At one of the hospitals where I work, in rural New Mexico, the COVID-19 patients are often young. Many are extremely sick, and most are unvaccinated. Not long ago, I walked into a room to find a woman in her mid-thirties. (Patient details have been changed to protect privacy.) She was unvaccinated, and had tested positive the week before. Her oxygen saturation was just fifty per cent, and her chest X-ray looked terrible. She seemed resigned and scared. When I asked her why she hadn’t got the vaccine, she shrugged. Down the hall, I visited a man in his early twenties who was breathing forty times a minute. We were still waiting for his test results, but his chest X-ray also looked terrible. When I asked him why he hadn’t got immunized, he said, “I don’t know,” and shrugged, too. Outside, in the hall, I checked our status board. A ten-year-old had been checked in with worsening COVID symptoms. Fifteen more patients were waiting to get tested. In New Mexico, it doesn’t feel like we’re experiencing a new “wave” of the pandemic—it’s more like we’re in the middle of an endless voyage, in twenty-foot seas, miles from land.
I’ve been working as an emergency-room physician all through the pandemic, first in Boston and now here. Taking care of unvaccinated patients stirs up complicated emotions in me. Severe COVID-19 is now a largely preventable illness, and I often feel anger and frustration: I think, You couldn’t be bothered to do something as simple as schedule two shots, and now you might die—what is wrong with you? I contemplate the risk that each unvaccinated person poses to everyone around, including to me, and my family, and our nurses, and their families, and the hospital staff who will clean the virus-slick rooms, and their families—the risks branch out with dizzying complexity, like ice crystals forming in a cloud. I try to keep these thoughts to myself, for obvious reasons. Who wants to hear, after they’ve totalled their car and broken their legs, that they shouldn’t have been speeding? Sometimes, when I stand at the bedsides of young, critically ill patients who shake their heads when I ask if they’ve got the vaccine, I murmur, almost to myself, “I really wish you had.” But their past choices are no longer the most important thing. They are sick and afraid, and need our help as much as anyone else. I tell them that we’ll do everything we can to keep them safe. I never tell them that, for some patients, everything won’t be enough.
By asking people why they have avoided these incredibly safe and effective shots, I’ve learned a lot about how confusing the information ecosystem has become. Patients used to tell me that they worried about adverse effects, such as myocarditis or blood clots. (These effects are vanishingly rare.) Then, in September, I started hearing about a new concern: “the VAERS report.” I heard more about it by listening to a conservative talk radio show; listeners kept dialing in to talk about it. They said that tens of thousands of Americans had died after receiving the coronavirus vaccine, and that this report proved it. My patients in the E.R. began saying this, too.
As if on cue, I received an e-mail from a woman I didn’t know offering to send me information on the hidden dangers of the vaccines. She included a link—just, she wrote, a “snippet of what is going on.” I clicked through to a video featuring Jessica Rose, an independent researcher who studied computational biology at Bar-Ilan University, in Israel. In the video, Rose says that the Vaccine Adverse Event Reporting System, or VAERS, has shown an increase of more than a thousand per cent in reports of people saying that they were harmed by vaccines in the past year. In a separate twenty-three-page document posted online, she and a co-author claim that the VAERS data suggest that as many as a hundred and fifty thousand people have died after getting immunized against COVID.
VAERS is real: it’s a public database, administered by the C.D.C. and the F.D.A., that allows anyone to submit a report about potential adverse events that they think might be connected to a vaccine. Early accounts of myocarditis associated with the mRNA vaccines came through VAERS, and were later confirmed after closer investigation. By the end of September, VAERS had received reports of 8,164 deaths after vaccination. That might seem like a lot, until you realize that more than two hundred and thirty million people in the United States have received at least one dose, and that about eight thousand deaths occur every day in the country—one every eleven seconds. Those two populations—the vaccinated and the dead—will inevitably overlap, but that doesn’t mean the vaccines caused the deaths.
