1st case of monkeypox reported in Pima County; new COVID variant keeps spreading

Pima County reported its first case of monkeypox, local health officials announced Tuesday, about a month since the first case appeared in Arizona. The infectious disease comes as a new variant of COVID-19 continues to spread through the county at an “accelerated” rate since early May.

Vaccines are available to treat monkeypox cases in their early stages, but supplies of the shots are limited, Dr. Theresa Cullen, director of the Pima County Health Department, said at a press conference Tuesday.

While only the single monkeypox infection has been reported locally, the rate of new infections of coronavirus is accelerating again, Cullen said. With many people not reporting infections determined through home tests, the real rate of new COVID cases is even higher than the reported numbers, she said.

The new BA.5 variant "has thrown us for a loop," Cullen told reporters.

The first case of the monkeypox in Pima County was found in a man younger than 40, Cullen said, though the CDC still has to confirm his diagnosis. The man is currently in isolation, and county health officials have done contact tracing.

This is also the first case of monkeypox in Arizona that’s been found outside of the Phoenix area, according to county officials.

There were three previous cases in Arizona, according to the CDC. The first case in the state was reported on June 7 in Maricopa County. Nationwide, 866 cases of monkeypox have been reported for 2022 by the CDC.

The county expects to first receive monkeypox vaccines to treat contacts of this initial case before getting a larger shipment on July 14 of 100 vaccine shots. Two doses of the vaccine are needed to effectively treat the virus, Cullen said.

Pima County will become a distribution hub for the monkeypox vaccine along with Maricopa and Coconino counties.

The shots can halt the virus within 14 days of infection, Cullen said. Individuals should be vaccinated within four to 14 days of exposure to monkeypox “to prevent the onset of the disease,” the Centers for Disease Control recommends.

Vaccines will be limited to people whom county health officials consider contacts of the first Pima County case or contacts of cases that may appear in outlying counties, in order to preserve the limited supply of shots.

Monkeypox vaccines won't be provided to the general public, because of the limited supplies, Cullen said. In other places where it’s already been used, the vaccine has only been given to people “who have been known to have been exposed” or “at high risk of exposure,” Cullen said.

People receiving the vaccine "are under the rubric of post-exposure prophylaxis," she said.

The infections can also be treated with antiviral medicines, according to the county.

“It’s highly controllable through simple precautions,” county officials wrote in a press release. “Including consulting a health care provider if displaying symptoms such as a rash, fever, or swollen lymph nodes.”

No fatalities, but a ‘community concern’

Pima County has information online about the symptoms of monkeypox, which are flu-like symptoms that appear in its early stage such as fever, chills, headache, muscle aches, and backaches. A rash or sores can also appear, either before, during, or after the flu-like symptoms, according to the county.

The health department also plans to set up a way to enroll for when the vaccine becomes available for anyone who considers themselves “at risk,” Cullen said. PCHD staff will call and assess whether someone is “at risk” once enrolled.

No fatalities outside of the continent of Africa, where monkeypox originates, have been reported from the current international outbreak of the virus, which began in early May. Globally, 9,647 cases have been reported across 63 countries, mostly in Spain, Germany and the UK.

Unlike COVID-19, the ongoing monkeypox outbreak isn’t considered a global public health emergency by the World Health Organization. Other viruses like Zika, Ebola and H1N1 have received that designation since 2007.

Cullen said that local health officials are responding to the virus quickly, despite the relatively low transmission and death rates, because “one role of a public health department is to respond to community concerns.”

“It’s getting this amount of attention because it’s unique. We haven’t seen monkeypox in the community before,” she said. “Whenever we have a new virus that comes into the community, people are concerned.”

PCHD is working to be able to move fast to manage monkeypox, Cullen said, as the spread of COVID-19 has taught them how to slow the spread of new viruses in the community.

“The good news for Pima County is,” she said. “Because of our lessons learned during our COVID response, we’re quickly able to put together a work plan of how we will respond to this.”

