Local public health experts say monkeypox isn’t likely to explode like COVID-19 cases because it’s less contagious compared to the coronavirus, which has killed thousands of Orange County residents and hospitalized many more.
They’re instead worried about a looming COVID wave which could hit in the coming months.
As of Tuesday, 233 county residents were confirmed to have monkeypox, and 13 people have been hospitalized for the virus, according to OC Health Care Agency data.
That’s up from 24 confirmed cases early last month.
UC Irvine epidemiologist and public health expert Andrew Noymer said residents shouldn’t expect monkeypox to take off like COVID did.
“Monkeypox has a pretty low reproductive number. This is the r-naught that – no thanks to COVID – we’re all familiar with now. So this is not going to explode like wildfire through OC,” Noymer said in a phone interview last week.
“There’s not going to be monkeypox in every high school boys football team and in every daycare. It’s just not going to be like the fall of Monkeypox, like the autumn of Monkeypox,” he said. “It doesn’t lend itself to explosive epidemics – it’s a slow burn, not an explosive wildfire.”
Although Noymer warned there could be monkeypox outbreaks, he said they won’t be anywhere near the same level as COVID outbreaks.
Noymer pointed to March 2020 – the onset of the pandemic locally – as a good lesson on how public health officials should approach the monkeypox virus.
“One of the lessons learned writ large from COVID is you have to test,” Noymer said, adding that COVID testing was difficult to find in the early days of the pandemic, putting a hamper on trying to limit the spread.
“In March 2020, when the U.S. hit a technical snag on testing and South Korea was testing like 10 times more people a day than we were – that was embarrassing,” Noymer said. “Testing gives people information and that could help stem the spread of the epidemic. With monkeypox, we’re making the same mistake — we’re not testing enough.”
Sanghyuk Shin, also a UCI epidemiologist, said testing and isolation is key to stunting the growth of monkeypox cases.
In a Monday phone interview, Shin said numerous studies show “with proper testing and isolation and targeted vaccination that we really can kind of control this outbreak – control this epidemic and hopefully get it to a manageable level or perhaps even eliminate it.”
“We need to be mindful that this doesn’t mean it’s going to stay within that group, said Richard Carpiano, a UC Riverside public health scientist and sociologist.
“This is how societies work, this is the fabric of things — we don’t all have these isolated lives.”
But he said the current situation makes public health response strategies challenging.
“If you’re fighting it in a particular population, you want to prioritize your resources there before it can spread to another community,” Carpiano said in a phone interview last week. “It becomes tricky saying we need to be vigilant — you don’t want to cause panic, but at the same time you want people to do the right thing.”
Carpiano, Noymer and Shin said the smallpox vaccine will help fight against monkeypox.
Another COVID-19 Wave Looms
“There’s going to be a significant wave of COVID this winter and the new formulation of the booster alone is not enough to suppress it,” Noymer said, adding he expects the next wave to resemble last winter’s surge.
Although, he said, the severity is tough to predict.
“My guess is that it will be on par with last year. It’s very hard to predict. I mean what concerns me is that the new booster uptake is going to be relatively modest,” Noymer said, adding that many people haven’t received their first or second booster shots.
As of Friday, Orange County’s positivity rate sits at 6.1%, according to state data.
That’s significantly down from the nearly 20% rate in July.
And 124 OC residents were hospitalized, including 21 in intensive care units, according to the data as of Friday.
During the last two winters, OC and California saw dramatic increases in COVID cases.
Over 2,200 county residents died during the first winter wave in January and February 2021, with more than 2,100 people hospitalized at one point.
The second winter wave of the pandemic, which ended earlier this year, saw a dramatic fall in deaths. During January and February 2022, the virus killed 920 people. Hospitalizations were far lower, with just over 1,200 people hospitalized at one point.
Public health experts say the dramatic decline in hospitalizations and deaths stem from the COVID vaccine.
In total, 7,432 people have been killed by the virus, according to the OC Health Care Agency.
But the long term virus effects remain unclear, with some local doctors reporting some of their patients have been fighting chronic fatigue, brain fog and a host of other symptoms for months after the initial infection.
Cases might already be increasing.
Shin said he’s been seeing an uptick in cases through wastewater surveillance in Los Angeles and San Diego counties.
“Our neighboring counties have signs of an upswing already,” Shin said.
In an email, Orange County Health Officer Dr. Regina Chinsio-Kwong said the county hasn’t seen a virus uptick in wastewater.
“There are lags in wastewater data that are due to a variety of factors including the time it takes for collection, transfer of specimens and reporting. The wastewater data can give a signal when there is a rise in cases, but the change in wastewater compared to PCR + COVID cases has been small- (days to 1 week),” Chinsio-Kwong said.
She also said wastewater data, coupled with COVID testing, can help public health officials determine if the county’s in a wave or coming out of a surge.
In an effort to keep hospitalizations and deaths relatively low, Shin said public health department leaders need to spearhead the new Omicron-targeted booster campaigns before the next surge hits.
“That vaccine, which is now currently administered as a booster only, should be even more effective than the previous vaccine. We don’t know how much more it will be effective — we don’t have the data for that now,” he said, adding the new boosters also protect against original strains of the virus.
Federal COVID Response Funding Drying Up
The new booster rollout efforts come as federal funding for the United States’ COVID response remains uncertain because money’s running out.
Earlier this month, the Biden administration asked Congress for an additional $27 billion for the pandemic response to help fund free vaccines and testing, among other measures, according to the New York Times. Monkeypox efforts would also be included in that money.
Shin said while many elected officials across the country have largely shifted their focus away from the pandemic response, many people have been going about life the way they did before the pandemic.
“I think this kind of messaging has led to a false sense of security. We’re still seeing close to 400 average deaths per day in the U.S.,” Shin said.
Free COVID testing also ended earlier this month.
“Ordering through the free at-home test program was suspended on Friday, September 2 because Congress hasn’t provided additional funding to replenish the nation’s stockpile of tests,” reads a marquee on the website to order free COVID tests.
With federal funds drying up, Shin said he worries about the disproportionate impact to minority communities and immunocompromised people – all groups who’ve been hit particularly hard throughout the pandemic.
“It’s a nightmare scenario. Even with the government really playing a huge role in trying to make things accessible, we’ve only done kind of a so-so job in reaching the vulnerable people and reaching the people in need,” Shin said.
If federal funding ends, it could widen the existing health gaps, he said.
“Every health statistic we see in terms of mortality, in terms of people hospitalized, in terms of vaccinated — there’s a huge disparity. People who are traditionally marginalized, people who are Black and brown, tend to fall through the cracks a lot more than other people,” he said.
Carpiano said he expects it to get tougher for people to get COVID tests and vaccines if the pandemic response efforts are shifted over to the private sector.
“We’re going to see all these classic problems occur where there are existing problems for everything else when we think of inequities by income and race and ethnicity,” Carpiano said. “In certain cases, there’s a certain cost paid out of pocket – that’s a disincentive for people to go out and get them.”
Spencer Custodio is the civic editor. You can reach him at firstname.lastname@example.org. Follow him on Twitter @SpencerCustodio.
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