Myeloma may have made Colin Powell more vulnerable to dying of COVID-19
After former Secretary of State Colin Powell's death from complications of COVID-19, experts pointed out that the 84-year-old Powell had a history of medical conditions that significantly raised his risk of severe COVID-19, though he was fully vaccinated.
Among them, Powell had multiple myeloma, a form of blood cancer that, both by itself and as a result of treatments given for the disease, can weaken the immune system.
"Myeloma patients, they make a lot of antibodies. But, they only make one type. So their ability to make normal antibodies to fend off infections is impaired. They also have T-cell, or cellular immunity, defects that contribute to their inability not only to fight off infections, but mount effective responses to vaccines," said Dr. James Berenson, medical and scientific director of the Institute for Myeloma and Bone Cancer Research.
Berenson co-authored research published in July by the journal Leukemia that found 55% of multiple myeloma patients in their study "failed to fully respond to COVID-19 vaccination," based on antibodies measured in their blood after two doses of the Pfizer or Moderna vaccines.
The American Cancer Society estimates that around 35,920 new cases of multiple myeloma will be diagnosed this year. Even some patients in remission after treatment may still face a compromised immune system and could struggle to mount a response, said Berenson.
Scientists hope booster shots could improve protection for Americans still vulnerable to severe COVID-19 despite vaccination, both in their bloodstreams and by bolstering the immunity of those around their communities.
Berenson said research from his team that has yet to be published suggests booster shots could be "promising" for patients with multiple myeloma.
"We've gone on to do a large study of looking at the decay rates of antibody levels, and we'll be submitting that in the next couple of weeks. We've also done a really large study of revaccination, boosting these folks with either Pfizer or Moderna, and the study is quite interesting," Berenson said.
Powell also faced other heightened risks of severe COVID-19.
He had been diagnosed with Parkinson's, a disorder that impairs the ability of the brain to control movement. Neurologic conditions are among those cited by the Centers for Disease Control as potentially increasing the risk of severe COVID-19 in patients. Data from Germany earlier this year found mortality rates were "much higher" in COVID-19 patients with Parkinson's.
The 84-year-old was also in the age group that has seen the worst rates of COVID-19 hospitalizations and deaths since the start of the pandemic.
While vaccinated people are far less likely to die from COVID-19 compared to their unvaccinated peers at the same age, recently published CDC data tallies the rate of COVID-19 deaths among vaccinated Americans 80 and over at the highest of any age group that has completed their shots. The rate of COVID-19 deaths among the oldest vaccinated Americans was higher than even some unvaccinated groups under 50, surging to record highs during the Delta variant wave over the summer.
Close to 96% of seniors have at least one dose of COVID-19 vaccine, according to the CDC, and more than 84% are fully vaccinated.
The CDC's Advisory Committee on Immunization Practices is expected to convene Thursday to discuss booster shots for a wider swath of Americans.
Booster shots of Pfizer or Moderna's vaccines are already authorized for immunocompromised Americans. However, the Centers for Disease Control and Prevention currently recommends that immunocompromised people and their families continue wearing masks and social distancing, even after booster shots.
"Be respectful of people who've been vaccinated and don't respond. Don't assume that, because all people have been vaccinated on the westside of Los Angeles, that therefore you are all protected and don't need to be socially distanced," said Berenson, arguing that masking was still needed "especially in a situation of high transmission."
Even as cases are once again falling from record highs over the summer, public health officials warn the disease's spread remains at dangerous levels in the U.S. and there are risks of additional waves of the virus. More than 84% of counties are at "high" transmission of COVID-19, according to the CDC.
Advocacy groups also say Powell's death "underscores the urgency" for broadening eligibility for booster shots, to cut the risk of spread of COVID-19 to immunocompromised Americans from their family and doctors.
"For many of these patients, residing in a home where other members or caregivers may not be eligible for COVID-19 boosters is still a threat to their health," heads of the American Association of Cancer Research wrote in a letter to CDC Director Rochelle Walensky this week.
A growing body of evidence suggests vaccine protection against any kind of COVID-19 infection may have declined in recent months, in the face of the highly contagious Delta variant.
"You cannot die of COVID-19 if you don't get COVID. I know it sounds stupid, but that's another reason why it's important to understand whether you're getting these breakthrough infections," said Dr. Barbara Cohn of the Public Health Institute.
Cohn co-authored a recent study, which has yet to be peer-reviewed, examining data from the Veterans Health Administration that found declining vaccine effectiveness against infection across records from some 620,000 patients.
The study concluded that, by August, protection had appeared to drop to 3% among Johnson & Johnson recipients, 64% among Moderna recipients, and 50% among Pfizer recipients. Cohn said their team had adjusted for age and comorbidities in estimating vaccine effectiveness, but cautioned other reasons -- like changes in behavior or prior immunity -- would be harder to disentangle.
"The importance of the rate of breakthrough infections is not just about what happens to you, personally. It is also related to how or whether or not you are continuing to spread this," said Cohn.