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monkeypox

    PUBLIC HEALTH

    Cases Are Few, but Monkeypox Is Still on the Radar

    AIDS Support Group is running vaccine clinics through the summer

    By

    PROVINCETOWN — The virus that roared through the gay community on both sides of the Atlantic last summer subsided almost as quickly as it arrived. Mpox — formerly known as monkeypox — landed at a massive gay gathering in the Canary Islands last spring and from there spread to Europe, Canada, the U.S., and across Latin America before starting to fizzle out.

    Chicago’s most recent Mpox summary shows a small bump in case numbers in May. (Image courtesy Chicago Dept. of Public Health)

    There were only 330 new cases nationwide last December, and just 41 cases in April. At the peak of the outbreak last August, there had been a total of 21,993 cases nationwide — and half of them had been discovered that month.

    Over the entire outbreak, women accounted for less than 3 percent of all cases. Previous outbreaks of Mpox had featured more casual transmission of the virus, including within households and to people doing laundry — but last year’s outbreak turned out to be almost entirely transmitted through much more intimate physical contact.

    Even so, that Mpox faded so quickly was unexpected. Massachusetts had reported about 350 cases between last Memorial Day and Labor Day. The data that were released did not break down the numbers by county or town, but several sources indicated to the Independent that a significant fraction of those cases were in people who had either lived on or visited Cape Cod.

    As a result, Outer Cape Health Services in Provincetown was one of the state’s first major distribution sites for Jynneos, a smallpox vaccine that also protects against Mpox. By early August, OCHS staff had vaccinated more than 2,100 people against Mpox.

    A bag of Jynneos vaccines last August, when they were scarce nationwide and Outer Cape Health Services was running well-attended vaccine clinics. (Photo by Paul Benson)

    Though vaccination does not completely prevent the disease, AIDS Support Group CEO Dan Gates said that the vaccination campaign — and the community’s willingness to talk about the disease — helped to stop it.

    “I think people took the potential risks very seriously and changed their behaviors a bit to protect themselves,” Gates said. “There was robust vaccine access here. And part of what spread the word was that people who experienced it shared about it, online or in their social circles, and that really helped us.

    “I understand why people were concerned about how to message it,” Gates added. “The first few people I spoke to about it had a really visceral response, remembering what it was like in the ’80s, and the ‘gay disease’ label of HIV. We went into this trying to be really cautious about that.

    “There was a real communal response though,” Gates said. “People were talking about it, posting pictures of their experience, and I saw countless examples that were really free of stigma and sex-positive, talking about how to protect one another.”

    The AIDS Support Group ran free Jynneos vaccine clinics in October, November, December, and January, Gates said. There will be several free vaccine events this summer as well, including during Bear Week, around the Fourth of July, and on Friday, June 2 and Saturday, June 3 — Pride weekend.

    Data from the CDC for the entire Mpox outbreak show that men accounted for more than 95 percent of all cases in the U.S. (Image courtesy Centers for Disease Control)

    Those vaccination events will run from 9 a.m. to 4 p.m. at the AIDS Support Group’s drop-in center at 301 Commercial St.

    Two weeks ago, the Illinois Dept. of Public Health announced that there were 24 cases in an Mpox cluster near Chicago — so the disease has not gone away. A majority of people in that cluster were vaccinated last year.

    The cluster was discovered more than a month ago and appears to be fading out already, however. The case curve, posted online by the Chicago Dept. of Public Health, has been flat and then downward in recent weeks.

    Massachusetts has not yet posted data for May, but in April there were no new cases of Mpox, and in March there was only one.

    “If someone has had both vaccines, their risk is considered to be significantly lower than someone who has not,” Gates said. “Much as has been the case with Covid, if they had a breakthrough infection, it would be a less severe case.”

    No additional doses of vaccine are recommended for people who have already had two shots.

    “If you’re going to be having fun this summer, our message is to get vaccinated twice and have your friends do the same,” Gates said.

