Vermont Monkeypox Rare and Mild

By Patrick Mcardle
THE RUTLAND HERALD
While a case of monkeypox was found in Vermont last week, no other cases have been identified and the virus is not expected to spread as rapidly or as widely as COVID-19 did during the pandemic, according to Dr. Mark Levine, commissioner of the Vermont Department of Health.

Levine said it was also much less likely to be fatal than COVID.

“To put it in perspective, while the level of monkeypox activity in the country is unexpected, the risk to the general population is low and possibly even lower to the Vermont population because there are way more cases in other parts of the country,” he said.

Levine said Vermonters should expect their risk to continue to be low if they avoid sustained physical contact with someone who has monkeypox and shouldn’t fear activities like shaking hands or sitting on a toilet seat “because that’s not how this disease is easily spread.”

“It’s very different than COVID, so it’s hard to draw a lot of analogies. It’s a very different proposition, and it’s something that we would hope, as a country, we can still get under control and prevent going any further,” he said.

Dr. Rick Hildebrant, chief medical information officer and director of hospital medicine at Rutland Regional Medical Center, said the most important thing local residents should know is that the medical community in the Rutland County area is aware of the identification of the illness.

“It’s very rare in Vermont. We only know of one case that has tested positive (but) it’s important that our medical professionals in the emergency department, in our hospitals, in our outpatient centers, are aware of the symptoms, what it looks like and try to test for it so they can appropriately recommend quarantine, testing and, in some cases, treatment,” he said.

Levine said tecovirimat (Tpoxx) the drug used to treat monkeypox, is available but said the drug is not plentiful.

There is a vaccine available for people who are at high risk, primarily because of exposure to someone with monkeypox, but Levine said only a small amount is available in Vermont because there are not many cases.

The vaccine has been used for smallpox, and while Levine said medical professionals expect it to work on monkeypox as well, he said the “real world effectiveness of it in the current context” is not completely known.

He explained that monkeypox, which health care professionals are encouraging people to call, “hMPXV,” is a viral infection that Levine said was in the same family as smallpox but “clearly not as serious” and has only recently been seen in greater numbers in America.

According to the Centers for Disease Control and Prevention (CDC), there were about 7,100 cases of monkeypox in the United States as of Thursday. Numbers in Northern New England remain low with one case in Vermont, two in Maine and 14 in New Hampshire. In New York, however, there were almost 1,750 reported cases.

The federal government declared a public health emergency on Thursday in response to the monkeypox outbreak, according to the Associated Press.

Levine said a person with monkeypox will often initially feel as if they have a flu-like illness and suffer fever, swelling of lymph nodes and aches. But under the current outbreak, many people may bypass the flu-like symptoms and just see skin lesions, which Levine said were “really a rash on the face and on the body.” They can begin as pimples or blisters but become raw, ulcerated lesions which can be very painful.

Comparing monkeypox to COVID, Levine said COVID was almost entirely spread through respiration and therefore, spread through the population quickly and in large numbers.

“This disease (monkeypox) should be rather hard to get because it requires prolonged skin-to-skin contact and can be transmitted through bedding material or clothing. It can be transmitted through respiratory contact but, that’s probably less than 1% of the cases because you have to have prolonged face-to-face contact for that to occur,” he said.

The population among whom the disease is having the most effect is men who have sex with men, especially if there are multiple partners involved or through an event during which many people can be in contact for an extended period of time like a “rave” dance party.

While safe sex was recommended as a way to slow the spread of HIV during the worst of the AIDS epidemic, Levine said the lesions on the body of someone who has monkeypox can be widespread.

“The thing that’s going to help the most — and it requires trusted resources like our health department, like our team that have traditionally dealt with this population of higher risk individuals — is trying to influence their behavior now. And when I say, ‘now,’ it’s really being viewed as now and not forever. Right now, this is not the time to be going to clubs or raves or parties that involve a lot of anonymous contact,” he said.

The Vermont health care community has “very good channels of communication” and partnerships with the community of men who have sex with men, according to Levine, which he said he hopes will allow greater opportunities for education and support.

Levine said it could be a “hard sell” to people who would ask if they’re being asked to change their lives forever but said this was the time to take action because the number of cases in the United States just went up 40% last week. The only way to deter an outbreak is to reduce its ability to spread, Levine said.

“It’s time to be much more restrictive and choose wisely in terms of events that you associate with and that you might become intimate with,” he said.

Levine said there were some parallels between COVID and monkeypox, noting there was a test for both, there was identification of what population was most at risk and there was a vaccine, which was not necessarily available or appropriate for everyone, but available for those at the greatest risk.

Hildebrant recommended that a patient who believes they have monkeypox or have been exposed to the virus contact their health care provider to get more advice, but said if the patient is feeling any symptoms such as difficulty breathing, get to the nearest emergency department. A person who knows they’ve been exposed to monkeypox should be tested, Hildebrant added, especially if they have lesions or pustules.

Levine estimated more than 99% of those who contract monkeypox will recover and few are hospitalized, but most who do get admitted are there for pain management because of the lesions.

For an untreated patient, monkeypox can last two to four weeks but Levine said there are anti-viral medications that can be given to people with a serious case of the virus.

Hildebrant said most patients who are hospitalized for monkeypox are admitted for the purposes of being in isolation. He said he expected there will be some cases in Rutland County at some point in the current outbreak but thought it “exceedingly unlikely” there will be a large number of cases at any given time in Rutland because the disease is uncommon and the symptoms are generally mild.

He added that he believed the medical community in Vermont was ready even after the stresses of dealing with the COVID-19 pandemic.

“I think, if anything, the part of medicine that is engaging, that keeps us excited about coming to work and caring for people is, we can diagnose and treat people with a condition. The thing that was challenging about COVID that I do not anticipate with monkeypox is the change to operations that had to occur. Seeing a clinical diagnosis that you’ve never seen before is in some ways exhilarating for a doctor. They can see how (the disease) acts and make sure the next time someone comes in they can identify it appropriately,” he said.

Levine pointed out that no second case of monkeypox has been identified in more than a week since one case was found in Franklin County, but he added Vermont is not too far from places with higher case counts, like New York City and Montreal.

He said Vermont was not seeing much spread to date, but it was one of the last half-dozen or so states to identify its first case.

“So certainly, the epidemic curve is not changing rapidly in Vermont,” he said.

Hildebrant recommended those with a strong interest check with the CDC website for the latest recommendations, guidance and information.

“Those are evolving rapidly. I will tell you the CDC website has changed dramatically in just the last week in terms of the breadth of information for the public so it really is the best site to go to. They’re updating it regularly to make sure that people are aware of the situation and what they should be doing,” he said.

patrick.mcardle @rutlandherald.com