Leon Kraybill

Leon Kraybill

Don’t tell me what to do!

Many recent discussions about COVID-19 protection and prevention focus on individual autonomy, personal rights, vaccination mandates and the opportunity for personal dissent.

I understand that. I like to consider my options and then decide what is right for me. Our country was developed in part on the principle of independence, making our own choices, and not allowing a king to dictate our lives. That proud don’t-tread-on-me attitude has created many strong, creative, productive and self-determined people.

We should never give up on making our own assessments, asking for explanations, questioning expectations or protesting injustice.

But a focus only on individual rights often misses an important part of the discussion.

We are no longer wilderness pioneers living 10 miles apart. We live in communities, neighborhoods and towns only feet apart from each other. Our lives are connected, and our actions impact others. My wish to play loud music limits my neighbor’s wish to sit quietly in the yard. My intent to dump sewage in my yard may directly threaten my neighbor’s health. My choice to drive after drinking may result in someone else’s death. My plan to store toxic chemicals may poison the local creek.

I may want to do all these things, or see them as important in my belief system, or not agree with my neighbor’s opinion — but I am only one person in a large community of people who have equally strong perspectives. If each person acts only on their individual preferences, the result is general chaos and community harm.

In reality, our country has long accepted some limitations of individual rights for the good of everyone. We fought the Civil War to abolish the perceived “rights” of some people to enslave others. We limit or prohibit the use of alcohol and drugs. We pay taxes for projects that help people throughout our country. We require testing for infectious health conditions like tuberculosis. We mandate sewer line connection when houses are adjacent. We accept yearly safety inspections of our cars. We elect leaders to make the best choices to help the country.

The question is not whether we can make all of our own decisions (we never have and never should), but rather what is the proper balance between individual preference and community well-being? How much can we stretch to honor the preferences of as many individuals as possible, and when is the public good more important? And, of course, how do we as a society discuss, debate and decide on an equitable balance?

As we approach these discussions, we must carefully and skeptically consider many contributing factors. We should not decide based on what happened to just me, but what many people have experienced. We must listen, learn and try to see others’ perspectives.

For me, a scientific data-driven approach is the only way to work through tough COVID-19 questions, as it tries to move beyond emotion-based personal experience and attempts to find what is true for many people. Science is far from perfect, but it keeps asking, searching and inching toward better understanding.

COVID-19 knowledge and management are prime examples of this. We now know that COVID-19 spreads mostly from person to person through the nose and mouth, even when minimally sick. We can significantly decrease the risk of infection by keeping distance from infected people and covering the main transmission pathways (the nose and mouth). We can safely prevent or diminish the consequences of COVID-19 infection by giving a vaccination that activates the body’s amazing immune system. People who receive that vaccination are five times less likely to have a breakthrough COVID-19 infection than people previously infected with COVID-19. We know the proven interventions that stop or at least slow COVID-19.

As a nursing home physician, I watched helplessly last year as more than 30 residents died of COVID-19. This year, with more than 90% of nursing home residents vaccinated, the deaths have plummeted to single digits. COVID-19 infections have not stopped, but the health consequences are markedly less serious.

The challenge has been to achieve high vaccination rates in nursing home staff, as infected people are often the way that COVID-19 enters the nursing home. As part of a COVID-19 support team, I help to support long-term care facilities in Lancaster, Philadelphia, Bucks and Chester counties. Recent facility outbreak tallies show a significant difference between these counties. While 20% of Lancaster facilities had recent outbreaks, the adjacent counties had outbreaks 2 to 4 times less than Lancaster. I believe this is related to staff vaccination rates in Lancaster County. While staff vaccination rates in the other counties are 87%, 89% and 94%, Lancaster’s rates are significantly lower at 67%. Restated, a staff vaccination rate that’s lower by only 20% may be related to a 400% increase in outbreaks.

I am unequivocally convinced that COVID-19 precautions (masks and physical distancing) and vaccination are examples where the community benefit is greater than other priorities. The very small theoretical risk of vaccination side effects is readily justified by the large known risk of COVID-19 infection and the proven benefit of vaccination.

I honor people who value and defend individual choice. I also honor the memory of my 30 long-term care residents who died without any choice about their exposure. I honor the health of individuals who survived this pandemic thus far but still don’t have the choice to receive care from people who have taken all possible precautions to prevent COVID-19 transmission.

If you are distressed by COVID-19 vaccination requirements, I have an easy solution. Make an independent decision today to receive COVID-19 vaccination as a wise health choice for you, your family, your community and our many long-term care residents. Then when someone inquires about your vaccination status, you can happily report that you have already exercised your independence.

Leon Kraybill, M.D., is a Lancaster geriatrician and certified medical director who works in post-acute and long-term care.

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