This week, in addition to its weekly COVID-19 updates with LA County Public Health Director Barbara Ferrer, the LA County Department of Public Health began providing updates in its weekly briefings on the current Monkeypox outbreak, with information from Dr. Rita Singhal, Chief Medical Officer and Director of LA County’s Disease Control Bureau.
COVID-19
In her address, Ferrer reported continuing good news, with “significant further decline” in COVID-19 cases and hospitalizations this week, and a slight decline in daily deaths as well. LA County is now averaging about 3,800 new cases of COVID-19 per day, Ferrer said, down from 4,900 last week, and about equal to where we were in the latter half of May, before the summer surge began.
As expected since last week, Ferrer reported that our falling case and hospitalization rates – now 302 cases per 100,000 residents, and 9.9 hospitalizations per 100,000 residents – were just enough to move us back down to the Medium community level, as defined by the CDC.  This means that while transmission rates are still high, our medical system is not currently at risk of being overwhelmed.
Also of little-to-no surprise this week was Ferrer’s report that the percentage of specimens sequenced in LA County shows that the BA.5 subvariant of the Omicron variant of COVID-19, which is the most highly-transmissible variant yet, continues to grow, and now represents about 80.3 percent of cases locally. And with percentages of other known variants falling, and no new variants spreading rapidly at the moment, Ferrer said it’s possible that BA.5 may be heading to a “saturation” point in the local population, which means our new cases could continue to decline for a while. At the same time, however, she also noted that it is still impossible to predict the emergence and transmissibility of new variants, so there are no guarantees of whether or how long the downward trend will continue.
Finally, as many schools prepare to open next week, Ferrer provided updates on current school policies regarding containment, response and control plans for COVID-19, including masking, testing, and reporting procedures.
First, Ferrer reported, all schools will have a COVID-19 compliance team (responsible for following Health Officer orders and school protocols), as well as specific protocols for isolating cases and identifying exposures.
Schools will also be required to offers teachers and staff medical-grade masks and respirators, Ferrer said. And although routine indoor masking is no longer required at schools, it is still highly recommended, and staff who test out of home isolation after day five of a COVID-19 infection are still required to wear a highly protective mask around others through day 10 of their infection. People who have been exposed to a known infection must also wear masks indoors for 10 days after the exposure.
And finally among requirements, Ferrer said that while schools will no longer require weekly testing for students and staff, they must still provide access to testing for those who are currently sick or those who were recently exposed to COVID-19, and they must report occurrences of three or more linked cases within a 14-day period to the Department of Public Health.
Ferrer said further recommendations for schools include improved ventilation systems, using outdoor spaces as much as possible to minimize crowding, wearing masks in all indoor areas while transmission is high (“which it is right now”), testing before or right after returning to school, and at least once a week while transmission remains high, and reminding parents to assess children for possible COVID-19 symptoms each day before school.
Meanwhile, Ferrer said making sure children are up to date on their COVID-19 vaccines is the number one thing parents can do to prepare for going back to school. And parents should also be sure to keep children home when they’re sick, get kids tested when they’re sick, test children 3-5 days after an exposure to COVID-19, and test before and after events and gatherings. Children should also wear masks indoors while viral spread is high, Ferrer said, during periods of isolation after testing positive for COVID-19, and when children are around others for 10 days after exposure to COVID-19.
Finally, acknowledging that many parents have questions about monkeypox at the moment, and may be wondering if a child’s rash could be monkeypox, Ferrer noted that there are many common causes of rashes in children, and the risk of monkeypox for children is extremely low right now. If a child does experience a rash, she said, parents should keep the child home, keep the rash covered, not touch the lesions, and contact the child’s doctor. Finally, Ferrer said, parents can also help children practice good “hand hygiene” to help prevent the transmission of rashes and other infections.
Monkeypox
As noted above, this was the first week that the Health Department also included in its weekly address an update on monkeypox in LA County, with Dr. Rita Singhal. Singhal reported that monkeypox cases are continuing to increase across the globe, with 31,800 cases now reported in 89 countries worldwide, 10,392 in the U.S., and 738 in LA County. The average age of current monkeypox patients is 35, Singhal said, and there have been only 15 hospitalizations and no deaths. Only about 30% of the cases locally have been associated with travel, which indicates that much of the current spread is within our own community…and about half of LA County infections so far have been in the LA metro area.
In LA County, as in other areas, as has been widely reported, Singhal said most monkeypox cases so far have occurred in gay men, and most of them white and Hispanic. That said, however, Singhal also emphasized that anyone who has close contact with someone who has the disease can contract it, and that there is nothing about monkeypox that is specific to gay men.
Moving to a discussion of monkeypox vaccines, Singhal reported that LA County has received more than 43,000 vaccine doses so far, with recent delivery of about 19,000 doses. And more will come later this month after 90% of the current “tranch” have been administered.  Singhal also noted that the CDC this week approved dividing monkeypox vaccine doses into smaller portions, which will increase the number of doses available by five times, to about 85-90,000 in LA County. And that will help a lot more people, she said, though it’s still short of the total number of doses needed.
In addition to the dose-splitting news, Singhal also reported that eligibility for monkeypox vaccinations was expanded last week, and now includes gay or bisexual men and transgender persons ages 18 and older who have had multiple or anonymous sex partners in the last 14 days (including those engaging in “survival” or transactional sex)…as well as those who are immunocompromised, including people with advanced or uncontrolled HIV infections. Those who are eligible under these new rules, she said, should visit ph.lacounty.gov/monkeypox to schedule a vaccination.
Singhal said that LA County is also working with a number of partner organizations, including community and faith-based groups, and focusing on areas where people are experiencing homelessness, to help reach those who are most vulnerable.
And finally, as noted above, while anyone can contract monkeypox, Singhal said there are some very clear risk factors. High-risk behaviors, she said, generally include direct skin-to-skin contact (including sexual or close intimate contact such as hugging, kissing, and cuddling) and/or sharing bedding, towels or clothes, with someone who has a monkeypox rash or scabs.
But for those not engaging in such behaviors, Singhal said, the risks are low. You are not likely to catch monkeypox, Singhal said, from brief interactions, casual conversations, or walking by someone who has monkeypox, or from attending an event with fully clothed people, traveling on an airplane or public transit, swimming in a pool, hot tub, or body of water, or by going to grocery stores, restaurants, or school.
And strategies for protecting yourself and others against monkeypox are simple – avoid close contact with people who have monkeypox or a rash that could be monkeypox, isolate those who have monkeypox from those who could be at risk, wear a well-fitting mask or respirator when interacting with someone who is infected, avoid contact with bedding or utensils used by someone who is infected, and wash your hands often.
Finally, for more information, see ph.lacounty.gov/Monkeypox or call 1-833-540-0473.
