Editorial: Here we go again

  • by BAR Editorial Board
  • Wednesday July 6, 2022
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These images from the UK Health Security Agency are more representative of what the current monkeypox outbreak looks like. Photo: Courtesy UKHSA
These images from the UK Health Security Agency are more representative of what the current monkeypox outbreak looks like. Photo: Courtesy UKHSA

When the COVID pandemic started in March 2020, the federal response was lackluster to say the least. Much of that blame fell on the shoulders of former President Donald Trump, who routinely spouted misinformation and hobbled U.S. scientists, researchers, and public health officials for many months. Finally, he advocated for vaccines, and the National Institutes of Health helped develop the Moderna vaccine, which, along with Pfizer, has proved to be a game changer in largely preventing serious illness or death. Now, although the country is still in the grips of the COVID virus — and cases continue to rise as new variants are easily transmissible and vaccine immunity wanes — there is a monkeypox outbreak and, this time, federal officials in the Biden administration have been slow to respond. They can and must do better. San Francisco has seen its probable cases more than double in less than a week, to 40 as of July 5.

Monkeypox is an old virus and is not a "gay" disease, as officials so wrongly said about AIDS back in the 1980s. And officials have rightly pointed out that anyone can contract monkeypox through close personal contact, as we have reported for the last couple of months. That said, we'd be foolish to ignore the present reality: the virus now is primarily spreading within networks of gay, bisexual, and other men who have sex with men. Many of these men reported multiple recent sex partners or attended venues and events where sex and other intimate contact takes place. Only a small number of cases have been identified among women and children.

As we've reported, the monkeypox virus is transmitted from animals and from person to person through skin-to-skin contact, kissing, and contact with contaminated clothes, bedding, or surfaces. It also can be transmitted through respiratory droplets at close range, but it does not spread through the air over longer distances like the coronavirus that causes COVID-19.

Last month, the Centers for Disease Control and Prevention stated that the monkeypox virus "is not known to linger in the air and is not transmitted during short periods of shared airspace." It can be transmitted between people who live in the same household and to caregivers, but it does not spread, for example, via casual conversation, passing someone in a grocery store or touching doorknobs, agency officials said.

Monkeypox, which is related to smallpox but less severe, causes flu-like symptoms, swollen lymph nodes, and a rash that can appear anywhere on the body. In the current outbreak, many men have presented with lesions on the genitals or in the anal area that may resemble common sexually transmitted infections such as herpes or syphilis.

Monkeypox has an incubation period of up to three weeks before symptom onset, and the illness usually lasts two to four weeks, we reported this week. It is considered infectious until the sores heal completely and scabs fall off. Most people recover without treatment, and there have been no deaths in non-endemic countries so far. But the sores can leave scars, some patients have required hospitalization for pain management, and people with severe disease can develop complications. Pregnant people, children, and immunocompromised individuals — including those with poorly controlled HIV — are at greater risk for severe illness.

Most experts do not consider monkeypox a sexually transmitted disease in the traditional sense, as we've also reported. It is not known whether the virus is transmitted in semen or vaginal fluid, but it can spread through contact with sores or face-to-face contact during sexual encounters. Dr. Demetre Daskalakis, a gay man who's director of the CDC's Division of HIV/AIDS Prevention, calls it a "sexually associated" — rather than a sexually transmitted — infection.

Yet monkeypox cases continue to climb, with California now having the highest number in the country, at 95 reported cases as of July 1, and there were 460 cases nationwide (those numbers are now likely higher). Meanwhile, federal officials have been slow to distribute a new effective vaccine, Jynneos, which was approved in 2019. It's in short supply because federal officials did not make procuring it a priority when the outbreak first started in May. San Francisco, for example, received about 560 doses of Jynneos. This is a woefully inadequate number. New York City and Washington, D.C. had offered vaccine clinics for gay and bi men but had to shut down within hours because they ran out of vaccine.

As the Washington Post reported last month, "The government's failure to clearly and urgently communicate the symptoms and risks associated with monkeypox, a disease spread by close contact that can lead to fever, pain and a visible rash, has left gay and bisexual men, who are disproportionately contracting the virus, especially vulnerable, public health experts say." Some administration officials have said that the monkeypox response raises doubts about the country's preparedness for the next pandemic, the paper reported. The same thing was said back in 2020 at the start of the COVID pandemic. And unlike COVID, monkeypox is not new. The Post pointed out the virus has been studied for decades, and health officials know the vaccine protocols that can limit spread.

All of this makes for a frustrating situation. The federal government needs to ramp up tests and vaccines — indeed, last month it did authorize more labs to run the tests starting this month. While updated education materials have been made available recently, it took longer than in other countries, according to David Harvey, executive director of the National Coalition of STD Directors, as the Post article mentioned.

Pride Month is now over, but other summertime events are coming up in the Bay Area, such as the Up Your Alley and Folsom Street fairs, as well as Pride events in San Jose and Oakland. The vaccine supply must be increased so that there can be clinics at these events where people congregate. The Castro LGBTQ Cultural District held a successful COVID vaccination program and could replicate the effort for monkeypox vaccines. But outreach like that will only happen if vaccine supplies are quickly distributed to local health officials. Time is not a friend in this situation, and the Biden administration must step up its efforts.

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