As Monkeypox spreads, a campaign to warn the public gains urgency

Grindr, the social networking app, sent a pop-up message about the risk of monkeypox to millions of European and American users. An organizer of sex parties in New York asked guests to check themselves for lesions before showing up. And the organizers of the city’s main Pride celebrations posted a notice of monkeypox on their Instagram account on Sunday.

As hundreds of thousands of people gather in New York and elsewhere to celebrate Pride this month, city and federal officials, health advocates and party planners are racing to issue a growing health warning. more urgent about the risk of monkeypox.

“Be aware, but don’t panic,” said Jason Cianciotto, vice president of communications and policy for Gay Men’s Health Crisis, summarizing the message the group is trying to convey.

The virus, which has long been endemic in parts of Africa, is now being transmitted globally and, although it can infect anyone, it is currently being spread mainly through networks of men with sex with men, officials said.

Since May 13, when the first case of the outbreak was reported in Europe, more than 2,000 people in 35 countries outside Africa have been diagnosed with the virus. As of Wednesday, 16 cases had been identified in New York, among 84 across the country. New York’s most recent cases are not travel-related, suggesting person-to-person transmission is taking place in New York City, the city’s health department said.

Although the raw numbers are still low, epidemiologists are concerned about the level of global transmission and because cases are popping up with no clear links to each other, suggesting wider spread. The World Health Organization will meet next week to determine whether monkeypox is now considered a global health emergency.

Monkeypox, so named because it was first discovered by European researchers in captive monkeys in 1958, can infect anyone, regardless of gender, age or sexual orientation. Although it is mainly spread by direct contact with lesions, it can also spread via shared objects such as towels, as well as droplets emitted by talking, coughing or sneezing.

Scientists believe it can also be transmitted by tiny aerosol particles, although this would likely require a long period of close contact. The virus in general is much less contagious than Covid-19.

Monkeypox has caused at least 72 deaths this year in African countries where the virus is endemic, WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Tuesday, but no further deaths have been definitively linked to the virus. global epidemic outside of Africa.

The first 10 cases in New York were all detected in men between the ages of 27 and 50, and most identified themselves as men who have sex with men, following the global pattern, according to the Department of Health. city ​​health. Most New York cases have resulted in mild symptoms, officials said, but even mild cases can involve an itchy, painful rash that lasts two to four weeks.

Public awareness of the epidemic, which would lead to greater demand for testing, is still at an early stage, and the virus sometimes causes only a few lesions in the genital area, which can make it difficult to differentiate from other diseases. sexually transmitted. Two vaccines, as well as antivirals, are available, although for now the vaccines are mainly offered in America to close contacts of identified or suspected cases.

Pride celebrations are the perfect time to raise awareness among members of the LGBTQ community who are most at risk, health officials said in interviews, but also create a challenge for those looking to get a message across. on protecting the community without creating alarm or stigma. More broadly, organizers and health officials don’t want to put a damper on Pride celebrations and their positive messages about gender identity.

Working with LGBTQ community advocates and partners, federal and local health officials have in recent weeks begun drafting social media posts, writing fact sheets, and posting images of what to do. what smallpox looks like to help people know what to look for.

Pride rallies also come at a crucial time, when there is still a chance that aggressive public health actions could keep monkeypox under control, but increased contact during the celebrations could create further spread of the disease, especially if people are uninformed about the virus.

“We need everyone to step up their game, because if we are to contain it, we need a real escalation of efforts at all levels.,said Gregg Gonsalves, a longtime AIDS activist and epidemiologist at the Yale School of Public Health, in an interview. “We are walking the line between containment and persistent spread, and containment would be better.”

The goal of health officials for now is to provide information on how the disease is transmitted – mainly through skin-to-skin contact – and to urge people to seek treatment if they have a rash. or feel bad. While the messages specifically target the gay and bisexual community, public health officials also stress that anyone can be infected.

Although the current risk to the general public remains low, it could increase if the virus becomes established in the United States and other countries outside of Africa, infecting more people, warned the WHO in a recent update. The organization is also working to change the name of the virus, which they say could increase the stigma surrounding it.

Still, many health experts are warning that public health messaging, which for now is mostly online, needs to move faster, and that education alone won’t be enough to stem the outbreak.

All aspects of the monkeypox response – from education to identifying cases to isolating those infected – should be stepped up, said Dr. Carlos Del Rio, chairman of the Rollins Department of Global Health. School of Public Health at Emory University and the new president of the Infectious Disease Society of America.

“To contain this, we need to act quickly,” he said. “I wish we did more.”

Testing for the virus is still rare in the United States. As of June 7, the Centers for Disease Control and Prevention had conducted 297 tests for orthopoxvirus, the family of viruses to which monkeypox belongs.

Public health experts warn that the CDC’s centralized approach could discourage more widespread testing, creating echoes of the testing debacle that slowed the country’s response to Covid-19 in February 2020.

Testing currently takes place in two stages: About 70 public health labs across the country are licensed to perform an initial PCR test for orthopoxvirus, but final monkeypox diagnoses are only performed by the CDC lab in Atlanta. Commercial labs still cannot test for the virus. There is also no rapid test or antigen for monkeypox, although one could be developed, as was the case for Covid, said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Answer.

“Without wishing to shed light on it, we have once again been caught with our pants down by a global pandemic for which we were unprepared,” said Mark Harrington, executive director of the Treatment Action Group and longtime campaigner for the AIDS. , who asked for improvements in testing at a monkeypox webinar hosted by the Manhattan Borough President on Monday.

Aspects of the federal response have been praised by the LGBTQ community. The CDC, for example, recently released a sex-positive fact sheet on social gatherings and safer sex, which, rather than telling everyone to stay home, contains specific advice for avoiding smallpox. of the monkey, such as keeping clothes on during sex and not kissing.

“Some people are concerned that this could happen during Pride,” said Dr. Demetre Daskalakis, CDC’s director of HIV/AIDS prevention and the agency’s monkeypox response manager. “I can’t imagine a better time to get messages out about something like this.

Parades and outdoor events this month “are not where the virus will spread,” said Gay Men’s Health Crisis’ Mr. Cianciotto, so people shouldn’t be afraid to attend. “And for clubs that have parties that have closer physical contact, or for people who like to be with others in an intimate way, they need to get information on what to look for and how to get help.”

Yet while there has been a growing urgency in education, there has been less scaling up of other aspects of the response, such as increased access to testing and vaccination for those who consider high risk, said Joseph Osmundson, a microbiologist at New York University who is part of a group of gay and queer activists who regularly speak with policy makers about the response.

He and other activists have also worked through their own channels to educate the LGBTQ community about the virus — for example, by crafting messages that promoters of sex parties can distribute to attendees that include pictures of monkeypox lesions.

“When I talk to my friends in the queer community, we want an intervention,” Dr. Osmundson said. “We don’t want monkeypox. The spaces where we meet for fun and camaraderie, we don’t want them closed, number one. And we like to enter these spaces with as little hassle and risk as possible. »

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