There are only a handful of confirmed monkeypox cases in the Bay Area, but following the lessons learned from the coronavirus pandemic, local health officials are scrambling to control the rapidly growing global outbreak.
With 48 cases counted in California since early May, the state represents almost 28% of the total to date in the United States.
Local health officials are advising Bay Area residents and their health care providers to look out for symptoms of monkeypox ahead of summer travel and other festivities, given that most of the cases identified so far are associated with possible sexual transmission.
“We are at a critical stage in this disease when we might have the chance to contain an outbreak if we act quickly and make people aware of the risks and how to protect themselves,” said Dr. Naveena Bobba, acting San Francisco health officer. “Monkeypox can be preventable. We know that people are excited to celebrate this summer after two years of a pandemic and we encourage them to do so safely by knowing how to protect themselves and seeing a doctor as soon as possible if they have symptoms.”
Here is the latest information about the disease to help keep you safe while you enjoy the summer.
How many cases of monkeypox are there?
While the number of cases reported in the US has raised some concern, the risk to the general public remains low. Since May, there have been 173 confirmed cases nationwide, according to the US Centers for Disease Control and Prevention, marking the largest-ever monkeypox outbreak in America.
Most cases reported so far are within networks of self-identified gay and bisexual men, trans people, and men who have sex with men, according to Bay Area health officials. But they added monkeypox is not limited to those individuals and no group should be stigmatized. There’s nothing about the disease, such as its method of transmission, that is in any way related to LGBTQ people.
“Right now, the risk is limited,” said Dr. Peter Chin-Hong, an infectious disease expert with UCSF. “It’s confined to select social networks, but it could spill over to other members of the population at some point. It is an equal opportunity disease.”
The cases are part of a global outbreak that took off this spring. There have been roughly 1,600 cases reported in more than 30 countries, according to the CDC. Most of the cases have been in men, and in particular men who identify as gay or bisexual.
Until now, monkeypox has mainly afflicted central and western African countries, where the first human case was reported in 1970 in the Democratic Republic of Congo.
How do you get monkeypox?
Humans usually contract monkeypox through a bite or scratch of an infected animal. Because this latest global outbreak is so widespread, human-to-human contact is suspected.
Although monkeypox spreads primarily through respiratory droplets, it can spread through direct contact with lesions or bodily fluids with an infected person or indirect contact with contaminated clothes or bedding.
“It’s mainly skin-to-skin contact in this outbreak,” Chin-Hong said.
He said it is not nearly as contagious as the coronavirus, which spreads through the air. Respiratory transmission of monkeypox typically takes more than three hours of contact within close range of someone who is infected.
“Because of the mode of transmission, we believe the risk is much, much lower (than COVID),” said Dr. Monika Roy, the assistant public health officer for Santa Clara County, during a Thursday press briefing.
Can monkeypox kill you?
Monkeypox is part of the same family of viruses as smallpox, though it generally causes milder disease and most people recover fully without treatment. The symptoms usually begin with a fever, headache, swollen lymph nodes, muscle aches, chills, and fatigue, according to the CDC.
The characteristic rash develops in one to three days in the form of pus-filled blisters that in the past began on the face and then moved to other parts of the body. But in many recent cases, the blisters start in different areas and are localized to one region.
“The difference in this outbreak is that the rash appears to start in the genital region, near the penis or anal area,” said Chin-Hong. “Over time, it moves to the mouth and arms. They can look like fluid-filled blisters but are generally more subtle than what you see in the pictures when you Google ‘monkeypox.’ It’s not just the rash but it’s the movement to watch out for. Eventually, they scab over and fall off.”
The CDC says the illness lasts 2 to 4 weeks. Many infected people have a mild, self-limiting disease course.
“None of the cases that have occurred regionally have required hospitalization,” said Roy.
Health officials said monkeypox is rarely deadly.
“It’s cosmetically disfiguring but not permanently,” said Chin-Hong. “It might have a stigma, so that might cause psychological distress. And you won’t feel well while you’re sick, just like any viral illness. But most people get well without treatment.”
Who is at high risk for monkey pox?
Bay Area health officials said having sex with multiple sex partners can increase a person’s risk of becoming infected while the virus is actively spreading in the community. The virus can also spread through shared clothing or bedding.
Many of the safety measures individuals practiced through the COVID-19 pandemic can also help curb the spread of monkeypox, such as avoiding crowded indoor spaces and staying home when sick.
If you plan on being intimate with someone, Chin-Hong recommends having a frank, non-judgemental conversation beforehand.
“Ask them open-ended questions like, how are you feeling?” he said. “Look for obvious skin lesions, particularly in the genital or anal area.”
Condoms may also help limit spread, but only offer one layer of protection.
Health officials also say it is best to avoid travel to areas with high infection levels.
Can monkeypox be treated?
Most people recover from monkeypox infection without any treatment. Until recently, there were no federally approved drugs to specifically treat it, but Chin-Hong said some hospitals in the city, including UCSF and Zuckerberg General, have started offering an oral smallpox antiviral Tpoxx to some patients who are experiencing severe symptoms.
Some vaccines can prevent infection, including after exposure.
New York City began offering shots against monkeypox to at-risk groups on Thursday, filling all available appointment slots almost immediately. Montreal and Toronto are also offering vaccination clinics.
No Bay Area cities have announced plans to do the same, but it may be only a matter of time. State Sen. Scott Wiener on Thursday said California’s health department is working on setting up vaccination opportunities.
“Monkeypox is real & we need to get at-risk people vaccinated,” Wiener said on Twitter.
Those vaccinated against smallpox before its eradication in the early 1970s may also have some protection against monkeypox.
“It’s not going to be 100% benefit because people have waning immunity but it will protect older individuals versus the younger group,” said Chin-Hong. “It might be the reverse of COVID where the majority of people who get monkeypox might be younger.”
Local health officials urge anyone with symptoms consistent with monkeypox infection to isolate, contact a health care provider, and avoid close contact with others. Masking is also recommended.
“We know how to contain the spread of monkeypox and we’re asking everyone to be aware of the signs of infection,” said Dr. Kavita Trivedi, Alameda County’s communicable disease controller. “If they are experiencing symptoms, they should stay home and contact their health care provider right away.”
San Francisco Chronicle staff writers Erin Allday and Kellie Hwang contributed to this report.
Aidin Vaziri (he/him) is a San Francisco Chronicle staff writer. Email: avaziri@sfchronicle.com