By age 39, Tricia Moses’ scleroderma had so scarred her lungs that she nearly died while waiting for a suitable donor. Before getting her double lung transplant in January 2014, she needed to carry an oxygen tank at all times.
To the relief of the many who cared deeply about her, she recovered exceptionally well after her transplant, and could get back to the life she loved. She still faced numerous hurdles. The need for lifelong immunosuppression medicine to reduce the risk of rejecting her new lungs placed her at a significantly higher risk of infection. Her other organs, including the gastrointestinal tract, remained severely damaged from the scleroderma — an autoimmune condition that involves the hardening and tightening of the skin and connective tissues and raises infection risk.
She understood that the median survival after lung transplantation is only five years. Still, by the time the COVID-19 pandemic began, she had thrived for nearly eight years.
Being immunosuppressed, she knew that her risk of becoming severely ill or dying from COVID-19 was frighteningly high. She carefully followed instructions from the CDC as well as her trusted physicians, some of whom she had been seeing for more than a decade. She used all of the appropriate precautions and received two doses of the Pfizer vaccine as soon as it was approved.
Nevertheless, when she contracted COVID-19 during the summer as the delta variant raged, her deterioration was rapid, and she was sent to the intensiv-care unit where I work. By then, we allowed family to visit patients, and so I came to know Tricia and her loved ones well.
Despite all available measures, including a prolonged course on the ventilator and even the heart-lung machine, she died from overwhelming infection with coronavirus. Whether it was because of delta’s virulence, or the fact that the vaccines don’t work as well in people with suppressed immune systems, in the end her body just could not overcome the virus.
The COVID-19 pandemic has time and again illustrated how closely connected we all are, despite Americans’ individualistic tendencies. Many people continue to resist public health measures such as mask mandates and vaccines, citing skepticism and claiming they are being asked to give up their personal freedoms.
Yet those “personal freedoms” have had serious and even deadly consequences not for any politicians or authority figures, but also for people such as Tricia Moses, whose immune systems are weak, and for children who are too young to be vaccinated. Pediatric hospitalizations have reached an all-time high, with nearly 30,000 new admissions in August. For the vulnerable, even if they take every measure to protect themselves, their survival ultimately relies on the choices and actions of those around them.
Currently, the delta variant continues to spread in the U.S. with more than 1,500 patients dying each day and numerous hospitals reaching critical capacity. The Biden administration has recently announced stricter policies to mandate all federal workers and contractors, as well as health care workers at government-funded institutions, to get vaccinated, a decision that has been met with political push-back and litigation.
We need to shift the national conversation. Vaccination is a personal health decision with significant social consequences. Even now, this moral imperative — to wear masks and receive vaccines, not for the sake of self-preservation or practical considerations, but rather for the well-being of others who face far higher risks than we — remains woefully underrepresented.
Tricia Moses is remembered by her loved ones as an endlessly generous person, one who, despite her health challenges, always placed others first. They gave me permission to share her story publicly, showing that same spirit of generosity.
“She had an infectious smile that lighted up the entire room,” wrote her cousin Jillian Alfonso, a physician. “She would make an impossible and disheartening situation possible, even when others may have had their doubts.”
In any discussion of vaccines as a personal choice, we all should remember brave spirits such as Tricia Moses, who cannot live without our consideration.
Jason Han is a cardiac surgery resident at a Philadelphia hospital.