The COVID-19 pandemic — A multi-faceted health, social and economic catastrophe

By Theresa Cullen, MD, MS and Jean E. Garcia, MA

Pima County Medical Society fully supports the Pima County Health Department in its efforts to provide accurate information on the safety and efficacy of the COVID-19 vaccine program.

Over the past year, the SARS-CoV-2 coronavirus, or COVID-19, has caused a worldwide pandemic with disastrous consequences. Since the first cases were documented in China, more than 103 million cases of the disease and more than 2.2 million deaths have been reported.

Few countries have been hit as severely as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID‑19 cases and deaths. To date, more than 26 million cases and 445,000 deaths have been reported in the U.S. The pandemic has created both public health and economic crises in America, disrupting lives, pushing hospital systems to capacity and creating an economic slowdown.

As the U.S. and Arizona struggle to contain COVID-19, indicators in Pima County reveal the impact of the pandemic on mental health. Local reports cite increases in domestic violence calls and opioid overdoses. Nationally, one in three Americans is dealing with symptoms of stress or anxiety, according to the Centers for Disease Control and Prevention (CDC).

The pandemic has disproportionately affected people of color and those who were already resource-constrained. The effect of social determinants of health (SDOH), such as employment, income levels and housing and food security, have threatened basic survival. Those at a disadvantage because of individual and structural discrimination are more likely than their counterparts to be vulnerable to negative health outcomes.

Negative social determinants, such as food insecurity, multi-generational housing, economic instability, the absence of insurance and discrimination increase the risk of COVID-19. Historical reports have shown that poverty, inequalities and SDOH facilitate the spread of infectious diseases. Inequalities in health and health care further add to disparities in morbidity and mortality. Those already resource-constrained now find themselves living with a perpetual sense of uncertainty, which is associated with outcomes ranging from negative psychological well-being to elevated blood pressure. This uncertainty also magnifies the psychological impact of other stressors.

The pandemic has been hard on American families, with many parents out of work, homes shrouded in grief and loss and children prohibited from attending the schools, which taught and cared for them. It has taken an unthinkable toll on children — a social, emotional and academic catastrophe so extreme that some advocates and experts warn that students will return with greater mental health needs than prior to the pandemic. In families that have experienced multiple hardships related to the coronavirus disease 2019 crisis, both parents’ and children’s mental health is worse.

Hope is on the Horizon

Hope is on the horizon with the emergency approval of the Pfizer-BioNTech and Moderna COVID-19 vaccines, with more in development.

As Pima County physicians, we did not have the luxury to celebrate the vaccine releases as we addressed a cruel and relentless disease surge with increased infections, hospitalizations and death tolls. Nevertheless, the vaccines represent hope for Pima County health care providers and for all Pima County residents who have lived through some of the bleakest chapters in the county’s history. Although we are headed in the right direction, the worst is far from over. Many more residents are likely to fall ill or perish in the coming months. The vaccines are not an instant fix but bring light to the end of a long, dark tunnel. However, the tunnel is very long. Our lives will never be the same as they were before the pandemic. Stopping the pandemic requires all the tools we have available.

Americans must get vaccinated to begin to live safely again. The vaccines are the best weapons to stop the disease assault.

However, false and misleading claims about vaccines and misinformation can hamper the progress of the vaccination program. The vaccines are safe, effective and life saving.

Myths versus Facts

The following prevalent claims and myths about the COVID-19 vaccines are false:

Myth: The COVID-19 vaccines are unsafe because they were developed so quickly.

Fact: The vaccines are safe and effective. They were created through the standard Food and Drug Administration validation process. No testing steps were skipped, but some steps were overlapped to gather data faster. Because COVID-19 is so contagious and widespread, the researchers were able to quickly determine if the vaccine worked for the study volunteers who were vaccinated.

Myth: The COVID-19 vaccines will alter my DNA.

Fact: The COVID-19 vaccines will not alter your DNA. The first vaccines granted emergency use authorization contain messenger RNA (mRNA), which instructs cells how to make a protein that triggers an immune response. When the immune system recognizes this protein, it builds an immune response by creating antibodies that protect against future infection. The mRNA never enters the nucleus of the cell, which is where our DNA (genetic material) is kept. The mRNA triggers the cell to produce protein to stimulate the immune system and then it quickly breaks down.

Myth: The COVID-19 vaccines have severe side effects such as allergic reactions.

Fact: Very few people experience severe side effects from the COVID-19 vaccine. Some participants in the vaccine clinical trials did report side effects similar to those experienced with other vaccines, including muscle pain, chills and headache. These side effects are normal signs that the body is building protection. Although extremely rare, people can have severe allergic reactions to ingredients used in a vaccine. The rate of severe allergic reactions is about eight cases for every 1 million patients. People who have had allergic reactions to other vaccines in the past are recommended to consult with a doctor before getting a COVID-19 vaccine.

Myth: The COVID-19 vaccines cause infertility in women.

Fact: There is no evidence that the COVID-19 vaccines cause infertility. Misinformation on social media suggests the vaccine trains the body to attack syncytin-1, a protein in the placenta, which could lead to infertility in women. There is an amino acid sequence shared between the spike protein and a placental protein; however, experts say it is too short to trigger an immune response and does not affect fertility.

Myth: People who have had COVID-19 do not need to get vaccinated.

Fact: People should get vaccinated even if they have had COVID-19. At this time, experts do not know how long someone is protected from getting sick again after recovering from COVID-19. The immunity someone gains from having an infection, called natural immunity, varies from person to person. Some early evidence suggests natural immunity may not last very long.

Myth: Once vaccinated, it is not necessary to wear a mask.

Fact: Everyone should still wear a mask after being vaccinated. Masking, hand-washing and physical distancing remain necessary until a sufficient number of people are immune. The best protection we can offer each other right now is to continue to follow current guidelines. As more people are vaccinated and experts have a better idea of how long natural and vaccine immunity last, public health experts will update their guidance as necessary.

Myth: It is possible to get COVID-19 from the vaccines.

Fact: It is not possible to get COVID-19 from the vaccines because they do not contain live viruses.

Myth: People not at risk for severe complications of COVID-19 do not need to get vaccinated.

Fact: Except for rare exceptions, everyone should get vaccinated. Healthy people can contract the infection and spread it to others, so it is important for everyone to get vaccinated. When healthy people decline vaccination, it creates a risk for others in their community. The easiest way to prevent spreading disease to vulnerable people like children and the elderly is to get vaccinated.

Myth: The COVID-19 vaccines include a tracking device.

Fact: The COVID-19 vaccines do not include a tracking device. A social media theory claims that there are microchips and tracking devices in the COVID-19 vaccines accusing Microsoft founder Bill Gates of implanting microchips in the vaccine, which are said to dissolve under the skin and leave “quantum dots” and are used to track people.

The Pima County Medical Society is committed to truth, safety and recovery from this pandemic. We are in a crisis. This is not time for charlatans, prevaricators and deluded ersatz medical practitioners. Until herd immunity has been attained, the best course of action is to continue following public health measures — physical distancing, masking in public and good hand-washing hygiene — to break the virus transmission chain.

Meanwhile, as physicians, we must do what we can to stop dangerous doctors and myths during a pandemic. It is a matter of life and death.

Theresa Cullen, MD, MS is the director of Pima County Health Department and a member of the Pima County Medical Society Board of Directors. Jean E. Garcia, MA is a technical writer, Global Health Informatics.