    PUBLIC HEALTH

    Monkeypox Testing Data: Slow and Incomplete

    Progress of outbreak is hard to judge because state won't release the numbers

    By

    PROVINCETOWN — For more than two years now, the state Dept. of Public Health (DPH) has been publishing highly detailed information on Covid, including key indicators that help to assess whether enough testing is taking place and how many cases might be escaping official attention. The state is not publishing these testing metrics, however, for the current monkeypox outbreak.

    New data from the CDC show a declining positivity rate and increased testing volume between mid-July and mid-August.

    The total testing volume and the percentage of tests that are positive both help put the total count of reported cases into context and make it easier to see if testing is adequate to discover the cases that exist. It can also indicate where there may be too little testing and lots of undiscovered cases.

    When the Independent asked for testing data in a phone interview with state epidemiologist Catherine Brown, she said, “I can get the exact numbers of tests for you this morning.”

    Those numbers were slow to come, however, because the DPH requires a formal records request to release the information. Records requests can take 10 business days, not counting the day they are filed and the day they are delivered, for a total of 16 calendar days.

    For four weeks in July — Sunday, July 3 through Saturday, July 30 — the state public health lab processed only 181 tests, 108 of which were positive. That makes a positivity rate of 60 percent for those four weeks.

    According to a DPH official who would speak only on condition of anonymity, the numbers are skewed because monkeypox testing in commercial labs was authorized early in July, and testing information from those labs was not included in the data release. “That’s an artificially increased positivity percent,” she said, “because it does not include commercial testing.”

    That official also said that positivity rate calculations were hobbled because “when the commercial labs started testing, we were not receiving the negative results.” So, she concluded, “we can’t calculate a total percent positivity.”

    The agency refused to provide the commercial testing data and declined to release any testing data more recent than the week ending Saturday, Aug. 6.

    There is reason to think the August data might be more reassuring. During the last week for which data are available, July 31 to Aug. 6, testing volume more than doubled, from 62 tests the week before up to 151 tests, but the total number of cases discovered was about the same. The rate of positive tests fell to 21 percent.

    The Independent awaits data for the remainder of August from another records request.

    Meanwhile, the CDC has added nationwide testing totals to its monkeypox dashboard. Positivity peaked at 55 percent nationwide in mid-July and is now running at 24 percent. Testing volume has approximately quadrupled over that period, from around 4,000 tests per week in mid-July to more than 16,000 tests per week in mid-August.

    That still means there have been about 4,000 cases discovered in each of the first three weeks of August, however.

    MEDICINE

    Monkeypox Spikes Nationwide as Provincetown Gets Vaccine

    Thousands of doses may be reducing virus transmission here

    By

    PROVINCETOWN — New data emerged last week on the global outbreak of the monkeypox virus. A report from the World Health Organization (WHO) shows that cases are falling off in several hard-hit countries, including Portugal, Spain, and France, but cases in the U.S. are spiking.

    The Aug. 5 Jynneos vaccine clinic at Outer Cape Health Services. Left to right: Meghan Ouellette and Sean Burnett of Mass. DPH, and Lois Beard, Wendy Judd, and Jillian Stockwell of OCHS. (Photo courtesy OCHS)

    When the Centers for Disease Control (CDC) completed another study on July 22, there were 2,767 cases total in America. Since then, 6,167 new cases were reported in less than three weeks. The country’s official case count tripled in only 18 days.

    Nationwide, the availability of vaccines is limited. There are not nearly enough doses to vaccinate the at-risk population of major cities like New York and San Francisco. Provincetown, however, has had a relatively large and steady supply of the Jynneos vaccine since early July.

    Outer Cape Health Services has given first doses of Jynneos to 2,100 people, according to Communications Director Gerry Desautels, who reported another 550 doses were on the way as of Aug. 9. There is a waiting list of several hundred people, Desautels said, but the organization is getting continuing shipments of the vaccine, and state Dept. of Public Health (DPH) staff were deployed to Provincetown to help deliver second doses in early August.

