Monkeypox cases appear to be on the decline in the Bay Area but San Mateo County leaders are continuing their efforts to combat both the virus and the stigma around potentially contracting the skin disease.
As of Tuesday, 43 county residents have contracted monkeypox, a skin disease that can produce rashes and sores and is generally spread through skin-to-skin contact or bodily fluids during close intimate contact, sexual activity and sharing bedding or clothing.
Marc Meulman, San Mateo County director of Public Health, said the low number of infections here makes it difficult to determine whether cases are falling locally or are remaining stagnant. Ultimately, he said, the risk of contracting the virus is still low.
“It’s a little hard to tell for sure how things are going as far as if things are really dropping,” Meulman said. “Generally to the community, the risk is low so we want people to understand this is not being transmitted widely.”
The virus began spreading across the states in mid-May with more than 3,000 cases reported in California to date. The virus is not known to be fatal, is typically less severe than smallpox and is treated with two shots administered at least four weeks apart.
To date, the county has received 2,236 monkeypox vaccine doses, with 950 of those doses having arrived this Tuesday. Initially, the county was sending its doses to San Francisco where demand was higher and many county residents who are considered to have a higher risk of contracting the virus are known to receive care.
“We’re trying to look at this regionally and at some level we recognize that San Francisco is the epicenter for the outbreak for our part of the state. Anything we can do to help there only helps the rest of us,” he said.
Of the county’s most recent allotment, 500 doses will be reserved for an appointment-only clinic being held this weekend for those eligible for the dose and have completed a vaccine request form, Meulman said.
More than 680 forms have been submitted to date but Meulman noted that 147 of those applicants have already received their first dose during the county’s first clinic a few weeks ago, another handful has already been treated at clinics in San Francisco and another small group do not qualify.
Combating stigma
Francisco Sapp, director of the San Mateo County Pride Center, also acknowledged that the county appears to be making a shift both in terms of resources and in its messaging about the virus.
He lauded the state for putting “financial weight” behind its emergency response and noted local clinics are a vital resource for many county residents including seniors, those with difficulties traveling and people with disabilities or other health risks.
But recognizing that vaccine supply has been low, Sapp also suggested early messaging was counterproductive by driving up alarm among people who were not at high risk of contracting the virus. For instance, someone may identify as a man who has sex with other men — a community regularly cited as behind high risk — but may not practice known high-risk behavior.
“We don’t want this to be anything more than it needs to be,” Sapp said. “Resources are so limited, we don’t need everyone coming to get a vaccine if they aren’t that at risk.”
About 40% of 3,065 people who have contracted monkeypox identify as Latino and about 95% identify as men who are gay, same-gender loving or bisexual, according to data collected by the California Department of Public Health.
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Having worked closely on HIV education and programming in the past, Sapp said he was alarmed by the focus on individuals rather than the behaviors that were known to increase someone’s likelihood of contracting the virus.
Sapp, reiterating points the organization made in a statement they released in late July, said the messaging could lead to a greater stigma of queer individuals which could spiral into acts of harassment, hate crimes, racism, homophobia and violence. And he worried many who have already lived through health crises like the AIDs epidemic and overdose crisis could be retraumatized.
“My friends would be messaging me, ‘Are you serious? Now this?’ That’s almost a direct quote. Like you’ve got to be kidding me. ... It’s the bigger picture. A lot of us are just processing the world that we’re in and its just too hard,” Sapp said. “Overall, the messaging has improved but initially, it was quite honestly a bit frustrating. The intention was there. The intentions don’t always equal impact but the intention does matter.”
Local efforts
The current priority group, according to County Health’s website, includes people who have had close contact with someone in the last 14 days who has a suspected or confirmed case of monkeypox, people who have had close contact with others at a venue in the past 14 days where a suspected or confirmed monkeypox case was identified, sex workers, “gay, bisexual and other men or trans people who have sex with men, who have had more than one sexual partner in the past 14 days,” lab workers performing monkeypox testing and clinicians who have high-risk exposure through work.
“It is helpful for people to understand how it is transmitted and what the risks are,” Meulman said. “If they’re in one of those categories they’re encouraged to seek vaccination through their health care provider and or submit the form online so they can get vaccinated and help protect themselves.”
Given the limited supply of vaccines, second doses are not yet being offered in the county but more are expected in the near future. According to a statement from County Health, the state received another allocation of vaccines this week but has not yet informed health agencies of the number of doses they’ll receive or when the shipment will arrive.
Inconsistent vaccine supply has created challenges for planning clinics, Meulman said, but based on the number of vaccine request forms submitted, he said he believes the county may be catching up on demand.
Looking forward
Sapp said he’s beginning to feel more hopeful about the regional response to monkeypox. He and his team at the Pride Center have been asked to provide guidance on messaging to a number of agencies including County Health and representatives from Gov. Gavin Newsom’s office and has since produced a resource guide.
Looking forward, he said he hopes to see more conversations around the experience of contracting and healing from monkeypox, which he said could also help reduce stigma.
“You don’t want to test positive for monkeypox. Nobody does. That person who tested positive also doesn’t want to be recovering from monkeypox,” Sapp said. “So it’s important to understand this and I think that’s the thing that can be missing and get lost, it’s empathy.”
Visit the County Health website at smchealth.org/monkeypox-response for more information on monkeypox and treatment.
(650) 344-5200 ext. 106
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