A suburban Chicago family who lost their fully vaccinated father to COVID-19 said they hope his story, though rare, can help others with certain pre-existing conditions and immune deficiencies as they say his unexpected passing left them with a major "what if."
Alan Sporn, owner and president of Spornette International and an outgoing father of four who was diagnosed with chronic lymphocytic leukemia in 2019, had been taking added precautions throughout the coronavirus pandemic, despite not yet requiring treatment for his cancer.
"We were very careful when we visited him, always wore masks," his daughter Bonnie Sporn told NBC Chicago. "When we came to his house we either ate outside, we would wear masks."
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But the 75-year-old hairbrush salesman was eager to get vaccinated as travel was his career and his life. He received his first shot of the Pfizer vaccine in January and his second in early February, his family said.
By March, he had decided to have dinner at a restaurant with some friends, one of whom tested positive for coronavirus in the days following the meal.
Sporn started experiencing a fever and his doctor urged him to go to the emergency room and get tested. There, he found out he was positive for coronavirus.
Coronavirus cases among fully vaccinated people are called "breakthrough cases" and while they are possible, they are also rare.
The Illinois Department of Public Health has so far reported 32 deaths due to COVID-19 or related complications among the more than 4.2 million fully vaccinated residents since Jan. 1, but further details on those cases aren't available. As of April 28, another 97 "breakthrough" vaccine cases had been hospitalized.
In Chicago, experts say "breakthrough cases" reported so far have been largely asymptomatic and account for 0.06% of fully vaccinated residents.
But Sporn's leukemia diagnosis could have played a role in his protection with the vaccine.
Current CDC guidelines indicate those with compromised immune systems should receive the vaccine, however, they should "be aware of the potential for reduced immune responses to the vaccine." The CDC said those with compromised immune systems should continue following the public health guidelines after vaccination.
It was that guidance the Sporns say they wish they knew ahead of his hospitalization.
After his positive test, doctors told Sporn's family that his lungs were clear and he was able to recover at home.
"That's where we wish we would have paused and hit the pause button because we feel that some communication, some red flag wasn't alerted that because my dad has CLL, even though it's dormant, because he's immunocompromised - anybody with cancer or HIV or lupus, you know, like anybody that has an autoimmune disease - it should be a red flag," Bonnie Sporn said.
Three days later, Sporn was admitted to another hospital. By then, his lungs were "completely covered," his family said.
"He had eight antibodies," Bonnie Sporn said. "And you're supposed to have thousands of [antibodies]. You know after you get your second vaccine, it should show up in your system."
One week later, on March 29, Sporn died. The Cook County Medical Examiner's office listed his primary cause of death as pneumonia caused by the novel coronavirus.
"We feel that if he were given an antibody test when he found out he had COVID it would have alerted us to his low antibody count, and we wouldn't have let him drive home," Bonnie Sporn said. "We would have been, you know, either send him straight to the hospital or at least monitor him."
Experts say some protection is still better than no protection, but those with weakened immune systems should continue following public health guidelines after vaccination.
"I think there's still ongoing work about, you know, how well it works in people who are immunocompromised, but I think it's an important thing to still be vaccinated because you're still getting, you know, some level of protection from that vaccination," Dr. Candice Robinson, medical director for the Chicago Department of Public Health, said in a Facebook Live Tuesday.
The Leukemia & Lymphoma Society, citing data from a recent U.K. study, reports that "some blood cancer patients may not get optimal protection from the vaccines and may be more susceptible to COVID-19 infections after vaccination compared to the general public."
In that study from King’s College London, data showed that three weeks after one dose of the Pfizer vaccine, an antibody response was found in 39% of solid cancer patients and just 13% of people with blood cancer, compared to 95% in healthy individuals, the society reported.
The group urged blood cancer patients to continue wearing masks and taking preventative measures like social distancing and handwashing.
Similarly, a recent study from the University of Pittsburgh Medical Center found that "people with cancer that affects the blood, bone marrow or lymph nodes are at elevated risk of COVID-19 vaccine failure, particularly those with chronic lymphocytic leukemia."
The study tested blood from 67 patients with "hematologic malignancies" who had been vaccinated with either the Pfizer or Moderna COVID-19 two-dose vaccines three weeks earlier. The tests found that more than 46% of the participants had not produced antibodies against COVID-19 and only three in 13 patients with chronic lymphocytic leukemia had produced measurable antibodies, even though 70% of them weren’t undergoing any form of cancer therapy.
“As we see more national guidance allowing for unmasked gatherings among vaccinated people, clinicians should counsel their immunocompromised patients about the possibility that COVID-19 vaccines may not fully protect them against SARS-CoV-2,” the study's senior author Dr. Ghady Haidar, a transplant infectious diseases physician and assistant professor in the university's Department of Infectious Diseases, said in a statement. “Our results show that the odds of the vaccine producing an antibody response in people with hematologic malignancies are the equivalent of a coin flip.”
According to Haidar, however, a negative antibody test does not necessarily mean a patient isn't protected from the virus.
Many medications and treatments for certain cancers or other conditions can cause immune suppression or weaken an immune system.
The University of Chicago wrote in a blog post in February that there is little-to-no data surrounding the coronavirus vaccines' effectiveness in immunocompromised people because they weren't included in the vaccines' initial trials.
"Researchers don’t know whether these immunosuppressant treatments make the Pfizer and Moderna vaccines less effective – as some do in the case of flu vaccines – or if pausing or delaying treatment could make the vaccines work better. But it’s important that patients not change their treatment schedule without first speaking to their doctor," the university's post read.
With little data to offer, the Leukemia & Lymphoma Society is asking those living with blood cancers to register to become a "citizen scientist" and share their experiences with COVID-19 and the vaccines currently available.
The Sporns say they still encourage people to get vaccinated, but hope their father's story can raise awareness for those with compromised immune systems to remain vigilant.
"It's just extremely sad and, you know, everybody does a what if," Bonnie Sporn said. "So we're trying to help people with their what ifs. What if this person has a pre-existing condition? Should they get the vaccine? Should they be monitored? Should they still wear masks until... until when?"
Sporn's obituary states that he "made friends where ever he went -- in school, traveling and through work."
"He left a warm and loving impression on everyone he met, even if it was for just a brief meeting," the obituary read. "He knew people in every city he visited and even knew the airlines that got you directly to that city. He did not know a stranger. Alan was so generous with his time and love. He was a very loyal friend, a mentor, and a philanthropist. To honor Alan please do something nice for someone or reach out to an old an old friend."