- Just ahead on Black Issues Forum, many wonder if monkeypox is something we should really be worried about.

And the 600,000 North Carolinians waiting for the decision to expand Medicaid must continue the wait.

But what for?

Stay with us.

[upbeat music] ♪ Welcome to Black Issues Forum.

I'm Kenia Thompson.

With a slight increase of outbreaks in the US, and the first documented cases in North Carolina surfacing, some are asking if monkeypox is something we should really be worried about.

So we asked the important questions to Dr. Cameron Wolfe, associate professor of medicine at Duke University.

By the end of our interview, I learned a lot.

We hope you do too.

Take a look.

There's a lot of confusion.

You know, after COVID, I think we've become hyper aware of other illnesses and viruses that pop up.

And a lot of people, for lack of better terms, are scared, right, about what that could mean for the next few years for us as we try to recover from a pandemic and from COVID-19.

And so we took to our social media.

We asked our social friends, what are some of the questions that you want answered?

And this is why we're here together today.

And I thank you for your time, and for providing some clarity around some of these questions.

So let's get started.

So our first question will pop up here on the screen.

What is monkeypox and what is its origin?

- Yeah, good place to start.

So monkeypox is a virus.

Its closest cousin that we may sort of all know or heard stories about is smallpox.

It's a viral illness that starts off as a sort of flu-like symptoms, fever, fatigue, maybe some lymph node swelling, and that can not always be present, but when it is, lasts for a day or two, and then people will then start noticing a rash.

And the rash is really the most characteristic.

It's the pox in monkeypox.

And the rash sort of typically evolves for folks over the space of two or three weeks.

It's quite slow.

Starting in originally as a red sort of rash, becoming a blister characteristically, and then actually a pustule.

And they can be quite painful.

They sort of classically would be really widespread across the whole body.

What we've seen this year is that as this has evolved in the United States and in Europe, it actually tends to be often quite regionally located into areas like the genitals for some men, different parts of the body, but can occasionally still appear widespread.

We didn't really have this in the United States prior to this year.

You know, we would see the occasional case of monkeypox when someone would acquire it accidentally on travels in west or central Africa, where this has been existing for many years.

And occasionally people would bring it back, but it never really existed in the United States.

What we've seen this year unfortunately is that it has been able to sort of set up camp if you will amongst groups of individuals in Europe, in particular, and now in the United States, and is passing between people comfortably within the United States.

So it's sort of now, it's here to stay.

- Yeah, and I was reading an article, and correct me if I'm wrong, please, 'cause I'm not a medical professional, but you know there's been some issue with the name monkeypox, especially within the Black and brown community, but it was originally found in monkeys, correct?

And so that's where it got the name.

But I think that some people have taken that a bit offensively.

- No, you're absolutely right.

And I think it's one of the real challenges here is how do I talk about this in a way that's not gonna be enhancing of stigma, or frankly, racism as you sort of hinted at.

You know, this was originally found as a virus in monkey populations, but it's actually not the place where it commonly exists.

You know, typically in an African context, it existed in small mammals and rodents, and would occasionally break into human populations.

Now it has nothing to do with monkeys whatsoever, and so it's really an unfortunate sort of leftover that that name still exists.

And unlike some other viruses that we often have a common and a scientific name, there actually isn't another name here that we use.

It's kind of a shame that that stigma still exists.

- Yeah, well, I'm glad that we can clarify that for our viewers and also, you know, provide that understanding that it's not a racial term.

It's not a derogatory term.

And it was just taken simply because of one of the sources that it came from so.

- Exactly.

- Thank you.

- I wish I could change that in hindsight, but that's sort of yeah, it's an unfortunate situation.

- It is.

Well, let's move on to question number two.

So our second question is how many cases do we have here in North Carolina, and is it something that we should be concerned about?

- Yeah, so, so far this is still uncommon.

We only have 13 cases that we know about in North Carolina.

That's dwarfed by other parts of the US.

And our total United States count is now over 2,000.

As you might imagine, there are states that are more populated than us, states that are traveled more than we do.

And so California, New York, areas around Atlanta, Chicago, Miami, these are cities and states that have been more heavily hit.

