How bad can monkeypox get in the Bay Area? Experts weigh the trajectories

Finally, he said, “It goes to the top and starts to come down again. The real question is: will it remain endemic in society because we can’t get rid of it? Or can we successfully get rid of it?”.

In San Francisco, California, which has the second-highest number of infections after Los Angeles County, cases are doubling every week — prompting the city to declare monkeypox a local emergency on Thursday. As of Wednesday, the most recent day for which data were available, San Francisco had 281 confirmed and probable cases — up from 141 a week ago and 60 the week before that, according to the city Health Department. The US epidemic curve has risen similarly, reaching 4,900 cases to date.

“We’re still in the expansion phase,” said Dr. Stephanie Cohen, medical director of the San Francisco City Clinic, which helps manage the public health department’s response to the monkeypox outbreak.

Monkeypox, a less severe relative of smallpox, is an old virus that has been endemic in West Africa for many years. The current outbreak is alarming because it is spreading in many parts of the world that normally don’t see many infections.

For a community collectively traumatized by SARS-CoV-2 — a virus that was deadly before being tamed by vaccines — the spread of monkeypox can seem terrifying. But experts say there are compelling key differences: the version that caused the current outbreak is less severe than the version that spread in West Africa. Among the thousands of cases in the U.S., no one has died and most patients have not needed hospitalization, but the sores caused by the virus can be uncomfortable and debilitating if they are near or near the eyes, mouth. urethra or rectum, because they make daily activities painful.

Monkeypox is a DNA virus, not an RNA virus like the one that causes COVID-19, so it’s more stable and doesn’t mutate as quickly as COVID. Unlike COVID-19, monkeypox is usually spread through prolonged skin-to-skin contact, such as sexual intercourse—rather than through short-term sharing of airspace. This dramatically changes the way it spreads.

Locally and nationally, monkeypox has so far been transmitted to gay and bisexual men who contracted the virus through intimate contact — often what health officials believe was the result of multiple sexual encounters, including anonymous partners. Monkeypox is not a sexually transmitted infection per se, but physical encounters allow for the sustained contact necessary for transmission.

According to the city’s latest demographic data, 98% of cases in San Francisco are men, the remaining 2% are trans men, and nearly 90% are gay, lesbian, or same-sex couples.

Recently, there has been a small but not significant spread to the general population outside of gay and bisexual men – two cases among children in the US were reported late last week by the CDC. But children have contracted it from a known household disease, as it can also be spread by touching the same bedding or clothing, or by non-sexual skin-to-skin contact, such as holding a child or sleeping in the same bed.

The fact that the children did not get it from an unknown source — indicating widespread community exposure — is reassuring, Dr. Abaar Karan, an infectious disease physician at Stanford. The highest risk remains within sexual networks, so researchers are looking at other high-risk groups, such as female sex workers and people with multiple partners who often seek treatment at sexual health clinics.

“We haven’t seen significant spread outside of men who have sex with men,” Karan said. “At this point, the fact that it hasn’t spilled more shows that you need a long-term intimacy like you see in sex networks.”

There are now so many cases of monkeypox around the world that the virus is more likely to enter reservoirs in animals like rodents — meaning it could be transmitted back to humans, Karan said.

“It’s going to be hard to destroy,” he said. “At least for the foreseeable future, once we get this initial outbreak under control, we will have minimal cases in the community. It will be very difficult to remove this from now on.”

Federal health officials said Thursday they will make an additional 780,000 doses of the Ginnyos monkeypox vaccine available Friday. But it is expected that it will not meet the current needs. San Francisco requested 35,000 doses for high-risk residents and has so far received several weekly batches of several thousand doses each. The city’s main public vaccine clinic had to close for walk-ins this week, and vaccine providers had to switch to a single-dose strategy to provide partial protection to more people. Vaccination must be given in two doses, at least four weeks apart, and the single-dose strategy means that people who receive the first dose cannot receive a second dose until the global vaccine supply improves.

“If we have an unlimited supply of vaccine, but we don’t have it, how quickly can we control it? I’d like to think we can get it under control quickly,” said Dr. Art Rheingold, professor of epidemiology at the UC Berkeley School of Public Health. “But we don’t have an unlimited supply of vaccines, and we won’t for a long time. I think we’ll see at least one broadcast in the coming weeks. There are just infected people out there. And they’re connected to other people.”