On the stupidity of comparing COVID-19 healthcare burden to lifestyle diseases

Here in the Netherlands, as elsewhere, hospitals are again seeing a huge surge in admissions of COVID-19 patients. But this time, as in many other countries, the overwhelming majority of these patients are unvaccinated. The disproportional burden on ICU capacity caused by these unvaccinated COVID-19 patients means that non-urgent care is now postponed in most hospitals.

Those opposing the COVID-19 vaccines (also known as ‘anti-vaxxers’) are rightly blamed for this situation. But the anti-vaxxers themselves disagree with that point of view. One of the more popular responses from anti-vaxxers is the argument that the choice not to get vaccinated is no different than any other life-style choice, like smoking, not exercising enough, eating too much, engaging in sports with high risk of injury, or drinking alcohol. The ardent anti-vaxxer will often claim that these risky behaviours are on equal foot with refusing the vaccine, and go on to remind us that smokers also take up ICU beds. Here I will illustrate why that argument is completely fallacious.

Let’s start with smoking. Smoking tobacco is an immensely complex addiction problem, involving strong physical and psychological dependence. And smoking related illnesses do not manifest immediately. It typically takes many decades before smoking cigarettes leads to disease. We should therefore remember that people who may occupy an ICU bed today because of smoking tobacco, often started this extremely addictive habit at a time when smoking was still allowed in public places and was widely considered socially acceptable behaviour. Furthermore, while a long-term smoker who quits today will certainly experience an enormous health-benefit by doing so, there will nonetheless always remain some permanent damage from the many years of smoking. Medical conditions from past smoking may thus still arise years later, requiring some degree of ICU level care. But this is in no way comparable to ending up in the ICU during a pandemic, when everyone floods the ICUs at more or less the same time by refusing a proven safe and highly effective vaccine. This just doesn’t happen with smoking: they don’t all just get lung cancer in the same year. And when (ex-)smokers do end up in an ICU, they don’t stay there for two to three weeks or longer. Refusing a safe medicine is not the same—at all— as a huge societal problem as tobacco abuse, or any other drug problem for that matter. In many cases, substance abuse is related to genetic factors, socioeconomic factors, and in some cases is considered by specialists to be a form of self-medication for certain mental illnesses. Oftentimes there is not so much ‘choice’ at all regarding this lifestyle. And refusing a vaccine, usually based on misinformation and by simply ignoring common sense, is nothing like that.

Other comparisons anti-vaxxers frequently make involves obesity and alcohol abuse. But just like smoking, these are intractably complex issues that cannot be readily solved in the short term. Extreme cases of morbid obesity are even treated with surgery, for Christ’s sake! How is that in any way comparable to refusing a vaccine? It’s insane! There are nations who have declared obesity a pandemic, and have literally imposed special taxes on certain foods (e.g. sugar-tax in the UK) in an attempt to stem the tide. Again, this has nothing to do with refusing a safe vaccine; an addiction or genetic predisposition to not getting vaccinated is unknown to science. A genetic component to the pigheaded stupidity of the anti-vaxxer also remains to be elucidated.

The final comparison I have seen is that in which the choice not to get vaccinated is likened to the choice to engage in high-risk sports. And for some reason I often hear skiing used as an example. Well, alright, let’s do the math. First we’ll look at COVID-19. In the case of unvaccinated people, let’s say the average risk of ending up in the ICU because of COVID-19 is about 5% and the chance of dying is about 1•6%. Could be more and could be less, depending on the country you look at. That’s 50,000 ICU patients and 16,000 deaths for every one million people. So how does skiing compare? Well, in the US the chance of dying from a skiing accident is just shy of one-in-a-million; for every million people visiting a ski-resort, statistically speaking one of them will die during their visit. ONE IN A MILLION! Skiing is over three orders of magnitude safer than getting COVID-19! An NSAA report from 2011 tells me less than 50 skiing related deaths were reported over a period of ten years in the US (at least from in the >90% of US ski-resorts represented by the NSAA). While every death is one too many, 50 deaths in 10 years is about 0.007% of the US COCID-19 deaths in a little over a year. Thus, comparing skiing to COVID-19 is statistically—in terms of fatality risk— just about the same as comparing a trip to the beach in a Volvo to a goddamn NASA rocket mission to outer space! That is literally how ridiculous the comparison is. So let me learn you something that is generally true: ANY sport or activity that is as dangerous as getting COVID-19 would be declared ILLEGAL immediately, without question. Normal people wouldn’t even be able to get insured for such an incredibly dangerous activity, unless you paid an ASTRONOMICALLY high insurance fee.

So to summarise: COVID-19 is not to be compared to health risks associated with ANY life-style. That has to stop right now. Not getting vaccinated is quite simply both insensible and irresponsible, and unnecessarily burdens public healthcare. Yes, in Western countries we have a lot of freedom. However, while you may very well exercise your freedom to refuse the vaccine, that choice does not liberate you from responsibility and consequence. And believe you me that choices always have consequences. In the absolute worst case scenario, if ICUs get completely overrun, you could very well find yourself being triaged right out of the ICU to receive just standard hospital care, with perhaps in the end some palliative sedation to ease your passing while your wailing loved ones can’t even give you a last kiss. This is a nightmare scenario no doctor ever wants to see, but the unvaccinated seem to be doing everything in their power to make it happen. If you are one of them, then please reconsider. Get the vaccine. It’s safe, it’s extremely well tested, and it really works. It’s never too late to change your mind.