Unvaccinated people are more likely to die of COVID-19 because they are more vulnerable to infection and severe disease

Key takeaway

The COVID-19 vaccines authorized for emergency use by the U.S. Food and Drug Administration are highly effective against severe COVID-19 and death. In contrast, unvaccinated individuals are more likely to get infected and sick, and now account for most COVID-19 infections, hospitalizations, and deaths in the U.S. Most of these deaths could be prevented by vaccination.

Reviewed content

Verdict:

Misleading

Claim:

Both vaccinated and unvaccinated people have over 99% chance of surviving COVID-19

Verdict detail

Misleading: Unvaccinated individuals are more likely to become infected and die of COVID-19 than those who are fully vaccinated. Because COVID-19 vaccines are highly effective in preventing severe disease and death, the vast majority of COVID-19 deaths in the U.S. now occur in unvaccinated people.
Lack of context: The post ignored the benefits offered by COVID-19 vaccines in reducing the risk of not only severe disease and death, but also persistent health problems in COVID-19 survivors.

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Full Claim

“Unvaccinated, you can get COVID-19 and have over 99% chance of survival. Get vaccinated and you can still get COVID-19 and will still have over 99% of survival”

On 18 July 2021, political commentator Tomi Lahren published this tweet claiming that vaccinated people can “get COVID-19 and have over 99% chance of survival”, just like unvaccinated people, suggesting that COVID-19 vaccines aren’t useful. She later shared the post on Facebook, receiving more than 122,000 interactions on the platform in one day, according to the social media analytics tool CrowdTangle.

Claims that COVID-19 vaccines aren’t useful because they don’t prevent 100% of infections or because the disease has a high survival rate aren’t new (see examples here, here, here, and here). In her post, Lahren further suggested that people have the same chance of surviving COVID-19 regardless of whether they are vaccinated or not. These claims are inaccurate and misleading in several ways, as we will discuss below.

Unvaccinated people are more likely to become infected, develop severe COVID-19, and die

It is false that unvaccinated individuals have the same chance of surviving COVID-19 as vaccinated people. Unvaccinated people are much more likely to become infected and get sick. In fact, unvaccinated people account for virtually all recent COVID-19 hospitalizations and deaths in the U.S. This was the clear message of the director of the U.S. Centers for Disease Control and Prevention (CDC), Rochelle Walensky, in a 16 July 2021 White House briefing:

“This is becoming a pandemic of the unvaccinated. We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk. And communities that are fully vaccinated are generally faring well.”

Besides the personal risk of infection, lower vaccination rates facilitate the transmission of the virus within the population, increasing the risk of outbreaks. Indeed, infections, hospitalizations, and deaths are primarily rising in those U.S. states with lower vaccination rates, such as Mississippi or Alabama. These two states, which have fully vaccinated 33% of their population, reported 18 and 20 COVID-19 deaths respectively and almost 9,500 cases together during the last seven days. Based on the 1 April 2020 U.S. population census, these numbers represent a rate of 6 and 4 deaths per million population respectively, and 119 cases per 100,000 inhabitants in both states together.

In contrast, the states of Massachusetts and Connecticut that have fully vaccinated more than 62% of their populations reported 12 and 3 deaths respectively and only 2,900 cases together during the same time. These figures represent a rate of 1,7 and 0.83 deaths per million population respectively, and 27 cases per 100,000 inhabitants. In Alabama, 96.2% (509) of the 529 COVID-19 deaths from the past three months occurred among unvaccinated people, and only 3.8% (20) were in fully vaccinated people.

Lahren’s post implied that vaccines are useless because a small proportion of vaccinated people can still get infected. This misleading argument is also known as the nirvana fallacy. Lahren dismissed a solution because it is imperfect, even though a perfect solution is impossible. No vaccine is 100% effective, and COVID-19 vaccines aren’t an exception. However, this doesn’t mean we should reject them, just as we wouldn’t reject a parachute before jumping from an airplane just because they don’t open in 100% of the cases.

Although not perfect, the three COVID-19 vaccines authorized by the U.S. Food and Drug Administration (FDA) are highly effective against severe disease. Real-world studies in Israel, the U.K., and the U.S. showed that mRNA COVID-19 vaccines are over 96% effective in preventing hospitalization and death, and about 90% effective against infection in real-life conditions^[1,2]. Furthermore, COVID-19 infections in fully vaccinated individuals are rare and tend to produce milder symptoms than in unvaccinated individuals^[2,3].

Not everyone has the same likelihood of surviving COVID-19; age, pregnancy, and certain underlying health conditions, such as cardiovascular diseases, respiratory diseases, diabetes, or obesity increase the risk of death

Lahren claimed that COVID-19 has a survival rate of over 99%. This claim is misleading because the likelihood of dying of COVID-19 varies greatly between individuals, depending on factors such as age or underlying health conditions, as Health Feedback explained in this review.