I don't know that we should view that low number as being super reassuring though, 'cause I think the virus doesn't care which state you live in or it doesn't care what gender, it doesn't care what race you are.

It cares about how it wants to transmit.

And this is a virus that transmits by really close sort of skin to skin contact.

- Okay.

- Which is reassuring because like we are left here with this memory of the last two years of COVID, aren't we, where COVID spreads very readily as we've all found out.

And you don't have to be right up against someone to be able to transmit COVID.

Monkeypox is actually much harder to transmit.

You really need to be sort of intimately close contact with someone for this to transmit.

We would expect that number of 13 to continue to go up.

I mean, that's something people should be aware of, but they should also take good heart that this is not something that's going to sort of liberally spread in the way that COVID did.

This is, relatively speaking, much more hard to transmit, and that's a good thing.

- Okay, that's good to know 'cause it's scary, honestly.

You know, we send our kids to school now, and we're trying to reemerge back into the outside, and it's like, well, what do we have to be scared about next?

- Now what am I facing?

- Right, exactly.

- And this is nothing like that.

So from a sort of pandemic potential, it's orders of magnitude different.

Not to say we shouldn't stick our head in the sand.

Like I think it's important for people to know what this is.

For those who are affected by it, it can be painful and disfiguring actually.

- Yeah, and I'm glad you brought that up because I think that that's part of the alarming reaction to this is that, visually, it looks pretty bad.

- Yeah, and I think that maybe there's also a part of here that goes back to some of those stigma questions.

'Cause if people Google pictures of monkeypox, what comes up are very stereotypical pictures of African skin, dark skinned individuals, with lots of lesions all over them, and actually that's not typically what we see.

- Okay.

- This can be on white skin, brown skin, black skin, all over the body or in limited areas.

But I think it is a reality that it can be quite painful.

The pox lesions, the little pustules, actually can scar when they heal.

And so if there's a way of, whilst this doesn't have this fatality rate, thankfully, that COVID had, very few people here will be sick enough to need to go into the hospital, which is a good thing.

It's not to say I want someone exposed to something that can cause a scarring, blistering lesion.

- Indeed.

- I'd clearly like to avoid that.

- Right.

Right.

All right.

Well, let's move on.

We got more questions.

You already alluded to this and shared how this gets transmitted, but a little bit more elaboration if you don't mind?

- Yeah, absolutely.

So this is a virus that most classically spreads through really close skin to skin contact.

So very similar to what people may know from chickenpox where you get a little blister or fever blisters, herpes, where you get a blister, it's the blister fluid and the skin over the blister that carry a ton of virus.

- Okay.

- And so skin to skin rubbing or hand contact on those blisters, is actually the most infectious.

So what we've actually seen is that mainly that's occurred between sexual partners.

It's not that this is a sexually transmitted disease.

You don't need to have sex to pass this.

But you need to be in that intimate level of contact in order to get that skin to skin contact to pass this along.

- Right.

- It exists throughout the body.

It's a virus that doesn't just sit in the blister, it exists internally everywhere for us.

All right, next question we've got from our social friends.

What are the side effects or long-term damage that can occur from it?

- Yeah, really good question.

So, and I'll tie in here, how long does it last and how long can you keep transmitting 'cause I think they're relevant?

- Yeah.

So like I said, those blisters can often last a couple of weeks.

They can be slow to heal.

And depending on where they are, as they heal and the blister comes off and the dead skin peels off, literally, and new skin forms underneath, occasionally they can leave scars.

And so if they're in a really crucial place like particularly if they're in the genitals, a scar in that area is meaningful and we really don't want that, clearly.

- Yeah.

Yeah.

- So there's not really long term damage per se, but the skin can be damaged, for sure, in the areas where it occurs.

I think the other thing is that these are painful.

It's potential still for a stigmatizing illness.

So, I don't wanna underplay the long-term damage that comes from having had this illness and all of the mental side effects and anguish that may come from thinking about it as an STD.

It's not really an STD, but it's being passed through sexual networks at the moment.

- Right.

- There's a rare situation where it can be more severe.

So, if you're someone who's immunosuppressed, for example, let's say you've had chemo, let's say you are on a bunch of lupus medicines, let's say you're someone who's had a kidney transplant or you're on dialysis, or some reason why your health is not sharp, this more commonly moves beyond the skin to affect internal organs.

