Connie Nugent MLS
Corresponding author: Connie Nugent
Contact Information: Connie.Nugent1@gmail.com
DOI: 10.12746/swrccc.v9i40.909
He who hesitates is lost.
That adage is an adaptation of a line from Joseph Addison’s 1712 play Cato: a Tragedy, in which Roman senator Cato the Younger’s daughter Marcia exclaims, “The woman who deliberates is lost.”1 Success comes from action; those who delay may not succeed.
In Genesis 19, two angels from the Lord appear before Lot one evening and warn him to flee Sodom with his family since the city is about to be destroyed. Lot’s sons-in-law disregard Lot’s entreaties, assuming he is jesting; Lot hesitates and does not pursue the idea. The next morning, the angels once again urge Lot to leave,
But he lingered, so the men seized him and his wife and
his two daughters by the hand, the Lord being merciful
to him, and they brought him out and left him outside
the city. When they had brought them outside, they said,
“Flee for your life; do not look back to stop anywhere
in the Plain; flee to the hills, or else you will be consumed.”2
Lot, however, hesitates again, pointing out that the hills are too far away but “that city is near enough to flee to, and it is a little one. Let me escape there…and my life will be saved.”2 The angels must now be impatient with the hesitancy of this family, surely thinking, We’re trying to save your lives. Get going! The family does eventually flee, but Lot’s wife hesitates, looks back at the city, and promptly turns into a pillar of salt. The angels’ patience apparently ran out. Lot’s wife deliberated and was literally lost.
Nuremberg, Germany, woodcut artist and painter Michael Wolgemut (1434–1519) and his apprentices prepared hundreds of woodcuts for Hartman Schedel’s comprehensive history Chronicle of the World, also called the Nuremberg Chronicle. One of these illustrations portrays an angel leading Lot and his daughters from Sodom as Lot’s wife’s hesitation transforms her into salt.3 As is often seen in early Renaissance artwork, the characters are depicted in contemporary clothing and the city resembles one from the late 15th century. In an attempt to portray depth before the refinement of perspective, the figures in the foreground are larger than the city in the background and dwarf the road upon which they are traveling. Even Lot’s wife’s pillar looms higher than the city gates in this flat 2-dimensional depiction.
Michael Wolgemut. Sodom and Gomorrah. Nuremberg Chronicle. Woodcut. 1493.
Hesitation also precipitated disaster in the myth of Orpheus and Eurydice. When Eurydice suffers a fatal snakebite and is ferried to the underworld, Orpheus grieves for his wife so much that Hades, god of the underworld, relents, allowing Eurydice to follow Orpheus from the underworld up to the land of the living. Hades issues one caveat: Orpheus is not to look back at his wife until they both emerge into the light. As Orpheus and Eurydice ascend and Orpheus begins to see glimmers of light from the world above, he calls to Eurydice behind him, who does not answer. Orpheus hesitates, possibly worried that she did not hear him or that Hades has reneged on his bargain and she is not even there. Orpheus turns to look, and disaster befalls. Eurydice is whisked back into the underworld.4
You say yes, I say no
You say stop, and I say go go go
Lot and his wife both hesitated when faced with dire circumstances, and were it not for the insistence of the angels, they both may have perished in the destruction of Sodom. Orpheus lost his wife once due to snakebite, but his subsequent hesitation in retrieving her from the underworld caused him to lose her permanently. Emerging from the long months of the Covid pandemic, residents of the United States face more than one kind of hesitation: vaccine hesitancy and vacillation between virtual and in-person learning.
Pulmonary and infectious disease specialists continue to emphasize the importance of vaccinations, and yet many people hesitate. As the Beatles lyrics5 suggest, medical experts say yes to vaccines, but many people say no; medical experts say stop harmful behavior that might result in viral infection, but many people say go go go.
Vaccine hesitancy is not new. When Edward Jenner (1749–1823) pioneered the use of material from cowpox blisters to develop a vaccine for smallpox, many people were skeptical. A cartoon by James Gillray, published in 1802, satirized the views of those who were worried about being inoculated with a vaccine with a bovine origin. The boy in the blue jacket holds a container labeled “Vaccine Pock hot from ye cow” as a physician administers the vaccine to a frightened woman. Previous recipients of the vaccine are shown with erupting bovine features.6 Of course, the refined smallpox vaccine proved immensely successful over time, and the World Health Organization declared the worldwide eradication of smallpox in 1980.
James Gillray. The Cow-Pock—or—the Wonderful Effects of the New Inoculation!
Published in 1802 by H. Humphrey, St. James Street, London.
The current Covid-19 pandemic has ravaged the world for nearly a year and a half, resulting in millions of deaths—over 600,000 in the United States alone. The original virus has mutated into at least four variants: Alpha, Beta, Gamma, and Delta. Vaccines provide protection against all variants, especially the highly transmissible Delta. So why are so many people in the United States reluctant to become fully vaccinated?
