Here's the extended version of Karyn's interview with Dr. Stack:
‘One on One’ Dr. Steven Stack_Monkeypox Interview 7/26/22
Karyn Czar:
You're listening to 'One on One' with WUKY I'm Karyn Czar and joining me one on one is the Commissioner of the Kentucky Department for Public Health, Dr. Steven Stack. Dr. Stack thank you so much for joining us. I wanted to get more information for our listeners from you today about monkeypox. On Sunday, the World Health Organization declared the spread a global health emergency now the US Health and Human Services Secretary Becerra says that the level of concern, his level of concern of the outbreak is now a 10 out of 10. But it hasn't been declared a public health emergency in the US. Do you think it should be at this point? And if not, when do you think that shift would happen?
Dr. Steven Stack:
So monkey pox is a major concern at this point it has spread around the globe. And the number of cases that are out there are almost certainly more than we are fully aware of. So I do support the escalation in concern and people being very serious and intentional about trying to address it as quickly as possible. The declaration of an emergency at the national level I'm sure has other implications and ramifications that I think I'd probably be better off to defer to the people at the federal level determining when that would be appropriate.
Karyn Czar:
And Dr. Stack, how does monkeypox compared to other global health emergencies we've had, most recently of course COVID or say SARS, in terms of spread?
Dr. Steven Stack:
So monkeypox is most certainly not COVID. COVID spread very easily and in the current BA.5 variants, spreads alarmingly easily. Where one person might infect more than 18 others. Monkeypox is not COVID. Not even close to that. In order to get monkeypox, you have to have close physical contact or proximity with someone. Usually it is direct skin to skin contact. That can be intimate contact, or it could be people dancing, when they're, you know, incompletely clothed and brushing up against each other. But it is not something you get casually just sitting in a room with someone or someone that you pass in a grocery store. You don't just pick up monkeypox from someone, it is much harder to transmit in that regard. And so for the general public, the risk remains exceedingly low. But it is a concern, nonetheless, because it's a disease that had not previously extended outside of and taken hold in places other than central and western Africa. And now what we're seeing is it is popping up throughout the world, and certainly across the United States.
Karyn Czar:
What are the risk factors?
Dr. Steven Stack:
So at present, this disease is impacting disproportionately a specific community and population. I'm going to comment on that directly, because the people in that population need to know that they have elevated risk, and that they should take extra care and precautions to avoid the risk. But for the general public, it's very important one to know at the moment, your risk is low. But that this is a disease that spreads by close physical contact with people, it is important for all of us to try to keep it contained. And it's important for all of us to recognize that we could all be at risk if we don't work together and we shouldn't inappropriately stigmatize or be critical of others just because it's not our community or population. So the population most directly affected at present is the men who have sex with men community. So generally gay males or bisexual males. And in that population, when they have close physical contact with each other, that is how it is spreading through that direct skin to skin contact. And so for individuals who are in the MSM or male who have sex with male community, you absolutely need to inform yourself, make use of the CDC resources on their webpage and other public health education information to lower and reduce your risk from getting and spreading this. Thankfully, people are all recovering from this, it is a very low risk from any kind of mortality. But it's an unpleasant disease, you have a skin eruption that can be painful, and people can have a very unpleasant course and it is a longer illness and that you can be pre-symptomatic for a week or two while it incubates and then it can take two to four weeks to get through the entire illness. So it is not something you want to get if you can avoid it but thankfully, it's not going to have the mortality figures that COVID had by a longshot.
Karyn Czar:
Dr. Stack, what is the best course of action if one you've come in contact, and you feel that you need to be tested? Where should you go to be tested?
Dr. Steven Stack:
So if you feel you have had exposure, you should talk with your primary care medical provider or if you go to a specialty clinic, so if you are an individual living with HIV or AIDS, you could ask your HIV AIDS clinic to assist you. But you should seek medical care and evaluation if you think you have the disease or consultation if you are concerned you could have been exposed and are in that high risk community of men who have sex with men at this point. This is not something you go to just the regular health department for, it is something you have to go seek regular medical care for evaluation. Now if you have a rash, that is the only way we can test you. You actually have to have the rash. Then private community can now send specimens for testing from Kentucky. Five different laboratories: Labcorp, Quest, Aegis, one called Sonic and Mayo Clinic. There are ways for medical practitioners, clinics and facilities and hospitals in the community to be able to send specimens to them to test a rash to see if it is in fact monkeypox.
Karyn Czar:
And how many cases are currently confirmed in Kentucky?
Dr. Steven Stack:
We believe we have six so far.
Karyn Czar:
How are we as far as supply in Kentucky when it comes to testing and when it comes to more importantly, the vaccines?