But otherwise this is usually an illness that people recover from in their homes.

Folks will remember from COVID, the idea of isolation and quarantine.

It exists here also.

So when we find someone who tests positive, one of our issues is not only look after that person but to make sure they haven't been able to pass this or don't accidentally pass it to someone else.

- Yeah.

- So, usually there would be a period for a couple of weeks of home isolation, until such time that all of those blisters have dried and a new skin is formed and sealed it in.

And we think at that point, from that forth, people are no longer infectious.

- All right.

And as we come to a close to our time together, last question, which I think you've kind of answered it, right?

How do we prevent the spreading?

What do we do?

- Yeah, so there's two things here actually, one we didn't talk about.

The first is, obviously, being aware of your symptoms.

And if you think you've got a febrile illness with a rash, pop your hand up and seek care from your physician to say, "Look, hey, could this be monkeypox?"

It's almost exclusively, so far, passed in men who have male sexual partners, 99%.

So that helps people, I think, understand who's at the most risk.

So the first is, identify if it could be you, and if it is let's not have that skin to skin contact until you know that things have improved.

Number two is that there's a vaccine.

And so unlike when COVID first emerged, we have a vaccine here, it's very effective.

It's been proven actually for some years.

It's not a brand new one.

And we're rolling that vaccine out at the moment, targeting specifically individuals who we think are at greater risk of running into this.

So, people who have sexual partners with folks who are positive or household contacts.

Folks who know that they have ongoing high risk sexual exposure, particularly amongst our LGBT community.

They would be the people who I think should be reaching out to their clinicians to say, "Look, hey, I'm in the scene.

Is this something that's appropriate for me?"

'Cause actually, often the answer is gonna be, "Yes.

We can prevent this."

And prevention is just a hell of a lot better than trying to fix it on the back end.

- It is, it is.

Well, I think I hope that, that provided some clarity.

I know it did for me and Dr. Wolff I just wanna thank you so much for your time.

Thank you for your research and your dedication to not only monkeypox and COVID-19, but all the other things that I'm sure we're unaware of that you're working on and much, much thanks for you to work on those things.

So, thank you.

- I appreciate the chance to talk.

Thanks so much for bringing this up.

- All right.

Here, to talk about it in a little more detail are our guests for today.

Political analyst, Steve Rao, and Professor La'Meshia Whittington.

Welcome to the show.

Thank you guys for being here.

- Good morning.

- So I'm not sure about you, but I was happy to hear some of Dr. Wolff's answers to those questions that so many of us are having about monkeypox.

It certainly helped clear up myths.

So, La'Meshia, I wanna come to you in a further conversation after that interview with Dr. Wolff, that we didn't show, we talked about how this virus doesn't care about your identity, doesn't care about your race, but we're also talking about a virus that is named monkeypox.

Using a derivative that unfortunately has been used to historically categorize us in a racial way.

What are your thoughts on that?

- Or so, the reality is historically, as you already mentioned, Kenya, in our history we've seen the depiction of monkeys, apes, other primates that have been used in racist tropes from fear mongering cartoons that were depictions after slavery used to either incarcerate folks, disparage our communities or minstrel shows or even to incite riots.

And so, this is not something that we are strangers to when it comes to how the media has depicted, just how primates have been [indistinct] to our community, how it's been likened to our people.

But what we have to be very clear is that we have to make sure that we understand the origin of monkeypox itself so that we can know how to combat these false media narratives.

And be caught up in the swindling of, again, the misrepresentation of our people.

The monkeypox, the actual term was of course, pulled from monkeys that were being researched at the time in 1958 in an actual European Danish laboratory.

So that was the actual origin.

Is these monkeys were being researched in a Danish laboratory in Europe, and it was an outbreak in 1958.

The first human case didn't actually arrive until 1970, nearly 20 years later in Democratic Republic of the Congo.

So when we talk about the history, it should be very clear that it was a derivative from animals, but it was specifically in a European country not in a country that was from the African continent.

And so, as we are navigating these conversations in our relationships and community, we have to understand that we have to fight against diminutive depiction and the fact that this monkeypox isn't anything new.

