Health

Covid Scotland: The unvaccinated are putting avoidable pressure on NHS


HE was a fit, healthy pensioner in his early 70s who didn’t smoke or drink and barely ever left his flat except to take his bins out or visit the Post Office.

But he was also a Covid conspiracy theorist who believed the pandemic was a hoax and had fallen out with family over his refusal to be vaccinated.

That was the claim on Thursday from a man claiming to be the stepson of the UK’s first Omicron victim, a patient who died in Northampton hospital on Monday.

Speaking during a phone-in to London’s LBC radio, a caller – who would only give his name as John – said his stepfather was an “intelligent man” who had become absorbed in online misinformation about the virus.

READ MORE: Why Delta variant has left herd immunity through vaccination mathematically impossible

He said: “He was a recluse, he never went out. He had his shopping brought to him. The only place he went to was the bin outside the block he lived in and the Post Office. He was one of the cleanest guys I’ve ever known.

“He wasn’t vaccinated at all. My sister is gutted but on the other hand she’s a little bit angry that he never took these vaccines.

“She had an argument with him at the end of October about this very thing – getting vaccinated. He thought it was a conspiracy.”

HeraldScotland: The numbers of first and second vaccine doses has flatlined, but more than 300,000 eligible Scots remain unvaccinatedThe numbers of first and second vaccine doses has flatlined, but more than 300,000 eligible Scots remain unvaccinated

It is probably the most intractable problem of the pandemic: how do you persuade the millions of eligible but still unvaccinated individuals to finally come forward?

In Scotland, one in five people aged 12 to 39 have yet to have a first dose – roughly 390,800 individuals.

Even now though, some are belatedly stepping up: between November 15 and December 15, an additional 33,686 first doses were administered in Scotland – roughly half of them to adults.

That at least should give us hope that even the most sceptical or apathetic can still be turned around.

As everyone should understand by now, vaccines have a dual role: they reduce the vaccinated person’s risk of severe disease but (by also reducing their probability of becoming infected in the first place) they curb the spread of the virus in the population as a whole.

Unfortunately this second element – herd immunity – was already pushed out of reach by the arrival of the highly transmissible Delta strain, which eroded the protection of two vaccine doses against infection and meant that each infected person was passing the virus on to around twice as many people as used to be the case with the original Wuhan strain.

HeraldScotland: Death rates, age-standardised and per 100,000, are six times higher among the unvaccinated in Scotland than people who have had two or more dosesDeath rates, age-standardised and per 100,000, are six times higher among the unvaccinated in Scotland than people who have had two or more doses

READ MORE: Why it doesn’t really matter if new Omicron variant causes ‘milder’ disease

An even more transmissible and immunity-eroding strain in the form of Omicron has thrown the equation even more out of whack.

If we had already downgraded our ambitions from herd immunity to endemicity – the point where a virus persists at a constant low level – then that remains our goal, but it has just been pushed further away.

Understandably, our current predicament might lead those unenthused about vaccines to think ‘what’s the point?’

After 12 months of first, second and now booster doses, Scots – vaccinated and unvaccinated -have been told to “defer Christmas parties”, to “minimise” socialising, and now to just “stay at home”. It feels less like Christmas, and more like March 2020.

Perhaps it is time we reframed what “protecting others” through vaccination looks like.

Even if 100% of the population is fully vaccinated with all three doses, Covid will continue to circulate due to the sheer transmissibility of Omicron and evidence suggesting boosters may only cut the risk of symptomatic infection by 75%: in other words, one in every four boosted individuals exposed to the virus would still develop mild disease (compared to only one in 20 with Delta).

HeraldScotland: The rollout of vaccines has meant that intensive care admissions during the Delta wave remained lower than the previous two waves, but unvaccinated people make up a disproportionate share of admissionsThe rollout of vaccines has meant that intensive care admissions during the Delta wave remained lower than the previous two waves, but unvaccinated people make up a disproportionate share of admissions

But given that vaccines still appear robust in protecting against severe disease, the unvaccinated need to consider what leaving themselves wide open to illness means for the wider NHS.

Between November 6 and December 3, 57 unvaccinated people in Scotland died with Covid listed as an “underlying or contributory cause of death” on their death certificates.

The Covid death rate per 100,000, matched for age, is nearly six times higher among unvaccinated people than those who have had two or more doses.

The hospitalisation rate is five times higher, and up to September 23 this year unvaccinated people were six times more likely to end up in intensive care with a positive Covid test.

During the most recent Delta wave in Scotland, around two in every five intensive care beds were occupied by Covid patients – mostly either immunosuppressed patients who respond less strongly to vaccines, or the unvaccinated.

Data for England shows that three quarters of ICU Covid patients up to July had not been vaccinated while nine in 10 of those who received the most specialist care between July and November – where artificial lungs are used to keep patients alive – were unvaccinated.

READ MORE: What’s really behind the worst winter crisis facing Scotland’s NHS?

This has far-reaching consequences for other patients whose complex surgeries – in some case cancer or heart bypass operations, or transplants – have been put on hold.

Covid patients also tend to spend longer in ICU on average than patients with other conditions: around nine days – or longer if they survive – compared to one or two days for elective patients.

Dr Dhruv Parekh a critical care consultant at the Queen Elizabeth Hospital in Birmingham said 100 to 140 planned operations a week in his unit are being cancelled to free up space for Covid patients.

HeraldScotland: Elective admissions into ICU in Scotland have remained well below pre-pandemic levels for most of the past 20 monthsElective admissions into ICU in Scotland have remained well below pre-pandemic levels for most of the past 20 months

In Scotland elective activity in ICUs – where the most critically ill patients are treated – was still 50% below pre-pandemic levels by mid-September this year.

Yes, fully vaccinated people also end up in hospital and die – but they are nearly all elderly or have multiple co-morbidities. Unvaccinated patients are younger and their admissions, in many cases, could have been avoided.

No, getting vaccinated – even boosted – won’t eradicate this virus; but it is the best tool we have to ensure that, as much as possible in 2022, NHS beds go to those who need them most.





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