Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is truly a radical selfless act of loving others (read: we need to redefine what it means to be healthy), “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week. This week I’m answering three questions I am being asked frequently these days.
Hoping these posts help to educate and empower you to be healthy and create healthy communities.
Here we go… Three Things Thursday.
Is COVID endemic yet?
There is no simple answer to this question. And that is because there are several definitions of endemic. According to the Dictionary for Epidemiology, a disease is endemic when there is a constant presence or a usual/predictable prevalence of disease in a population. Others, however, define endemic to mean that the average infected person infects less than one other individual (meaning the R-naught is less than one). And still, others say that to be endemic the footprint of the disease is consistent (the same number of cases, hospitalizations, and deaths).
So — endemic? or not?
Honestly, it is hard to say. If we use the definition based on the R-naught, COVID is DEFINITELY not endemic right now. There is a lot of disease in our communities. Some forecasters are predicting that it is possible that 80 percent of all COVID cases could occur in 2022; making it the most deadly infectious disease (on par with the number of deaths per year from diabetes). That’s a lot of COVID!
COVID continues to circulate — making people sick and upending all of our lives.
What should we expect in the fall?
I am expecting that Omicron-like variants will continue to spread and people will continue to be sick. Many of the mitigation strategies used last school year — distancing, testing-to-stay, masking, quarantine/isolation — will likely not be in place this year (CNN is reporting CDC will be releasing back-to-school guidance at any moment; I anticipate it will be released late on Friday afternoon).
Regardless of whether COVID has become endemic or not, we all need to take steps to prevent the spread of COVID, protect ourselves, and build healthy communities. This means we must all take responsibility for —
Getting vaccinated.
Staying home when you are sick.
While you might be able to go to work and push through with a cold, stay home. Keep your germs to yourself. Do not expose others; stop the chain of transmission from person to person. This also means we must also keep our kids out of school when they are sick.Wearing a mask if you have been in close contact with someone who has COVID or are in a crowded indoor space with limited airflow. New guidelines for creating healthy indoor environments are available.
Encouraging people to seek out COVID testing and treatment.
Do not make fun of someone or out them for testing positive for COVID. Or the flu. Or for having lice. These are infectious diseases; they are not a joke nor should we be gossiping about them. Diagnosing an illness allows for proper treatment and slows the spread of disease. Let’s work to create a healthcare system where seeking testing, getting diagnosed, and receiving treatment and instructions for isolation are the basic tenants of the healthcare system and the rights of all individuals.Recognizing the amount of stress we have experienced individually and as a community during the past two years. Let’s be supportive and loving toward our neighbors, friends, community leaders, teachers, and school nurses, among others.
I’ve had COVID. Now what?
There are so many questions (and some conflicting answers) related to when one can return to work/school after they’ve been sick with COVID. According to CDC, an individual diagnosed with COVID must isolate for a minimum of five days. At the end of those five days, you can return to normal activities IF you have been symptom-free (without medication/treatment) for at least 24 hours. CDC does encourage individuals to wear a well-fitting mask for an additional five days (after symptoms are gone).
But the big question is… how can I be sure I am no longer contagious?
Several infectious-disease experts said they believe patients with COVID should have a negative antigen test — which gives results within minutes — before exiting isolation. The CDC currently leaves that as an option and does not explicitly recommend it.
Here’s what you need to know — the peak period of viral shedding starts about a day or two before symptoms appear (what we call asymptomatic spread) and continues two or three days after an individual is symptomatic (or tests positive for COVID). Experts say it is very unlikely an individual will pass along the virus after 10 days even if a person still is testing positive.
Tom Inglesby, director of the Johns Hopkins Center for Health Security, recently told The Washington Post —
“Given that a substantial portion of people do have a rapid positive test after five days, I think an updated recommendation should include people having a negative rapid test before coming out of isolation for COVID.”
If you’ve had COVID, you should stay at home (isolated from others, if possible) for at least 5 days. If at the end of those five days, you have been symptom-free for at least 24 hours, you can return to your normal activities. To be extra cautious, take a rapid test to be sure you are negative and wear a mask for another five days.
Please note — many people are reporting experiencing several (upwards of 4-6) days of symptoms. Omicron-specific symptoms include fatigue, fever, a cough, runny nose, and scratchy throat.
Stay home if you are sick.
Can monkeypox be spread asymptomatically?
There has been a lot of talk recently about how monkeypox is spread. And concerns are rising, as several more children across the United States have been diagnosed with the disease and back-to-school season is here. We know monkeypox is spread through skin-to-skin contact, droplets (close contact with another person), and contaminated sheets, towels, or clothing. There is also increasing evidence that the monkeypox virus can be found in semen, making this a disease that can be transmitted through sex (both through the close contact that sex requires and bodily fluids).
To complicate matters more, earlier this week a pre-print (read: a research paper that has not been peer-reviewed) was released online. It is titled Asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium. The study was conducted retrospectively (meaning cases of monkeypox were found first and then the researchers looked backward to determine what had happened in the past). They identified three men who had monkeypox antibodies (evidence of the previous infection). All three men reported NOT having any symptoms of monkeypox. The researchers concluded —
“We found evidence of asymptomatic monkeypox virus infection in three individuals.”
The researchers go on to say —
“The existence of asymptomatic monkeypox infection indicates that the virus might be transmitted to close contacts in the absence of symptoms. Our findings suggest that identification and isolation of symptomatic individuals may not suffice to contain the outbreak.”
I think this is a BIG JUMP in logic.
Just because three cases of (reported) asymptomatic monkeypox were identified, this provides ABSOLUTELY NO EVIDENCE that the disease was spread through individuals who were asymptomatic. In fact, the researchers reported that the contacts of the three cases were traced and none of those contacts tested positive for monkeypox. Meaning the three cases identified in the study did NOT transmit monkeypox to any of their contacts.
We cannot conclude from this study that monkeypox is spread asymptomatically.
What is needed is more research.
For now, we need to focus on what we do know. And take steps to break the chain of monkeypox transmission by staying away from individuals who have symptoms of the disease, talking openly with sexual partners about symptoms of disease, and cleaning hands, clothing, bedding, and other objects that may have been touched by a person with monkeypox.
If you or someone you love develops a rash, contact your physician as soon as possible.
Questions? Please ask — only when we understand a disease and how it is transmitted can we control its spread and create healthy communities.