A vaccine is administered at Latinos Salud, a cluster of health clinics that serve the gay community in south Florida. Photo courtesy of Latinos Salud
Efforts to curb the spread of monkeypox in the United States — especially in communities of gay and bisexual men hardest hit by the virus — are being complicated by ongoing efforts to contain COVID-19.
Public health officials also confronting local outbreaks of deadlier illnesses like meningitis and a worsening surge of sexually transmitted diseases.
“As cases of monkeypox rise across the country, local health departments and communities have another challenge to add to their long list — educating the public, alerting health providers and ensuring care whether their community has hundreds of cases or is waiting for the first,” said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials.
Casalotti pointed to another stumbling block: funding.
“As of today, there haven’t been any additional funds for monkeypox efforts at [local] health departments,” she told UPI in a phone interview Friday.
She said her Washington, D.C.-based organization that represents 3,000 local health officials is working with the Centers for Disease Control and Prevention and the Biden administration “to make sure [localities] have the funds and flexibility they need.”
“Nearly every dollar they get is tied to a specific disease,” she said, explaining that COVID-19 funds sent to county and city health agencies are tied to that virus and cannot be used for emerging illnesses like monkeypox.
Casalotti said the group also is working with member of Congress “so they understand the needs on the ground for monkeypox.”
Meanwhile, front-line health providers in local communities continue their efforts with limited staffing and limited funding.
In Florida, Latinos Salud opened more than a dozen years ago to try to control surging HIV and sexually transmitted infections in south Florida’s gay community. Then, COVID-19 hit hard, followed by meningococcal disease a few weeks ago.
So when the first presumptive case of monkeypox appeared in Florida in late May, Stephen Fallon, Latinos Salud’s co-founder and executive director, said its three community clinics in Miami Beach, southwest Miami and Wilton Manors, already faced heavy foot traffic.
Florida had 154 reported monkeypox cases as of Friday, according to the CDC, and it’s surging in South Florida, cited as the outbreak’s epicenter.
“I think we all changed from our glass half full to our glass half empty,” given the continuing onslaught of public health threats, Fallon told UPI in a phone interview. “Some days it can feel like, ‘Now what. What’s coming next?'”
The CDC still characterizes U.S. monkeypox cases as “very rare.” It noted there were two cases from travel to Nigeria in 2021 and 47 confirmed and probable cases in six states in 2003. But these are far lower than this year’s count.
And there is every indication that containing the spread of monkeypox is becoming far more urgent.
In California, a state lawmaker warned Thursday that San Francisco faces an “uncontrolled” monkeypox outbreak, according to a news report. The local health agency had expected to close for the rest of the week due to a vaccine shortage.
In New York City, a report Thursday indicated that heavy demand for the monkeypox vaccine caused the appointment system to crash.
In fact, demand nationally is outstripping the supply, CDC director Dr. Rochelle Walensky said at a news briefing Friday.
The federal government made 131,000 doses of the vaccine called Jynneos available to states that day, and another 2.5 million doses are expected before year’s end from maker Bavarian Nordic, Health and Human Services officials said.
Orders for even more doses are planned, the officials said. The protocol calls for two injections four weeks apart, and the CDC says full immune response take two weeks after the second dose.
While many of those affected in the current global outbreaks are gay, bisexual or other men who have sex with men, anyone in close contact with someone who has monkeypox can contract the illness, the CDC says.
The national total, as of week’s end, was 1,814 cases — and rising since the first cases were discovered in May.
“By no means is the current risk of exposure to monkeypox exclusively to the gay and bisexual community in the U.S,” said Dr. John Brooks, a CDC epidemiologist.
He added that monkeypox “is not a sexually transmitted infection in the typical sense,” but can spread from intimate contact or shared contaminated bedding or clothing.
Monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo, according to the World Health Organization.
WHO has warned of the risk of monkeypox spreading to high-risk groups, including children, pregnant women and immunocompromised individuals.
The time from exposure to an infected person to onset of symptoms ranges from five to 21 days, and symptoms typically last two to four weeks.
