The death of Colin Powell, the United States' first Black secretary of state, from COVID-19 complications is a reminder of how immunocompromised and older people who are vaccinated can still be vulnerable to the virus.
Fatalities among vaccinated people are still exceedingly rare. According to the Centers for Disease Control (CDC), as of Oct. 12, more than 189 million people in the United States had been vaccinated, and there had been 7,178 deaths of fully vaccinated individuals. Adults over the age of 65 made up 85% of these cases.
Powell's family confirmed that the 84-year-old had been fully vaccinated before his death, although they did not note whether he had received an additional dose on top of his initial vaccination. In addition to his age, the fact that Powell had previously been diagnosed with multiple myeloma, a blood cancer, increased his susceptibility to the disease.
“No vaccine is 100%. There are always subgroups where vaccines won’t provide the same level of protection," Amesh Adalja, infectious diseases physician and senior scholar at the Johns Hopkins Center for Health Security, told BuzzFeed News.
"It’s not surprising to see that the vaccination may not have been enough to prevent [Powell’s] death from COVID-19," Adalja said.
Cancer cells and their treatments impair the body's immune system, making people with cancer more susceptible to hospitalization and death as a result of COVID-19. And a study published in July specifically highlighted that people with multiple myeloma responded less strongly to the Pfizer and Moderna COVID vaccines. In August, the CDC recommended that people who are moderately to severely immunocompromised receive a third dose of these vaccines.
The deaths of vaccinated individuals from COVID-19 are very rare, and Adalja noted that advanced age and medical problems are both additional risk factors. Powell, he said, fit into the group “you’d be the most worried about.”
Despite this information, a number of conservative media figures seized on Powell's vaccination status as a reason to question how much protection individuals get from a COVID-19 shot.
As many critics quickly pointed out, linking Powell's death to his vaccination status without providing information about his underlying conditions missed the point.
But the risk of COVID to older and immunocompromised people does highlight how difficult this upcoming Thanksgiving may be, even if loved ones are vaccinated.
That's why the FDA has authorized a booster dose of the Pfizer vaccine for all those over the age of 65, those at high risk of severe illness, and those who live or work in high-risk settings. (The health agency is currently weighing authorizations for Moderna's and Johnson & Johnson's shots too.)
In anticipation, the CDC on Friday issued new guidelines on safe holiday celebrations, with recommendations for how to limit the risk of COVID-19 transmission to at-risk individuals — even in gatherings where individuals have been fully vaccinated.
"People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fully vaccinated and have received an additional dose," the CDC emphasized in these new guidelines.
The CDC advises these at-risk individuals to operate for the most part as if they were not vaccinated, wearing a mask and social distancing unless they have been advised otherwise by their healthcare provider.
It also lays out guidelines for those fully vaccinated individuals who will be attending gatherings with at-risk people.
The federal agency recommends that every eligible person who will be attending a gathering get fully vaccinated before traveling for the holidays. (Unlike last year, the CDC is not recommending that individuals cancel travel plans.)
The CDC emphasized the importance of all participants wearing masks during travel and before any holiday get-togethers. "Even those who are fully vaccinated should wear a mask in public indoor settings in communities with substantial to high transmission."
Gatherings should be held either outside or in well-ventilated areas. And even if individuals are fully vaccinated, those attending holiday gatherings "might choose to wear a mask regardless of the level of transmission if a member of your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated."
While the vast majority of breakthrough infections will lead to mild cases of COVID-19, the CDC estimated that immunocompromised people account for up to 44% of vaccinated people who end up being hospitalized. Overall, unvaccinated people made up about 86% of people hospitalized for COVID-19.
“If you walk through a hospital, it’s not vaccinated people you see with COVID — it’s the unvaccinated," Adalja said.
Above all else, the CDC urged eligible people to get the vaccine before celebrating the holidays together.
“The goal of vaccines is not to prevent every infection and every death," Adalja added. "Vaccines aren’t magic force fields, but they do a good job with making it very unlikely that you get a severe case.”