In my rural community in West Michigan, those warnings have been ignored. Our system is overwhelmed. The levees have broken, and we are all looking for life rafts to weather this ever-strengthening storm. President Biden’s vaccine mandate is the life raft we need now.

I worked three shifts last weekend where nearly half of my 20 ER beds were occupied with patients waiting for admission or transfer to tertiary care hospitals in our region. The problem: Nobody had beds. Every hospital in our region is at or beyond capacity. We all have more COVID-19 inpatients than ever, and this fourth wave is proving to be longer, with sicker patients than during any of the previous three. In my critical access hospital alone, 15 of 18 patients that week had COVID-19. Three of them were on ventilators.

In my emergency departments, COVID-19 patients weren’t the only ones who couldn’t be admitted. Stroke patients had to wait. Patients experiencing heart failure had to wait. For people experiencing a stroke or a heart attack, waiting could be deadly. 

Waiting was all we could do because the health care infrastructure of nearly half of an entire major Midwestern state was at a breaking point, overburdened by a patient load that could have been avoided if only those patients had gotten vaccinated.

Meanwhile, emergency medical services are short-staffed because COVID-19 has sickened their crews. The few still on duty are overworked, pulling 24-hour shifts for $15 an hour.

We are staring at the abyss in large part because too many people are unvaccinated. More than 90% of hospitalized COVID-19 patients are unvaccinated. If a fraction of that volume had been hospitalized, our hospitals would not be overburdened. Our health care system could be able to care for and serve our communities.   

Instead, people are waiting days for a bed. Emergency physicians are working as hospitalists. Hospitalists are working in emergency departments. Labor and delivery nurses are pulling shifts in trauma care. Emergency nurses are monitoring patients for hours, even days, while responding to patients with chest pains and broken bones. At any given moment, we are triaging between patients facing imminent peril and making those who won’t deteriorate wait for hours. 

We were all trained to care for sick people. We love being able to care for sick people, even caring for really sick people who hang in the balance between life and death. We understand the mortality rate of humans is 100%, yet we use our skills and training to pull a few people back from that mortality for a little while longer. We were not trained for the flood of patients we see in our emergency department and the profound strain it puts on our health care system.

Emergency medicine includes caring for people who have neglected themselves for a lifetime, whose bodies reached a breaking point. We know how to care for people who suffer heart attacks and strokes. We know how to respond to medical emergencies that result from the choices people make, from smoking to poor diets to sedentary lifestyles. Emergency medicine also allows us to respond to the social neglect of entire groups of people: populations without access to healthy food, targeted by Big Tobacco, forced to work multiple jobs to make ends meet. Emergency medicine can respond to the accumulation of stress and trauma that underserved people experience, leaving their bodies and their spirits broken. As an emergency physician, I’m the one who cares for patients whose health has been neglected because they couldn’t afford to see doctors even as insurance companies rake in massive profits at their expense.  

We have not been trained or prepared for the tide of people flooding our hospitals because of a largely preventable disease. Though COVID-19 is still new, safe, effective, and free vaccines are now available–and yet too many of our fellow Americans are saying “No, thanks.” They have chosen to reject the advice of doctors and trust disinformation on social media with their entire lives.

By rejecting vaccinations, they are jeopardizing the health and safety of people who have weakened immune systems. By refusing vaccinations, they are endangering their neighbors’ lives because the local hospitals they rely on are full, and the care they need for heart attacks, strokes, and surgical emergencies is delayed because the system has cracked. 

The immovable refusal of a few people to get vaccinated and help protect the rest of us makes a vaccine mandate absolutely necessary. If they want to fly with me, or dine in my presence, or shop in the same store as I do, they should be required to prove they’ve been vaccinated. Anything short of this will only prolong our suffering, put whole communities at risk, and unravel our entire health care system.

Dr. Rob Davidson is an emergency room physician in West Michigan and the executive director of the Committee to Protect Health Care.

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