August 24, 2022

Monkeypox, COVID Create Challenges for Health Officials

By Donald Gilpin

With COVID-19 case numbers, hospitalizations, and deaths declining and monkeypox infections low in Mercer County, Princeton residents might be tempted to relax, or at least take a deep breath. The Princeton Board of Health (BOH) is not recommending that.

“It’s great that we don’t have a lot of cases right now,” said BOH Chair George DiFerdinando regarding the monkeypox virus, “but this is a long haul situation where we’re going to be focusing on vaccinations and messaging on how to prevent exposure.”

He pointed out that the Centers for Disease Control and Prevention (CDC) and the New Jersey Department of Health (NJDOH) are preparing a long-term vaccination effort. “The planning is for a longer-term problem, not just for one season,” he said. “There’s a need for a sustained response.”

Since monkeypox has a three-week incubation period, case numbers need to be looked at from month to month rather than week to week, he added.

The first case of monkeypox in New Jersey was reported on June 18 this year, and, as of Tuesday, August 23, the state had 441 cases, mostly in northern counties bordering New York City, which has the highest case numbers in the country. Mercer County on Monday reported a total of 13 cases.

Monkeypox can cause flu-like symptoms, swollen lymph nodes, and a rash that often begins on the face and spreads to other parts of the body. It is rarely fatal but can be very painful. The vast majority of people infected with monkeypox in this country are men who have sex with men, but health officials warn that monkeypox can infect anyone, regardless of gender or sexual orientation.

The monkeypox vaccine, though limited in supply, is available to high-risk New Jerseyans and those who think they have been exposed to the virus. Further information on the virus and vaccines is available on the NJDOH website at

In commenting on the monkeypox health emergency, DiFerdinando cited areas where the health officials’ response has been informed by lessons learned 40 years ago in the HIV/AIDS crisis. “In the early years of the HIV epidemic there was a lot of stigmatization and finger-pointing,” he said. “I think we learned from that and many other situations that local, state, and federal public health officials must build relationships with the entire LGBTQ community. We’re building on decades of those relationships in being able to get the word out on this situation.”

He also pointed out that the medical community had learned the need to respond to a crisis, often before arriving at a final answer. “We’ve learned that lesson very well,” he said. “For example, in the recent decision to employ what’s called the intradermal use of the monkeypox vaccine. It’s the correct dermal dose, but it’s a lower dose than the muscle dose. We’re not diluting the impact, but we’re vaccinating more people.”

DiFerdinando emphasized the challenges faced by public health workers. ”Here in Princeton we’re in very fortunate circumstances,” he said. “There’s a municipal Council and mayoral support for the public health system, and yet here’s one more thing being put on the plate.”

He mentioned new Moderna and Pfizer vaccine boosters, more monkeypox vaccine, and the flu vaccination season coming up. “And we’re still doing catch-up on child vaccinations that were missed during the first two years of the pandemic,” he said. “The Princeton Health Department, the New Jersey Department of Health, local providers, and especially child vaccinators — there’s a lot of work they have to do.”

As for COVID-19, “People are acting as if it’s over,” said Ferdinando. “Any observer will agree with that, but this year the coronavirus is the fourth leading cause of death in the U.S., behind heart disease, cancer, and accidents in all forms, and ahead of lung diseases, pneumonia, and many other diseases.”

He continued, “No one would say, ‘Heart disease is not a problem anymore. Cancer’s not a problem anymore.’ No one would say ‘Lung infections are no longer a problem.’ People are acting like it’s over, but the numbers do not say that.”

DiFerdinando pointed out that people with heart issues take medications, exercise, get their blood pressure checked. “They do all these interventions to make sure they don’t have heart problems. We have to think about COVID like that — not in panic mode or denial, but somewhere in between.” He noted the value of vaccinations and boosters, proper ventilation at indoor gatherings, and judicious mask-wearing when appropriate.

Health departments, he added, need to make an extra effort to address underserved populations. “There is plenty of data from the COVID pandemic that persons of color and persons of lower income have consistently had less access, especially less early access, to different vaccines and treatment types,” he said. “So in parts of Mercer County and other parts of the state you have to make an extra push to reach those populations. It’s one of the lessons learned again and again from COVID. Even if you think you’re doing a good enough job, you may be missing a substantial part of the population.”

He continued, “I know we make that extra push in Princeton,” he said, highlighting the efforts of the health officer and the health department outreach coordinator.