HENDERSON, N.C. (WNCN) — North Carolina reported 46 monkeypox cases as of Thursday afternoon. So far, the state has not seen a wave of cases but if there are more in the future and increased testing is required, Mako Medical believes they are prepared to take on the challenge.

When monkeypox test samples arrive the Mako’s Henderson lab, testing starts by hand. Works take each sample out of their tube, placing them in processing equipment.

“This is the most labor intensive and rate limiting step in the process,” said Matthew Tugwell, director of the genomics departmet at Mako Medical.

He said turnaround time for their monkeypox testing is currently 24 hours.

“We’re turning those around very quickly,” he said.

That speed is a result of advances in testing during the COVID-19 pandemic.

“It’s been challenging but in a good way. I’ve learned more than I could have ever hoped to learn in my career,” Tugwell said.

When expanding this lab in 2020, Tugwell said Mako made sure the facility could easily switch from testing for COVID to any other virus or pathogen.

“All the equipment we use for COVID-19 testing, we can also use for monkeypox testing. The workflow is actually identical except for the last part,” said Tugwell.

He said Mako Medical can run up to 25,000 monkeypox tests per day right now, but they’ve only processed about a dozen so far. While other tests capture the family of viruses monkeypox, the company has partnered with Thermo Fisher to offer a test is specific to monkeypox.

“It’s important because it improves the turnaround time and reduces a lot of redundancies in getting a positive monkeypox result,” said Tugwell.

That time is crucial as more people become exposed to the virus.

De-stigmatizing testing

A recent report from the New England Journal of Medicine found 98 percent of the cases reported worldwide from April through June were in the LGBTQ community.

“I think that stigma needs to be broken down,” said Steve Hoover, vice president of lab operations at Mako Medical.

While the LGTBQ community is over-represented in infections, Hoover wants people to know this isn’t an LGBTQ-only disease. Anyone can get if exposed through physical touch or even linens that have touched a monkeypox lesion.

“It’s very crucial to not have people be stigmatized by it and not be afraid to test openly,” Hoover said.

The median age for infection is about 38 years old. Older populations may have some protection already.

“If you’ve been vaccinated for smallpox and you had to be older than a certain age to fall into that category, that does offer some protection against monkeypox,” said Tugwell.

Everyone else should consider testing if they’ve been exposed. Anyone who suspects they’ve been exposed, should contact their local health department.

Tracking community spread

While Mako Medical is processing individual samples, the state does have a way to track community wide spread.

NCDHHS confirms they started surveilling wastewater for monkeypox about two weeks ago.

“All 25 sites sampled were negative/below detection for monkeypox. It is unknown how many cases are needed in an area before detection is possible in wastewater,” NCDHHS said.

The department said sampling will continue through the coming weeks and months.

To detect COVID-19 in wastewater, labs collect samples from two dozen water treatment plants across the state. The information from the collected wastewater acts as a crystal ball, predicting trends up to six days early.

When it comes to COVID, the samples allow the state to plan where they may need to increase testing or where to expect increased hospitalizations.

What the data cannot tell researchers is the number of people infected in a given community or how sick they are. Because what individuals flush all ends up at wastewater treatment plants, surveillance can’t tell exactly who is infected.