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COVID Corner: Rocky IV edition

For nine months, we've been getting battered by COVID-19. The US of A has suffered over 250,000 deaths and worldwide 1.34 million people have died. As someone who loves analogies and sports movies, I have been thinking about Rocky IV; COVID-19 has been Ivan Drago, and our country has been like Rocky Balboa. With the COVID-19 vaccine on the near horizon, the FDA approval is going be like landing the punishing blow that cuts Drago and turns the tide of the fight. We will be fighting for a few more rounds, but momentum will finally be on our side. (Watch the scene here:

I'm waiting to see the final data from the five or six vaccines in phase 3 trials, but right now, I'm very optimistic. There are some vaccine questions that we won't know until we see all the data, namely how long does immunity last. I want to address two reasons I'm hearing regarding why people are reluctant to get the vaccine. For these questions, we already have good answers.

Why get vaccinated for a disease with a "low" mortality rate?

Why should you get vaccinated for COVID, given that most people do recover?  First of all, COVID-19 has already killed 250,000 and continues to kill around 1,000 people a day. We do know that your risk of dying of COVID is higher based on your age. Because of this, when the vaccine is released, the recommendations will likely be that older people should get the vaccine first.  A paper that will soon be published found that the age-specific infection fatality rate was low among children and young adults, measuring 0.002% at age 10 and 0.1% at 25. However, the rate progressively increased with age, growing from 0.4% at 55 to around 15% at 85. While the death rates in young people are low, here is a sobering statistic: for people ages 25-44, COVID is likely going to be the number one cause of death in 2020, overtaking accidental overdoses. 

Many of the diseases we vaccinate for now have similar rates of death or less. When the polio vaccine came out in 1955, families lined up to immunize their children due to the virus's devastating consequences. Death rates and severe cases of polio were actually relatively rare. Seventy percent of people who got polio had no symptoms, and 25% only had a slight fever and sore throat. Severe polio cases that resulted in permanent neurologic damage or death occurred in about 1 out of every 200 people who contracted polio. Obviously, because polio-affected children and COVID hits older adults, there are some differences between the two diseases.  

For comparison, here are mortality rates for other vaccine-preventable diseases:

  • Mumps:  1 death/10,000 infections
  • Measles: 1-2 deaths/1000 infections
  • Chickenpox: 1 death/60,000 infections
  • Whooping Cough: 1-2 deaths/1000 infections
  • Hepatitis A:  3 deaths/1000-2 deaths/100 cases depending on age
  • Haemophilus influenza:  3-6 deaths/100 cases

So your chances of dying if you get COVID are actually in line with many of the diseases we vaccinate people for. Another critical reason to vaccinate kids for measles, mumps, and chickenpox is to prevent mild to moderate illness and not just death. We've had 12 million cases of COVID already. Beyond the 250,000 deaths, over 500,000 people have been hospitalized.

Even with mild COVID disease, because everyone needs to isolate for at least ten days, the amount of lost school time and worker productivity loss has been staggering. Personally, this is one of the main drivers for me wanting to get vaccinated; I really don't want to have to miss at least ten days of work, if not more. There are similar benefits for other vaccine-related diseases. One study calculated that for every 100,000 children vaccinated for chickenpox, our economy benefits over 6 million dollars by reducing medical care and maintaining worker productivity.

Isn't natural immunity better than vaccine immunity?

The other thing I'm hearing is that the immunity you get from getting COVID is better than the immunity you would get from a vaccination. The honest answer to that is we don't know yet. However, we have several examples where vaccine-induced immunity is better than natural immunity. The most recent one is with the relatively new vaccine for Human Papilloma Virus (HPV). The high purity of the HPV specific protein in the vaccine leads to a better immune response in your body than with natural infection. With tetanus, the toxin made by tetanus is so potent that the amount that causes disease is lower than the amount that induces a long-lasting immune response. This is why we recommend the tetanus vaccine to tetanus survivors.  Similarly, we also see better immune responses for Haemophilus influenza type b (Hib) and Pneumococcal vaccines because of how the vaccines are structured. Even if vaccine immunity turns out to be less than natural immunity, it’s better to get booster shots down the line as opposed to contracting COVID and having to deal with possible long term side effects of the virus.

As more data on COVID vaccine comes out, we'll be able to answer more of the unknowns. Until we do have the vaccine, please continue to wear masks and isolate.

Andy Pasternak, MD, MS

Andy Pasternak, MD, MS

Dr. Andy Pasternak is a family medicine practitioner who founded the Silver Sage Center for Family Medicine in Reno, NV. Silver Sage Center for Family Medicine provides high quality health care for the entire family, treating the entire spectrum of medical conditions ranging from simple ear and sinus infections to more complex problems like heart disease and cancer.