‘Anybody can get it’: UPMC prepared, says public shouldn’t panic about monkeypox

This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak. Monkeypox, a disease that rarely appears outside Africa, has been identified by European and American health authorities in recent days. (Cynthia S. Goldsmith, Russell Regner/CDC via AP)

Recently declared a global health emergency of international concern by the World Health Organization, monkeypox — initially transmitted to humans from mammals, such as rodents or prairie dogs — is spreading person-to-person worldwide, including in the United States and locally.

“It’s usually spread by contaminated secretions through, primarily, skin-to-skin contact — more so the prolonged, intimate skin contact — as well as through respiratory secretions,” said Dr. Rutul Dalal, director of infectious diseases with UPMC North Central Pa.

Although the virus can be transmitted through respiratory secretions, such as if you are in the proximity of an infected individual for a long period of time — fewer than 6 feet for around three hours or more — the primary mode of transmission is through skin-to-skin contact.

That is one of the major differences between monkeypox and COVID-19, which was commonly transmitted through respiratory secretions.

“[For monkeypox], respiratory secretions come down to No. 2, but No. 1 is skin-to-skin contact,” Dalal said.

Another difference between the two viruses is that, so far, there have not been any fatalities from monkeypox recorded in this country.

“COVID had a 3 to 5% fatality rate, since it was primarily transmitted through respiratory secretion that spread like wildfire, compared to monkeypox, which is slightly more contained and more prevalent in urban areas,” he said.

Monkeypox, in the public perception, is often associated with men who have sex with men.

“Anybody can get it,” Dalal said. “But, initially, the close intimate contact, which is associated with sexual encounters, is the biggest risk factor for contracting this. And for reasons unknown right now, it’s more prevalent in the gay population.”

“But, again, one needs to be careful because it can happen to anybody. It’s wrong for people to ostracize people in the gay population,” he stressed.

“Transmission can be made even to women or even to children or even to straight men,” he added.

The symptoms of monkeypox are a fever, cough, feeling tired, a sore throat, swollen lymph nodes and a rash. The rash, which can begin with a red, inflamed spot and, in some cases, can be itchy, is typical of the disease.

As the disease progresses, usually by the third day, the rash becomes like a dewdrop in appearance, and there are small bags of pus on the skin, primarily on the face and also in the genital and anal areas and then anywhere on the skin, Dalal said.

“It takes around two to four weeks for it to completely heal and the new skin to come in and take over,” he explained.

People who have decreased immunity, due to being treated with steroids or people on certain medications, will have reduced immunity and are at risk. Also, people with HIV with a low c4 count — which indicates an autoimmune disease — people who have a herpes infection, eczema or atopic dermatitis are more susceptible to the virus.

“Those individuals who already have pre-existing skin conditions are more likely to catch it and sometimes have more severe symptoms,” Dalal said.

If you think you might have monkeypox, Dalal said the first thing to do is to isolate yourself. The second is to cover your skin, especially where the rash is located, and then call your health care provider and ask for further advice.

“If it’s severe enough — which means if your eyes are involved, or if the rectal or anal canal are severely inflamed, or if you start having symptoms of respiratory distress such as difficulty breathing or confusion — then you will be prescribed a medication,” he said.

The medication, however, is in short supply, but it is given. The health care provider will then alert the Department of Health.

Then, depending how bad the disease is, you may be able to come in and have a visit with your health care provider.

“But, just giving them extra time to prepare and letting them know that you are coming in would go a long way in containing this,” Dalal said.

The health care provider will examine you and decide if you are a candidate for a special antiviral medication used to treat the virus.

“There are vaccines for the disease, and there is also some evidence that vaccines given for smallpox many years ago are helpful in preventing the infection and, in several cases, can initiate a quicker resolution of the symptoms,” he said.

In the next few weeks, students will head back to school.

“I’m more worried about the college kids coming back from vacation because we see a different spectrum of individuals studying at colleges, as well as they could be in contact with people they shared their vacation with,” Dalal said.

“So, there is a concern that this might be increased, but I don’t think we’ll ever reach the pandemic proportions of COVID as we look back in the last couple of years,” he said.

“But, there is definitely a propensity, and it will increase the caseload in our county,” he added.

At UPMC, they are preparing for that possible scenario.

“The infection preventionists, as well as the infectious disease doctors, such as myself, we are in touch with our local Department of Health authorities,” he said. “Among all the conglomeration of UPMC hospitals, we have had robust policies with regards to how to order a particular test when a suspect individual comes in.

“As we had in the past, we have robust practices in place about how isolation will have to be initiated and when should we give a particular subset of the population the vaccines as we have already seen,” he said.

UPMC is providing weekly updates for its workers through email communications about the situation, giving them proper advice and appropriate phone contacts in the event they encounter a suspected case.

“We are strongly advising people that any rash is to be considered suspicious for monkeypox, and no rash should be touched with bare hands,” Dalal said.

Additionally, Dalal said, UPMC is encouraging staff to use the utmost isolation practices, which include the use of gloves and N95 medical masks when available and isolating patients properly and promptly.

“Communications are coming almost every day; in fact, as we speak today, we also spoke about we are going to start initiating giving vaccines to individuals who are high-risk, most likely starting from [Monday],” Dalal said.

One thing Dalal emphasized is not to panic about monkeypox.

“This virus so far has not shown any evidence of being fatal. Like COVID, masking and hand hygiene go a long way in protecting oneself, and whenever suspicion is there for you or your loved one to have a particular case or if you’ve been exposed to somebody, promptly isolate yourself and contact your health care provider as soon as possible,” he said.

With the Little League Baseball World Series bringing people from all around the world to town this week, Dalal said, “more people should be around, and all the more reason why we should be diligent and be watchful for any kind of suspicious symptoms.”

For more information on monkeypox, visit the Centers for Disease Control and Prevention website, https://www.cdc.gov, or the World Health Organization website, https://www.who.int.


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