Gottlieb: The Window for Containing Monkeypox “Probably Has Closed”

MARGARET: Give us a sense of the scale of this because the CDC numbers are out. According to them, there are only eight females within this group. There are no children. This is considered a pandemic. This is not the word that the Administration uses yet. What level of emergency do we have?

GOTTLIEB

: I see, they won’t hesitate to use the term pandemic because it suggests that they have failed to contain. This is a sign that we have failed to control it. This is a dangerous time when it could become an endemic disease. We need to keep fighting this virus. The window to contain it and get control is probably closed. If it hasn’t, then it is certainly closing. 11,000 cases across the world right now. As you mentioned, there are 1 ,800 instances in the US. Because we only have a narrow definition of who was tested, it’s possible that we are only detecting a small fraction of actual cases. We’re mainly looking at men who have had sex with women and STD clinics. We’re searching there and we are finding cases. It’s also a known fact that cases exist outside of that particular community. They are not being picked up because they don’t exist. The problem has spread to more people. It’s not surprising that there are thousands of these cases.

BRENNAN : I find it a bit chilling that you are claiming containment has failed. That’s something I have heard before, COVID.

GOTTLIEB

: This isn’t going out like COVID. It is slower-moving virus. This could be why we would have been able to control it if we were more aggressive. We made many of the same mistakes with COVID – not testing enough early enough and not using vaccine aggressively enough to ring vaccinate. This is now firmly embedded within the community. It’s unlikely that it will spread rapidly, as it is much harder to transmit the virus. However, this fact will be ingrained in your daily life.

BRENNAN – The CDC states that monkey pox may develop up to 3 weeks after exposure. These are some of the most common symptoms. You should call your dermatologist if you notice a rash. Who do you call?

It’s called a vesicular skin rash. This is associated with fever and achiness. It was common for people to develop a diffused rash in the past. People aren’t showing a diffused rash anymore, sometimes only a few vesicles. It’s possible that it could be confused with Herpes or Coxsackie, which can cause a vesicular skin rash. Anyone who has a rash or symptoms that cannot be explained by any other etiology is eligible for treatment. A rash that produces vesicles should be checked for monkey pox. This is how we intend to get rid of it. This was impossible because we didn’t have sufficient testing. The CDC now has more testing that is likely adequate to accomplish this. This is why physicians need to send these tests.

BRENNAN – The issue with testing, it seems that access or distribution to vaccines is also an issue. New York’s mayor, Governor Andrew Cuomo, has asked the Biden administration for more help to make this happen. This is a serious problem.

GOTTLIEB: Well, we didn’t have adequate stockpiles of the vaccine, the one vaccine that’s proven monkeypox, we only had 2,000 doses in a national strategic stockpile. We didn’t have enough to cover smallpox so it was put there for a precaution. They ordered about 300,000 doses that have been delivered. 150,000 have been distributed, another 130,000 will go out this week.

BRENNAN – Some of it overseas.

GOTTLIEB: Some of it- well, there’s 800,000 doses that were overseas, that the manufacturer, Bavarian Nordic, had overseas. These are currently being imported into the USA. FDA must inspect the doses in order to ensure they are properly manufactured. They’re doing that inspection at the same time that they’re forward deploying those 800,000 doses. These doses are being sent to the cities now. These doses can be given to patients or distributed as soon as FDA has completed that process, which is expected this week. The situation with vaccines is expected to dramatically improve this week. You’ll see literally thousands upon thousands of new doses. To take more control over the response from CDC, the White House intervened. The White House and political leaders must step in when CDC fails to respond. This is what happened. This happened at COVID. These-these crises require fundamental reform in how we react.

(*BRENNAN) You have written a book about that. You have a question about COVID. According to the CDC, about 54% Americans now live in areas with high COVID community spread. This is a significant increase from 31%, last week. It seems like this trend is fast-moving. These variants are now different.
GOTTLIEB

: It’s actually the B-5 version that is growing. This variant can evade immunity we have acquired through vaccinations and previous infection. B-2 infections seem to confer stronger immunity to this B-5 variant, so areas with large outbreaks like the Northeast will likely be better protected. There’s 100,000, over 100,000 cases on average being reported on a daily basis. We’re probably detecting one in 10 infections right now. It’s likely to be more than a million. This is something that most Americans accept as part of their daily lives. Partly that’s because there are very few people who can protect themselves from risk. People feel, rightly, less likely to suffer a negative outcome. This spread must be seen against the background of everyday living.

BRENNAN – But, while the White House suggests that you put on a mask if attending indoor events, Los Angeles has indicated they may institute it at the end the month.

GOTTLIEB

: I doubt we will see mandates. There isn’t a lot tolerance for mandats in certain cities like Los Angeles.

BRENNAN – But is this advisable?

GOTTLIEB

: If you are going to a gathering with many people that you do not know, a mask may be prudent. This is especially true if your area has a high risk of exposure. While I don’t wear it in all settings, the mask I do wear is what I use to get through security at airports. When I get COVID, I prefer it to come from someone I know and not someone I am sitting beside on the plane. When I am in mixed company, I make sure to remain prudent. It’s best to avoid living in high-prevalence areas, particularly if your family is vulnerable.

BRENNAN. And a booster shot. In the autumn, will we get a revised bivalent vaccine?

GOTTLIEB

: Yes, well, the vaccine will be made from B-4. The manufacturers are currently developing it. We could deploy a bivalent vaccine that is B-1-based, but there’s no such thing. This would probably be better protected from the B-4 and B-5 variants. They’ve decided not to use that vaccine and to wait until the B-4 variant vaccine is available. If you are over the age of 50, it is recommended that you get this vaccine. As sequencing is excellent, get your dose right away if possible if there’s a high-risk person, then come back later.