A cautionary tale: COVID-19 infection after vaccination is rare, but breakthroughs can happen. It happened to this man.
Carey Alexander Washington was thrilled to get his first shot of COVID-19 vaccine in January.
"He was just so excited," his daughter Tanya Washington said.
The 80-year-old, who was still actively working as a clinical psychologist in Columbia, South Carolina, got his second Pfizer-BioNTech shot on schedule three weeks later.
That's why, when he began to feel poorly in early March, it never occurred to him or anyone else he might have COVID-19.
He thought he had a bad cold. His internist thought he was having a cardiac episode. His cardiologist sent him home with a prescription to treat an irregular heartbeat.
The day after his appointment, Washington testified virtually in federal court as an expert witness. But by the end of that day, "he was barely putting together two sentences," said Tanya Washington, chief of staff for an investment bank in Atlanta. "I was pretty frantic."
Two nights later, in the emergency room, he was finally tested for the coronavirus. His daughter checked his record the next morning and saw it was positive. "I was like, 'What in the world?!'"
Although COVID-19 vaccines are extremely effective, like other vaccines, they're not perfect.
The Centers for Disease Control and Prevention estimates that out of more than 75 million fully vaccinated Americans, just 5,800 have had so-called breakthrough infections.
"To date, no unexpected patterns have been identified in case demographics or vaccine characteristics," Kristen Nordlund of CDC Public Affairs said via email.
So far, just over 40% of the breakthrough infections were in people 60 or older and 65% were female, she said.
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Nearly 30% of those with post-vaccination infections had no symptoms at all. But 7% were hospitalized, Nordlund said, and just 1% — like Carey Alexander Washington — died.
"I just still can't believe it," Tanya Washington said of her father's March 25 death. "He was the most joyous, vibrant, kind soul."
Variants and bad luck
She found out after his death that he had been infected, possibly by someone in the office where he saw his clients, with a variant of the virus first detected in California.
Called B.1.427, the variant is believed to be more transmissible and perhaps more dangerous than the original version of the SARS-CoV-2 virus.
State health departments are supposed to notify the CDC when there are breakthrough infections like Washington's, though his daughter said she hasn't heard from the state yet and isn't sure if he's among the 74 people nationwide counted by the CDC as having died from breakthrough infections. The federal agency tracks breakthroughs from variants when possible, Nordlund said.
Although vaccines have been shown to be at least somewhat effective against all the known variants, Washington likely was not as protected as he would have been against the original virus, said Dr. Helmut Albrecht, the infectious disease specialist who was involved in his care at Prisma Health and confirmed his infection with the variant.
Then a combination of his heart disease, prediabetes, genetics and bad luck led to Washington's severe infection and eventual death.
"It's probably a one in a million case," said Albrecht, who is also medical director of the Center for Infectious Disease Research and Policy at the University of South Carolina. "Whereas we see deaths in unvaccinated people all the time."
Tanya Washington said she doesn't know if her father would have fared any better had his COVID-19 infection been identified sooner, but she's haunted by the idea he might still be alive if he'd known people in his office were sick, or if his infection had been recognized early enough to give him monoclonal antibodies, drugs that can help prevent severe disease.
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Although delirious during most of his hospital stay, at one point he said to her, "Can you please try to save me? I want to feel better."
"Daddy, I'm trying," she responded.
Another time, he told her he couldn't talk because he was trying to check out of the hardware store.
But he always knew who she was. "He would say, 'Isn't my daughter so beautiful? I love you,'" she said, choking up at the memory.
Washington lived a full life. In addition to his job as a psychologist, the Greenville, South Carolina, native was a tennis official, working major collegiate tournaments, as well as events like the U.S. Open and Special Olympics.
"He had a mighty 80 years, that's for sure," said Tanya Washington, who remains a steadfast supporter of vaccines.
"He didn't deserve that death at all," she said, adding that neither did the other 566,000-plus Americans who have died of COVID-19.
Everyone remains vulnerable when infections remain high
Serious infections after COVID-19 vaccinations are incredibly rare, as CDC figures show. But breakthrough infections will happen as long as there is a circulating virus, experts say.
And there is plenty of virus in the U.S. right now.
Over the last week, there have been more than 60,000 new coronavirus cases a day and over 5,400 hospital admissions — both up more than 6% from the previous week, CDC Director Dr. Rochelle Walensky said Wednesday.
With such high rates, and vaccines less than 100% protective, everyone remains at risk, she and others said.
Both the Pfizer-BioNTech and Moderna vaccines, which more than 70 million Americans have received, were shown to be 95% effective in clinical trials.
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Real-world effectiveness is usually lower than what's seen in trials because the sickest, most vulnerable people aren't in a position to volunteer, experts said. But in Israel, studies show the Pfizer-BioNTech vaccine prevented 97% of symptomatic disease, severe disease and death, according to a company study.
Still, that leaves three to five people out of every 100 vulnerable to infection, said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine in Nashville, Tennessee.
Some of the breakthrough infections — though it's not yet clear how many — occur in people who are immunocompromised, he said. Those on cancer treatment or immunosuppressive medication, and elderly people, who often have weakened immune systems, are likely to be less protected by vaccines and therefore more vulnerable.
They will not be safe until infection rates come way down and vaccines help them stay there, Schaffner said.
Dr. Daniel Griffin, chief of infectious disease at ProHEALTH, a physician group in the New York City region, said most of the breakthrough infections he's seen were in people who got a little careless a week or so after their first of two shots. He called it "acute post first-dose vaccination celebration behavior."
But there will always be people who get infected, even if they've had both doses.
"It's important not to think that everyone will become bullet-proof after the vaccination," Griffin said.
Precautions like mask-wearing and avoiding crowds and poorly ventilated indoor spaces remain important for everyone, even those who have been vaccinated, said Dr. Robert Glatter, an emergency room physician at Lenox Hill Hospital in New York City.
Booster shots are likely coming, too, he said, to keep people safe longer term.
The bottom line, the experts agreed, is that the vaccines work terrifically well, even if there are still rare deaths like Washington's.
"Nothing is 100% in vaccinations," Glatter said. "The take-home is that if we prevent hospitalizations, severe disease and death, then we've performed an incredible feat."
Contributing: John Bacon
Contact Karen Weintraub at email@example.com.
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