    “I think Provincetown has been really fortunate,” said state Sen. Julian Cyr. “Five or six weeks ago, I was expecting a much tougher summer. Monkeypox is affecting people, and we have to be vigilant, but I think our ability to vaccinate people has reduced the cases we’re seeing.”

    Cyr said there were several factors that led to Provincetown’s large allocation of doses, but last year’s Covid outbreak was one of the big ones.

    “The Delta outbreak established very strong relationships between the DPH, our health care providers, and our local and county health agents,” said Cyr. “I think the state was confident we could get shots in arms quickly.”

    Transmission in Networks

    While the WHO and CDC studies indicate there are reasons to worry about the course of the disease in America, the good news, if there is any, is that the outbreak is still almost entirely confined to the gay and bisexual male community and is not readily spreading outside it — not even to roommates or “household contacts.” The WHO’s report shows that 99 percent of cases globally are male, and 97 percent are gay or bisexual.

    Prior outbreaks in Central and West Africa have seen a high degree of spread within households and families, with nearly equal numbers of male and female patients and many children. But a report from the health ministry in Madrid said that, after tracking hundreds of household contacts there, the only cases of transmission were to sexual partners. There are two women among 500 cases studied in Madrid. The CDC report shows only five cases in women out of 1,195 cases studied.

    The WHO report says that “at present there is no signal suggesting sustained transmission beyond these networks” of gay and bisexual men. Occupational infection of health-care workers, for example, has been virtually nonexistent.

    With Covid, the ability to spread the disease without having symptoms, or before symptoms developed, was a huge driver of the pandemic. Monkeypox is still thought to spread only after symptoms have emerged.

    A troubling finding of the CDC study, however, is that only about half of the cases in this outbreak have begun with what are called “prodromal” or flu-like symptoms: fever, malaise, chills, headaches, or swelling of lymph nodes. When these symptoms appear first, people know they are sick — many have reported thinking they have Covid — and they are more likely to avoid intimate contact.

    Many patients have only small skin lesions as their first symptoms, often in the anogenital region where they aren’t immediately noticed. The Madrid report notes that this has contributed to a lack of awareness of the disease among those infected.

    A Mild Case

    Joe Fischel is a professor in Yale University’s Department of Women’s, Gender, and Sexuality Studies and a summer resident of Truro. He got a Jynneos shot on July 8 but developed a relatively mild case of monkeypox on the night of July 12 from an exposure that he thinks came over the July 4 weekend.

    He went to Outer Cape Health Services with a fever and swollen lymph nodes on July 13 and was instructed to pay careful attention to his skin and return if any lesions developed. The next morning, he found one, returned to OCHS, and was given both the antiviral medicine tecovirimat (TPoxx) and strong medicine for pain.

    Fischel was sharing his family’s home with his mother and his partner — although all three were sleeping in separate bedrooms.

    “I asked if my mother should get the shot,” Fischel said. “I described that we’re in separate bedrooms, separate bathrooms, separate linens. We’re not going to eat on top of each other.” Fischel and his family continued to take meals at the same table, although with more distance between them than usual.

    “They said she probably didn’t need one — she’s probably fine,” said Fischel. “That kind of captures everything that’s scary about this: what does ‘probably’ mean?”

    Fischel’s case resolved fairly quickly, he said. He had one night of significant pain, and his lesions lasted only two days, although he continued in quarantine until his skin was fully normal. He thinks the TPoxx may have shortened his illness.

    That drug comes from a federal stockpile meant to protect the nation from smallpox, and the process of getting it has been onerous for many providers nationwide. OCHS apparently had doses on hand.

    “Part of what quelled the fear around HIV was queer activists who promoted the science of how HIV was transmitted,” Fischel said. “From everything we know, monkeypox is more transmissible than HIV, and not only through sexual fluids, and that can generate anxiety.

    “The chances of my giving HIV to my mother by having dinner every night is zero,” Fischel added. He knows the chance of his transmitting monkeypox is extremely low — but the public needs data to know that.

