Covid Update + some other things: May 20, 2022

Quick State of COVID Address, and Monkeypox, the next thing to watch.

1. COVID cases are on the rise in every state with daily averages back to around 100k a day. This is about a 55% increase over prior weeks although some of that may be because many states are no longer reporting daily numbers so our surveillance is less reliable now. Additionally, this does not capture people who home test and do not report. Monitor cases in your area and resume preventative practices such as masking indoors in public places when needed. (i.e. when your area has moderate to high transmission rates/risk). If you have slacked on the hand washing and hand sanitizer now is the time to restart. And finally, you may want to start thinking about your next booster for those who are vaccinating and eligible for a booster. Oh....and research has shown the flu shot provides some protection against severe COVID, so if you are unsure about the COVID vaccine then consider a late-season flu shot - they are still available and flu season is lasting longer than usual this year so it could be a win-win. Here are a couple of additional updates pasted from the headlines:

   1. Reports of heart inflammation linked to COVID-19 vaccines are significantly lower for 5–11-year-old boys—who saw only slightly more elevated rates than normal—compared to adolescents and young men, the CDC said yesterday, citing Vaccine Adverse Event Reporting System data. Reuters

   2. COVID-19 can lead to osteoporosis-like conditions, causing severe inflammatory bone loss in the arms, legs, and spine, according to a University of Hong Kong study of Syrian hamsters, which experience COVID infection similarly to humans. South China Morning Post

2. No update on the hepatitis among kids situation - but cases continue to climb. I am monitoring that and will update you as soon as there is something worth updating.

3. Monkeypox, the cousin of smallpox. I could go on and on about smallpox because it is the most interesting disease ever - in my opinion, but I am, of course, a disease nerd. Monkeypox is essentially the monkey version of smallpox. Every species of mammal has its own version of smallpox, even dolphins. Typically, each species keeps its version to itself but there is a touch of cross-over between animal species. Getting it requires close contact. Monkeypox is not unheard of in humans (in 2003 the US saw 47 cases - it was a bit of an exceptional year). We have only seen about 1500 cases total of Monkeypox since its discovery, so that gives you an idea of how rare it is. Typically we see the majority of cases in Africa and any cases outside of Africa are generally among people who traveled to Africa. Community transmission (spreading from person to person) which is what we are now seeing, is more rare.

There is at least one confirmed case in the US from a person who recently traveled to Canada. Canada is now reporting numerous cases as are multiple other countries in Europe. In response, the US government has ordered millions of doses of the vaccine. This is a long-existing vaccine and not something new. The vaccine would protect against both monkeypox and smallpox.

The monkeypox vaccine is 85% effective against someone getting monkeypox and highly effective against severe outcomes. The vaccine is not life-long, it typically lasts around 3-5 years, similar to the smallpox vaccine. If you were vaccinated for smallpox in the last 3 years you should not get a monkeypox vaccine.

Having been vaccinated against smallpox at some time in the past (this is common if you served in the military or received your childhood vaccines in the US prior to 1972 -the year we stopped vaccinating against smallpox because it was no longer needed -that data will be later in other countries). That vaccine will continue to provide some level of protection but not full protection. The smallpox vaccines produce 95% protection against infection which is really amazing. But they only protect at that level for 5 years, after which protection from infection wanes while protection from severe outcomes persists. Monkeypox is not nearly as deadly as smallpox which is very good news. Case fatality rates for Monkeypox are about 3-6% with illness lasting for 2-4 weeks.

With the "pox" diseases you have a host of symptoms such as fever, headache, body aches, swollen lymph nodes, chills, and exhaustion. About a week later you will get a rash that will produce small blisters all over the skin. These will eventually rupture and ooze until they finally scab. Once all the scabs fall off you will be recovered and no longer be contagious. But until then, contact with the ooze and the scabs is contagious. The scabs remain contagious even after they fall off.

The pox themselves spread widely across the body and usually leave scars behind, similar to smallpox. But the vaccine is not readily available (we maintain low-level amounts in labs around the country but not nearly as much as the government ordered). We are expecting a couple of million doses to be ready by the end of the year with more in 2023 and 2024, just in case. Your risk of monkeypox at this point is pretty nil. But it is something to watch.

As a final note on this, while childhood chickenpox also produces ooze-filled blisters, it is not caused by the same virus as the rest of the pox. It is an unfortunate naming convention that happened before we had the knowledge and tools to realize they weren't the same virus family. So chickenpox is something different entirely and does not provide you any protection against monkeypox or smallpox.

You can read more about monkeypox here and here.

FINAL THOUGHTS: I hope you are doing well. I have been trying to re-establish a work/life balance (which has only been partially successful). So often in life, we have this false sense of control. Then things like COVID and Monkeypox come along and reveal to us in very real ways that there is so little in our actual control. Today I remind you that we can only truly control ourselves and our responses to stimuli whatever those stimuli may be. But controlling that can change the world.

Monkeypox