The Underlying Problem

The divisiveness in our society between the unvaccinated and vaccinated is a problem that will keep us from moving forward in a time where we need to stand together the most. The narrative that I have been hearing for the past two years is summarized generally like this:

“Get vaccinated, reduced transmission, protect others and yourself.”

This has been the mantra since the beginning of the pandemic when the vaccines were rolled out and is still being used as the narrative today. However, I question as to whether this is appropriate in our current situation and is this productive to our society in moving forward with our continued response to the pandemic?

At least from what I have learned through researching into Covid-19, it seems to me it is much less about your vaccination status, but rather, your underlying health complications that makes the narrative of this Covid-19 so deadly and terrible. There are several research studies highlighting the link between obesity and Covid-19 patients that were more susceptible to being hospitalized or admitted into the ICU. In a systematic review by Yu et al., 70% of hospitalization cases were represented by people who were 45 and over with a Body Mass Index (BMI) between 30-40, and 30% had severe obesity. Furthermore, the authors indicated in 3615 Covid-19 patients in New York, those who were under the age of 60 with a BMI between 30-34 had a 1.8-fold increase in chance of ICU admission and those with a greater BMI of 35 was 3.6 folds compared to patients with a BMI less than 30.[1] The evidence is apparent even in a larger scale; countries with high obesity rates such as in the USA and France, 39.8% and 19% of patients were transferred into the ICU compared to China with a lower obesity rate with only 5.4% of patients transferred into the ICU.

The evidence proposed by several authors indicates that adipose tissue has a high expression of Angiotensin-Converting Enzyme 2 (ACE2) receptors that binds to the virus surrounding the heart, connected vessels, around your organs in the waist, etc. The adipose tissue acts as a reservoir for the virus. [1,2] Complications may arise such as Cytokine Storm which is an immune hyperactivation that creates pro-inflammatory environment and the more obese you are, the likelier it may exacerbate inflammation that allow increase of viral spread and extended infections. [2,3] Previous studies have also proposed that obesity increases the likelihood of poor vaccine-induced immune response.[4]

Now, I have not ran across any studies that stratified the data between vaccinated and unvaccinated obese individuals being hospitalized or admitted into the ICU, but that is beside the point. Using Ontario Covid-19 data, as of January 26th, 2022, 752 patients are unvaccinated, 216 patients are partially vaccinated, and 1818 patients are fully vaccinated in the hospital. Meanwhile, 206 patients are unvaccinated, 20 partially vaccinated, and 232 fully vaccinated that are in the ICU. [7] Looking at this data, it seems to me that fully vaccinated people are being hospitalized more than unvaccinated. But this could just be because we have almost 80% of the population vaccinated, so a larger proportion of people infected would represent a larger amount of people being hospitalized.

But why is that the case?

According to a study by Levine-Tiefenbrun M. et al., they found that people who were second-dose vaccinated with BNT162b2 (Pfizer/BioNTech), there was a waning of effectiveness over months and completely vanishing over time at about 6 months. Those who were triple vaccinated showed comparable results to the waning effect of the vaccine 31-60- and 61-120-days post vaccination. The authors warrant the effectiveness of these mRNA vaccines and additional boosters needed. [8] This has been demonstrated with other studies indicating the waning of humoral responses within 6 months of taking the BNT162b2 vaccine. [9]

Now is this definite proof that vaccines are ineffective against Covid-19? Not necessarily because they are still efficacious in protecting against the virus, but effectiveness is dependent on when you took the vaccine. This poses a much bigger problem as of right now. The public must be weary and attentive to their vulnerability to the virus, especially if you are in the categories that are susceptible to the disease and higher risk of hospitalization or ICU with severe symptoms. The vaccine may give some people a false sense of security that they are protected from the virus, when in reality they are not.

