The reported rate of positive tests for COVID-19 is likely well below the actual infection rate, particularly for the highly-transmissible BA.5 strain of Omicron, health care officials said.

“I expect that we’re at least double, and we’re probably significantly higher than double,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “I, like many others, am quite concerned for the fall and winter.”

Indeed, with positive results for PCR tests in the range of 10 to 12% during the summer, the percentage of people who might contract the most infectious variant of the virus yet could surge in the colder months, when students return to school and people spend more time indoors.

The good news so far is that the number of people who have been hospitalized with COVID has stayed relatively steady at Stony Brook University Hospital, at around 50.

Over the past few weeks, the number hasn’t dipped below 40 or gone above 75, which means that the current infections generally aren’t causing hospitalizations, Nachman said.

“While COVID-19 rates may be higher than reported, cases are less severe than they were at earlier stages of the pandemic and hospitalizations are fewer,” Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Service, explained in an email. “Vaccinations play a large role in the reduction of hospitalizations.”

The number of people hospitalized with COVID on Long Island averages about 450 per day, which is down from 4,000 in April of 2020 and 2,200 in January of 2022, according to the county Department of Health.

Suffolk County hosted a back to school test kit distribution event on Tuesday at the H. Lee Dennison Building for parents and residents.

Raising awareness of monkeypox

At the same time, government and health care officials are dedicating more resources to combat the threat from monkeypox, a virus with symptoms including fever, headaches, exhaustion and a rash that can last two to four weeks.

In Suffolk County, the number of confirmed cases has climbed to 22 as of the beginning of August, according to Department of Health officials.

Working with Northwell Health and Stony Brook University, the county has been providing monkeypox vaccinations. The county expects to get more vaccines later this month, although the demand continues to exceed the supply.

Governor Kathy Hochul (D) declared a state of emergency on July 29 over the outbreak, which will allow a faster response and enhance the distribution of vaccines in the state. The governors of California and Illinois have also declared states of emergency over a virus that is rarely fatal but is painful and can cause scarring. The more vulnerable populations include pregnant women, young children, people who are immunocompromised and individuals who have a history of eczema.

Nachman said the response from the governor was a “way of getting ahead” of the spread of the virus.

The state of emergency “raises everyone’s concern,” Nachman said. “When you go to a local physician, more people are thinking, looking and testing [for monkeypox]. Testing is critical” to confirm cases and to reduce the spread.

Vaccinations, which involve getting two shots that are four weeks apart, can accelerate the immune response, Nachman said.

Stony Brook hopes in the next few weeks to work on a National Institutes of Health-funded clinical trial with children, pregnant and postpartum women on a potential treatment for the virus.

Spread during physical contact, the large majority of monkeypox cases have occurred among men who have been intimate with other men.

Pigott has been working closely with the community to promote prevention efforts and vaccinations. He spoke on Monday at a forum hosted by the LGBT Network, where he said gay or bisexual men in their 20s and 30s were at the highest risk.

Other viruses

In addition to COVID concerns for the fall, Nachman explained that other seasonal respiratory viruses have become more prevalent and problematic through the summer.

Flu has historically been a winter virus, starting in late November or early December and ebbing in its infectiousness around March.

In 2022, the flu season stretched through June. At the same time, respiratory syncytial virus, or RSV, typically starts in November and lasts through February.

“We had RSV all summer long,” Nachman said. “We never had a break.”

Nachman is concerned that the overlap among the viruses with infection rates may increase at the same time.

“I worry about the juxtaposition with other respiratory pathogens” that have exceeded their usual seasonal limitations, Nachman added.

Those other viruses are highly contagious, but were limited in their spread when people were wearing masks. Once people stopped taking precautions for COVID, these other viruses also spread.

“No one had been exposed, and it was like a match to tinder,” Nachman said. “It spread through the population” after few people had contracted these illnesses.

Health care providers urged people to take several steps to protect themselves, their families, and their communities.

“If you’re sick, please don’t go to work,” Nachman said. ‘If your child is sick, please don’t send them to school.”

People also need to practice safe cough techniques. If they need to cough or sneeze, they should minimize the number of aerosolized particles by covering their nose and mouth or coughing into their clothing.

A plea for proper vaccinations

With a reluctance to return to the widespread use of masks or other restrictions that might limit the spread of COVID, health care officials continue to urge people to benefit from the protection vaccines provide.

Indeed, most of the people who have required more extensive medical care at Stony Brook University Hospital have not been fully vaccinated.

Some of those who have required medical attention received a single dose of a vaccine over two years ago, which is effectively not vaccinated, she said.

Nachman expects that COVID vaccinations may become required as they are for measles mumps and rubella and other diseases for students to attend class in person.

“I do see in the future that will happen,” Nachman said. “Not vaccinating hurts the child and the entire community.”

Amid an increase in cases of a virus caused primarily by close skin contact, Suffolk County started to provide vaccinations this week.

By appointment only, Suffolk County is administering 750 vaccinations to eligible people at pop-up clinics on Fire Island. Within under two hours, the county, with help from Northwell Health, had received requests for all of the available vaccines.