The CDC recommends vaccination for people who have been exposed to monkeypox and individuals at higher risk of being exposed to it. Two Food and Drug Administration-approved vaccines and one antiviral medication can treat the virus.
Press secretary Jared Todd, of the Human Rights Campaign, a Washington, D.C.-based LGBTQ+ advocacy organization, said health officials and the government must ramp up much needed testing along with vaccine doses.
“We’ve heard and read stories of people waiting up to three or four weeks just to get a test result — and that’s if they’re lucky enough to get a test,” Todd told UPI in an email. “In that timeframe, the virus has pretty much run its course.”
Todd added: “So we need more focus on testing so we can learn more about the spread [of monkeypox virus]. The fact that we are experiencing a response with glitches, which in some ways reminds us of the early days of COVID-19, is frankly unacceptable.”
In Washington, D.C., lesbian, gay, bisexual, transgender and queer individuals comprise roughly 10% of the population, and the D.C. Department of Health recently opened two new clinics for monkeypox treatment to augment its main clinic. But the agency got a late start.
Anil T. Mangla, who became the D.C. health agency’s state epidemiologist in November, told UPI in a phone interview that “our focus was still on COVID-19 when this [monkeypox] hit” in early June.
In response, the D.C. health agency gathered what Mangla calls a “mopox team,” training a cadre of staff members available to assist physicians in diagnosing monkeypox rashes.
“It’s a 24-hour service because an emergency doctor calls at 2 a.m. and says, ‘I have a monkepox patient. What do I do?’ I feel if I don’t have [assistance] in place, the physician will send the patient home,” Mangla said.
He added: “We want to ensure that we can treat or assist any patient who comes into the physician’s office or ER with a rash that we can actually diagnose to be monkeypox.”
Meanwhile, Mangla said he and his staff are “modeling, making projections and looking at the epicurve on how the [monkeypox] outbreak is trending in the District … and we have ‘doubling time’ — an algorithm to help predict how often the number of cases will double.
“Now, in D.C., our doubling time is about five to six days,” Mangla said last week. “But it’s slowed down and that’s not uncommon. You’ll have troughs and peaks in the early phases.”
Despite this close tracking, Mangla said that epidemiologists are working with only about a month’s worth of data points — and that’s not much for making predictions.
“We’re averaging between three to five [new] cases a day, he said, noting the District had 69 cases as of July 11. By Friday, D.C. had 108 cases, CDC said.
That total was exceeded only by Florida, California Illinois and New York. All but seven states had reported at least one case as of Friday.
Shirley Morales, an epidemiologist with the Cook County Department of Public Health covering parts of suburban Chicago, said she is one of five staffers working on case investigations and following up on close contacts of infected individuals to handle what she described as a “manageable level” of monkeypox in suburban Cook County.
“We have not yet had to rely on COVID contact tracers” or staffers in the department’s sexually transmitted infection program, Morales told UPI in a phone interview.
But she said this arrangement could change, depending on how many confirmed cases arise in the county — a number used by the state to allocate doses of the vaccine.
Morales cited nine confirmed monkeypox cases and 17 cases identified for follow-up as of Tuesday. By Thursday, the numbers had risen to 12 and 27, respectively.
“The first thing that we emphasize when we do outreach is anyone can get monkeypox,” Morales said.
Most people infected with monkeypox have reported mild symptoms, she said. “Some are experiencing enlarged lymph nodes, some have had fever, but the majority are just reporting the rash.”
Mangla, the D.C. state epidemiologist, describes the situation differently. Lesions from moneypox embed deeply in the skin and can be “excruciating,” he said, adding that hospitalizations in D.C. haven’t occurred for the virus, “except for pain management.”
Mangla said he remains cautiously optimistic after 25 years as a epidemiologist, including time spent in Africa during an Ebola outbreak, that the disease will abate.
“I try to stay very calm and train my staff” to stay calm, too, amid the latest threat to public health, he said.
“We have vaccine, we’re able to test individuals and do contact tracing, “so we are blessed to have what we have and need to optimize what we have,” he said.