SFAF town hall addresses monkeypox questions

  • by Liz Highleyman, BAR Contributor
  • Wednesday July 13, 2022
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Clockwise from top left, Russell Roybal, Jorge Roman, Dr. Susan Philip, and Dr. Hyman Scott answered questions during a July 12 virtual monkeypox forum. Photo: Screengrab
Clockwise from top left, Russell Roybal, Jorge Roman, Dr. Susan Philip, and Dr. Hyman Scott answered questions during a July 12 virtual monkeypox forum. Photo: Screengrab

The nearly 600 participants of a July 12 virtual town hall sponsored by the San Francisco AIDS Foundation raised many questions about the city's monkeypox outbreak, but the answers weren't always satisfying as the speakers acknowledged testing limitations, a shortage of vaccines, and difficulty getting treatment.

"We have an imminent window to address monkeypox between our Pride events and the upcoming street festival season here in San Francisco, and that window is closing," said SFAF CEO Tyler TerMeer, Ph.D., a gay man who is living with HIV. The next major community event, the Up Your Alley leather and fetish street fair, is just two weeks away on July 31.

On July 13, the San Francisco Department of Public Health updated the city's monkeypox tally to 68 cases — up from 40 a week ago — and experts expect numbers to rise even faster as testing capacity increases.

Earlier Tuesday, gay District 8 Supervisor Rafael Mandelman, health officials, and community advocates held a news conference on the steps of City Hall to call on the federal government to do more to address the growing outbreak.

During the virtual forum, SFAF medical director Dr. Hyman Scott explained that monkeypox, which is related to smallpox but less severe, often starts with flu-like symptoms (known as the prodrome) followed by a rash anywhere on the body. Monkeypox is thought to be infectious when symptoms start, but mild or non-specific early symptoms may be missed. The illness usually resolves on its own without treatment, but several people in San Francisco have been treated for more severe cases, he said.

Although anyone can get monkeypox, most cases in the current outbreak have been gay and bisexual men. The virus spreads primarily through skin-to-skin contact and bodily fluids. Transmission through respiratory droplets or contact with contaminated bedding, towels, or surfaces is "much less common," according to Scott. It is not yet known whether monkeypox is transmitted in semen, but it does spread through contact with sores during sex, and many men in the current outbreak have developed lesions on the genitals or in the anal area.

"This is not a new virus, but it's behaving in [new] ways that we're identifying in this outbreak," Scott said.

SFAF responds

SFAF's dedicated monkeypox hotline has gotten up to 500 calls per day, and the Magnet sexual health clinic at its Strut facility in the Castro is seeing two to three suspected cases per day on average, according to Jorge Roman, Magnet's clinical director. "We've responded as quickly and agilely as we could, trying to respond to the demand from the community," he said.

Much of that demand is for monkeypox vaccines, but the new Jynneos vaccine remains in short supply. San Francisco Health Officer Dr. Susan Philip said the city has received 2,888 doses, mostly during the past week. Almost all have been sent out to clinics and community organizations, and the city has requested another 35,000 doses from the state. So far, more than 1,700 San Franciscans have received their first dose.

The Jynneos regimen consists of two doses administered a month apart. "You get quite a robust immune response" two weeks after the first shot, but "I wouldn't say you're completely protected if you get the vaccine the day before Dore Alley," Roman said.

Hyman added that people with monkeypox appear to develop lasting immunity that protects them against getting the virus again. People over age 50 or so who received a smallpox vaccine as a child may still have some immunity, but Magnet has seen cases in older individuals so this protection "might not be lifelong," said Hyman.

Magnet is one of only a few sites that has been offering monkeypox testing and vaccines in SF, along with City Clinic and Zuckerberg San Francisco General Hospital and Trauma center, but DPH plans to add more locations as the supply increases, Philip said.

However, the day after the forum, the health department announced that it is running out of vaccines. The clinic at SFGH was down to 50 doses and will close until it is resupplied; other sites are also running low. The city is awaiting more doses from the federal government.

Gay state Scott Wiener (D-San Francisco) said the situation was turning into a public health crisis.

"Due to a lack of vaccine supply — and what will continue to be a sluggish pace of vaccination due to limited supply going forward — we are veering toward a public health mess of uncontrolled monkeypox spread in our community and many other communities," Wiener stated in a release. "Failure to control this outbreak will result in intense — and completely unnecessary — misery for many people, particularly gay and bisexual men."

With more than 2,000 people on its vaccine wait list, Magnet had received only 290 doses as of July 6, but expects to have another 500 for a vaccine clinic on July 17. Some 6,000 doses are needed just to cover current Magnet clients who are at risk, with thousands more needed for the broader community.

Because the monkeypox virus has a long incubation period, vaccines can be used as both post-exposure prophylaxis for people who were exposed during the past several days and as pre-exposure prophylaxis for individuals at risk for future exposure. DPH is currently prioritizing the first group. Eligible individuals include asymptomatic people who are close contacts of a confirmed or suspected case and those who received a notification from an event or venue about a potential exposure.

As the B.A.R. first reported online July 5, organizers of two large pre-Pride dance parties recently alerted attendees that people known or suspected to have monkeypox were present at the events. Steamworks bathhouse in Berkeley also warned patrons about potential exposure.

"Vaccines are the best way we have to protect people and stop the virus from spreading," said Philip. "Because we have such limited vaccine supply, we are temporarily asking everyone to prioritize those who have had a direct exposure. We really thank all the San Franciscans who have been taking care of each other and allowing people who have been exposed to go first until we have more vaccines available."

Anyone potentially exposed to monkeypox should try to get vaccinated, self-monitor for symptoms, inform partners, and limit close contact, Roman advised. People with a rash or other symptoms should seek medical care. Those who don't have a regular provider can contact City Clinic or Magnet.

Currently, testing is done by swabbing lesions, so it's not available for people who have been exposed but do not yet have sores. Testing has been limited by the capacity of state public health labs, but DPH's in-house lab and commercial labs started doing tests this week.

People who test positive are advised to refrain from sex and other close physical contact until their sores heal completely, which takes about three weeks. Treatment with the antiviral drug TPOXX (tecovirimat) is limited to a few providers and requires extensive paperwork, so it's only used for serious cases.

"It's extremely infuriating that our federal government has once again failed in their response, especially after a two-year public health crisis like COVID-19," said SFAF community mobilization manager Ande Stone. Access to testing, vaccines, and treatment "must be expanded and streamlined at all levels" to ensure that they're available to all people who may be at risk, including gay, bisexual and other men who have sex with men, sex workers, and trans and nonbinary folks.

For the latest updates on vaccine eligibility and locations, click here.

To contact City Clinic, click here or call its new phone number, 628-217-6600. To contact SFAF's Magnet clinic at Strut, click here or call 415-581-1600.

Updated, 7/13/22: This article has been updated to note that the SF health department is running out of vaccine.

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