As the world moves on, the unvaccinated and vulnerable are still dying from COVID-19
After more than a year of playing it safe during the pandemic, Patrick Stroh wanted nothing more than to see his son get married in April. He gambled that his COVID-19 vaccine, and a mask, would at least afford him some protection from the virus even though his immune system was suppressed.
Less than a month after the wedding, the 51-year-old husband and father was dead, his life taken by the virus he had been so careful to avoid.
“It's still kind of not real to me,” said his sister, Julie Lundrigan. “We went from seeing him at the wedding, and then three weeks later, he was in a coffin.”
Patrick died on May 3, a time when the number of coronavirus infections was declining after a small peak in April, and about 45 percent of Minnesotans 16 and older were fully vaccinated.
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Even though the pandemic has abated — for now — a handful of people are still dying from COVID-19 every day, and for the most vulnerable the war against the virus is anything but over.
While most of those deaths are among people who aren't fully vaccinated, a much smaller number are organ transplant patients like Patrick, who received their shots but didn’t mount a strong enough defense against the virus because they were immunocompromised.
Patrick remained vulnerable to COVID-19 because he had his lungs replaced a few years earlier.
As the world starts to resume normal life, his death is just one data point in a trend that's fading from the headlines. Most days, Minnesota is still reporting deaths from COVID-19, even as those numbers and case counts have waned.
State infectious disease director Kris Ehresmann said that since vaccines became widely available, most people who are being hospitalized and dying from the disease are younger and unvaccinated. A sliver of deaths — 52 of them — were among the nearly 3 million people who were fully vaccinated, like Patrick.
His passing is a stark reminder that more people need to choose vaccination to protect the most vulnerable, said Ehresmann.
“Individual decisions don't always just impact the individual,” Ehresmann said. “When you think about Patrick, Patrick did everything he could to protect himself."
‘He was so good at everything’
Patrick was a hard-core foodie who trained at Le Cordon Bleu in Mendota Heights and collected fine wines to pair with his meals. His wife, Michelle Gordon-Stroh, said the first time she cooked for her future husband, she probably should have picked something more impressive.
“The first meal I made for him was Hamburger Helper,” she recalled with a laugh. “He was mortified.”
After that, Patrick did all of the cooking, preparing everything from flank steak with rich sauces to freshly baked loaves of bread.
But cooking wasn’t his only forte. The youngest of seven children, Patrick was driven to prove himself — starting his own business executive consulting company, writing books and even starting a personal chef side hustle.
“He had so much energy and passion. He was so good at everything,” said his son, Alex. “I think the hat he was most proud to wear was being my dad.”
But in 2017, Patrick started to show signs of what would later be diagnosed as interstitial lung disease triggered by an allergy to black mold.
Alex said he realized things were getting serious in the winter of that year, when he and his dad went to a museum. Patrick was using oxygen at the time and still struggling to catch his breath.
"This was the first time I kind of had the realization that your parents aren't invincible," Alex said. "I can still hear the sound of that oxygen in my mind in what that must have been like for him."
Rachel Stroh said her dad's enthusiasm for embracing new experiences was evident even as the disease progressed, putting him on a path for a double lung transplant.
At Christmas of 2017, Rachel was in college, poised to leave for her study abroad trip. Patrick loved to travel, and loved to travel with his children, too.
“Everyone was really sad before I went, but not my dad,” she said. “He was just like, 'Go get out. It's gonna be great. I can't wait to hear the stories.’”
The following spring, in 2018, Patrick had a double lung transplant. Michelle, his wife, says his recovery was long and complicated. More than once, she thought Patrick wasn't going to make it.
At home, life was different, Michelle said. Patrick's eyesight deteriorated after the transplant. He couldn't work any more.
“It took a long time just for him to be able to walk for any period of time or stand for any period of time,” Michelle said. “After months, he was able to get back and do some cooking.”
At home, Michelle and Patrick started the next chapter of their lives. Just as the two were settled into their new normal, Michelle started seeing headlines about a mysterious virus that attacked the lungs. At her job at U.S. Bank, she was helping to prepare her company for a pandemic.
