Tier 5: Will They Come?
I’m a volunteer vaccinator in Chula Vista, the hardest hit city in San Diego County. Since January, I’ve received heartfelt gratitude by dozens of elderlies who are grateful to finally get protection from a virus ravaging our community. Recently, a seventy-something spry lady responded to my usual, “Are you ready?” with “What other choice do I have?” It was a quick-witted quip, in keeping with her energetic style. But hidden in that benign facile comment was a harsh reality: Covid is killing our parents and grandparents. That is why our clinic lines are still in the hundreds by the hour and are now filled with second shot vaxxers along with first responders, teachers, and food handlers. What we haven’t seen yet are the twenty and thirty-year-olds—the Tier 5s. Will they come when it’s their turn? What will make them come?
The Tier 5 members of our community are the most active⏤socially, the least protective⏤mask-wise, and the least concerned⏤about death. What has driven the elderly to line up in the hundreds, I fear will not be enough to get our twenty and thirty somethings to get a jab. Death just isn’t enough. What do I mean? Unlike Tiers 1-4, who are the elderly, the sick, the healthcare workers, first responders and other essential workers, Tier 5, represents healthy 19- to 64-year-olds, the one class of individuals that had no special risk at all in the past twelve months.
So, what will encourage a Tier 5 individual to line up and take a jab? Well, I’m sure many are eagerly ready to get vaccinated. But sights of spring breakers in Florida and polls showing huge percentages of antivaxxers, depending on your politics, suggests that far too many Americans feel complacent about their actual risk of death. It would seem lifestyle is more important. In keeping with this theory, I believe a concern of the young that may bring them to the vaccination clinics is losing their smell and taste. This issue hasn’t been given much press, as yet, but scratch the surface of this common side-effect to Covid and you will find a majority of patients that get the virus lose these delicate senses. In fact, in my practice, if a patient complains of unexplained taste loss, they are classified as Covid positive, regardless of their PCR test. Studies vary on the incidence of smell and taste loss with Covid, but it ranges from 40% (1) to 96% (2), with up to 89% (3,4) regaining at least some of their senses within a month. But what of those that don’t? It has become clear that not all patients recover these senses, and if they do return, the nerves may need rehabilitation to process what used to be familiar odors. I know of two former Covid patients still managing their loss of taste. One has been without it for over two months, the other for twelve.
Besides the obvious safety issues of detecting fire and spoiled food, the more insidious consequences to losing our smell and taste have to do with building connections with our life experiences. A mother and newborn, a trip to the coast or the mountains or that favorite park with flowers in bloom, or the simple delight of enjoying a favorite meal, may no longer have an emotional connection. That last one has other implications as well. A loss of taste means our biggest motivation to eat is no longer there. Pregnant mothers may give birth to underweight babies, family gatherings may lose participants, or just the simple enjoyment of going out to a bar for burgers and brew, no longer has its appeal. The patient I mentioned who is now a year without taste has lost fifteen to twenty pounds and must force herself to eat regularly. She simply has no desire. The medical community has diminishing confidence that these senses will return the longer they remain absent.
Should twenty- and thirty-year-olds be concerned? I think so. They may not care much about dying, but prolonged, possibly permanent, loss to such a basic function that determines quality of life, is not something to be cavalier about. I believe this is the talking point we should be having with the younger generations that have an outsized impact on spreading Covid 19. They are very active with non-family members and are likely the largest asymptomatic spreaders in our community. They need to get vaccinated and a threat to their social life may be the key to getting them to line up.
References:
1. Agyeman, A, Mayo Clinic Proceedings, June 6, 2020
2. Moein, S.T., International Forum Allergy and Rhinology, 10:8, 944, August 2020.
3. Reiter, E.R., American Journal Otolaryngology, 41, 102639, 2020
4. Boscolo-Rizzo, P., JAMA Otolaryngology. Head Neck Surgery. 146, 729-732, 2020
5. BBC Future, How your sense of smell predicts your overall health, March 13, 2021
6. Nature.com, Covid’s toll on smell and taste, January 14, 2021
© Eric Clark 03/07/2021
Photo by: ruslan-zh @ unsplash