So when we talk about 1958, then the first human case in 1970, there were also cases as recent as 2003 in the United States when there were 47 humans that actually received an outbreak in Texas from a shipment of animals from Ghana.

So, we've been dealing with this in the United States in small factions, but also in Canada, Israel, Spain, Italy.

So we're seeing different countries that are dealing with the monkeypox and different variants, but we have to be very realistic.

And I appreciate the doctor's explanation of how we reduce contact is the racist trope is very real, but we have to make sure we are grounding ourselves and how to protect one another.

And it's very similar to how we've protected ourselves against COVID-19, social distancing, using PPE, so masks, and we have to make sure that corporations, industries, plants, factories, and rural communities are abiding by these rules as we're dealing with small factions of outbreaks that are emerging in North Carolina, but across the United States.

- As always, La'Meshia, thank you so much for the educational perspective.

Steve, in our interview, we briefly touched on the vaccines availability in our state.

Is there anything that we need to be aware of when it comes to state budget and vaccine access when we're suddenly presented with a viral illness?

- Well, the one thing we learn from the COVID pandemic is that we just cannot underestimate the importance of having a healthcare system that's prepared for dealing with shocks to our healthcare system.

And COVID-19 killed over 25,000 North Carolinians.

We were, when you look back two years ago just did not have the bed capacity, the healthcare workers.

So, it's important that any budget that the state approves and that the governor signs, would actually have enough investments to local governments, counties and cities to do vaccinations, not only as the state of emergency has been lifted for COVID and the variance, but also additional diseases like monkeypox and there will be future pandemics.

Kenya, I think that this budget falls short of that.

I mean, the state budget that we signed basically, is 4.84 billion for Medicaid.

We're gonna talk about that in a little while, about 1.84 billion for the Department of Health and Human Resources.

And some things it does do is it actually allows the Chief Medical Officer to continue to authorize vaccines and give tests.

Now, that the emergency will be lifted by August 15th, hiring new pathologists, paying more for workers, nurse workers and healthcare workers, flexibility in terms of allowing unlicensed nurse practitioners to actually work in these facilities.

But what it doesn't do, is there's very few new health initiatives that are supporting the efforts at the county and the city level.

For example, we've talked on this show, the importance of vaccination strategies and getting vaccines out to minority communities, disenfranchised communities, communities that they may not have access now that we're in the midst of inflation and gas prices.

They may not be able to drive from Southeast Raleigh to a healthcare facility or clinic, whether it's WakeMed or UNC.

And so, we need to make sure that we're getting the vaccines out to the people where they work, getting the vaccines out to where they live, not only COVID vaccines, but monkeypox vaccines.

And so, I think that's what this budget doesn't do.

And I hope that we can focus on that in the new budget and the short session next year.

- Indeed, and as we move on to another medical topic, we're talking about North Carolina Medicaid expansion.

It's been a quiet yet consistent conversation for years now.

And for many people, the recent pause to find out if the 600,000 North Carolinians who've been waiting to hear if they will get coverage that they need is a deafening sound of defeat.

Just last week, the House of Representatives said they're not ready to embrace the bill and they need more time to study and plan for next steps.

Meanwhile, we've got people who fall into the medical coverage gap and simply cannot get the basic medical attention that they need.

Steve, back to you.

What exactly do you think is the hold up and is there maybe a larger strategic play or plan for the November elections?

- Well, the first thing I'll say is that I think that, clearly, Senator Berger, Pro Tem Berger and Speaker Moore have decided that partisan politics and partisanship is more important than bipartisanship, because clearly, there was an opportunity here.

Governor Cooper has tried this three times in the past, he really wanted this, but 39 other states in our country have joined together, even in Virginia, in a bipartisan manner to pass Medicaid expansion, and what this would do is provide access to over 600,000 North Carolinians.

It would take, basically, at the 138% poverty rate, that people would be able to qualify for Medicaid.

Let's not forget that 6% of our children do not have health coverage because of no Medicaid access, and so, to answer your question, I think what this is about is that, yes, Senator Berger got everyone excited when he said he wanted to do this, and Medicaid advocates were very excited.

