Blood sample tube positive with Monkeypox virus, new epidemic disease in 2022. Credit: Getty Images
A South Florida doctor urged the federal government on Monday to ease access to tecovirimat, a medication that’s demonstrated effectiveness against the monkeypox virus but remains widely unavailable because of health regulations.
“It seems to significantly shorten the duration of illness — that’s what I’ve gathered from my patients,” Dr. Zachary Henry, medical director of the Aids Healthcare Foundation clinic in Broward County, said during a Zoom press conference hosted by Agriculture Commissioner Nikki Fried.
“So, someone who might be stuck in isolation with visible signs of rash for six weeks, by taking the tecovirimat properly, it shortens it to one to two weeks,” Henry said.
As he spoke, the Florida Department of Health was reporting that monkeypox infections had surpassed the 400 threshold in the state — specifically, that there were 442 confirmed or probable cases including 211 in Broward and 108 in Miami-Dade counties. Palm Beach County accounted for 27 cases and Orange County for 26. Twenty-two counties reported at least one infection.
The U.S. Centers for Disease Control and Prevention reports 22,484 confirmed cases worldwide, including 4,906 in the United States.
The disease has mostly spread among men who have sex with men, but it’s also been reported in women and children. According to a Washington Post report on June 22, one case involved a toddler living in California; the other an infant from overseas whose family was traveling in Washington, D.C.
The Florida data show four cases in people in the 15-19 age group — two in Miami-Dade and one each in Broward and Lee counties — but none involved anyone younger than that.
Federal health agencies began the research that led to tecovirimat following the Sept. 11, 2001, attacks out of fear some terrorist organization could weaponize smallpox, which is related to the monkeypox virus, according to a report by the medical news organization Stat.
The feds have approved tecovirimat as an investigational treatment of smallpox and has 1 million doses on stockpile, but for monkeypox it’s largely available only through closely regulated clinical trials — although Henry said his clinical network has had access to the drug.
According to Henry, the feds are targeting the drug toward “people who are very young, pregnant, immunosuppressed, people who have lesions in atypical sites such as mucous membranes.” Also targeted are people with complications including bacterial infections at the site of the monkeypox rash, he said.
“Something that politicians and people who are viewed as leaders within the community need to be doing is helping to push to have the restrictions on tecovirimat lifted. That would make it more easily prescribed by more physicians both across the state of Florida and across the country,” Henry said.
‘We need more vaccine’
Demand for treatments is high, said Robert Boo, CEO of the Pride Center at Equality Park in Broward County, a community center for the LGBTQ population that provides HIV testing and education.
He said his clinic was the first in Broward County to offer vaccine doses.
“We had 864 appointments at our clinic and those filled up within 15 hours. We were then offered an additional 180 vaccinations; those filled up in an hour and a half. And then, last, 864 [doses] were offered through the Department of Health; those filled up in three hours,” Boo said.
“So, the fear is in the community. The concern is there and a lot of people are wanting to get vaccinated,” he added.
“We need more vaccine, more doses, more jabs in the arms, and more vaccination sites, and then more of a campaign to educate the general community such as PSAs,” Boo said.
Fried’s appeal to Washington
Fried wrote to the U.S. Department of Health and Human Services last week urging stepped up deployment of tests and vaccines but said public awareness is also key to containing the outbreak.
“That’s what we are doing here today, and that’s why it is so important for members of the media to help us get this message out and make sure the information is being spread,” Fried said.
She’s seeking the Democratic nomination to run against Gov. Ron DeSantis in November.
The Florida Department of Health has posted this summary of the disease on its website:
“Human-to-human transmission generally requires prolonged, face-to-face contact, direct contact with an active rash, or indirect contact with an active rash through contaminated items, such as contaminated clothing. Therefore, the risk of exposure remains low.”
Hosts don’t appear to spread the virus during its incubation phase, Henry said.
“It is only once the person becomes symptomatic with the onset of systemic symptoms — typically, fevers, chills, sweats, body aches, lymphadenopathy [lymph node swelling], and then two days later the onset of a rash,” he said.
“I’ve seen patients where their last potential point of exposure was three to five days prior. I’ve seen some people go an entire month. I think, if you look it up in the general literature, the consensus is about two to three weeks,” Henry said.
People concerned about possible exposure should get tested and treated as soon as possible, he continued, because they are unlikely to be infectious until the onset of symptoms.
“Being vaccinated before symptoms start stops the infection in its tracks. You typically will not develop symptoms — you can never say never, unfortunately — but typically will not develop symptoms.” Additionally, they’re less likely to develop symptoms and infect others.
If you do test positive, you need to completely isolate, Henry advises. That’s because in mild cases patients can mistake the monkeypox rash for something more benign, like mosquito bites, and can risk spreading the disease. The incubation period can last between three to six weeks. The infection won’t have run its course until all pustules have scabbed over; that’s when it’s safe to leave isolation, he said.
Both doctors praised the response from public health officials in Broward. “I don’t know if that has been the case in all of the other counties. It needs to be a statewide approach,” Boo said. “It doesn’t know any borders.”
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