Chatham’s health voices on monkeypox, long COVID and more


New COVID case counts continue to drop — down 25% the last two weeks across the U.S., and trending down since mid-July — and more discussions center around whether the pandemic is “under control.”

But with Chatham County home to its first case of monkeypox and COVID mutations continuing — faster, in fact, than the world’s dominant flu strain — we checked in with Chatham’s resident health experts on those and a variety of related topics, including long COVID, the pandemic’s fall outlook and the flu vaccine.

For this wide-ranging conversation, we spoke with Johnsie Hubble, RN, MPH, the infection preventionist for Chatham Hospital, and two men from the Chatham County Public Health Department: Director Mike Zelek, and Public Information Specialist Zachary Horner.

Chatham has its first case of monkeypox. Remind us how serious/significant this virus is, particularly in terms of transmissibility…

JOHNSIE HUBBLE: Monkeypox is a rare but serious disease caused by a virus. It is endemic to Central and West Africa, circulating in rodents and causing occasional human outbreaks there. This past summer we also saw cases in many other countries, including the U.S. In those infected it causes a variety of symptoms, including fever, chills, swollen lymph nodes, fatigue, body aches, headache, sore throat and cough. Most all get a rash located almost anywhere on the body that goes through stages of pimples, blisters and then scabs. A person is contagious until the scabs fall off and the underlying skin is completely healed. It is spread through close, personal contact, most often by skin to skin contact. Most cases in North Carolina have been in men who have sex with men, and within that group, about 60% have been African American men. We do not have any specific information on the case in Chatham County, and that is to protect the identity of the individual. The physicians at Chatham Hospital are aware of the national and state outbreak and know what to look for to identify a case.

Has news of this first case generated any particular concern for your offices?

MIKE ZELEK: While the news hits home when it is in our county, we were mindful that there were more than 500 confirmed cases of monkeypox in North Carolina at that time, including in surrounding counties. For us, it is an opportunity to continue to encourage those who are eligible to get vaccinated, and for those with potential symptoms to reach out to their doctors.

Shifting back to COVID: a new report shows that 24 million U.S. adults have “long COVID,” with more than 80% of them having some trouble carrying out daily activities. Nearly 30% of adults previously infected with COVID reported having long COVID at some point. Can you share what we need to know about long COVID, and your experience of it (from a personal and professional perspective)? And is there a “normal” recovery from COVID?

ZELEK: Long COVID is an unfortunate reality for many. It also includes a range of symptoms of varying severity and duration, and there is no test to diagnose it. I expect that the statistics don’t completely capture those with mild or intermittent symptoms.

I have talked to many who haven’t completely recovered months after being infected. The most common symptoms of long COVID are fatigue and brain fog. For me, nearly three months after having COVID, I would say I have recovered other than occasional mild symptoms like fatigue. But it has become clear that “normal” recovery is tough to define since experiences are so varied. And I am hoping the bivalent booster I got today will not only reduce COVID symptoms if I am exposed, but also reduce the risk of long COVID.

HUBBLE: Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as post-COVID conditions (PCC) or long COVID. It can last weeks or months or longer. It is found most often in those who had severe COVID-19 illness, but anyone infected can develop symptoms of long COVID. Long COVID can be considered a disability under the American with Disabilities Act (ADA). Examples of common symptoms of long COVID include:

• Tiredness or fatigue

• Difficulty thinking or concentrating (sometimes called “brain fog”)

• Shortness of breath or difficulty breathing

• Headache

• Dizziness on standing

• Fast-beating or pounding heart (known as heart palpitations)

• Chest pain

• Cough

• Joint or muscle pain

• Depression or anxiety

• Fever

• Loss of taste or smell

This list is not exhaustive. Some people also experience damage to multiple organs including the heart, lungs, kidneys, skin and brain.

UNC Medical Center has a special clinic where they advise and work to help those suffering from Long COVID. It is called the COVID Recovery Clinic. For those with questions, they can call the UNC Center for Rehabilitation Care at 984-974-9747, then press 2.

There’s no test to diagnose long COVID. How would someone know they have it?

ZELEK: It can be very difficult to diagnose because there is no test and symptoms can vary. By definition, long COVID symptoms occur at least four weeks after infection. A medical provider will look at infection history along with symptoms and your health history to make a diagnosis. If you are experiencing what you think may be long COVID, reach out to your medical provider.

We’re moving into our third fall of the COVID era. What are case numbers looking like, and what’s your anticipation for the winter ahead?

HUBBLE: Cases are a moderately high level at this time, having peaked at a higher level in July. There are still more than 10,000 cases per week being reported in North Carolina, with over 800 hospitalization per week. The state does monitor wastewater for an indication of the directions of viral spread (up or down), and most recently COVID-19 virus particles found in wastewater had increased slightly. It is impossible to predict what will happen in the months ahead. Given the way this virus does mutate, we expect new variants to cause more infections, even in those previously infected or vaccinated.

Despite that prediction, the best way to protect yourself against severe disease or hospitalization and death are to be up-to-date with COVID-19 vaccination. Updated boosters are recommended for persons age 12 and older, the bivalent booster from Pfizer or Moderna, if it has been at least two months since their last COVID-19 vaccine, whether that was their first primary series or an original monovalent booster (in general, a booster prior to September).