This table from the CDC shows how the risk of COVID-19 hospitalization and death increases with age. Adults aged between 30 and 39 years old are already four times more likely to die than people aged 18 to 29 years old. The likelihood of dying increases up to 600 times for those aged 85 and older.

Although children and young adults are less likely to die of COVID-19 compared to older age groups, there is no group that experiences the absence of risk. In the U.S., provisional death counts from the CDC as of 14 July 2021 show that people aged 0 to 17 years old accounted for 335 COVID-19 deaths, while 2,446 deaths occurred among people between 18 to 29 years old.

In addition, certain medical conditions, such as heart and respiratory conditions, weakened immune system, cancer, diabetes, or obesity can increase a person’s likelihood of dying from COVID-19, regardless of their age. Pregnant people are also more likely to get severely ill from COVID-19 compared with non-pregnant people.

The proportion of infected people who end up dying of COVID-19 is difficult to estimate and can vary depending on the characteristics of the population, such as age, sex, and percentage of people with underlying health conditions. Even within the same population, this proportion can change over time depending on the circumstances at that specific point in time. While the development of vaccines and effective treatments can help decrease mortality, an overloaded healthcare system due to a surge in the number of infections might lead to higher death rates.

Small differences between the survival rates of vaccinated and unvaccinated people might seem negligible but they still account for a high number of deaths. For instance, a difference of just 0.1% in the likelihood of death means that one more person will die for every 1,000 who become infected. Only in the past week, the U.S. reported more than 200,000 new COVID-19 cases. In this case, an increase of 0.1% in COVID-19 mortality would represent 200 more deaths in just one week.

The danger of COVID-19 is not only limited to death; some COVID-19 survivors experience persistent health problems months after recovery

In her post, Lahren presented COVID-19 outcomes as a dichotomy between death and survival. However, the evidence shows that such a reductive view is inaccurate and misleading.

Lahren’s post ignored the fact that many COVID-19 survivors continue to suffer from health problems even months after recovery. In some cases, these problems are a consequence of long hospitalization stays after severe illness. However, about one-third of people who recover from COVID-19 show persistent health problems even after mild disease^[4,5]. This condition is known as long COVID. Symptoms include difficulty breathing, fatigue, cognitive problems, or joint and muscle pain. These symptoms can last at least for one year after recovering from infection^[4,6].

Growing evidence indicates that long COVID causes considerable loss in quality of life and is a serious health concern. An international survey published in July 2021 in the scientific journal The Lancet found that 22% of the 3,762 recovered COVID-19 patients involved in the study reported to be unable to work seven months later, and 45% of them required a reduced work schedule^[7]. In this context, COVID-19 vaccines are an essential tool that can help prevent infections and thereby minimize people’s risk of developing long COVID.

Many governments are anticipating the potential impact of this disabling condition by developing rehabilitation programs and promoting research on the subject. For example, the U.S. National Institutes for Health (NIH) announced in March 2021 that it would invest 1 billion dollars in investigating this condition. In the U.K., the National Institute for Health Research (NIHR) will fund 15 new studies with more than 27 million dollars to understand the causes and find potential treatments for long COVID.

Conclusion

Lahren’s claim suggested that unvaccinated individuals have similar chances of surviving COVID-19 as those who are fully vaccinated, which makes vaccines seem useless. This is inaccurate and misleading. Unvaccinated people are much more likely to become infected and get severe disease or die. Furthermore, low vaccination rates favor the spread of the virus, posing a health risk for all the individuals within the community, including those who cannot be vaccinated for medical reasons.

COVID-19 vaccines are highly effective in preventing hospitalization and death and also reduce the risk of infection. They reduce the spread of the virus within the population and prevent further health problems associated with COVID-19 infections, such as long COVID.

REFERENCES

• 1 – Dagan et al. (2021) BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. New England Journal of Medicine.
• 2 – Thompson et al. (2021) Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021. Morbidity and Mortality Weekly Report.
• 3 – Thompson et al. (2021) Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines. New England Journal of Medicine.
• 4 – Logue et al. (2021) Sequelae in Adults at 6 Months After COVID-19 Infection. Infectious Diseases.
• 5 – Jacobson et al. (2021) Patients With Uncomplicated Coronavirus Disease 2019 (COVID-19) Have Long-Term Persistent Symptoms and Functional Impairment Similar to Patients with Severe COVID-19: A Cautionary Tale During a Global Pandemic. Clinical Infectious Diseases.
• 6 – Blomberg et al. (2021) Long COVID in a prospective cohort of home-isolated patients. Nature Medicine.
• 7 – Davis et al. (2021) Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinical Medicine.