    Fortunately, there is at least one other enormous difference between monkeypox and HIV. Fischel had symptoms for about a week, and he continued to quarantine for about 10 days after that. He was back to normal by August.

    HEALTH

    With Case Counts Growing, Provincetown Gets MPV Vaccines

    Large allocation of doses will help protect working people, says Cyr

    By

    PROVINCETOWN — Nationwide, the news about monkeypox continues to get worse. Case counts are still doubling every 10 days or so: 42 in Massachusetts, 156 in New York, and 9,647 globally as of July 11, according to the CDC.

    Workers at Outer Cape Health Services in Provincetown administered hundreds of vaccinations against monkeypox on Friday, July 8. From left: Chris Casale, Joe Kennedy, Lakia Norwood, and Jeff Schaffer. (Photo by Paul Benson)

    Testing is limited, the vaccine supply is still constrained, and, while no one in the outbreak countries (now including most of Europe and the Americas) has died, the disease is painful, with reports emerging of people being hospitalized for pain management.

    Against this backdrop, Provincetown received a major dose of good news — 900 doses, to be exact. The Biden Administration’s release of 56,000 doses of the Jynneos vaccine resulted in 1,800 doses coming to Massachusetts. Half of that allotment came directly to Outer Cape Health Services in Provincetown, said state Sen. Julian Cyr, and public health workers launched a campaign to get eligible people vaccinated.

    According to the CDC, “presumed contacts” eligibility includes “presumed contacts,” which is currently defined as a man who has sex with men, has had multiple partners in the last few weeks, and is in an area where the virus is spreading.

    Because there have been cases in Provincetown, any gay man here with multiple recent partners meets that threshold.

    The town’s health workers aimed their vaccine campaign at those men, especially those who work in hospitality for the short summer season.

    “We were able to vaccinate so many of the people in our community who could be at highest risk from this,” said Cyr. “Monkeypox is unlikely to be fatal, but it could be devastating to your livelihood. Given the isolation and recovery period, you could lose three or more weeks of work.”

    Provincetown’s health dept. alerted business owners about the vaccination campaign, while the AIDS Support Group of Cape Cod and other groups used their networks of service industry workers to get the word out. The health dept. also posted the news on social media. Hundreds of people were vaccinated at OCHS Provincetown on July 7, 8, and 9, and the organization is now keeping a waiting list for the arrival of the next batch of the Jynneos vaccine, expected later this week.

    “We’re encouraging all eligible individuals to call Outer Cape Health and make an appointment,” said Cyr.

    Eligibility criteria could change, but for the time being, the focus remains on men who have sex with men. Though there is a possibility of monkeypox transmission in intimate nonsexual settings — to roommates, health-care providers, housekeepers, or family members — actual case data in this year’s outbreak have not yet shown significant transmission along those lines.

    According to a July 6 World Health Organization report, 99.5 percent of the cases for which data exist are in males; only 25 out of thousands of cases are in health-care workers; and only six out of 5,584 cases are in minors. The fact that women, children, and health-care workers have not been getting the virus — during this outbreak, at least — helps explain why the vaccination campaign has been tightly focused so far.

    That global transmission pattern has been playing out locally, Cyr confirmed.

    “The town has been very deliberate in all the information it’s put out,” said Cyr. “This is truly playing out like a sexually transmitted infection. That’s still the case — there’s no new evidence there.”

    MPV

    Amid Growing Outbreak, a Vaccine Strategy Comes Into View

    The still-scarce doses will go to close contacts of monkeypox cases

    By

    PROVINCETOWN — The global outbreak of monkeypox has continued to expand. There were 23 cases in Massachusetts, 90 in New York, and 5,780 worldwide as of July 1, according to the Centers for Disease Control. But a vaccine strategy to contain it is now underway.

    Both the state and federal governments confirmed at the end of June that vaccinating close physical contacts of cases will be the first step toward containing the disease until wider pre-exposure vaccination programs can begin in two or three months.