‘Accelerated’ COVID spread

At the same time as monkeypox has arrived on a limited basis, COVID-19 is spreading at an “accelerated” rate in Pima County, Cullen said, despite reporting earlier in this month that cases appear to be “plateauing.”

The most recent COVID case count for Pima County was 2,210 new confirmed cases and 11 deaths from the virus in the seven days leading up to July 6.

That’s a slight decrease from 2,263 new COVID cases and seven deaths from the virus, which was the seven-day number reported on July 1, but an increase from the 1,906 new cases and five deaths reported for the week leading up to June 26, according to the Arizona Department of Health Services.

A lack of COVID test results being reported to county health officials, however, is hiding more accurate numbers, Cullen said.

Pima County has been ranked in the “yellow,” meaning “medium” levels of COVID in the community, by the CDC. It has kept that rating since COVID reporting changed in early March, when cases started to drop off heavily compared to earlier in the pandemic.

The county currently has a transmission rate of 211 new COVID cases per 100,000 people over a seven-day period. It also has a rate of 8 new COVID hospital admissions per 100,000 people for the same period along with 3 percent of hospital beds being used by COVID-infected patients.

Neighboring Maricopa and Pinal County saw a brief surge to an “orange” ranking, meaning “high” community levels of COVID, by the CDC leading into the July 4 weekend. Those two counties and several other Arizona counties — such as Yavapai and Coconino — have seen their community levels drop to “yellow.”

Statewide, 20,198 new cases of COVID and 57 deaths were reported during the week leading up to July 6. That’s an increase from the 16,514 cases and 63 deaths reported for the week leading up to July 1.

Respiratory diseases such as strep throat and the flu were also spreading through Pima County into the summer at a higher-than-normal rate compared to previous years, Cullen said. That's since slowed down, but she recommended people vaccinate against the flu.

BA.5 has thrown us for a loop

Pima County and other counties across the U.S. are battling the spread of the BA.5 variant of COVID-19, which is a subvariant of the Omicron strain of the virus that began spreading globally in December.

The BA.5 variant now makes up 66% of all COVID cases in Arizona, California, Nevada and U.S. territories, a region tracked by the U.S. Department of Health and Human Services. The variant is able to get around the immune system, even in vaccinated individuals, the Arizona Mirror reports.

“BA.5 has thrown us for a loop,” Cullen said, as the Health Department tries to slow the spread, even in vaccinated individuals.

Masking and vaccinating against COVID, including booster shots, is still recommended to stay safe and protect others, Cullen said.

The “major difference” between previous surges and the current spread of COVID, Cullen said, is more “COVID fatigue.”

“County residents, like myself, are tired of COVID,” Cullen said. “What we’re seeing is this inappropriate belief that ‘if I’m (COVID) positive, I can still go do what I want to do,’ so we have subsequent accelerated spread.”

The county’s ability to track the virus is also “limited right now,” she said, because residents aren’t reporting the results of at-home COVID testing.

“At-home testing is wonderful. From a public health perspective, we are 100% supportive of this,” she said. “But there is a responsibility for the person that tests that if they test positive to follow the appropriate guidance,” which is to isolate for five days if fully vaccinated then wear a mask for another five days once out.

Pima County continues to offer free testing and COVID vaccines. Information on free testing sites and self-test giveaways is available online. Hours and locations for free COVID testing, including for children between 6 months and 5 years olds, is also online.

How does monkeypox spread?

Monkeypox spreads through direct skin-to-skin contact with an infected person’s rash, sores or scabs but also by “living with an infected person and sharing their bed, towels or unwashed clothing,” according to Pima County.

Respiratory droplets can also spread the virus, the county reports.

The virus can spread through sex or “intimate sexual contact,” Cullen said. However, the virus isn’t a sexually transmitted infection, or STI, she said, because the most common way to spread the virus is skin-to-skin contact.

“Men who have sex with men” are considered at higher risk for the virus, Cullen said, “though it’s important to note that not all the cases are being identified are in that cohort."

The best way to prevent the spread of monkeypox and other viruses is to “wash your hands after touching someone else and stay home if you feel ill,” the county reports. “Always avoid touching a rash or skin lesions on someone else.”