“It was heartwarming that so many people signed up for the vaccine right away in the at-risk community,” said Dr. David Galinkin, an infectious disease specialist at Port Jefferson-based St. Charles Hospital. People want to “stop this in its tracks.”

While monkeypox was discovered in 1958 and had its first reported cases in humans in 1970, the current limited outbreak is the first time health officials documented it spreading through person-to-person contact in the United States. Previous outbreaks involved a returning traveler from Africa or through contact with an infected animal.

As of the end of last week, Suffolk County had reported three cases of monkeypox.

About 98% of the cases in the country were reported among members of the gay and bisexual community of men who have sex with other men, Galinkin said.

A rare condition, monkeypox has symptoms including fever, headache, muscle aches, swollen lymph nodes, chills, exhaustion, and a rash that looks like pimples or blisters on people’s faces, inside their mouths and on hands, feet, chest
and genitals.

People who contract monkeypox can have symptoms that last for two to four weeks.

“While the current global outbreak appears to have heavily impacted [men who have sex with men], it is important to understand that this is a disease that is transmitted by intimate prolonged contact with an infected individual,” Dr. Susan Donelan, medical director of Healthcare Epidemiology at Stony Brook Medicine, explained in an email. 

Medical officials pointed out that monkeypox doesn’t present the same threat to public health as COVID-19, which can be spread by breathing in air contaminated with viral particles.

Health officials, however, are urging people to take steps to protect themselves against a virus that can be uncomfortable and that can spread to others through various levels of contact.

“Most important to understand is that monkeypox is not a sexually transmitted disease,” Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health. “It is sufficient to touch an active lesion to be exposed.”

Prevention

The Centers for Disease Control and Prevention has considerable information on a website dedicated to monkeypox, which people can access at the link: www.cdc.gov/poxvirus/monkeypox

The CDC urges people to avoid close skin to skin contact with the rash. The center also recommends that people not kiss, hug, cuddle or have sex with someone who has the virus.

People should not handle or touch the bedding, towels or clothing of someone who is sick. To protect themselves, those who might have come in contact with a person who has monkeypox should wash their hands with soap and water or use an alcohol-based hand sanitizer.

Adding to the list of concerns during pregnancy, women can spread the virus to their fetus through the placenta.

Unlike COVID, people who do not have monkeypox symptoms can’t spread the virus to others.

Vaccinations

The most commonly used vaccinations involve two shots that are 28 days apart. Like vaccines for COVID, the optimal protection is expected two weeks after the second dose, Donelan said.

The CDC recommends that people who are close personal contacts of those with the virus get the vaccine. The center also urges those who may have been at increased risk of exposure, through laboratory testing, to consider receiving shots as well.

The CDC suggested that people get the vaccines within four days from the date of exposure for the best chance to avoid developing the disease.

Vaccines given between four and 14 days after exposure may reduce symptoms but may not prevent the disease.

Combining the vaccination with self-isolation and other measures can control outbreaks and prevent further transmission of the virus, the CDC explained.

Monkeypox vaccines aren’t as readily available as those for COVID.

“As vaccine production ramps up, we will expand our operations to ensure that anyone who wants to get vaccinated is able to,” County Executive Steve Bellone (D) said in a statement.

Dr. Gregson Pigott, county health commissioner, also explained in a statement that he encourages “those who may be at risk to get the vaccine and, in the meantime, be cautious with your intimate relations.”

COVID-19 update

COVID, meanwhile, continues to spread through Suffolk County, despite the warmer weather and the greater opportunity for outdoor interactions.

As of July 10, the seven-day average for positive tests was 9.3%, according to the New York State Department of Health. That is up from 7.5% on a seven-day average in June.

“The incidence of COVID has increased in the last few weeks in Suffolk County,” wrote Popp, of Huntington Hospital, which, earlier this week, had 15 COVID patients at the hospital.

The high current positive rate is “likely due to the fact that most COVID-related prevention measures have been discontinued” including masks and social distancing and the current omicron subvariants are also more transmissible, Popp said.

As of July 11, Stony brook University Hospital had 52 positive COVID inpatients, compared with 39 on June 11, according to Stony Brook Medicine officials.

Over the past weekend, Galinkin admitted more patients with COVID at St. Charles Hospital than he had in months.

“It seems to be on the rebound,” he said, as the BA-5 strain is the “most contagious strain we’ve seen,” he said. He expects the numbers to continue to rise.

COVID symptoms from BA-4 and BA-5, which are the dominant variants in Suffolk County are milder than previous types. Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Disease at Stony Brook Children’s Hospital, wrote in an email. The hospital is also seeing much less frequent loss of smell or taste with the current variant.

Nachman is concerned about possible increased rates of infection in the fall and winter.

“Overlying that concern is the heightened risk of our routine, formerly seasonal viruses co-occurring with COVID leading to more illness visits and hospitalizations, especially among our most vulnerable populations,” Nachman said in an email.

Galinkin said the higher level of COVID infections underscores the importance of vaccinations.

“It’s our best defense against this,” he said. “There’s talk of a new and improved vaccine coming out in the fall” that will provide protection against omicron variants. “Hopefully, people will take advantage of that.”