Retired Gen. Colin Powell died Monday of COVID-19 complications at the age of 84. Powell was “fully vaccinated,” according to his family. But he was also immunocompromised because he was fighting a type of blood cancer.
The death of this career public servant, soldier and diplomat points out how important it is for people who can be vaccinated to step up.
We have known since the vaccines became available that they are not as effective for people who have suppressed immune system. Almost 3% of the U.S. population is immunocompromised, according to the Centers for Disease Control and Prevention. The list of the most compromised patients includes those who have:
- Been receiving active cancer treatment for tumors or cancers of the blood
- Received an organ transplant and are taking medicine to suppress the immune system
- Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
- Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response
This is important. Nearly half of people who have suffered so-called breakthrough COVID-19 infections have been people with compromised immune systems, Jonathan Golob, an assistant professor of infectious disease at the University of Michigan, wrote for The Conversation. Breakthrough infections refer to people like Powell who are vaccinated but still get infected. Golob wrote:
People who are immunocompromised have weakened immune systems. This can result from certain diseases and their medical treatments, such as cancer, autoimmune diseases, untreated HIV, organ transplant medications and some forms of kidney disease. The common thread is that the body’s defenses against infection are impaired.
Two parts of the immune system seem to be particularly important in protecting people from getting sick with COVID-19: T cells and B cells. B cells make antibodies that can bind to and inactivate viruses. T cells kill off virus-infected cells, prevent infection from further spreading and organize the body’s overall defense response. Different types of immunocompromising conditions and treatments can either kill or decrease the effectiveness of these key immune cells.
That can result in a hampered response to vaccines. As a result, people who are immunocompromised often need to follow different vaccination guidelines from people who are not immunocompromised to best protect themselves from infection. After a bone marrow or solid organ transplant, for instance, patients are routinely revaccinated against such infections as hepatitis B.
Researchers have known for some time that once infected, immunocompromised patients are more likely to suffer long-term effects. That also leads to something the experts call “viral shedding,” which means immunocompromised people are more likely to pass the virus along to others.
The initial vaccine trials received some criticism for not including immunocompromised patients. Drug trials typically take a decade to complete so they can study the effects on many vulnerable populations. But in this pandemic, when time was the enemy, the most vulnerable patients were not included and instead would be studied longer term.
The longer-term observations of the COVID-19 vaccines show us that booster doses are important for patients like Powell. Booster shots may jump-start immune systems that are suppressed by cancer treatments, for example.
Journalists will do a disservice if the story of his death is framed as the death of a vaccinated person. Instead, it is the death of an immunocompromised person who would have been especially vulnerable to being infected.