    The current monkeypox outbreak appears to have begun in May and has been spreading mostly through intimate contact within the community of gay and bisexual men, or men who have sex with men.

    The disease can spread when the first flu-like symptoms develop (fever, chills, malaise, body aches, and swollen lymph nodes). But it is most easily transmitted through contact with skin symptoms that typically develop a day or two later, according to Mass. Dept. of Public Health Assistant Commissioner Kevin Cranston.

    Those symptoms include rash and characteristic swollen pox. The disease is painful, and although it tends to clear up on its own in about four weeks, it can leave scars.

    Most cases are occurring through “sexual or really, really direct personal contact,” according to DPH epidemiologist Catherine Brown, and all transmission has been from people with symptoms, according to Cranston.

    Monkeypox was discovered in the 1970s and is closely related to smallpox, so there are vaccines that prevent it. If given to a patient after exposure to the virus but before the first symptoms appear, one of the vaccines, Jynneos, can prevent the disease from developing.

    The incubation period of the monkeypox virus, or MPV, can be 6 to 21 days, so reaching the contacts of newly discovered cases and inoculating them against the disease is the current priority for the state DPH and the CDC.

    “Post-exposure vaccination in Massachusetts is going to be prioritized,” said Brown. “We are deploying this vaccine within hours to the places where patients will receive it.”

    There’s a need for a public health practice people got familiar with during the pandemic — contact tracing. “Every time a case of monkeypox is identified, the DPH, local boards of health, and health care providers work together to identify their close contacts,” said Brown.

    Then, vaccination is recommended only for high-risk, close-contact exposures, she said. That is, “direct contact, while someone is symptomatic.”

    Because the Jynneos vaccine is being deployed from federal stockpiles and production contracts, federal rules will govern its use, Brown said. That means health officials in other states should also be following guidelines on vaccinating contacts.

    The Biden administration published its monkeypox vaccine strategy on June 28. It includes a CDC recommendation of vaccination for “confirmed exposures and presumed exposures.”

    According to the statement, “This includes those who had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner was diagnosed with monkeypox, and men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading.”

    Right now, the state’s capacity to process monkeypox tests is limited because viral DNA must be manually extracted from test samples at the lab. For that reason, each test has to be authorized by the DPH. Still, Brown said, “People are getting results in less than 36 hours — mostly within 24 hours.”

    Within two weeks, the DPH is expecting testing capacity to expand dramatically, when the CDC and FDA validate an automated process of DNA extraction.

    Additionally, the Biden administration is looking to expand testing capacity by authorizing five commercial laboratories to process tests.

    The federal vaccine strategy also says that, as supplies increase over the summer, jurisdictions can expand availability of the vaccine to a “broader population of individuals at risk.”

    The federal government expects to receive an additional 240,000 doses in the coming weeks, and more than 750,000 doses over the summer, the statement says. An additional 500,000 doses should arrive in the fall. It also says the government will be working to ensure vaccines are being made available to communities most at risk and where transmission has been highest.

    Still, Brown said that pre-exposure vaccination for “everybody who might want it” is a ways off.

    “The feds are very clear that there’s not going to be enough vaccine to do pre-exposure for everybody who might want it,” said Brown. “We’re going to have to be thoughtful and careful about how we apply a prioritization system.”

    With 1.6 million doses expected this year, a pre-exposure campaign is likely in the cards. In the meantime, people who have been in very close physical contact with a person who had symptomatic monkeypox should contact their health-care provider directly, said Cranston and Brown.

    PUBLIC HEALTH

    State Leaders Detail Response to Monkeypox

    Public awareness and vaccinating exposed people are key strategies

    By

    PROVINCETOWN — The official case counts for monkeypox are still low — 13 cases in Massachusetts, 63 in New York as of Tuesday, June 28. But the numbers have been doubling about every seven days, and public health leaders want the public to know how the disease spreads, what the symptoms are, and what kind of care is available to people who catch or are potentially exposed to it.

