reasonably well. But we’ve been in anything but normal times—like throwing in an extra 40,000 or 60,000 or even 100,000 hospitalized persons on any given pandemic day. All the streamlining and slimming down and just-in-timing has a dark and tragic downside. There’s precious little surge capacity.

In a for-profit system, there’s really only one way to convince hospital systems to maintain spare capacity that everyone knows will be dormant 99% of the time. Pay them to do so. Sure, the government maintains strategic stockpiles of some equipment, ventilators being the most salient recent example. But getting Congress or state legislatures to pay for purchasing and maintaining these stockpiles is increasingly dicey the further we get from the last major health crisis.

Any Good From All This?

If any good can be said to come from the COVID pandemic, it may be our being forced to pull back the curtain on the way we’ve provided healthcare to Americans since the end of World War II.

Yes, the American healthcare sector is a leading innovator in medical and pharmaceutical research worldwide. That comes at a steep cost in terms of dollars—two or three times other developed nations. What COVID has shown us, however, is the brittleness and fragility of our system when confronted with a pandemic-scale public health crisis. 

For what we pay, Americans have a right to expect better. With vaccines ending community spread by summer, perhaps we’ll have the political space opened for a serious discussion of how we intend to provide healthcare for the next 75 years.

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