By KENDRA SITTON
On Thursday, Aug. 11, County, city public health officials and partner organizations held a virtual town hall about the monkeypox outbreak in San Diego. At the time of the event, there were 121 confirmed or probable cases of monkeypox in the county. Since then, that number has doubled with the count at 249 as of Aug. 25.
County chair Nathan Fletcher, Mayor Todd Gloria and City councilman Stephen Whitburn pre-recorded a message to attendees that they were taking the outbreak seriously and coordination between the county and city was high. Still, they assured people that the risk to the general population remains low.
“We can stop the spread of monkeypox in our community,” said Gloria.
Whitburn, who represents the areas of San Diego with high LGBT+ populations, assured people that resources were being distributed as quickly as possible.
The rest of the town hall was led by a panel of public health experts followed with questions from the audience. After three years of the COVID-19 pandemic, the panelists emphasized that the monkeypox outbreak is fundamentally different situation than COVID-19. There is already a vaccine and treatment options for the well-studied virus and it is much less infectious than COVID-19.
In addition, institutions like schools, daycares and long-term care facilities that were devastated by COVID-19 outbreaks already have protocols in place to prevent the spread of monkeypox since these institutions have dealt with other diseases in the past few years that spread in a similar fashion to monkeypox. The county has been communicating with nurses at schools and staff at care facilities about recognizing the rash that indicates monkeypox and ensuring practices like washing bedding and towels continue to keep people safe.
Monkeypox is not a sexually transmitted disease. However, the sharing of droplets over prolonged skin-to-skin contact, which occurs during sex, is how the virus spreads. Currently, all San Diego cases have occurred in men who have sex with men. Due to the history of the AIDS crisis, monkeypox has caused worry among the LGBT+ community afraid that the tragedies of the past may be repeated.
Dr. Wilma Wooten, the County Public Health Officer, assured the audience that the county is preparing for the worst while predicting that the spread will be able to be contained.
Mikie Lochner, the chair of the HIV planning group, said, “It is imperative we come together as one… We need to educate ourselves and each other. It is up to us to come together and create safety nets in our community.”
He told people to remember that the hard times will not last forever. “People are tired, scared and even angry. And that’s ok. And what is not okay if we have the correct information and do not share it.”
Of the dozens of San Diegans who have been infected, a typical case would affect a white or Hispanic gay man who is 34 years old living in central San Diego with multiple sex partners. The characteristic rash that signals someone is infectious can occur on many areas of the body, but in this current outbreak has been seen most often in bumps in and around the rectum that look similar to syphilis and oral lesions around the mouth.
The number one question from the audience regarded the availability of vaccines. Currently, the county has received a little over 5,000 vaccines from the state of California despite requesting closer to 27,000 vaccines. Even the request for 27k doses was significantly lower than what officials think they will ultimately need to contain the virus. With more demand for the vaccine than doses available, the county has prioritized inoculating high-risk populations like those who are immunocompromised and men who have sex with men.
“The issue lies with the federal Strategic National Stockpile. We have received unfortunately a small amount of the vaccine,” explained Dr. Ankita Kadakis, Deputy Public Health Officer.
To combat this, the White House has issued guidance that people should only receive one dose of the vaccine to provide temporary immunity instead of the two doses that would provide long-term immunity from the disease. In addition, the White House issued a new plan this week to make the vaccine available to more people by giving people 1/5 of a regular dose subdermally instead of a full dose subcutaneously. The county is hopeful about this new approach and is training practitioners on how to administer vaccines with this new method.
In addition to giving the vaccine to high-risk populations, the county has reserved a portion of doses for those who have been exposed to the virus. If the vaccine is administered within 14 days of the exposure, it can make the symptoms of the monkeypox much milder and in some cases prevent infection.
A portion of the community may already be protected from monkeypox if they received a smallpox vaccine. Although “pox” is in the name, it should be noted that the chicken pox vaccine provides no protection from monkeypox.
While waiting for more vaccine doses, public health officials made recommendations on safer sex practices including not having anonymous sex partners, reducing the number of sex partners or forming a closed pod of sex partners, not having group sex, using condoms, washing bedding and towels, and not sharing sex toys. Oral and anal sex are considered particularly risky although monkey pox can spread through naked cuddling, vaginal sex, and even long kisses.
When questioned on what prolonged meant, Dr. Kadakis noted that in the current cases, people had been exposed during an average of three hours of skin-to-skin contact.
As the county uses its resources to prevent the virus from further spreading, Dr. Wooten did mention that there is still the need to aid those who are infected. While people can receive housing to isolate in and treatment, the infection typically lasts two to four weeks which could financially harm people who cannot work while ill and isolating.
Public health officials urged the audience to educate their communities to recognize the symptoms of monkeypox and on practices to help prevent its spread. To watch the recording of the town hall, visit the County website.