Now, he wanted to tweak telehealth, he wanted to provide more flexibility for nurse workers to do some of the work that medical doctors do, changing the way hospitals are regulated, but then Speaker Moore had a different vision.

So there is a joint task force, a committee, which is a good sign that they're gonna continue these efforts, but I think it's really parliamentary jocking.

I mean, we could have done this this year, in the midst of a pandemic, inflation, rising prices, providing the access to healthcare during a pandemic and with future diseases like monkeypox.

The final thing I'll say is preventive care, you know?

I mean, testing for obesity, diabetes, hypertension, making our immune system strong.

Medicaid is gonna provide that so that somebody who has an immunocompromised system would not be as vulnerable to get another virus or another pandemic.

So I think it falls short of new initiatives we need, and I'm hoping that we will pass Medicaid in the short session.

We've got to do it, we've gotta come together.

This is an issue that's not a Democrat or Republican, it's about what's in the best interest of North Carolinians and our children.

- Exactly, and, La'Meshia, while we're talking about those North Carolinians, those childrens that are impacted, we see a large number of black and brown Carolinians in this gap.

How does that further impact our community?

- Sure, well, first, it's preposterous to hold Medicaid and the process of actually passing it to conduct more studies, while our people, we're not gonna ask folks to wait to conduct a study when we ask them to get out and vote, right?

We're gonna collect their votes.

But we can't make sure that all of our communities actually have access to healthcare, access to medical intervention, and so I just wanna ground that it's preposterous, because the reality is, when we were seeing the marketing of frontline workers during COVID-19, the bedrock of our state that kept our state moving, and the economic suppression that we're about to go into, they were the ones keeping us afloat, but our state is neglecting to keep their households afloat by giving them expansion in Medicaid.

When we talk about Medicaid gap and then the impacts on black and brown communities, let's talk about what that gap means.

It means that everyday folks who work at factories, whether it's a poultry plant, a hog plant, whether it's McDonald's working, and they work hours, 40 to 60 hours a week, they still may not make enough to actually qualify for the Affordable Care Act, or qualify for health benefits, and so they're in the gap.

They work the hardest, but guess what?

They don't earn enough.

They earn too much to qualify for Affordable Care Act, but they don't earn enough to actually pay for their own benefits.

So this is what's impacting the 600,000 North Carolinians who even lost healthcare coverage in pandemic because of loss of jobs.

So when we're talking about the most impacted, that's rural communities.

The black belt of North Carolina is eastern North Carolina, the largest population of black community.

Even though we also have black communities in the west, and we have it in the triad in the region, the most concentration is in rural communities in eastern North Carolina.

The largest population east of the Mississippi is within the Native American population from the Lumbee all the way to Haliwa-Saponi and between.

So when we're talking about the gravest impacts, this will be on workers in plants, factories, restaurants, food service, construction, grocery stores, building, you can keep going, landscape, farm workers.

And when we talk about black communities specifically, as a black woman, this hits home for me, black women are two to six times more likely to die from complications of pregnancy than white women in the United States.

We have the highest infant mortality rates, we have the worst infant mortality rates since 20 to 25 years after slavery.

That is incredibly, just disheartening to understand the lack of progress.

And why is that, Steve already mentioned it, it's because we don't have adequate access to healthcare to address asthma, chronic conditions, and our rural hospitals are closing because we actually don't have the support, and in North Carolina, we don't have the infrastructural resource to make sure they're staying open for our people to even access medical intervention, when we know emergency rooms are oftentimes replacement for positions in rural communities.

That's the impact that we're dealing with.

- Indeed, La'Meshia, Steve, thank you.

As always, great contribution to the conversation.

Thank you so much.

- Thank you.

- I wanna thank today's guests for joining us.

We invite you to engage with us on Twitter or Instagram, using the hashtag #BlackIssuesForum.

You can also find our full episodes on pbsnc.org/blackissuesforum, or listen at any time on Apple iTunes, Spotify, or Google Podcast.

For Black Issues Forum, I'm Kenia Thompson.

Thanks for watching [upbeat music] ♪ - [Announcer] Quality public television is made possible through the financial contributions of viewers like you, who invite you to join them in supporting PBS NC.