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Colin Powell

The Colin Powell Question and the COVID-19 Vaccine

Our primary care doctors in Delray Beach were saddened to learn of the death of Gen. Colin Powell last month from COVID-19.

We were also concerned to see that some misinformed people took the wrong lesson from his particular case.

Several people heard he received a full dosage of the vaccine against the coronavirus. Then, they asked what might seem a logical question: “Then how did he die of COVID?”

The answer is, his having received two doses of the coronavirus vaccine wasn’t the whole story.

Here’s the rest of it.

Complicating factors

Colin Powell was 84 years old. His age automatically put him at higher risk of contracting a more severe form of the disease.

To date, the Centers for Disease Control and Prevention (CDC) reports 7,178 deaths among those who received the full vaccine dosage. Of those, 85 percent were over 65. In addition, men seem to be at higher risk of dying from breakthrough COVID-19 cases, although the reasons why are so far unclear.

Powell also had Parkinson’s disease and treated for prostate cancer.

But most important for his prognosis, he had a serious blood cancer known as multiple myeloma (MM). Both the disease itself and the treatment used to fight it inhibit the body’s ability to produce antibodies, leaving MM patients particularly vulnerable to such invaders as the coronavirus.

Those with weakened immune systems, including cancer and HIV patients or those who have had organ transplants, make up only about 2.7 percent of the U.S. adult population, the CDC says, but they represent about 44 percent of hospitalizations for breakthrough COVID-19 cases.

Studies show why

One study published this past July in the journal Cancer Cell found that, while the mRNA vaccines (Pfizer and Moderna) showed “robust safety and efficacy” against the coronavirus, as many as a quarter of those with various types of blood cancer had no detectable antibodies after being fully immunized.

Another study published in the journal Nature, also in July, found that only 45 percent of patients with active MM developed an “adequate” immune response after receiving either of the mRNA vaccines.

“Unfortunately, the same mechanisms that impede multiple myeloma patients’ ability to fend off infections also reduced their ability to generate immunity from vaccination,” the researchers wrote.

In other words, typically their bodies would be making antibodies against the coronavirus once they received the vaccine just like everyone else, but their disease prevented it.

The takeaway

The lesson learned from Powell’s breakthrough COVID-19 infection and subsequent death is not that vaccines don’t work. They work remarkably well, even though no vaccine for any disease is 100 percent effective at preventing viral transmission. This includes those for the flu, the mumps, or the measles.

The real lesson is that everyone who can receive a vaccine should, protect people like Powell.

Gwen Nichols, chief medical officer for the Leukemia & Lymphoma Society, told The Washington Post that those who have blood cancers can only do so much to protect themselves, like getting vaccinated, wearing masks, avoiding crowds, and so on.

“We hear it every day,” she said. “They’re angry at people who won’t help them by getting vaccinated. They remain at risk despite doing everything right.”

And this is not a tiny minority of the population, either. Nichols told the paper that approximately 1.3 million Americans are either living with blood cancer or are survivors of the disease.

Others who can’t get the vaccine, or for whom it may not be as effective include:

  • older individuals
  • young children
  • other cancer patients and survivors who may be on immune-suppressing therapies
  • those living with HIV
  • those who have received organ transplants

Together, that equals millions of people at risk from those who choose to remain unvaccinated.

Danger to others

Dr. Craig Spencer, an emergency-medicine physician and director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center, writing in September in The Atlantic, shot down the common belief that vaccinated individuals are just as likely to spread the virus as those who haven’t received the vaccine.

“So let me make one thing clear,” he wrote. “Vaccinated people are not as likely to spread the coronavirus as the unvaccinated . . . . To spread the coronavirus, you have to have the coronavirus. And vaccinated people are far less likely to have the coronavirus—period.”

A new study released from the University of Oxford found that vaccines do reduce transmission of the delta variant. In some cases, it is by as much as 65 percent. They examined national records of nearly 150,000 cases to reach their conclusions.

“It’s the highest quality study we have so far on the question of infectiousness of vaccinated people infected with delta,” Dr. Aaron Richterman, an infectious disease physician at the University of Pennsylvania, told NBC News. There was no involvement by Richterman in the research.

“People who have been vaccinated will have immune systems at the ready that can coat the virus in antibodies much more quickly than unvaccinated people who have to build up an immune response,” he explained.

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