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The Americas’ health watchdog just went on emergency alert over the monkeypox outbreak

June 15, 2022, 6:16 PM UTC

The Pan American Health Organization has activated emergency procedures in response to the global monkeypox outbreak, international health officials said Wednesday.

No additional information regarding what such procedures entail was provided by the international agency, which represents health interests in North, South, and Central America.

The announcement comes on the tail of the World Health Organization’s Tuesday decision to convene an emergency committee on June 23 to determine whether monkeypox represents a “public health emergency of international concern.”

The Americas have seen 230 confirmed cases so far—the majority in the U.S. and Canada, said Dr. Carissa Etienne, director of the PAHO, at a World Health Organization media briefing.

Some countries lack training in identifying the virus, endemic to Africa and rarely seen outside of it until this year’s global outbreak. Training in Brazil last week led to the detection of the country’s first case, and similar training will take place in the Caribbean this week. Such training will likely increase case counts, she added.

As of Tuesday more than 1,600 monkeypox cases had been confirmed in 32 countries, with an additional 1,500 suspected cases pending confirmation, WHO officials said Tuesday. In countries where monkeypox is already endemic, 72 deaths were reported. 

No deaths had been reported in countries where it isn’t, but media reports of a monkeypox-related death in Brazil are being explored, officials said.

As of Tuesday the U.S. had seen 72 confirmed cases of monkeypox in 18 states and Washington, D.C., according to CDC data.

Monkeypox is usually found in rural African areas where people have close contact with infected rats and squirrels. It is typically transmitted from human to human through close contact, which may include sex and could include contact with personal items like sheets and clothing. Airborne transmission is known to be possible but has yet to be confirmed.

Long COVID burdening outpatient care

Wednesday’s media brief also addressed governmental approaches to COVID in the Americas. Etienne said countries must take into account the burden of long COVID—not just hospital capacity—when formulating their public health response to the new coronavirus.

Health systems in the Americas are “coping” with the COVID pandemic “because the majority of people in the Americas are vaccinated and therefore better protected against severe disease and death,” she said.

Governments now tend to develop COVID policies and restrictions based on beds available in hospitals, not community transmission of the virus. But such entities must also take into account the burden on outpatient clinics of those with “long-hauler” symptoms stemming from the virus, Etienne said.

“We are at a moment in the pandemic where we need to take the long view,” she added.

COVID infections, deaths rising in the Americas

Levels of COVID have been rising in the Americas over the last eight weeks, with more than 1.2 million cases reported last week, an increase of 11% from the past week. Just over 4,000 deaths were reported last week, an increase of 19% over the week prior, Etienne said. 

North America experienced a 2% increase in hospitalizations and a 4% rise in ICU admissions last week, for the second week in a row. Cases are also rising in Mexico and South America. Central America, however, reported a 32% decrease in cases week over week. 

The rise is likely due at least in part to new, highly transmissible Omicron subvariants BA.4 and BA.5, which are able to evade immunity. Cases of the subvariants are “increasing around the world,” said Maria Van Kerkhove, technical lead for COVID-19 response at the World Health Organization, at a Tuesday media availability.

Such subvariants appear ready to overtake the once dominant “stealth Omicron” in the U.S., according to data from the U.S. Centers for Disease Control released Tuesday. BA.2.1.12 remains dominant in the U.S., for now.

BA.4 and BA.5 were first detected in the U.S. in late March, as Fortune previously reported. The variants, first discovered in South Africa, swept the country in April and May despite the fact that almost all South Africans have been vaccinated or had COVID.

A recent study out of South Africa found that those who had been previously infected with Omicron but not vaccinated experienced a nearly eightfold drop in neutralizing antibodies when exposed to BA.4 and BA.5. Those who had been vaccinated and previously infected with Omicron saw a milder threefold decrease. 

Alex Sigal, a professor at the Africa Health Research Institute in South Africa, told Fortune in May that symptoms of the new subvariants are similar to typical Omicron symptoms, which include fever, loss of smell, and malaise. 

“I haven’t seen early symptoms of respiratory distress, the major COVID-specific symptom that makes this disease so dangerous,” he said. “It doesn’t feel nice, but there’s less chance of dying.”

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