Treating a cough or sore throat used to be a lot simpler. But since the COVID-19 outbreak more than two years ago, common symptoms have become a potential sign of something more serious.
And now, with monkeypox making its way through the country for the first time in decades, diagnosing the problem is getting even more complicated.
Headache, exhaustion, fever, cough and congestion – these are some of the initial symptoms of monkeypox, a viral disease related to smallpox but generally milder and rarely fatal. Spotting the virus early can be tricky.
“We see around 165 people a day and I would venture probably 45 of them have something on that list,” said Andrew Raposo, nurse director of emergency services at Kent County Memorial Hospital. “We really had to update our front-end process to screen.”
Since June, Kent and other local hospitals have instituted a more stringent process to detect patients who may have monkeypox. Some symptoms now trigger questions about rashes or bumps, recent travel and recent intimate contacts.
It’s one of the steps that health care providers in the state have taken to slow the spread of monkeypox, which the U.S. declared a public health emergency on Aug. 4. Some Rhode Island hospitals are offering treatment options for patients in more severe condition, and more clinics have started distributing vaccines for at-risk populations.
“We want to get the information out there, we want people to be aware that this is happening, what the signs and symptoms are, and to get tested,” said Dr. Philip Chan, consultant medical director at the R.I. Department of Health and chief medical officer at Open Door Health clinic in Providence. Chan is also a member of the Monkeypox Task Force established in July by Gov. Daniel J. McKee to monitor the outbreak and guide the state’s response.
Meanwhile, Providence-based immunology company EpiVax Inc. is looking for a partner with funding and experience to start clinical trials for a smallpox vaccine EpiVax developed that could also be effective against monkeypox.
Monkeypox, a viral disease that predominantly lives in animals but can infect humans, can be transmitted through close contact with lesions, body fluids or through contact with contaminated objects.
For decades, cases of monkeypox have been primarily found in central and west Africa. But in May, a milder variant started spreading globally. Rhode Island recorded its first case in June. As of Aug. 9, there were 31 confirmed cases in the state.
“All patients are being screened, and we have isolation procedures in place for any patients with suspected or confirmed cases,” said Dr. Laura Forman, chief of emergency medicine at Kent Hospital.
As of Aug. 9, there had been 30,189 cases of monkeypox reported globally, with 8,934 cases in the U.S., the country with the most reported cases. None of the U.S. cases has been fatal.
Most cases so far have affected men who have sexual relations with other men, but experts are warning the public not to lower their guard. “It’s important for everybody to be aware of it and not to have a false sense of security that only people who fit into a particular group are at risk,” Raposo said.
While many patients have mild symptoms that fade within a month, some people with more aggressive symptoms can take an antiviral medication called tecovirimat. It has not been approved by the Food and Drug Administration, but early data indicates it is safe and effective against monkeypox.
The medication is offered for inpatient treatment at Rhode Island Hospital, The Miriam Hospital and Newport Hospital, while the Miriam’s Infectious Diseases & Immunology Center and Sexually Transmitted Infections Clinic offer it for outpatients, too.
The only vaccine currently administered against monkeypox is Jynneos, a smallpox vaccine developed by Danish biotechnology company Bavarian Nordic A/S and approved by the FDA in 2019. Jynneos is administered in two doses, but the vaccine has been in short supply.
Since May, the federal government has shipped more than 600,000 doses of Jynneos nationwide. Because of its low case count, Rhode Island has not been allocated as many doses as neighboring states.
As of Aug. 4, Rhode Island had received 1,874 doses, which only vaccinate a small portion of the state’s at-risk population. Department of Health spokesperson Joseph Wendelken said health officials were expecting to order another 650 doses on Aug. 15.
Because vaccines have been scarce, Rhode Island had been offering them only to patients believed to have come in close contact with the virus. But a delivery of 900 doses in early August allowed the state to expand its eligibility to other at-risk groups.
More than 390 people were vaccinated at two community clinics in Rhode Island earlier this month.
“If the higher-risk individuals can all be protected, that may prevent the virus from spreading more broadly,” said Dr. Joseph M. Garland, the medical director of the Infectious Diseases & Immunology Center at The Miriam. “I certainly am hoping that we can get ahead of this outbreak.”