“It was really scary. I really started getting involved in it and realized how serious it was going to be pretty early on,” she said.
The couple knew the virus could take Patrick down in a heartbeat.
They locked down in February, started to have their groceries delivered, and closed off most contact with the outside world. These strict precautions were in place for more than a year — until vaccines became available.
Michelle and Patrick got their shots in early March. They wanted to feel safe again.
And Patrick's son, Alex, was getting married the second week of April.
Studying immune responses
What Patrick and Michelle didn’t know then — and what researchers are just starting to discover — is that COVID-19 vaccines don't work well for immunocompromised people like Patrick.
“The vast majority of healthy people have a robust response and are protected from infection,” said Dr. Amy Karger, a professor of laboratory medicine and pathology at the University of Minnesota Medical School.
She said initial studies for the vaccines left out immunocompromised patients by design, and that has proven challenging.
“We really didn't know what the response was going to be to the vaccine in those populations, until very recently, now that we've been able to vaccinate those vulnerable groups and then study their immune responses,” Karger said.
Patrick was on medications to prevent his body from rejecting his new lungs that likely also kept him from mounting an immune response to the virus.
While the medical field predicted that the vaccines might not be as effective for immunocompromised people, Karger said researchers have been surprised that a high number of them didn't respond to the shot at all.
Karger said current research focuses on whether certain drugs might erode someone's immune response, or whether their response is connected to the type of organ transplant they had.
"There are a couple studies where they've given additional booster shots," Karger said. "They are seeing that they can boost the antibody response in some of these people, but not all of them."
A risky calculation, an impossible decision
Michelle said that for these reasons, she and Patrick were worried about their exposure at his son's wedding. It would be their first time at a large gathering in more than a year, and they worried that people wouldn't take precautions.
Ultimately, Patrick couldn’t bear the idea of missing Alex’s wedding.
“Patrick really felt that the personal loss to him of not being able to go to that wedding outweighed the risk, and so he took the risk,” Michelle said.
Daughter Rachel said that it was wonderful to see her dad so happy that night.
"It was so good to see my dad surrounded by family and celebrating after a year of not being able to talk to anyone and three years of him being sick," Rachel said. "I have not seen him that happy in three years."
But that joy would not last long.
Within days of that April wedding, Patrick woke up with a fever and tested positive for COVID-19, as did others who attended the wedding, including his sister, who had been partially vaccinated.
About a week later, Michelle says, Patrick was admitted to the ICU.
“He was on high flow oxygen, and they called me and told me he wasn't going to live,” Michelle said.
At this point, Michelle and Patrick faced an impossible decision made even more complicated by the hospital's COVID-19 protocols.
The doctor told Michelle that without a ventilator, Patrick would surely die. She could come and say goodbye in person and while he was still conscious if they chose not to put him on one.
But a ventilator offered a slim chance of survival. If Patrick went on the ventilator, Michelle wouldn't be allowed to come see him unless he was near death. At that point, Patrick would be sedated and unable to communicate.
“I think people don't understand what it's like to have a loved one [in the hospital] and you can't be there with them,” Michelle said. “It's very lonely for them.”
Patrick and Michelle eventually settled on the ventilator — and a sliver of hope that he'd survive.
A few weeks later, the family was gathering again, this time for Patrick's funeral.
‘No joy for me’
Alex, who will defend a dissertation for his doctorate in mathematics soon, says he's saving one last loaf of Patrick's famous bread to enjoy on that day, as a way to be close to him even though he's gone. He says his father was his idol and his “North Star.”
“I would give everything I have, just for five more minutes with my dad,” he said.
Michelle said she gets angry when people refuse vaccines because they just don't want one. She said that decision is selfish.
“I get really upset when people say, 'It's my body. I don't have to get vaccinated. It's my choice,’” she said. “Just because you decide you don't want to get a shot, you could be killing someone like Patrick.”
And for Michelle, losing Patrick so late in the pandemic — after already living through the near-death experience with his lung transplant, after being so vigilant for so long during the pandemic — seeing the world move on from COVID-19 is hard.
“There’s no joy for me in living a more normal life without him,” she said. “I’d rather he be here.”