Colin Powell's death from COVID-19 complications despite vaccination reminder immunocompromised at higher risk

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TORONTO — The recent death of Colin Powell, the first Black U.S. secretary of state, due to COVID-19 complications is a small warning, experts say, reinforcing that those of advanced age or with health complications are still at a greater risk than other vaccinated populations.

Powell, who was fully vaccinated but immunocompromised according to reports, died Monday from complications arising from a breakthrough case of COVID-19. Powell was 84 years old, and part of what some experts are calling the “vulnerable vaccinated.”

There is ample evidence that the COVID-19 vaccines are hugely effective at lessening infection and preventing hospitalization and deaths in the event of a breakthrough case.

Tania Watts, an immunologist with the University of Toronto, pointed out that in Ontario alone, according to the Ontario Science Table Dashboard, those who are vaccinated are 85 per cent less likely to contract COVID-19, and 97 per cent less likely to end up in the ICU if they did.

“These are extraordinarily good vaccines,” Watts told CTV News. “However, they're not 100-per-cent perfect.”

Experts are stressing that widespread vaccination is necessary to protect the vulnerable few who do receive less protection from the vaccines.

“The older we get, the less effective our immune system is and this is particularly worsened [in those] over 60s,” she added. “But even more so in the much older group, the over-80 population, and also people who are fragile, like in long term care.”

Even though double vaccinations have dramatically reduced the risk of hospitalization and death for the population overall, they have less effectiveness in certain populations.

“In the case of Colin Powell, he’d been treated for multiple myeloma, so like other cancer patients, many times the treatments can suppress your immune system so he would have been particularly vulnerable,” Watts said.

Multiple myeloma is a blood cancer that damages the body’s ability to fight off infections, as well as hampers the body’s reaction to vaccines. Powell had been receiving treatment for multiple myeloma over the past few years.

Researchers believe about three per cent of the population is immune-compromised — meaning around one million Canadians may not be fully protected by just two doses.

And they, along with older Canadians vaccinated early in the year, may now be showing signs of waning immunity.

“What I'm seeing now is that the vulnerable that we vaccinated first are becoming vulnerable again,” Rodney Russell, a professor of immunology and infectious diseases at Memorial University of Newfoundland, told CTV News.

“We've been focused on getting people vaccinated now for a long time. But in countries like Israel where we saw very early and aggressive vaccination programs, back in January, February, by the time the sixth, eighth month mark rolls around, we've seen that you start to get these breakthrough infections [even with] double vaccines. And it's because antibody levels do decline, which is normal. We know that with all vaccinations and with infections.”

This doesn’t mean that the vaccines don’t work, and the term “waning immunity,” while scary-sounding, also doesn’t mean that protection disappears completely after a certain point.

“It's not that you have no immunity,” Watts said.

What it means is that for at-risk groups who may already have mounted less of a response to the vaccine, more caution needs to be taken by them and those around them, as the risk of them contracting the virus may be higher as the months go on.

It’s also one of the reasons why the National Advisory Committee on Immunization have recommended third doses for those in long-term care as well as immunocompromised populations, but not for the general population.

“Mr. Powell, and people in his age group, and generally anybody over 65 here, my concern because if they're six months past a second dose now, they may have a decrease in the amount of antibodies in their blood,” Russell said. “And now they may be more susceptible to infection and then may not be able to deal with the virus as well as a younger person.”

Watts emphasized that we do need to keep an eye on waning immunity to see if this occurs in the general population, and how that will affect long-term plans, such as the potential for Canadians to require booster shots once a year, similar to a flu shot.

But right now, the evidence only points to a growing risk for those already at risk.

“In special populations like long-term care who are older and particularly fragile, there's already emerging evidence for not as good immunity and evidence to start boosting them and also evidence to make sure people around them [are] fully vaccinated,” Watts said.

Russell pointed out that the U.S. Centres for Disease Control and Prevention (CDC) state that out of the more than 7,000 people who have died of a breakthrough COVID-19 case, 85 per cent were older than 65 years of age.

“Typically, most of the breakthrough cases that result in death are people over 65,” he said, adding that the risk is greater if they had other risk factors or were immune-compromised.

The concern from scientists is that these groups may not realize they are now at a higher risk.

“They think they're OK because they've had their shots, but if they had their two shots six or eight months ago, they may not be as protected as they think,” Russell said. “Those are the ones I'm really worried about.”

He added that those with a greater risk due to age or underlying health conditions who received their two shots around six to eight months ago should be more careful this upcoming holiday season, especially around large family gatherings or going to shopping malls where there may be people who are unvaccinated.

The answer, say public health experts, is a third shot — and some 280,000 at-risk Canadians have already received one, with vaccination campaigns to deliver booster shots to the vulnerable already underway across parts of Canada.

The other key part, Watts says, is ensuring those around vulnerable people are vaccinated.

“The more we're vaccinated, the less virus circulates, and the better,” she said.

“If you have a really good immune response, you'll clear that virus quickly even if you did get a breakthrough infection, but really, particularly to protect the vulnerable, the more of us vaccinated, the better.”

She said that while Canada’s high proportion of vaccination makes us more protected, and less likely to overwhelm the health care system, “if we left the remaining 20 plus per cent or so that [are] unvaccinated get infected, that still can be a real disaster, so we shouldn’t lose our vigilance yet.”

Still — doctors say Colin Powell's case should not be used as an example of vaccine failure, rather as a reminder that even with vaccination, the ailing and aging human body has its limits.