Yet we are still running with the same narrative that the vaccines are effective at protecting you from infection, transmission, and reducing your likelihood of being hospitalized or admitted into the ICU. Which is quite interesting because a substantial proportion of people, even in the early days of the pandemic, there was a 99.5% survival rate amongst healthy people under the age of 65. Most of the population was not ending up in hospitals or ICU. This rate has stayed readily now with practically the same survival rate [10], which begs to question whether the vaccines had any role in protecting citizens.

What about the immunocompromised, citizens with 2-3 comorbidities, and old age?

The Sars-CoV-2 disproportionally effects these 3 categories under the vulnerable population in addition with obese citizens. This is mostly because they already are suffering from other diseases and have a lowered to no immune system. There is some efficacy in vaccinating these groups of people, but vaccinations are not a long term solution. As of right now there is no clear advantage of vaccines and no clear indication of how many boosters citizens will need. It is my belief that these disproportionally affected populations must have a targeted health intervention proposed by experts in the health field and guide our government to make the right decision.

As we can see right now whether you are unvaccinated, double vaccinated, and even triple vaccinated, you are still susceptible in contracting the virus. This is especially true with Omicron being the dominant variant with high immune escape as of right now. Therefore, I ask once again, is this more about your underlying health condition or your vaccine status?

The fact that public health is not addressing the underlying health issue is a key concern for Canadians. Instead of promoting eating healthier, sleeping better, exercising, and adopting strategies to mitigate stress (improve immunity), we are pushing for mass vaccinations that have little to no impact on the trajectory of Covid-19. It is unnecessary to continue the vaccine vs. unvaccinated narrative as it is not conducive to our future; instead, we need to come together as we all are citizens of Canada.

• Kai Cheung

1. Yu W, Rohli KE, Yang S, Jia P. Impact of obesity on Covid-19 patients. Journal of Diabetes and Its Complications. 2017;35(3),1-14. https://www.sciencedirect.com/science/article/pii/S1056872720306115

2. Liu T, Zhang J, Yang Y, et al. The role of interleukin-6 in monitoring severe case of coronavirus disease 2019. EMBO Molecular Medicine. 2020;12(7),1-12. https://www.embopress.org/doi/full/10.15252/emmm.202012421

3. Yang J, Hu J, Zhu C. Obesity aggravates Covid-19: A systematic review and meta analysis. Journal of Medical Virology. 2021;93(1),257-261

4. Painter SD, Ovsyannikova IG, Poland GA. The weight of obesity on the human response to vaccination. Vaccine. 2015;33(36),4422-4429. https://www.sciencedirect.com/science/article/pii/S0264410X15009184

5. Field AE, Coakley EH, Must A, et al. Impact of overweight on risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001;161(13),1581-586. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/648604#:~:text=Overweight%20and%20obesity%20are%20risk,6%20diabetes%2C7%20and%20mortality.&text=In%20addition%2C%20overweight%20also%20exacerbates,13%20dyslipidemia%2C%20and%20musculoskeletal%20problems.

6. Coronavirus Disease (COVID-19). Who.Int. Accessed January 26, 2022. https://www.who.int/health-topics/coronavirus#tab=tab_1

7. Covid-19 Hospitalizations. Covid-19.Ontario.ca. Updated January 26, 2022. Accessed January 26, 2022. https://covid-19.ontario.ca/data/hospitalizations

8. Levine-Tiefenbrun M, Yelin I, Alapi H, et al. Waning of SARS-CoV-2 booster viral-load reduction effectiveness. MedRxiv. Preprint posted December 29, 2021.

9. Levin EG, Lustig Y, Cohen C, et al. Waning immune humoral response to BNT162b2 Covid-19 vaccine over 6 months. The New England Journal of Medicine. 2021;385(84),1-11. https://www.nejm.org/doi/full/10.1056/nejmoa2114583#article_references

10. Covid-19 daily epidemiology update. Health-infobase.Canada.ca. Updated January 26, 2022. Accessed JAnuary 26, 2022. https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html