Dr. Steven Stack:
So for the testing, this is, again different than COVID because the only way to get tested is if you actually have a rash that looks like monkey pox for someone to use a specialized swab to brush the actual base of the lesion on your body. So you can't just go get tested thinking, Oh, I may have been exposed, I want to get tested. Until you actually develop the illness, and have a rash, we don't currently have a way to test you. So the first thing is, don't go rushing out and saying I think I was exposed, I want to test because that just won't be possible. If you develop a rash though, go seek medical care, and describe how you think you may have been exposed, and they'll review your risk factors with you and if you're high risk, or if there's any other concern, they can collect that specimen hopefully or refer you to somewhere that can and you can use that at the private labs. As far as therapeutics and other things, the vaccine that we have for this, there are two vaccines that are possible. One is the older one, called ACAM2000, which is approved for monkeypox. That is not being used in any significant way around the country because it has limitations. It's a live virus, and you have to scratch the skin to put the virus under the skin and then there's actually replicating or reproducing virus in that. You have to keep it covered for an extended period of time and if you don't, people who don't keep it covered and exercise very high hygiene with that can spread it to their own eyes, the rest of their body or to other people and people who have immune compromised and conditions can have a very serious illness from that. So that vaccine is not being used in any significant way at present. The second vaccine, which does not have those risks whatsoever, is called JYNNEOS and that one unfortunately is available in exceedingly limited quantities. And just to put that in very concrete terms, we received only 296 doses for our first allocation about another 300 for the second allocation and I think we have in our third allocation will be about another 900 more. So if you add all of that stuff up, it's only in the ballpark of 1600 doses give or take and it's a two dose vaccine, which means we will only have enough through our first three shipments to treat with the vaccine about 800 people. So it is not possible for the general public just to go out and get vaccinated. At present, the only way to qualify for it is to be in a confirmed high risk population, in high risk settings where you may have either had direct firsthand exposure to the virus, or perhaps and they call this a f plus plus or post exposure prophylaxis plus plus approach, where you are in a high risk community at a high risk setting. So perhaps you went to an event or a gathering, that was considered to be high risk because monkeypox was in fact confirmed there. In those instances, if there is enough vaccine available, we may do broader vaccination to reach some of those additional individuals.
Karyn Czar:
But currently, and I want to make sure I'm accurate here, you have to be in that high risk group and know that you were exposed correct? Both of those two criteria?
Dr. Steven Stack:
Right. So it present, again this is all subject to the limitations of quantity. When the quantity of vaccine available increases, we will rapidly make it available to high risk persons as much as we possibly can. And ideally would change over to a pre-exposure prophylaxis model where if you're a high risk individual, we would offer you the vaccine so that you receive it and have the benefit of its protection. But that's not going to happen for many months down the road if not longer. So for right now, you will either have to have had a confirmed exposure to someone with active monkeypox, or you have had to have been at an environment or a gathering where you and the environment were both high risk in order to qualify and then it's of course all subject to the availability of supply.
Karyn Czar:
Where should someone go to get the vaccine if they need to and they qualify?
Dr. Steven Stack:
Well, first, you should go seek medical care and if you test positive that will be recorded the public health and public health will engage directly with the individuals who test positive at this stage of the response and encourage people or recommend where they can go if they're eligible to get vaccinated. So at present, it'll probably be just through a handful of health departments, because we've only been able to distribute a small quantity to a few health departments distributed around the Commonwealth and it's not available for people to call those health departments and say, Hey, I think I have this, I'm in high risk. It's only available if you meet the epidemiological criteria to be high risk. And in fact, then we may ship secondarily to other locations where they can actually administer it to people.
Karyn Czar:
Dr. Stack, what's your greatest concern at this point regarding this virus?
Dr. Steven Stack:
Well, my concern is multi fold. One, people have pandemic fatigue, we're not yet over with COVID. And as our case numbers escalate, in COVID, now, and then we look to the fall with kids going back to school and cooler temperatures that will drive us back indoors, we still have this ongoing global pandemic with COVID, which has caused so much disruption and harm. And the concern would be that this new epidemic which could meet criteria now for a pandemic is it's spreading around the world. If this takes hold, people are tired, they're tired of being disrupted in their daily lives by these infections, and that is what it is. So one, we have to overcome that fatigue and take this seriously because if we don't, we do so at our own peril. The second thing is, at the moment, it continues to be a challenging messaging task. We need to reach and we need to make sure the community of men who have sex with men and so, gay and bisexual males understand this is currently in that population, right now. You have to take extra steps to become informed and reduce your risk so that you don't get this because we don't have enough vaccines, and enough access to things to help mitigate your risks so you have to take active steps to modify your risk profile. But the second thing is for the general public to understand that this is a disease that started in one community but could very easily get into other communities because of the way it spreads. So we all have to pull together and just like we did in COVID, where we were supportive to each other and kind and concerned for each other's well-being and welfare, we absolutely have to apply that same approach now with monkeypox. We're all in this together and just because it is currently in one community of the MSM population is no reason to be confident that it won't subject more and larger groups of individuals to the disease. So it's important for us all to look out for each other and take the steps we need to lower the risk.
Karyn Czar:
That was actually one of the questions I had for you. Because I've heard some response from people when I've been out in the field of oh, well, I don't have to worry about that because that's not going to affect me. We don't know that. And there's already been, what two cases in the US of children who've gotten it?
