Monkey pox cases are rising exponentially in California, US

Monkey pox cases are rising exponentially in some gay and bisexual communities, raising hopes that officials can quickly gain control of the virus that has the potential to gain a lasting foothold in the United States.

The U.S. reports about 450 monkeypox cases per day during the seven-day period ending Tuesday, according to Our World in Data. That is double from two weeks earlier. Los Angeles County reported 683 cumulative cases as of Tuesday — a doubling in the past 10 days. A further 29 cases were reported in the province on Wednesday.

More than 1,800 cases of monkeypox have been reported in California since Wednesday, according to a Times tally of data from LA and San Francisco counties and the Department of Health.

“If you look at the rates of increase, you can see it’s approaching an exponential curve. And unfortunately, it’s going to get harder and harder to control as these numbers get higher,” said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco.

Doctors fear an increased spread could lead to the virus becoming endemic in the wildlife population, meaning it would be virtually impossible to eradicate as a new disease of concern in the US

“Hopefully we can keep this under control. But if it doesn’t, it could spill over to other populations,” Chin-Hong said.

About 10% of monkey pox cases result in hospitalization, Chin-Hong said, usually for severe pain or a superinfection. “There have been 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 unbearable and cause patients to have difficulty sleeping, walking, eating, drinking or going to the bathroom.

Here are some challenges in managing the global outbreak.

Rapid dispersion in high-risk environments

Cases are rising sharply among men who have sex with men and transgender people who have sex with men, Chin-Hong said. About 98% to 99% of cases are among people in these groups.

The spread of monkey pox cases has also been exacerbated by LGBTQ pride events, particularly in gay saunas and 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. However, it can be transmitted through infected sheets and other household surfaces where there is continuous exposure.

Not diagnosing it quickly

Monkeypox can be difficult for medical professionals to diagnose early, especially since it was virtually unheard of in the US until recently.

“The rash can look very harmless at first, like a pimple or an ingrown hair. So that’s why it’s so hard for clinicians to diagnose it,” Chin-Hong said. “If you can diagnose people, you can keep them away from people [who] are not infected.”

Chin-Hong urged clinicians to be more suspicious and take samples of lesions for testing. Even if there isn’t much skin disease, clinicians should take samples to test for monkeypox in the rectum, urethra and mouth, he added.

For example, a person infected with monkeypox may test positive for the virus from a sample from the urethra, but the infection may not be detected on the skin.

“Many people stroke the skin as if there is no tomorrow. But if the disease is in your mouth or in your anal area, you get a false negative because you’re not going where the disease is,” Chin-Hong said.

According to the Centers for Disease Control and Prevention, monkeypox symptoms usually begin within three weeks of exposure. The illness can last two to four weeks.

About 80% experience flu symptoms, but about 20% don’t, Chin-Hong said. The telltale rash occurs in almost all monkey pox patients; in many it appears first in the anus and genital areas and then moves to the face, arms, mouth, trunk, palms and soles.

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 that he assumed was an ingrown hair or pimple. Within five days, Watson had developed symptoms that became so painful that he went to a hospital.

“I ended up with excruciating pain three times over the course of 4½ days that opioids could barely touch. My first time in the hospital, it took two doses of morphine to bring the pain down to manageable levels,” he said. “It didn’t matter if I was sitting, standing or lying, the pain was gone.”

Limited vaccine stock

Federal officials have been criticized for acting too slowly to increase vaccine numbers, but Tuesday announced a new plan to stretch limited supplies of the Jynneos vaccine, which may help protect against monkey pox. The plan includes reducing the dose of the vaccine to one-fifth of its current reading by administering the injection intradermally (between layers of skin) rather than subcutaneously (into the underlying fat).

But even federal officials recognize that the new strategy won’t end the vaccine shortage.

“We probably still won’t have vaccines until we run out of guns,” said Dr. Demetre Daskalakis, the White House’s national monkeypox control coordinator, during a briefing Tuesday.

Health officials say an adequate supply of vaccines is vital to control the monkeypox outbreak.

