With over 6,900 cases of monkeypox across 51 countries, and the emergence of new COVID-19 Omicron subvariants BA4 and BA5, we must continue to maintain heightened public health mitigation and preparedness measures through the coming summer months.
COVID-19 cases in the United States (US) are at their highest levels since April and the increase comes as Americans have gathered for Independence Day celebrations amidst the emergence of the more transmissible, and potentially more serious, Omicron BA.4 and BA.5 subvariants. A preliminary study from the University of Tokyo shows that the new variants may have evolved to cause more serious infection of lung cells than previous Omicron variants which resulted in mostly mild cold-like symptoms. This may be the reason why countries with widespread BA4 and BA5 outbreaks, such as the United Kingdom (UK), Belgium, France, Germany, Portugal,and Israel, all with largely vaccinated populations and strong public health data tracking, are seeing sharp increases in hospitalizations. In addition to rising COVID-19 cases and hospitalizations from new emerging variants, monkeypox cases have tripled in the last two weeks.
What is Monkeypox?
Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in monkeys being used for research. While the origin of the virus remains unknown, it was given its name due to it first appearing in monkeys. The current 2022 monkeypox outbreak is the first time in 64 years since discovery that we have seen community spread from human to human on such a large scale outside the continent of Africa.
Monkeypox presents with normal viral symptoms such as fever, malaise, headache, and weakness. This is followed by swelling of lymph nodes, rash, and the presentation of lesions. The illness typically lasts between two and four weeks and can be potentially fatal. Thus far, community spread of the virus appears to occur when another person comes in close contact with lesions, body fluids, respiratory droplets, and/or contaminated materials, such as bedding from an infected person. There are limited quantities available of vaccines used to eradicate smallpox that appear effective against monkeypox; however, the Centers for Disease and Control and Prevention (CDC) is not yet recommending widespread vaccination but rather a more heightened focus on educating communities on how monkeypox is contracted and steps to be taken to prevent further human to human transmission if monkeypox is in your community. These steps include avoiding the following with individuals with monkeypox:
- Avoid close, skin to skin contact.
- Do not kiss, hug, or have sexual contact.
- Do not share eating utensils or cups.
- Do not handle or touch bedding, towels, or clothing of a sick person.
While cases of monkeypox continue to rise, most public health experts believe it will not be as widespread as the COVID-19 pandemic as it does not appear to be as transmissible at this time.
What Can Communities Do to Stay Safe?
Whether it is monkeypox, new variants of COVID-19, or any future emerging infectious disease, the mitigation and preparedness measures with widespread viruses circulating in a community remain the same. Proven measures include:
- Masking. Wearing a well fitted N95 or KN95 mask when in an indoor crowded setting not only will continue to protect against COVID-19 but other respiratory viruses such as cold and flu.
- Increase ventilation indoors. While outdoors is always better than indoors, creating air exchanges indoors to move any viral particles out of the air goes a long way. Open windows or doors to allow for fresh air to circulate inside the space. In spaces without windows, consider investing in an air purification system. There are many systems available, and you should look for one that creates air movement while utilizing high level HEPA filtration to clean the air.
- Wash your hands often. Frequent hand washing is one of the best ways to prevent the spread of COVID-19, monkeypox, and other viruses. Throughout the day, we all touch many common surfaces and then scratch our faces, eyes, or rub our noses without realizing. Viral particles spread from common surfaces to our hands. Hand washing or use of alcohol-based hand sanitizer when you cannot wash your hands must be done for 20 seconds to kill viruses. In addition, when washing your hands, it is important to clean all surfaces including palms, under nails, between fingers, the back of your hands, and even up to your wrists. Remember to wash your hands before you prepare food and eat, after using the bathroom, and after touching any common surfaces.
- Get Vaccinated. Three doses of a MRNA vaccine continue to show strong results keeping people out of hospitals and with only mild disease if they contract COVID-19. We must continue to develop our vaccines to better defend against emerging COVID-19 variants.
- Isolate. When we get sick with any illness, we should isolate ourselves from others.
Communities should have strategies in place for:
- Community education: Outreach and education should focus on helping people make the best-informed decisions to protect their health and the health of their loved ones. This means putting out prevention strategies for avoiding viruses and disease as well as real time data on level of risks in one’s community.
- Efficient testing capacity with minimal turnaround time: Lessons learned from early 2020 when COVID-19 first emerged taught us the importance of testing availability, capacity, and rapid results turnaround in being able to quickly identify individuals with COVID-19 and isolate them from others. Last week, the White House announced that commercial labs in communities can begin testing for monkeypox. This significantly expands testing capacity as up until last week, clinicians performing monkeypox testing had to send samples to a CDC laboratory which slowed results processing times. Communities should continue to promote the importance of testing for COVID-19 or monkeypox if one thinks they were potentially exposed to help stop the spread of further viruses. Continued federal funding will be needed for states to maintain testing capacity.
- Increase vaccination capacity: Plan now for administering new vaccines that may better neutralize emerging COVID-19 strains. We may not need to fully stand-up mass vaccination sites, but we will need to expand capacity come late summer, early fall when a new vaccine is scheduled to arrive. As it relates to vaccination for monkeypox, the US continues to order hundreds of thousands of vaccines but is not yet recommending widespread administration. This could change quickly and communities should plan now if mass administration of vaccines are recommended.
- Increased treatment capacity: Over the last year, the US has been a few weeks behind Western European countries, like the UK, when it comes to mirroring COVID-19 trends and surges. If this continues to be the case, we must be prepared now for a rise in hospitalizations week over week and maintain healthcare capacity to care for potentially more severe disease from the BA4 and BA5 Omicron subvariants.
Emerging infectious diseases such as COVID-19 and monkeypox will continue to be with us for the foreseeable future. The faster we can adapt to basic virus mitigation measures being a part of our lives the faster we can drive down illnesses, help save lives, and keep our vulnerable populations protected.
Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health and served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations.