How the Bay Area crushed the monkeypox curve
Two main factors can be credited with the rapid decline; the response from the at-risk community, and an effective vaccine.
When the state and local health departments started referring to the monkeypox virus as MPX, it wasn’t long before more than the stigmatizing name started to disappear. So did the virus’ exploding case rates.
In San Francisco, one of the hardest hit spots in the country, the number of new daily cases has dropped 90% from the peak, to levels the city last saw in early June, when cases first started skyrocketing.
“We are in such a better place right now than we were earlier in the summer,” said Dr. Susan Philip, San Francisco Health Officer.
What happened? The community’s response and increasing supplies of an effective vaccine are “the two main explanations for the drop in cases” according to Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley’s School of Public Health.
The case rate by mid-September had dropped to just 0.2 new daily cases per 100,000 residents, one-tenth of what it was at its height in San Francisco when it reached over 2 in late July. While the case rates in the country as a whole never reached the heights they did in the Bay Area, the decline elsewhere has also been much less dramatic in recent weeks.
The gay community has been the most directly affected, and Philip largely credits the drop to the same people who were also most at risk. “Community has really been the key,” she said “and in SF we are really fortunate to work with such committed community advocates who really embraced what was needed to bring the case rate down.”
While the number of new infections was still growing, many events in the city were canceled, extra precautions were taken, and “they were beating down the doors to get vaccinated,” Swartzberg said.
“There were lots of precautions being taken,” he said. “The public took responsibility.”
During this outbreak most identified cases have been among men who have sex with men, but there is no epidemiological barrier to the virus spreading elsewhere. A 2003 outbreak in the Midwest was associated with pet prairie dogs. The virus causes a painful rash of pustules across the body and spreads through contact with the sores or anything that has touched them, such as bedding or towels.
“From the very beginning, we have been very concerned about stigma,” Philip said “and we’ve been very clear to say this is not a gay disease, and it is not limited to men.”
But the haunting memory of those who have died in the HIV/AIDS epidemic may have contributed to the response in San Francisco and the rapid decline in cases.
“The previous generation talked all about what it was like dealing with HIV infections” Swartzberg said, “what they did and how they had to adapt to it, how they saved themselves. It’s clearly spilled over into this generation.”
A lot of work has been done to repair the community’s trust in the public health system after many felt they were left to fend for themselves early in the AIDS epidemic. Partnerships between public health and advocacy organizations are well-established now, but the response to MPX has not been without controversy. Reporting from this news organization showed that San Francisco’s health department pulled back on contact tracing early on and was not transparent with the public about its strategy.
The vaccine, which is also the vaccine for smallpox, is proving to be effective, though supply has not been able to keep up with the demand as evidenced in the waiting lists and long lines to get the vaccine. Advocates and public health officials have succeeded in getting San Francisco extra vaccines because the demand has been so high and “the new data suggest that the vaccine is preventing cases,” according to Swartzberg.
Over 140,000 California residents have received the vaccine, nearly 25,000 of them in San Francisco alone. That is second only to Los Angeles, with a population 10 times larger, which has administered the vaccine to 53,000 residents. Combined, the other Bay Area counties identified fewer cases than San Francisco, and cases are also declining around the bay.
And while cases are approaching zero, they have not disappeared yet. Philip encourages eligible residents to get vaccinated or get their second shot if it has been more than 28 days since the first.
Now, the question is whether San Francisco can eradicate the virus.
“It is a goal that is still achievable. We ought to try to achieve it,” Swartzberg said, but even then, the threat remains. The virus could always be reintroduced by people from other places, or by rodents.