Dr. Steven Stack:
And so I don't know the exact number. But yes, I know that there have been confirmed cases in children. There have also been confirmed cases in women. And again, it could be any other disease, right? If you had chickenpox, right, and the chickenpox just started in a community of children, right? It may stay in children because they're in schools for a while but then once those children start going home and exposing adults, right, it starts to spread more. Now, again, this is a disease, monkeypox, that at present still appears to require pretty significant personal or physical contact between people to have a significant risk of transmission. But I think we underestimate how much we mix and match with each other and interact with each other and just how easily this could spread from the community it started with into other communities and then take hold and impact a lot more people. So people should not ignore this. The general public should not be fearful. But we should be attentive to supporting everybody who needs to know that this is a major concern and take the steps we can to reduce its spread.
Karyn Czar:
Dr. Stack I can't let you off the hook without asking a COVID question. What are your thoughts on Jefferson County Public Schools doing the mask mandates again as of now, which could be in effect when school starts depending on their what color their county is? Are you hoping more schools will fall in line as we get closer to the first day of classes?
Dr. Steven Stack:
I support Jefferson County Public Schools taking the steps they feel are necessary to keep their students, their staff and their other employees’ safe and the parents of the children and their family members when they go home. So I support them having taken the step. It is consistent with our guidance, which is on our website, which says in red counties, people should consider wearing masks and all indoor spaces. And I spoke publicly in support that Toyota made a similar decision at their Georgetown manufacturing facility when their county went red. Now, I will also say though, and this is again difficult because messaging nuanced and complex, we are solidly at a stage where individuals who are at high risk have got to take extra precaution to protect themselves. Because the rest of society at this point is in a different phase where the individuals at highest risk needs to take measures to reduce their risk, recognizing that a lot of people out in public aren't going to be wearing masks. And as we follow the metrics for the number of new cases and things like the frequency of testing and the burden on hospitals and health care capacity. What we see now is even though the cases are markedly elevated, and even though the demand on healthcare resources at hospitals has increased, the demand for the hospital resources has increased very small, relative to the much larger increase in cases. And so the combination of widespread vaccine availability, and even in here in Kentucky, I think it's 77% of the population 18 and older have been vaccinated, I think it drops to 70% when we go to five and older, and of course, we just recently opened up to the younger cohorts. So the combination of vaccines, plus the widespread number of people who have been infected, has provided some level of community protection. And so now I think what we're seeing is the virus becoming a little less severe, and people through their natural exposure, and then also through their vaccine protection, seeing that the population is not suffering the same adverse consequences. But as long as the virus is multiplying and spreading, it has the opportunity to mutate, and we have to all be very hopeful it doesn't mutate into something more severe again.
Karyn Czar:
What are you going to feel like the day you actually get to say endemic?
Dr. Steven Stack:
Well, what do I feel like? We're the day we can say endemic, I'd be very curious day, because I'd be curious how they reached that final determination. There's no flip of a light switch. It's kind of one of those things where you look back in history, and you may be able to say, Aha, there was an inflection point. It's much harder to do that when you're living life in the present moment. So when we get to that point, it'll be a relief, if it means that we can kind of be back to sort of this is regular part of life and adjust to it but remember endemic doesn't mean it's gone. Endemic means it's there, like all the time, like the flu. And so every year, we have 10s of 1000s of people who die in the United States from influenza, and COVID, has been much more fatal than has the influenza virus. And so mortality rate is still over 1%, globally, nationwide, and in Kentucky for COVID overall. So the concern I would have is that when it becomes endemic, we don't have to talk about it as much, but it doesn't mean people don't still need to be aware of it is a risk in our daily lives. I think that we will see that people have to take extra precautions, if you're in a high risk population for quite a while to try to reduce your risk of serious harm from the disease. But this too, we shall overcome. Challenges look very big in the present moment, may look big in hindsight, but humanity has shown over and over that where there's a will there's a way, and that there's a very high likelihood we'll find a way to adapt and coexist with COVID.
Karyn Czar:
Dr. Stack is there anything else you'd like to add that I didn't ask before I let you go?
Dr. Steven Stack:
I would just share this. So, Karyn as we talk about the COVID pandemic, which still has not left us alone and monkeypox, which is now the new and emerging disease. And there's other diseases we haven't talked about Syphilis is on the rise. Multidrug resistant bacterial infections are on the rise. There are a number of concerns. And I would just want the listeners to know, public health is here every day, doing the very best we can to work with society and the healthcare community to keep us safe, to reduce our risks and to give us the information we need to try to be informed and take steps that can help keep us all safe and healthy. And two, the thank the people in Kentucky because I know that at some point, hearing all this science and all this medicine may get fatiguing, but I just want to thank people for listening and coming to us as a trusted resource. So that together we can all get through these things better. If we ignore them we do so at our own peril. And I think in Kentucky we have gone through a difficult but bonding journey over the last two and a half years where we've shown that if we come together our communities can be one of our greatest strengths.
Karyn Czar:
I've been joined by Dr. Steven Stack, Commissioner of the Department for Public Health here in Kentucky. My sincere thanks to Dr. Stack for always taking time to bring the latest health information to you our listeners. And my thanks to you for joining us 'One on One' with WUKY.
