Any respiratory virus has the potential to become a pandemic. We have had influenza pandemics in the past, and we are always worrying about an influenza pandemic, but this is the first pandemic since 1918. The 2018-2019 influenza season was really bad with hospitals packed to capacity, but it did not reach pandemic level proportions. There were 35.5 million cases of influenza worldwide with 490,600 hospitalizations and 34,200 deaths. That’s a 1.4% hospitalization rate and a 0.1% death rate.

Compare that to COVID-19, which has 92.3 million cases worldwide with 1.98 million deaths. The death rate is 2%. That’s 20 times the death rate of influenza. The COVID-19 hospitalization rate is 40% for those with one underlying health condition (this includes BMI > 25) with an ICU rate of 13%. The hospitalization rate for those who are completely healthy with BMI < 25 is 9% with a 2% ICU rate. That’s at least 10 times the normal hospitalization/ICU rate during cold and flu season, and we literally don’t have room in our hospitals and ICUs, we don’t have enough ventilators for those who need them, we don’t have enough doctors and nurses to care for COVID-19 patients. Even if you are young and healthy and not worried about COVID-19, you should worry that if you get appendicitis or get into a serious car accident, you may die because there’s no room in the hospital, there’s no available ventilator for your emergency surgery. 

Interestingly, viruses with a very high death rate are unlikely to reach pandemic proportions. MERS is another corona virus which had a 35% death rate. Severe symptoms requiring hospitalization usually began within 4 days. The infected were too sick to go to parties and spread the virus. Viruses with a very short incubation period are less likely to cause a pandemic for a similar reason. Influenza causes symptoms within two days of exposure, so the infected don’t have much time to spread the virus. COVID-19 has all the markers of a pandemic virus: a very long incubation period (up to 14 days), no symptoms or very mild symptoms in the majority of infected people, and a low-to-moderate rate of hospitalization and death. All of these factors allow for maximal spread of the virus and a very large number of hospitalizations and deaths even though the majority of the infected recover.

I am extremely excited about the Moderna and Pfizer mRNA vaccines which are both over 90% effective at providing immunity against COVID-19 with miniscule risk. Essentially, the only risk is a slightly higher risk of anaphylaxis (11 out of 1 million) as compared to other vaccines. Anaphylaxis is serious but very easy to treat, so as long as you are monitored by a nurse for 15 minutes following administration of the vaccine, there is nothing to worry about. This vaccine does not change your DNA, and there are no long-term side effects. Since the mRNA codes for the spike protein, which is the way that the virus enters our cells, I am not concerned about mutations decreasing effectiveness of these vaccines. Basically, if a viral mutation changes or eliminates the spike protein, this virus would not be able to cause infection. The scientific trials were done perfectly and were not rushed. The only reason that this process was faster than usual is that all of the bureaucratic red tape was eliminated and funding was guaranteed. Basically, we have these amazing vaccines not because of the government but because the government stepped out of the way.

The government response to this pandemic has been abysmal. Mandatory shutdowns and school closures have resulted in economic devastation and predictable worsening of mental health, addiction, suicide, spousal and child abuse as well as educational delays which are especially harmful to low-income children whose parents cannot afford to support their family with a single income or to pay for private schools, childcare centers, tutors, or nannies. Widespread vaccination is the best way to keep our businesses and schools open and get back to normal, but I do not believe mandatory vaccination will be necessary. I believe that enough Americans want this vaccine and that once we vaccinate everyone who wants it, we will achieve herd immunity or at least decrease the spread enough that our hospitals will be able to handle COVID-19 cases. I am encouraging my patients to get the vaccine not for the greater good but for their individual protection. I respect everyone’s right to decide whether or not to get the vaccine, but I hope that they make that decision using objective data rather than falling prey to conspiracy theories.