Cases of monkeypox are rising exponentially in some gay and bisexual communities, dampening hopes that authorities can quickly gain control of the virus which has the potential to take a lasting hold in the United States.
The United States is reporting about 444 monkeypox cases per day for the seven-day period that ended Monday, according to Our World in Data. That’s double the daily case rate from two weeks earlier. Los Angeles County reported 683 cases on Tuesday – a figure that has doubled in the past 10 days.
More than 1,600 cases of monkeypox have been documented in California, according to a Times tally of data from Los Angeles and San Francisco counties and the state Department of Public Health.
“When you look at the rates of increase, you can see that they’re really close to an exponential curve. And unfortunately, it’s going to get harder and harder to control the rise in those numbers,” said UC San Francisco infectious disease expert Dr. Peter Chin-Hong.
Doctors fear that further spread could make the virus endemic in the wildlife population, meaning it would be virtually impossible to eliminate it as a new disease of concern in the United States.
“Hopefully we can contain this. But if not, it could spread to other populations,” Chin-Hong said.
About 10% of monkeypox cases result in hospitalization, Chin-Hong said, usually for severe pain or superinfection. “There were a few deaths in Spain, one in Brazil, outside the African continent,” Chin-Hong said.
And “although we don’t see a lot of deaths,” Chin-Hong said, monkeypox infections “really cause a lot of suffering.” The pain can be excruciating and cause difficulty sleeping, walking, eating, drinking, or going to the bathroom.
Here are some challenges in controlling the global epidemic:
Rapid spread in high-risk settings
Cases are rising sharply among men who have sex with men and transgender people who have sex with men, Chin-Hong said. About 98-99% of cases involve people from these groups.
The spread of monkeypox cases has also been amplified by Pride events, particularly at gay saunas and at pool parties where there is intimate skin-to-skin contact, Chin-Hong said. The virus is not transmitted through swimming pool water and generally not through public surfaces. It can, however, be transmitted through infected linens and other household surfaces where there is continuous exposure.
Not diagnosing quickly
Monkeypox can be difficult for medical professionals to diagnose early, especially since it was virtually unknown in the United States until recently.
“The rash can really look very innocent when it starts, like a pimple or like an ingrown hair. That’s why it’s really hard for clinicians to diagnose it,” Chin-Hong said. people, you can keep them away from people [who] are not infected.
Chin-Hong urged clinicians to be more wary and take samples of lesions for testing. Even if there aren’t many skin diseases, clinicians should take samples to test for monkeypox from the rectum, urethra and mouth, he added.
For example, a person infected with monkeypox may test positive for the virus from a sample of the urethra, but the infection may not be detected on the skin.
“A lot of people dab the skin like there’s no tomorrow. But if the disease is in your mouth or in your anal area, you’re going to get a false negative because you’re not going where the disease is. disease,” Chin-Hong said.
According to the Centers for Disease Control and Prevention, symptoms of monkeypox usually begin within three weeks of exposure. The illness can last two to four weeks.
About 80% have flu symptoms, but about 20% don’t, Chin-Hong said. The telltale rash appears in almost all patients with monkeypox; among many, it first appears in the anus and genital areas, then moves to the face, arms, mouth, trunk, palms, and soles of the feet.
San Francisco resident David Watson said he contracted the virus after hugging and kissing a friend on the cheek. His friend had a lesion on his cheek which he assumed was an ingrown hair or pimple. Within five days, Watson developed symptoms that became so painful he was taken to hospital.
“I ended up in the ER three times in 4½ days with excruciating pain that opioids could barely touch. It took two doses of morphine my first time in hospital to reduce the pain to a manageable level,” he said. “It didn’t matter whether I was sitting, standing or lying down, the pain was out of this world.”
Limited supply of vaccines
Federal officials have been criticized for moving too slowly to increase vaccines, but on Tuesday announced a new plan to expand the limited supply of the Jynneos vaccine, which can help protect against monkeypox. The plan is to reduce the dose of the vaccine to one-fifth of the current measure by delivering the vaccine intradermally – between layers of skin – rather than subcutaneously, into the underlying fat.
But even federal officials acknowledge that the new strategy will not magically end the vaccine shortage.
