On this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes infectious disease specialist Dr. Mark Burns of UofL Health and Louisville’s V.A. Medical Center to discuss fall 2022 developments in the COVID-19 pandemic, the spread of monkeypox, and a rise in sexually transmitted disease rates.
A Pandemic That May Be Less Dangerous But Still Prevalent
Even though President Joe Biden declared the COVID-19 pandemic to be “over” in September, Dr. Mark Burns says the coronavirus is still very much a part of daily life in the U.S. and the world. First introduced into the American population in the waning days of 2019, the virus continues to evolve and develop new ways to attach itself to human cells in order to survive, he explains.
“COVID in and of itself, despite what the president said, has not gone away,” he notes. “But the great news is, we’ve come up not only with vaccines for this, we also have therapeutics, we have treatments for this too. So we’re in a much better place than we’ve ever been before.”
While COVID-19 infection rates in Kentucky have declined through the late summer and early fall, Burns says we should be prepared for cases to spike during the winter months as people spend more time indoors. He recommends that folks consider proven methods to prevent transmission like social distancing and masking, depending on the amount of local community spread, and also the health risks COVID poses to themselves and those they live with.
The best option to reduce the risk of getting severely ill from the virus is to be vaccinated, Burns advises.
“We now have the new bivalent COVID vaccine,” he says. “What that does is protect not only against the original ‘wild-type’ COVID, but also Omicron and its potential variants and subvariants.”
Many people hesitant to receive one of the vaccines argue that they don’t prevent infection, but Burns emphasizes that the primary objective of any vaccine including the ones for COVID is to prevent serious illness, hospitalization, and death from the disease. Those grave outcomes have plummeted since the early days of the pandemic, all due to effective vaccines and treatment, Burns says.
When asked whether COVID-19 will ever be completely eradicated, Burns warns that prior predictions of such a scenario by many leading experts, including Dr. Anthony Fauci from the National Institutes of Health, have not come to pass.
“I will say this, though: The more people that get vaccinated, the more people that become immune to this, the virus will have no place to go and to reproduce,” he says. “The reason we get these variants in the first place is because of viral replication, so if people are protected, if people are vaccinated, the virus has no place to go to replicate – and if it can’t replicate, it cannot mutate.”
If a person develops COVID symptoms or comes into contact with someone with the virus, Burns recommends getting tested at home or in a clinic. If positive, the person should isolate until five days after the positive test (assuming all symptoms have ended by day five) as per new guidance from the U.S. Centers for Disease Control and Prevention, and then wear a mask around others and socially distance for another five days.
Burns says Paxlovid, also known as nirmatrelvir, is the most effective antiviral treatment for COVID currently in use.
“That should be started within the first five days of testing positive,” he advises. “Paxlovid is what we call a protease inhibitor – it actually blocks the proteins that the COVID needs to reproduce itself, thus rendering the virus ineffective.”
The Threat of Other Infectious Diseases, Old and New
Over the past several months, the monkeypox virus has spread through the U.S., causing no small degree of alarm among the general public and infectious disease specialists, although the virus is far less transmissible than COVID.
Monkeypox, which is in the same family as smallpox, was found in monkeys in the late 1950s, Burns explains. The first human case was diagnosed in 1970, and until recently the virus was mainly confined to west and central Africa. It is passed from person to person primarily through intimate contact such as sexual intercourse and kissing, and Burns says the majority of cases in the U.S. so far have been found in homosexual or bisexual men.
“It can happen to anyone,” Burns cautions. “It started in this (specific) population, but if it goes on long enough, it will likely spread to the entire population, no matter the sexual orientation.”
Monkeypox initially presents with viral symptoms such as fever, cough, and muscle aches, Burns says. Eventually two unique characteristics develop: swelling of the lymph nodes, and a blistering rash. As of late September, Burns says about 50 cases of monkeypox have been confirmed in Kentucky.
For people with a healthy immune system, monkeypox is self-limiting, according to Burns. Treatment for these folks should focus on alleviating discomfort from symptoms, such as the rash until it subsides.
“For people who are immunocompromised, they can have problems with (monkeypox), anywhere from sepsis, encephalitis, and possibly even death,” he says.
While there are no specific vaccines for monkeypox, Burns says the Food and Drug Administration has granted an emergency use authorization for a smallpox vaccine to prevent monkeypox.
“We’re getting those (smallpox) vaccines from stockpiles,” Burns explains, “as the last cases of smallpox were found in 1977 and it was declared eradicated in 1980.”
With COVID and monkeypox gaining so much media coverage, rising incidence rates of common sexually transmitted diseases have received scant attention. But Burns says gonorrhea, syphilis, and chlamydia remain significant public health concerns. There’s no consensus opinion on the main cause behind the current increase in STDs, but he notes that one possibility could be a spike in drug and alcohol usage during the pandemic, which led to more risk-taking sexual behavior.
The three STDs are treated with antibiotics: penicillin for syphilis, ceftriaxone for gonorrhea, and azithromycin for chlamydia. The long-term complications from gonorrhea and chlamydia are mainly restricted to infertility, Burns says.
“Syphilis is a lot more problematic,” he says. “It can actually lead to neurologic deficits and blindness as well. A lot of people in their later years who have never been treated will begin to have these types of problems.”
If a person is diagnosed with a STD, Burns advises him or her to contact their local public health department, which will record the positive case and then assist with contact tracing to identify and inform all sexual partners.
“Condoms, used consistently, do help prevent the spread of all of these sexually transmitted diseases, both for males and females” Burns says.