    Four different QR codes to keep you informed on monkeypox. (Image courtesy AIDS Support Group of Cape Cod)

    At a community forum on Tuesday, officials of the state Dept. of Public Health joined government and nonprofit leaders from across Cape Cod to answer questions about monkeypox and the state’s medical response.

    Monkeypox is not a new disease. Multiple strains have been endemic in central Africa since at least the 1970s, said Kevin Cranston, assistant commissioner of the DPH. The virus is related to smallpox, and vaccines for smallpox have proven effective against monkeypox.

    The multinational outbreak that is happening in Europe and the Americas has primarily affected gay and bisexual men and men who have sex with men (MSM) but don’t identify as gay. According to the World Health Organization, “most but not all” of the cases that have appeared outside of Africa in May and June this year — 4,700 or so cases in all — have been in the gay or MSM population.

    That is because of the virus’s initial appearance at “events that were identified in Europe” — the British and American press have identified a week-long gay pride celebration in the Canary Islands in early May — and the virus’s tendency to spread along lines of extremely close skin-to-skin contact, said Cranston.

    “Gay men may be the ecosystem that the virus is taking advantage of at this time, but it’s not limited to them by any means,” said Cranston, who identified himself as gay at the outset of the forum.

    Key variables distinguish the current monkeypox outbreak from Covid or other epidemics, Cranston added. The method of spread, the time to contagiousness, and the existence of treatments and vaccines are all important differences.

    “While we are anticipating this will be an ongoing outbreak, we don’t consider this a pandemic-level event,” said Cranston. “This is not a respiratory virus. This is not a virus that is easily transmitted. It requires extremely close skin-to-skin contact between a symptomatic infected individual and an uninfected individual.”

    Other forms of transmission do exist, but they typically involve people who are living with or providing care to people with visible illness. “Respiratory contact — we are talking extended, close, almost face-to-face, for six hours or more,” said Cranston.

    “There’s no general recommendation for handling laundry in a different way,” said state epidemiologist Catherine Brown. “If I were talking to people working in the service industry, I could imagine wearing gloves and not shaking the linens out vigorously before laundering, but standard laundry practices are sufficient.”

    In other words, both respiratory and laundry-based transmission are seen as problems faced by the partners, roommates, and caretakers of people who are conspicuously ill — not as avenues of stealth transmission or spread.

    “There is no evidence the virus is transmitted before a person is symptomatic,” Cranston added.  “That’s good news.”

    Symptoms typically begin with a flu-like cluster: headache, body aches, malaise, fever, chills, and swollen lymph nodes. Not long after come a variety of skin manifestations, including “a flat rash, raised macules, the actual pox, which often has a little navel in the center of it, and vesicles of fluid under the skin, and pockets of fluid emerging through the skin,” said Cranston.

    The “skin manifestations” and fluids are especially contagious, but transmission is possible from the appearance of the first symptoms until the last scab has fallen off — often around four weeks in all.

    No one has died of monkeypox during this outbreak — but the infection is painful, and it can leave scars. No one has been hospitalized for lifesaving care either, but there have been some hospitalizations for pain management, Dr. Brown said.

    There is an unusually long latency period between exposure and the development of symptoms — 6 to 21 days. A vaccine called Jynneos, which is made from a related virus that can no longer replicate, can be given to people who have been exposed to monkeypox and haven’t yet developed symptoms. It prevents them from getting the disease.

    Having time to identify contacts and prevent transmission of the virus is something like the Holy Grail in public health. DPH leaders and state Sen. Julian Cyr, who moderated the forum, said that getting access to more Jynneos vaccine is the most pressing conversation.

    “At this point, the vaccine is primarily being used post-exposure for high-risk close contacts,” said Brown. “We are working to make sure we get that vaccine to those contacts as promptly as possible. There’s a lot of interest in what role pre-exposure vaccination can play. The feds are talking about it, but we have to be realistic about the amount of Jynneos vaccine they currently have. They’re working with the manufacturer to speed up supply and are expecting additional doses in July and then more through this year. But the feds are the sole supplier of Jynneos right now.”

