Monkeypox is not comparable to COVID-19, according to Bayonne Health Officer Michele O’Reilly. While residents may be concerned as the virus has made it’s way to New Jersey, with the first confirmed case in Jersey City, there is no cause for alarm.
In an interview with the Bayonne Community News, O’Reilly explained why a large-scale monkeypox outbreak is unlikely and not something to fear. O’Reilly noted there were no cases of the virus in Bayonne at the time of the interview.
No comparison to COVID-19
“It’s certainly different from COVID-19,” O’Reilly said. “This is a rare disease that’s really not prevalent in New Jersey or anywhere in our area.”
While COVID-19 spreads through respiratory droplets in the air, monkeypox is largely spread by close contact. Symptoms of monkeypox include fever, malaise, headache, weakness, swollen lymph nodes, as well as the skin lesions the virus is notorious for.
“With monkeypox, you have to have close skin to skin contact with someone who has a rash or lesions on their body,” O’Reilly said. “You have to come in direct contact with somebody that is already infected. So that’s a huge difference between the two.”
There are other ways that monkeypox can spread other than close contact, but the virus does not do so easily. It has a one to two week incubation period, and can last from two to four weeks.
“If you’re not coming in direct contact with somebody who has the rash or skin lesions, possibly sharing bedding could be a way to spread the virus too,” O’Reilly said. “There’s also prolonged exposure to respiratory droplets, but that’s within six feet for three hours or more.”
According to O’Reilly, the virus can be spread through respiratory droplets in the air, but no where near the rate of COVID-19.
“It’s quite different from COVID-19,” she said. “It’s not easily transmissible through respiratory droplets. It’s really mostly skin to skin contact with someone who’s infected.”
Another difference between the viruses is the approach to contact tracing.
“For example, there’s a huge difference between the viruses when it comes to contact tracing,” O’Reilly said. “With COVID-19, we were contact tracing 48 hours prior to symptom onset. Contact tracing begins right at symptom onset, we’re not looking 48 hours prior to symptom onset for monkeypox.”
Preventing the spread of monkeypox
Therefore, O’Reilly doesn’t believe that monkeypox will become the pandemic that COVID-19 has been.
“I’ve been surprised in the past before, but I can confidently say in my professional opinion, no,” O’Reilly said. “With COVID-19, we’ve had large scale mass testing and vaccination of the public. That is definitely not something that being asked of local health officers and or at the county or state level.”
As for vaccines, according to the Centers for Disease Control and Prevention (CDC) the smallpox vaccine will also be effective against monkeypox.
“I think the smallpox vaccine would offer some layer of protection,” O’Reilly said. “If the hospital called me and told me they think they have a suspected monkeypox case here, one of the questions I would ask would be if they are up to date with immunizations for varicella, for chicken pox, because sometimes it could possibly mimic that. What we’re seeing is either the patient is unaware or they don’t really remember if they had that vaccination as a child. So that’s just a good question for us to ask so we can possibly rule out something like chickenpox, because they could resemble the monkeypox lesions.”
O’Reilly noted that the smallpox vaccine is available to those at-risk of contracting the virus at work, as well as those who have been exposed to the virus. Those exposed to the virus who are vaccinated with 4 to 14 days may have lessened symptoms, but not prevent the disease.
“There is vaccine available,” she said. “Right now, we’re looking to ensure that anybody who’s been identified as a high risk contact to a known monkeypox case, that post-exposure prophylaxis is available within four days. You may have lessened symptoms, but it may not prevent the disease. So the earlier you receive it, the better chance of having reduced symptoms. The symptoms include the rash, so we definitely want to prevent those symptoms.”
Ways to prevent the spread of monkeypox do however, overlap with the methods of preventing COVID-19.
“Wash your hands, practice good hygiene, and keep an open line of communication with your physician,” O’Reilly said. “If you feel like something is wrong, maybe there’s a rash or a sore that you’ve noticed. It is rare, but I also think it’s important to keep in contact with your physician. If something does come up, contact them right away and get checked out.”
Testing for the virus
If someone did go to their physician for suspected monkeypox, the physician would review a monkeypox worksheet. It would ask questions about international travel within the past 21 days to an area with a known monkeypox outbreak, any contact with a known monkeypox case within the past 21 days, among other vital questions.
“The physician goes through that worksheet with the patient,” O’Reilly said. “Then if possible, we get photos of the rash. We ask the physicians not to provide photos of the face or any genitalia. Then we review those photos and the investigation worksheet.”
After the physician hands over the information about the suspected case to O’Reilly, she would then review the materials in conjunction with the state. If the case meets the requirements, then the state will okay testing for the virus.