Additional actions that decrease your risk include improving ventilation and spending time outdoors; getting tested for COVID-19 if you have symptoms or have been exposed (a PCR test from a physician or clinic or three at home tests, 48 hours apart); wearing a high-quality mask when indoors around others if exposed, including your own home, for 10 days; staying home when sick with COVID-19 and away from others for at least five days and wear a mask around others from days 6-10.

In North Carolina, as of last week 78% of adults are vaccinated with two vaccines, and 61% have received at least one booster vaccine. Only 30% of children and teens have been vaccinated. In Chatham County, 46% of people have been vaccinated with the primary series plus one booster.

ZACHARY HORNER: Weekly cases in Chatham and statewide last peaked in late July and have been declining since then. But the last two winters, we have seen spikes in COVID-19 cases, so I would be surprised if we didn’t see that again. If cases follow the same pattern, we’ll see this decline continue until mid-November, when they’ll begin to rise again and peak in late January/early February.

It’s worth a reminder here that colds, flus and other respiratory illnesses (like COVID) are also more common in colder months because people are indoor more often, meaning more opportunity for virus transmission. While we are always concerned about people getting sick from COVID, we’ll likely see those other illnesses pop up with more frequency in the coming months as well.

What are the numbers and trends looking like for the new booster?

HORNER: We don’t have any data available right now specifically for the new bivalent booster among the Chatham population, but we have been seeing a steady stream of people, around 200 so far, come to our Siler City clinic for it.

ZELEK: That nearly 200 includes me as of today!

Although the Omicron subvariant BA.5 is currently causing most new COVID-19 cases in the United States, the number of cases caused by another Omicron subvariant — BA.4.6 — has prompted the FDA to issue a warning: The only monoclonal antibody authorized for immunocompromised individuals may be completely ineffective against it.

HUBBLE: The Centers for Disease Control and Prevention last Friday estimated that by Oct. 8 nearly 14% of the circulating coronavirus variants in the United States were of the BA.4.6 subvariant of Omicron. The BA.5 variant, however, still makes up the majority of cases at this time.

In North Carolina, according to the N.C. Dept. of Health and Human Services report, BA.4.6 made up 16% of cases for the week ending 9/24/22. BF.7 is another variant that has recently been increasing, and made up 2% of cases as of that same report.

The BA.4.6 subvariant has been found to be better at evading COVID-19 antibody therapies, with the U.S. Food and Drug Administration in early October warning healthcare providers that AstraZeneca’s Evusheld had the risk of being ineffective against some variants it cannot neutralize. According to the FDA, the BA.4.6 subvariant was likely to have more than 1,000-fold reduction in susceptibility to the antibody therapy, based on laboratory tests.

Evusheld is a combination of two long-lasting, lab-created antibodies (called monoclonal antibodies) made by AstraZeneca. When given every six months to people with immune compromising conditions, it can prevent a COVID-19 infection. These are people who may not get enough protection from vaccines because their immune system can’t respond effectively to them, such as those with certain cancers or on cancer treatment or those who have had organ transplants. The CDC estimates that about 7 million Americans could benefit from the protection of Evusheld.

This vital therapy had been holding up well against new coronavirus variants. But in some new laboratory tests, Dr. David Ho, a professor of microbiology and immunology at Columbia University, found that even though BA.4.6 doesn’t seem to bind to our cells more easily than others, it does appear to evade the ability of some antibodies to neutralize it, including those in Evusheld. Similar results were found by some researchers in China.

There is one monoclonal antibody that is still effective against this BA.4.6 variant, and it is called bebtelovimab. However, with more and more therapies becoming ineffective, there is concern among many in the medical community that we may be running out of options.

ZELEK: There is a level of unpredictability with future variants, and that is reflected in this news. It is also a reminder of having a wide range of tools and ongoing research to update those tools. For example, if existing monoclonal antibodies are not effective against an emerging variant, we can still look to the bivalent boosters and other forms of treatment to help those exposed to COVID. So, this news should not cause panic, but rather reinforce the importance of taking preventive measures, specifically getting the bivalent booster, to add that layer of protection.

And what’s your best flu shot advice?

HUBBLE: Get a Flu Shot if you are 6 months old or older, and now is a good time to get one. It is best to get the vaccine in the fall before influenza becomes more widespread. Influenza (flu) vaccines take about two weeks to help the body make antibodies to protect against infection or severe disease. These antibodies provide protection against infection with the flu viruses that are used to make vaccine. The seasonal flu vaccine protects against the influenza viruses that research suggests will be most common during the upcoming season.

People 65 and older should get a higher dose or adjuvanted flu vaccine, including: Fluzone High-Dose Quadrivalent, or Fluad Quadrivalent, or Flublok Quadrivalent. These vaccines are preferred for people 65 years and older because a review of existing studies suggested that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines.

HORNER: It’s pretty simple: If you or someone you love is six months of age or older, get a flu shot. Recent studies show that flu vaccination can reduce the risk of flu illness by between 40% and 60% among the general population and vaccination reduced flu-related hospitalizations by an estimated 105,000 in the 2019-20 flu season. More on flu vaccine effectiveness here: We’ll have the flu shot soon, but it’s available many places already. Check with your doctor or pharmacy about getting one today.

ZELEK: And, as always, wash your hands and stay home if you don’t feel well.