    There have been around 30,000 courses of Jynneos vaccine (a course is two doses, four weeks apart) distributed to the states thus far, said Dr. Larry Madoff, medical director of the state’s Bureau of Infectious Disease. Massachusetts has received “hundreds, not thousands” of doses, Cyr said. More are expected soon — in fact, at the Independent’s deadline, the federal government released another 56,000 doses to the states. In the near term, the focus is likely to remain on vaccinating the contacts of people who develop symptoms.

    Given current supplies, “We need clear evidence of contact — not more distal contact,” said Cranston. Sharing a bed would definitely qualify; sharing a dance floor probably would not.

    “The number of cases we’re dealing with and the transmission dynamics of this virus do not say that people should stop going to parties and stop dancing,” said Cranston. “An individual may say, ‘I may not want to have the skin-to-skin contact I would normally have on a night I go out,’ ” he added, but current facts are not leading public health authorities to target dance floors.

    Nonetheless, one doesn’t have to wait for a contact tracer to call, either.

    “If someone has good evidence of exposure to someone with monkeypox, and they believe they’re eligible for post-exposure, they need to go to their care provider and their provider will reach out to us,” said Brown.

    MONKEYPOX UPDATE

    Leaders Say, ‘Don’t Panic; Be Vigilant’

    Knowing the symptoms is critical to controlling spread

    By

    PROVINCETOWN — As of June 21, the Centers for Disease Control report seven confirmed cases of monkeypox in Massachusetts, 22 in New York, 37 in California, and 210 in Canada.  There are nearly 500 in Spain and Germany, and nearly 800 in the U.K. The CDC website says that “many — though not all — of the reported cases have been among gay and bisexual men.”

    On Cape Cod, state Sen. Julian Cyr says the Provincetown Health Dept., Outer Cape Health Services, AIDS Support Group of Cape Cod, and the state Dept. of Public Health are preparing for the likely eventual appearance of monkeypox here.

    “At this point, we should expect this,” said Cyr on Tuesday. “Based on what we know, cases are likely to surface anywhere there’s a large gay community, and that includes Boston, Providence, New York, Washington, Montreal, and yes, Provincetown.”

    Cyr is himself gay and was formerly a director of policy in the state’s public health dept. He said that, right now, awareness and information are important.

    “Indications are that transmission is occurring when people are symptomatic, so we need to be aware of what the symptoms are, and people need to decide to stay home and not try to take an Advil and shake off that fever or chill they’re feeling and go out,” Cyr said.

    According to Provincetown’s health dept., the characteristic symptom of monkeypox is a rash, often appearing first on the face or genital area and then spreading to other parts of the body including hands and feet. The rash is typically preceded by fever, chills, swollen lymph nodes, and other nonspecific symptoms like malaise, headache, and muscle aches. These symptoms emerge 6 to 21 days after exposure, and it is this constellation of symptoms that public health leaders here want people to know about.

    “This is transmitted by very close contact,” said Cyr. While transmission via surfaces or airways is technically possible, “We are talking about being face to face for so long that you’re almost kissing,” Cyr said.

    The Provincetown Health Dept.’s website describes this as “respiratory secretions through face-to-face interactions (the type that mainly happen when living with someone or caring for someone who has monkeypox).” The health dept. also says that “monkeypox does not spread through casual conversations, walking by someone with monkeypox in a grocery store, or touching items like doorknobs.”

    In other words, monkeypox does not spread like Covid, Cyr said.

    Although no one has died in the outbreak countries (there has been one confirmed death in Nigeria, one of several countries where monkeypox is endemic), the disease is still serious. Skin sores can be painful, the infection can take four weeks to clear, and the potential exists for scars.

    “We want people to know the symptoms and avoid close contact if they’re feeling them,” Cyr said. Or as it says on Provincetown’s website, “If you are feeling sick, stay in!”

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