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Tuesday, August 16, 2022

Local transmission is likely occurring, a Santa Clara County health official said

Monkeypox infections are steadily rising in much of the Bay Area, with nearly 100 cases diagnosed among six counties in the region as of Wednesday, mirroring a national trend as the vaccine supply to combat the growing global outbreak remains critically low. 

“There’s a tremendous need but it is not being met,” said UC Berkeley epidemiologist John Swartzberg of the dwindling supply of vaccines from the federal government.

When the virus was first discovered in the Bay Area in June, health officials linked the case to an individual who had traveled. Now, it appears that local transmission is occurring within or beyond the Bay Area’s borders.

San Francisco has 68 reported infections, while Alameda County currently has 17 and Santa Clara County reported nine cases Wednesday — a jump from the two announced last week. Marin, Contra Costa — which reported its first case Tuesday — and San Mateo remain in the low single digits. Health officials are currently grouping infections as both probable and confirmed.

Even so, the increase hardly comes as a surprise to health experts.

“It is in line with what we’re seeing in the Bay Area and across the country,” Santa Clara County Deputy Health Officer George Han said. “We were expecting an increase even earlier. But it is happening now. Whether or not (the positive individuals) were exposed elsewhere or within Santa Clara County, we can’t say for sure. But for sure there is local transmission occurring.”

Symptoms of the virus include fatigue, muscle aches, fever, headache and swollen lymph nodes. A rash and sores then appears on an individual’s face and body. Those affected by the virus usually experience symptoms for two to four weeks. Public health officials said that the virus is most likely spread through physical touch or fluids and that sexual activity is what is causing much of the spread.

Overall, Han said the risk to the general public remains low. However, gay, transgender and bisexual men make up a majority of the cases in Santa Clara County, he said, a trend public health officials in other counties and the rest of the country have acknowledged and say is due to the virus first gaining a foothold within the LGBTQ community’s party scene.

Monkeypox, a cousin of smallpox, is much less transmissible than COVID — and hospitalization is also unlikely, Han said. Of the nine individuals with the virus in Santa Clara County, one was hospitalized, and their symptoms improved greatly after the antiviral tecovirimat was provided.

The state’s first case was reported on May 24 by officials in Sacramento. The first Bay Area case was reported on June 3 in San Francisco.

On Wednesday, Bay Area officials rang out a chorus of criticism against federal health officials for what they view as its slow approach in attacking the virus.

San Francisco officials say that doses of JYNNEOS, one of two vaccines available to prevent infection, are running “extremely” low and have “urgently requested” additional supplies from the federal government. Last week, the city’s health department distributed over 2,000 doses of the vaccine to city clinics and hospitals and has requested an additional 35,000. S.F. General Hospital, where some of the first-come-first-serve vaccine distribution is available, is set to close after Wednesday and remain shuttered for the rest of the week until more supplies are delivered.

City officials said they do not know when the next resupply will be or how many doses will be provided.

LGBTQ politicians in the region in particular are calling for action.

Assemblymember Evan Lowe, Chair of the state’s LGBT Legislative Caucus, said his community has a history with public health and recalled the fight for AIDS and HIV to be taken seriously by the federal government in the 1980s.

“That’s why we take this very seriously,” Lowe said in an interview. “And we demand that our government responds accordingly.”

On Wednesday, state Sen. Scott Weiner in a statement urged the federal government to provide additional doses “immediately.”

“Once we move past this emergency, we need accountability for these failures — failures that put people’s lives and health in jeopardy,” said Weiner, a fierce advocate for the region’s LGBTQ community.

In Santa Clara County, health officials are providing JYNNEOS on an invitation-only basis because of the short supplies. Those who have tested positive, have confirmed symptoms or are at high-risk are eligible. Health officials urge residents to contact their primary care provider if they suspect they have contracted monkeypox. The county did not immediately respond to an inquiry asking for how many vaccines they have distributed or requested from the federal government.

Epidemiologist Dr. John Swartzberg cited the lack of vaccines as another example of an inadequate public health infrastructure.

“The monkeypox response by the federal government, and more specifically the CDC and the Food and Drug Administration, is the reflection you get when you underfund decades of public health,” he said. “It is not surprising but very disappointing. There’s no one person or one institution to blame.”

For their part, the Biden Administration announced in late June that 1.6 million doses of the vaccine will become available over the coming months. On July 11, around 150,000 doses were shipped around the country from the Strategic National Stockpile.

Overall, Swartzberg said that monkeypox poses a much smaller risk to the public than COVID. And, since it’s a DNA virus, that makes it much less likely to mutate and suddenly become more transmissible or deadly like COVID’s RNA virus makeup.

But Swartzberg also said that there’s a chance the virus could ultimately circulate among the community permanently, or become endemic, like the flu or HIV.

“In the 1990s, West Nile virus came to the United States,” he said. “It had never been here before. And now, West Nile is endemic to the U.S. in the bird and fowl population. That’s what we’re going to see in monkeypox.”

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