The Atlantic writer Derek Thompson’s 2021 survey suggests that complacency, culture, and politics cause vaccine refusal in at least 25% of respondents.7 An apathetic truck driver, for example, pointed out that his was an essential profession, so he would get Covid “no matter what” and that his antibodies would protect him. A Black woman stated that as a descendent of slavery, she was “bottom class” and would be unable to sue the government or a pharmaceutical company in case of adverse side effects. Still others would not consider a vaccine pushed by “liberal elites” and Democrats due to perceived loss of “civil liberties.”7 An ABC network/Washington Post poll supports the results of Thompson’s survey.8 Thirty percent of those polled say they will not get a coronavirus vaccine; 73% believe that officials are exaggerating the risk of the Delta variant.
Vanderbilt University School of Medicine Infectious Disease specialist Dr. William Schaffner begs to differ, “Unvaccinated people are potential variant factories.”9 He points out that the only source of new variants is the body of an infected person, “The more unvaccinated people there are, the more opportunities for the virus to multiply.”9 The Wall Street Journal reports that vaccination rates “are stubbornly low” in the Southern United States.10 Centers for Disease Control Director Dr. Rochelle Walensky agrees, emphasizing that the Southeast and Midwest are the most vulnerable, “In some of these areas, we are already seeing increasing rates of disease.”9 Populations of unvaccinated people allow the virus to evolve and change, risking even more potential variants. Ed Yong writes in The Atlantic, “The year is only half over, but more people have already been infected and killed by the coronavirus in 2021 than in 2020. And new variants are still emerging. Lambda, the latest to be recognized by the WHO, is dominant in Peru and spreading rapidly in South America.”11 How soon Lambda will arrive in the United States is uncertain.
Unvaccinated people pose not only a physical risk to others, but they also pose a possible economic burden. Krutika Amin of the Kaiser Family Foundation says, “If even close to 30 percent of Americans get Covid-19 because they refused to get vaccinated, you’ll see a massive spike in health care costs.”12 Millions of vaccine refusers could become thousands of Covid patients, raising insurance premiums or tax dollars if they are treated in the emergency departments of public hospitals. Jay Inslee, the governor of Washington, states, “You have a liberty right, and that unfortunately is imposing on everyone else and their liberty right not to have to pay for your stubbornness. And that’s what’s maddening.”12
Also maddening is the amount of misinformation being disseminated through social media regarding the Covid-19 pandemic and vaccination programs. Imran Ahmed is the chief executive of the Center for Countering Digital Hate, a nonprofit group that tracks anti-vaccination misinformation. He points out that 147 social media anti-vaccination accounts have increased their followings by 25% since the beginning of the pandemic, “Covid generated a lot of anxiety, and conspiracies and misinformation thrive where there is anxiety.”13
Should I stay or should I go?
A refrain from the British punk rock band The Clash says it all.14 Most states have indicated that their public schools will fully reopen in the fall for in class instruction. With the rise in Covid-19 variant cases, many parents may hesitate to send their children back to school. A recent New York Times article reports that nearly 25% of parents prefer virtual learning at home.15 Unfortunately, current data indicate that children learn less in virtual school; two research organizations—the Rand Corporation and Opportunity Insights—found that remote students learned less in basic subjects like English and math, and that lower-income students learned the least.15
Individual teachers confirm the research data. Washington, DC, teacher Lelac Almagor states, “If [parents] could work out the logistics, their kids got a couple of hours a day of Zoom school. If they couldn’t, they got attendance warnings. Home alone with younger siblings or cousins, kids struggled to focus while bouncing a fussy toddler or getting whacked repeatedly on the head with a foam sword. Others lay in bed and played video games or watched TV.”16 Not surprisingly, students’ grades suffered during the year of virtual learning, prompting school districts to plan for in-person classes. While New York City school’s chancellor Meisha Porter maintains, “Nothing, absolutely nothing, replaces the interaction and the learning that happens between a student and teacher in [the] classroom,” Tafshier Cosby of the National Parents Union states that requiring in-person school is “doing parents a disservice” and is “disrespectful.”16
Parents are not the only ones who may hesitate over in-person school. Students who have been learning remotely during this past year may feel anxious about returning to the classroom. Writing in The Wall Street Journal, Andrea Petersen suggests, “…the prospect of heading back to in-person school in the fall can be daunting.”17 Psychologist Mary Alvord says that friendships are crucial in a child’s development and emotional well being, and that the social isolation from a year of remote learning can contribute to depression and anxiety.17 Re-entry anxiety is real, and in-person school may be overwhelming at first. Students who are recovering from a pandemic year may be confused about a school’s new mask and/or social distancing requirements or lack thereof. Eli Lebowitz, Associate Professor in the Child Study Center of Yale School of Medicine, suggests “being really forthcoming and frank” in explaining any changes in an age-appropriate way.17
Complacency, culture, and political beliefs are contributing to vaccine hesitancy in the United States, as cases of Covid-19 and its variants continue to rise. Now that vaccines are available to children ages 12 and up, most school districts plan to open for in-person learning in the fall. Parents who refuse the Covid-19 vaccine themselves may also refuse the vaccine for their teenagers who will be exposed to school groups. Those who remain unvaccinated risk not only their own health but also the health of their communities. “The vaccine is the most important pathway to ending this pandemic,” states US Surgeon General Dr. Vivek Murthy.18
Article citation: Nugent C. Hesitancy. The Southwest Respiratory and Critical Care Chronicles 2021;9(40):69–73
From: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 7/15/2021
Accepted: 7/16/2021
Reviewer: Gilbert Berdine MD
Conflicts of interest: none
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