Why breakthrough COVID deaths can be misunderstood

The death of former Secretary of State Colin Powell due to COVID-19 complications has sparked conversations about breakthrough deaths among vaccinated individuals.

It would be inaccurate, however, to jump to any conclusions about vaccine effectiveness from a single breakthrough death such as Powell's, who was 84 years old, immunocompromised and being treated for multiple myeloma, a blood-borne cancer that "in and of itself can lead to compromised immunity," Dr. Todd Ellerin, director of infectious diseases at the South Shore Medical Center in Massachusetts, told ABC News.

In a statement, Dr. Paul Richardson, the director of clinical research at the Jerome Lipper Multiple Myeloma Center at the Dana-Farber Cancer Institute, said myeloma patients are "not only vulnerable to infection but once infected, they are more prone to serious complications including vascular effects and profound immune dysfunction."

Dr. Craig Devoe, chief of medical oncology and hematology at Northwell Health in New York, said that myeloma doesn't just put patients at a higher risk of severe illness but could have also put their immune system at a disadvantage for fighting off COVID-19 even when fully vaccinated “because both the disease and the treatment itself are highly immunosuppressive.”

According to his spokesperson, Powell was fully vaccinated and was being treated for myeloma, which is not curable. He had also recently been diagnosed with Parkinson's disease, which can itself be debilitating depending on the stage.

According to the Centers for Disease Control and Prevention, there have been roughly 7,000 breakthrough deaths among the 187 million vaccinated Americans, with more than 6,000 over the age of 65 in contrast to the more than 700,000 COVID-19 deaths among the unvaccinated.

"Without question, we can expect deaths," Ellerin said. "It is much more common in those unvaccinated than vaccinated. But we are seeing breakthrough vaccine deaths, especially in the elderly -- patients in their 80s and older -- or those who are immunocompromised."

No one who receives a COVID-19 vaccine is 100% protected from death, but the vaccines have shown to be extremely effective at lowering the risk of getting the disease.

The CDC recently updated its website with data illustrating the fact that vaccines are still dramatically reducing the risk of testing positive or dying of COVID-19 amid the latest delta surge. While there has been a slight uptick in COVID-19 cases and deaths since July 2021, the increase is more pronounced among unvaccinated individuals.

In August, unvaccinated people were 6.1 times more at risk of testing positive for COVID-19 and 11.3 times more likely to die from COVID-19 compared to vaccinated individuals, according to federal data pulled from 16 states and jurisdictions.

"[A breakthrough vaccine death] is not an argument for 'don't get your vaccine,'" Ellerin said. "That is an argument for 'get your vaccine because that's the best way of reducing your likelihood of death.'"

Additionally, when broken down by age, death rates in every age group were higher among the unvaccinated populations. Older Americans (80+) had the highest rate of deaths among fully vaccinated people per capita, though their risk of death was about 5.7 times lower than their unvaccinated counterparts in the same age group.

Among the breakthrough deaths, the U.S. is currently seeing what Ellerin labels "a precarious triangle" of risk factors -- old age, underlying diseases that lead to immunocompromisation and treatments for those diseases -- which make individuals more susceptible to severe COVID-19 infection.

Vaccinated people who fall into the intersection of these risk areas should also prioritize non-pharmaceutical interventions, such as masking when indoors and optimizing ventilation, experts say.

Dr. Edward Stadtmauer, director of the myeloma program at the University of Pennsylvania, told ABC News that the best way for cancer patients to prevent COVID-19 infection or limit its severity is to get vaccinated.

"If you have abnormal plasma cells to begin with or are getting therapy that might suppress or damage plasma cells, you can see why that this group of patients may have the most difficulty responding to a COVID infection and responding to vaccines," he said.

Stadtmauer said he is seeing about 70% of patients with myeloma generate COVID-19 neutralizing antibodies after vaccination.

“If there is any group of patients who should be vaccinated and get a booster, it is this group of patients,” he said.

The Food and Drug Administration on Sept. 22 authorized Pfizer COVID-19 vaccine boosters for people 65 years and older and those at risk. Powell himself was due for the booster shot the same week he fell ill with COVID-19, his spokesperson said.

"None of these are perfect strategies, but you have the best chance of survival," Ellerin said.

The misuse of the news of Powell's death to spread misinformation about vaccine failure and discourage individuals from getting vaccinated can be harmful to those immunocompromised, according to experts, who say that in order to protect those with underlying diseases, it is imperative that everyone around them gets vaccinated to curb the spread of COVID-19.

"Hopefully his life and the fact that he believed in vaccination can be a catalyst for many others to get it," Ellerin said.