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U.S. ‘at the cusp’ of losing control of monkeypox; outbreak could become endemic

Top health experts warn that the United States may be too late to contain the outbreak, citing vaccine shortage, inadequate testing

SHARE U.S. ‘at the cusp’ of losing control of monkeypox; outbreak could become endemic

Illustration by Alex Cochran, Deseret News

Monkeypox could become endemic in the United States, according to former Food and Drug Administration Commissioner Scott Gottlieb, who told CBS’ “Face the Nation” on Sunday that America is “at the cusp” after failing to contain the outbreak when it was small.

“I think the window for getting control of this and containing it probably has closed. If it hasn’t closed, it’s certainly starting to close,” Gottlieb said.

He’s not the only public health official warning that we need to step it up or lose the battle to contain the outbreak. When a disease becomes endemic, it can always be found in a certain area or among a particular population.

“This is something we definitely need to take seriously. We don’t know the scope and the potential of it yet, but we have to act like it will have the capability of spreading much more widely than it’s spreading right now,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and President Biden’s chief medical adviser, told CNN Saturday.

The latest map update from the Centers for Disease Control and Prevention shows 1,814 lab-confirmed cases have spread across the United States and Puerto Rico as of July 17. Only six states are not reporting monkeypox cases at this point.

Those with more than 100 cases include New York (489 cases), California (266 cases), Illinois (174 cases), Florida (154 cases) and Washington, D.C. (108 cases).

Right now, worldwide, there are more than 12,550 cases spread across 68 countries, according to national and international public health agencies.

According to CNN, Fauci said the numbers are “very likely an undercount.”

Several issues have hampered containment of the outbreak.

According to The Guardian, “at-risk communities continue to face a limited supply of vaccines and lack of access to testing, while those contracting the virus in the U.S. have struggled to receive treatment, according to reports.”

Both Fauci and Gottlieb noted that testing has not been adequate and that the vaccine, which was developed for monkeypox’s cousin smallpox, is in short supply in many places, although the vaccine has been made available from the national stockpile and manufacturers have ramped up production.

About monkeypox

As the Deseret News reported, monkeypox typically spreads by touching infected animals, humans or contaminated material by way of sores and broken skin, the respiratory tract or through the mucous membranes in the eyes, nose and mouth.

Symptoms initially are pretty unremarkable: Monkeypox feels like influenza, with chills, exhaustion and muscle weakness. People may have a fever, headache, muscle or back pain, and swollen glands.

That evolves into a rash that quickly creates pus-filled lesions that eventually scab over and fall off. The time from exposure to symptoms can range from about five to 21 days.

Most often, cases have resolved on their own within about three weeks.

But it’s not a benign illness. Besides the misery it can create and how easily it spreads, some people have died from complications of monkeypox.

Although this monkeypox outbreak was linked initially to travel to countries in central and western Africa where the disease is endemic, it has more recently been linked in some cases to men having sex with men.

But public health officials emphasize that monkeypox is not a sexually transmitted disease. It spreads through close physical contact with those pus-filled lesions and respiratory drops. It can also spread by contact with objects and materials that have touched secretions, including linens and clothing. Anyone can get it. And not all the cases involve men who have sex with men.

Spreading quickly

In late May, the Deseret News reported remarks by U.S. public health officials that the risk was very low for most people. That conversation has changed, along with the level of urgency.

At that time, The Washington Post reported, “Monkeypox is not known to spread easily among humans. The fact that cases are emerging in several countries at once — with signs of ‘sustained’ transmission in people — is striking, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.”

There is no monkeypox-specific treatment; rather health providers try to manage symptoms. The best approach is to vaccinate against the disease.

The Jynneos vaccine is preferred because it has fewer side effects and complications, compared to a smallpox vaccine that was developed years ago and helped nearly eradicate smallpox in most of the world.

“More than 132,000 doses of vaccine against monkeypox have been taken out of the U.S. strategic stockpile and sent across the country, but health authorities estimate that more than 1.5 million U.S. residents qualify for this two-dose vaccination,” CNN reported.

At this point, the vaccine is being given to people deemed at high risk because of close contact with those known to have monkeypox. But the rollout of efforts to vaccinate high-risk populations have in some populous locations been plagued with problems, particularly in New York City.