“Every week you wait, more and more people infect a circle around them. And those circles around them are infecting circles around each of them,” Chin-Hong said. “We’ve treated so many patients this week, much more than in previous weeks.”

“I think vaccines are the way out,” he said. “And monkey pox in the beginning … it looks like nothing, like a pimple. It’s really hard to diagnose early cases clinically. So if it’s dramatic, you’ve probably unmasked a lot of people by now.”

Kim Saruwatari, public health director for Riverside County, said there is a particular need for additional vaccines in the Coachella Valley because of international sex tourism in Palm Springs.

“This area has 11 sex clubs, the largest number in any jurisdiction in Southern California,” Saruwatari said during a legislative hearing on Tuesday. “As a result, Palm Springs may be the source for many cases in other jurisdictions.”

Difficult messages

It’s been difficult to balance messages that don’t stigmatize gay, bisexual and transgender men who have sex with men—those most likely to be infected with monkeypox—while also clearly pointing out ways to reduce the risk of developing the disease. to reduce the spread of the virus.

“I think it’s hard to say, ‘Limit sexual activity or don’t have sex,’ because you want to be as sex positive as possible,” Chin-Hong said. “But I think these are the messages some people are starting to see.”

The San Francisco AIDS Foundation has suggested “skipping the dark backrooms at parties when they’re super busy and there’s no way to control who you’re bumping into and rubbing skin-to-skin with.” People can also reduce the risk by “having open and honest conversations about monkeypox symptoms and possible exposures” before having sex.

“It may be time to hang up on the group sex and saunas until we’ve all gotten shots one and two of the vaccine. This is temporary and out of love for group sex and those who enjoy it,” read another guide to safer sex.

Experts are also trying to allay unfounded fears about how to get monkey pox. Officials see no proliferation of activities such as changing in a locker room or casual encounters at a crowded festival, or fitness equipment.

“While it is technically possible to transfer monkeypox to surfaces (such as sharing a towel with someone who has monkeypox), the chances are less. There isn’t much of a risk of getting monkey pox from sharing things like toilet seats, swimming pools, and fitness equipment,” according to the San Francisco AIDS Foundation.

There is no risk of getting monkey pox from public encounters, such as passing someone on the subway. It would also be difficult for monkeypox to transmit during a massage unless there is a visible lesion in skin-to-skin contact.

“The monkey pox risk is really in the intimate setting,” Chin-Hong said.

It’s hard to get treatment

There is one antiviral drug — tecovirimat, also known as Tpoxx — that can be administered to relieve symptoms. However, many health care providers have struggled to access the drug, which is only recommended for use in severe cases or for those with certain high-risk health factors. CDC officials have said they are working to streamline the process so more people can get the drug.

Tpoxx — given twice daily via three pills for two weeks or intravenously — is approved by the Food and Drug Administration for the treatment of human smallpox disease, but its use to treat monkeypox has not been approved by the agency. As a result, obtaining Tpoxx is complicated and involves contacting a state health department or the CDC and having a patient fill out an informed consent form, which takes an hour.

Federal officials have said they are developing randomized control trials to determine the safety and efficacy of Tpoxx for treating monkeypox in humans. Although it has been shown to be effective in animal models of monkeypox, without such data for humans, we “will not know whether tecovirimat will benefit, harm, or have no effect on people with monkeypox disease,” FDA and CDC officials wrote in a statement. perspective article for the New England Journal of Medicine.

Dan Tavares Arriola, a city councilman in Tracy, California, said when he tested positive for monkey pox in late July, he faced a labyrinth of bureaucracy as he tried to get treatment for himself and a vaccine for his exposed partner.

“I’m a lawyer. I’m an elected official. I have experience in how to advocate for myself and others and how to navigate the systems,” Arriola said. “I can only imagine how much more challenging it is for those who don’t have that experience or who face different barriers, such as language barriers.”

Times staff writers Grace Toohey, Emily Alpert Reyes and August Brown contributed to this report.

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