Colin Powell was vaccinated but died from COVID. Here’s why the rare event is possible

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Coronavirus vaccines were designed to prevent severe COVID-19, including the need for hospitalization, and death — and can do so even in the presence of the highly infectious delta variant.

But to many’s surprise, the shot was not a guarantee for lifelong immunity against the disease.

There remains the misconception that COVID-19 vaccines are intended to prevent infections altogether, leading people to believe the shots aren’t working as they should when they see the vaccinated, too, contract the coronavirus, and in some cases become severely ill or die.

Colin Powell, former secretary of state under President George W. Bush, is the latest high-profile example. He died Monday morning from COVID-19 complications despite being fully vaccinated. Powell, 84, had been battling a type of blood cancer that likely affected his body’s response to the coronavirus vaccine. His age may have played a role in his death, too.

It’s unknown if he had received a coronavirus booster shot.

Experts call these cases “breakthrough infections,” which are defined as cases that occur two or more weeks after complete vaccination.

As of Oct. 12, more than 187 million people in the U.S. had been fully vaccinated against COVID-19. Until then, 24,717 fully vaccinated people had been hospitalized with COVID-19 and 7,178 people had died — that’s 0.003% of people who had been fully vaccinated at the time, according to the Centers for Disease Control and Prevention. The agency only records breakthrough cases that lead to hospitalization or death.

While data show the COVID-19 shots are still preventing infections in many outbreak scenarios, the fact they are happening doesn’t suggest failure, experts say.

“You will see breakthrough infections in any vaccination when you’re vaccinating literally tens and tens and tens of millions of people,” Dr. Anthony Fauci, President Joe Biden’s medical adviser, said of breakthrough coronavirus cases across the country during a White House COVID-19 briefing in March. “So, in some respects, that’s not surprising.”

It’s not all about the vaccines

Some people could still contract the coronavirus after complete vaccination because their immune systems may not produce as many protective antibodies as others, Ali Ellebedy, an immunologist at Washington University in St. Louis, told The Atlantic.

Some people may also have medical conditions that make it hard for their bodies to defend themselves against germs. Generally, people ages 65 and older face higher risks of severe COVID-19 than younger people, too.

Powell had been fighting multiple myeloma, a blood cancer that affects a specific type of white blood cell that helps the body fight infections, according to NBC News.

It’s unclear what role Powell’s cancer played in his battle with COVID-19, but evidence shows certain medical conditions, such as diabetes, obesity, heart disease and HIV, may make one more likely to develop severe illness — and less likely to respond to coronavirus vaccines.

A study published in July found that among 103 patients with multiple myeloma, only 45% of people developed “an adequate response” to either the Pfizer or Moderna COVID-19 vaccines, while 22% had “a partial response,” suggesting most patients with this cancer will not receive the full protection the shots offer.

The range of vaccine responses “isn’t a variation of two- to threefold; it’s thousands,” Ellebedy told The Atlantic. “Being vaccinated doesn’t mean you are immune. It means you have a better chance of protection.”

Behavior patterns could also explain breakthrough cases. Vaccinated individuals who spend time with unvaccinated people face higher risks of infection.

It’s like tanning; the more time spent under the sun, the greater your chances of getting sunburned.

‘Pandemic of the unvaccinated’

Vaccine efficacy tells us about risk reduction, so people who get vaccinated with the Pfizer or Moderna shots benefit from about a 95% lower risk of developing COVID-19 once exposed compared with those who are not vaccinated. So no, it doesn’t mean vaccinated people have a 5% chance of getting COVID-19 or that 95% of people are protected from the disease.

This means vaccinated people are about 20 times less likely to get the disease than those who didn’t receive a shot. The Johnson & Johnson vaccine has about a 72% efficacy rate among Americans.

Data from around the country show unvaccinated people account for the majority of new coronavirus cases, hospitalizations and deaths. A recent CDC study found people who are vaccinated are five times less likely to get infected and greater than 10 times less likely to be hospitalized or die from COVID-19.

President Joe Biden’s administration has been calling it a “pandemic of the unvaccinated.” But some experts find that phrase misleading.

“It is true that the unvaccinated are the biggest driver, but we mustn’t forget that the vaccinated are part of it as well, in part because of the delta variant,” Dr. Eric Topol, professor of molecular medicine at Scripps Research in California, told The Associated Press. “The pandemic clearly involves all people, not just the unvaccinated.”

It’s important to note the clinical trials did not test whether the vaccines prevented infection in participants. It tested how well the vaccines prevented the development of symptom-causing disease.

“People should be reassured that if they are fully vaccinated that they are very likely, highly likely, to be protected against severe or critical illness, the kind of illness that would cause them to be hospitalized or killed by this virus,” Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, told The Washington Post. “Vaccines save your life.”

Evidence shows all three vaccines offer similar levels of protection even when put up against the delta variant. Still, no vaccine is 100% effective.

The flu vaccine, for example, is between 40% and 60% effective, depending on the version of the virus that’s circulating in a given year, the CDC says. Yet, the flu shot was still capable of preventing an estimated 7.5 million flu illnesses, 105,000 hospitalizations and 6,300 deaths during the 2019-2020 season.

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