San Francisco, New York state declare monkeypox emergencies as outbreak grows

Courtesy of National Institute of Infectious Diseases
An electron microscopic image of the monkeypox virus

San Francisco and the state of New York declared public health emergencies Thursday amid the growing monkeypox outbreak, the latest in a series of escalating measures responding to the rapidly spreading virus.

The action by two of the hardest-hit areas comes after the World Health Organization declared a global emergency last weekend and as the Joe Biden administration weighs a national emergency declaration.

More than 40% of the nation’s confirmed 4,907 monkeypox cases have been reported in California and New York.

San Francisco Mayor London Breed, D, announced a local public health emergency Thursday, noting cases of monkeypox had nearly doubled, to 261, in a week. She said the move would mobilize resources, accelerate emergency planning and allow for future spending to be reimbursed by the state and federal governments.

California state Sen. Scott Wiener, D, who had called for the emergency declaration, said the decision would make it easier to expand testing and vaccines and pressure the federal government to take the outbreak more seriously.

“It’s a powerful declaration to the country and the world about the need to act decisively and strongly,” Wiener said in an interview.

After the state of New York recorded more than 1,200 cases, State Health Commissioner Mary T. Bassett on Thursday declared an imminent threat to public health, retroactive to June 1.

“This declaration means that local health departments engaged in response and prevention activities will be able to access additional State reimbursement, after other Federal and State funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities,” Bassett said in a news release.

Monkeypox infections result in an illness that lasts several weeks with symptoms including fever, swollen lymph nodes and a rash that can spread throughout the body. No U.S. deaths have been recorded, but some patients have reported intense pain from lesions.

The outbreak has overwhelmingly been concentrated in men who have sex with men. Gay leaders such as Wiener and longtime HIV activists have urged health officials to act decisively to contain monkeypox and avoid repeating mistakes from the AIDS crisis when the suffering of gay men was minimized and the world failed to act quickly. Vaccines are believed to be effective before and after exposure, and an antiviral approved for a closely related disease, smallpox, can be used to treat monkeypox.

Local officials, including Breed, say the supply of vaccine is not sufficient to provide shots to everyone at high risk of exposure.

“Our declaration of emergency is to sound the alarm and make it very clear we are in desperate need of more vaccine and more treatment,” Breed said Thursday.

Monkeypox spreads primarily through close contact, and experts believe skin-to-skin exposure during sexual activity is a major source of transmission in the current outbreak. But they caution the virus spreads through other forms of touch and can circulate outside the gay community, noting a handful of cases in women and children.

WHO officials advised men who have sex with men to temporarily reduce their number of sexual partners in an attempt to reduce transmission. The New York and San Francisco announcements did not include containment measures or restrictions designed to curb spread.

“We are not implementing behavior restrictions or other measures like we did under COVID. This is all about having the resources and ability to move quickly to deploy these resources,” Breed said in a post explaining the emergency.

Health and Human Services Secretary Xavier Becerra said Thursday that officials had not made a decision on a national emergency declaration, noting the virus had yet to become as formidable a threat as coronavirus. Becerra touted vaccines and treatments that the Biden administration has continued to send to local health departments and providers, including about 800,000 doses that federal officials cleared for distribution this week.

“We will weigh any decision on declaring a public health emergency based off the response we’re seeing throughout the country,” Becerra told reporters at a briefing. “Bottom line is, we need to stay ahead of this and be able to end this outbreak.”

Federal officials have spent the week privately wrestling over whether to declare an emergency, with some senior health officials arguing it would elevate public awareness of the outbreak and allow for a more robust response, including compelling hospitals to report more data on monkeypox patients.

But other health and White House officials have raised questions about declaring a U.S. emergency, saying it would be mostly symbolic and create pressure to declare additional emergencies for other issues such as abortion, which advocates have sought. HHS also has continued to renew a 2 1/2-year-old public health emergency declaration for coronavirus amid some conservatives’ demands to end it.