Rose seems oblivious to this fact, and she and her co-author deploy a lot of charts and math to lend scientific embroidery to a baseless idea. They derive an “under-reporting multiplier” from a single unrelated study of anaphylaxis, and use it to inflate the number of reported deaths nearly twentyfold. Rose’s document underwent no peer review and was not published by any journal. As a work of science, it’s worthless. But, as an emotional screed disguised to look like a scientific paper, it’s very good. If you don’t have experience interpreting research, it seems like the real thing. It’s not hard to imagine someone on Facebook reading it and thinking, Holy shit.
One of the most striking graphs in the paper shows a huge spike in VAERS reports soon after the COVID vaccines were introduced. Rose interprets this as a signal of harm, but the political scientists Matt Motta and Dominik Stecula have a different take. “Because VAERS claims are self-reported, they tell us something about what ordinary people, as opposed to doctors and medical researchers, think about vaccine safety,” they wrote, in August. “People may be more likely to report side effects, for example, in response to media stories about vaccine safety concerns.” They aren’t noticing harm from the vaccines—they’re looking for it. In this sense, Motta and Stecula argue, “The reporting system may be functioning similarly to a public opinion poll.” Now, in the E.R., I’m seeing the consequences of those opinions.
Not all of my coronavirus patients are unvaccinated. Breakthrough infections now account for twenty-three per cent of hospitalizations in New Mexico. Last month, I took care of a man in his sixties, vaccinated but suffering from COVID, who had been sick for a week. His oxygen saturation was seventy-three per cent. I found out later that the patient in the neighboring room, who had come in the night before and been intubated with a severe breakthrough infection, was his sister. My breakthrough patients are almost always older, and have additional medical problems. They were among the first in line to receive their vaccines, and often look crestfallen when I tell them that they’ve got the virus anyway. Many have lost friends, siblings, even children. I can’t help but feel that, collectively, we’ve let them down.
Do these awful breakthrough cases mean that the vaccines aren’t working? Vaccine skeptics have cited rising numbers of breakthrough cases as evidence that the shots are ineffective. But the truth, as usual, is more complicated. As more people get vaccinated, the number of breakthrough cases will rise for reasons of simple arithmetic, in just the same way that a large country will have more cases of cancer each year than a small country: only a small proportion of vaccinated people will end up with severe breakthrough COVID, but that translates to a fairly large number of actual patients as vaccination rates rise. And how widely the virus is circulating matters, too. Vaccines are like a city wall: they can repel invaders, but they’re not impervious. The size of the attacking force matters, and the longer the siege, the more likely that the city will fall. Community transmission remains high throughout the country, and, in New Mexico, because so many people—about four in ten—are still unvaccinated, every time a vaccinated and an unvaccinated person meet, it’s an opportunity for a breach to occur. The idea that we can partition people into two separate worlds, vaccinated and unvaccinated, is an illusion. We are all in this together, vaccinated or not.
I circled back to the man in his twenties. He was now on oxygen, and no longer breathing forty times a minute. I told him that his COVID test had come back positive, and that his chest X-ray showed severe inflammation in his lungs.
“Oh,” he said, looking down at his blue hospital blanket. “Can I go home?”
“No,” I said. “I’m afraid not.”
I stepped out to start making phone calls. Before the coronavirus, our hospital sometimes transferred patients to other, larger hospitals for speciality services, such as cardiology or gastroenterology. Usually, that meant one or two phone calls. Now we transfer patients because we simply don’t have room, and arranging transfers takes ten, fifteen, twenty calls or more, because nobody else has room, either. It’s a rare victory when we can find an in-state bed for a patient, and I routinely fly patients five hundred miles to Nevada. A few days ago, one of my colleagues called thirty-eight hospitals across seven states. When he handed the patient over to me at shift change, she was on twelve hospital wait lists. “We considered Timbuktu,” he said, with what I imagined was a wry grin under his N95. The process is hell for families, who often look at us in disbelief when we tell them that we’ve found a bed in Nevada or northern Colorado or Texas. Sometimes patients die alone in these distant hospitals, and families struggle to get the bodies back.