“In consultation with the state, we determine whether or not the suspected case meets the case definition,” she said. “If it does, then the state approves some testing and then the physician will collect a swab sample and ask that patient to isolate at home and away from any healthy family members. It’s kind of similar to COVID-19, but just until the test results come back and we can say that the case is probable.”
O’Reilly said that testing for monkeypox is longer than for COVID-19, because it requires two rounds of testing.
“Two specimens are collected,” she said. “If the first specimen tests positive for the orthopoxvirus by the state, the second sample gets sent to the CDC for confirmatory testing for monkeypox.”
Throughout the whole process, there would be coordination from the CDC level, to the state and the county level, down to the municipal level.
“The physicians are calling asking what to do, and it’s been kind of a clear path for them,” O’Reilly said. “We guide them and ask them to provide us with the necessary information.”
According to O’Reilly, while there have not been any monkeypox cases in Bayonne, there are physicians calling up concerned. There have been a handful of suspected cases, but none have come anywhere close to being approved for the first round of testing by the state.
“There are some physicians calling concerned and suspecting monkeypox,” she said. “Once we talk it out and go through the investigation worksheet, then we realize that doesn’t really meet the case definition. So we’ll see what the state has to say.”
COVID-19 has not gone away
Overall, O’Reilly seeks to calm any concerns residents may have when hearing news about monkeypox being the next pandemic.
“It upsets me a little bit with the media sensationalizing monkeypox and comparing it to COVID-19,” O’Reilly said. “In my opinion, it’s apples and oranges. You can’t compare the two in my opinion. I don’t want the residents of Bayonne to be concerned about being exposed to monkeypox. We don’t need fearmongering that there’s another COVID-19 on the way. If the state is able to provide local health departments across the state with more public health funding priority, then we’d be able to perform better outreach.”
Speaking of COVID-19, that virus has been subsiding somewhat in Bayonne but has not gone away, according to O’Reilly.
“Hospitalizations remain low,” she said. “Our case numbers have certainly gone down.”
However, the city has been far from virus-free, largely due to the unvaccinated.
“A lot of people are still unvaccinated and are still being required to be tested at work,” O’Reilly said. “Or people want to travel so they get tested. That’s where we’re seeing a lot of our positive cases. Also amongst our child care facilities where children of a certain age don’t have the opportunity to get vaccinated, which now they do. So that’s why we’re seeing an increase in cases, but they’ve come down quite a bit.”
While the city can no longer calculate the total number of cases or positivity rate due to the widespread availability of at-home and other testing options and the lack of a municipal site, O’Reilly said that the city has not seen more than 20 cases a day recently.
“I don’t think we’ve gone over 20 cases a day for maybe two to three weeks,” she said.
O’Reilly said this was indicative of the city being in an okay place when it comes to COVID-19. The city is focusing on vaccinations at this stage in the pandemic, which she credits to yielding milder virus cases in the most recent outbreak.
“We’re faring well,” she said. “We’re focusing more of our efforts now on vaccinations, boosters, and testing, as well as COVID-19 antivirals and things of that nature… People are still testing positive, but a lot of the cases we have been seeing in the most recent surge have been extremely mild. That is due, in fact, to the vaccine keeping people out of the hospital.”
The focus remains on vaccinations
While children ages six months to five years old can now receive the vaccine, the city does not plan on reopening a vaccine distribution site, instead relying on local pharmacies and other locations to provide vaccines to residents. The vaccination for COVID-19 will become a part of children’s vaccination schedule, O’Reilly added.
“This is the point in the pandemic where we rely on our partners, stakeholders, and providers, such as pediatricians offices to administer these vaccines to their clients as part of a normal child vaccination routine,” she said. “We are relying on them, but we are also of course partnering with the county and the Hudson Regional Health Commission. They are already vaccinating the six months to five year population.”
O’Reilly said the city will release a list of pediatric vaccination locations in Bayonne soon.
“I’m still waiting on the state to see which vaccine providers in Bayonne had placed an order for this population,” she said. “Once we get that information from the state, then we’ll be abke to further assist the residents with places to go to receive the vaccine.”
O’Reilly had the same advice she has offered throughout the pandemic regarding each resident doing their part to mitigate the spread of the virus: “We’ve all learned a lot throughout the pandemic and one of my favorite terms is personal responsibility. If you’re sick, stay home. Wash your hands. Consult with your physician regularly. Stay safe.”
For updates on this and other stories, check www.hudsonreporter.com and follow us on Twitter @hudson_reporter. Daniel Israel can be reached at firstname.lastname@example.org.