“We’ll probably run out of vaccines again before we run out of weapons,” Dr. Demetre Daskalakis, White House deputy national monkeypox response coordinator, said during a Tuesday briefing.
Health officials say an adequate supply of vaccines is key to controlling the monkeypox outbreak.
“Every week you wait, more and more people infect a circle around them. And these circles around them infect the circles around each of them,” Chin-Hong said, adding, “We treated so many patients this week, way more than the previous weeks.
“I think vaccines are the solution,” he said. “And the monkey pox at the beginning…it looks like nothing, like a pimple. It is really difficult to clinically diagnose the first cases. So when it’s dramatic, you’ve probably already exposed a lot of people.
Kim Saruwatari, director of public health for Riverside County, said there is a particular need for additional vaccines in the Coachella Valley due to international sex tourism in Palm Springs.
“This area has 11 sex clubs — the most of any Southern California jurisdiction,” Saruwatari said at a legislative hearing on Tuesday. “For this reason, Palm Springs may well be the source of many cases in other jurisdictions.”
It has been difficult to balance messages that do not stigmatize gay and bisexual men and transgender people who have sex with men – those most likely to be infected with monkeypox – while clearly indicating ways reduce the risk of contracting the virus.
“I think it’s hard to say, ‘Limit sexual activity or don’t have sex,’ because you want to be as sexual as possible,” Chin-Hong said. “But I think those are the messages that some people are starting to see.”
The San Francisco AIDS Foundation suggested “avoiding dark back rooms at parties if they are very crowded and there is no way to control who you bump into and who you rub your skin with” . People can also reduce risk by having “open and honest conversations about monkeypox symptoms and possible exposures” before having sex.
“Perhaps it is time to suspend group sex and saunas until we all get injections one and two of the vaccine. It’s temporary and out of love for group sex and those who enjoy it,” reads another guide to safer sex.
Experts are also looking to dispel unfounded fears about how you can catch monkeypox. Officials do not see the spread of activities such as changing clothes in a locker room, casual contact at a crowded festival or gym equipment.
“Even though it is technically possible to transmit monkeypox on surfaces [like if you share a towel with someone who has monkeypox], it is less likely. There’s not much risk of catching monkeypox from sharing things like toilet seats, swimming pools and gym equipment,” the San Francisco AIDS Foundation said.
There is no risk of contracting monkeypox from casual public encounters, such as bumping into someone on the subway. It would also be difficult for monkeypox to be transmitted during a massage unless there is a visible lesion from any skin-to-skin contact.
“The risk of monkeypox is really in the intimate setting,” Chin-Hong said.
It’s hard to get treatment
There is an antiviral – tecovirimat, also known as Tpoxx – which can be given to help relieve symptoms. However, many healthcare providers have had difficulty accessing the drug, which is only suggested for severe cases or for people with certain high-risk health factors. CDC officials said they are working to streamline the process so more people can get access to the drug.
Tpoxx – given as three pills, twice a day, for two weeks, or intravenously – is approved by the US Food and Drug Administration to treat human smallpox, but its use to treat monkeypox is n is not agency approved. As a result, obtaining Tpoxx is complicated and involves contacting a state health department or the CDC and asking a patient to fill out an informed consent form, which takes an hour.
Federal officials said they are developing randomized controlled trials to determine the safety and effectiveness of Tpoxx for treating monkeypox in humans. Although it has been shown to be effective in animal models of monkeypox, without such human data, “we will not know whether tecovirimat would benefit, harm, or have no effect in people with of monkeypox disease,” FDA and CDC officials wrote in a perspective article for the New England Journal of Medicine.
Tracy City Council member Dan Tavares Arriola said when he tested positive for monkeypox in late July he faced a maze of bureaucracy as he tried to get himself treatment and a vaccine for his exposed partner.
“I’m a lawyer. I’m an elected official. I have experience in advocating for myself and others and navigating systems,” Arriola said. “I can only imagine how it is more difficult for those who do not have this experience or who face different obstacles such as language barriers.”
Times writers Grace Toohey, Emily Alpert Reyes and August Brown contributed to this report.
Los Angeles Times