Grindr, the social networking app, sent a pop-up message about monkey pox risk to millions of European and American users. A sex party organizer in New York asked invitees to check themselves for lesions before showing up. And the organizers of the city’s main Pride celebrations posted a message about monkey pox on their Instagram account on Sunday.
As hundreds of thousands of people gather in New York City and elsewhere to celebrate Pride this month, city and federal officials, health advocates and party organizers rush to spread an increasingly urgent health warning about the risk of monkeypox.
“Be warned, but don’t panic,” said Jason Cianciotto, the vice president of communications and policy at the Gay Men’s Health Crisis, summarizing the message the group is trying to get across.
The virus, long endemic to parts of Africa, is now being transmitted worldwide and while it can infect anyone, it currently spreads mainly through networks of men who have sex with men, officials say.
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. By Wednesday, 16 cases had been identified in New York City, 84 of which were nationwide. The most recent New York cases are unrelated to travel, suggesting person-to-person transmission occurs in New York City, the city’s health department said.
While the raw numbers are still low, epidemiologists are concerned about the level of global transmission and the emergence of cases with no apparent links to each other, suggesting wider distribution. The World Health Organization is meeting next week to determine whether monkeypox now qualifies as 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. While it usually spreads through direct contact with lesions, it can also be spread through shared objects such as towels, as well as droplets released when speaking, coughing, or sneezing.
Scientists believe it can also be transmitted via small aerosol particles, although that would likely require a long period of close contact. The virus is generally much less contagious than Covid-19.
Monkeypox has caused at least 72 deaths this year in African countries where the virus is endemic, said WHO director-general Dr. Tedros Adhanom Ghebreyesus, Tuesday, but no other deaths have been definitively linked to the global outbreak outside of Africa.
The first 10 cases in New York were all discovered in men between the ages of 27 and 50, and most have been identified as having sex with men, following the global pattern, according to the city’s health department. Most cases in New York have resulted in mild symptoms, officials said, but even mild cases can be accompanied by an itchy and painful rash, lasting two to four weeks.
Public awareness about the outbreak, which would lead to increased demand for tests, is still in its early stages, and the virus sometimes causes only a few lesions in the genital area, making it difficult to distinguish from other sexually transmitted diseases. Two vaccines are available, as well as antivirals, although vaccines are currently offered primarily in America to establish contacts with identified or suspected cases.
Pride celebrations are the perfect time to raise awareness among those in the LGBTQ community who are most at risk, health officials said in interviews, but they also create a challenge for those looking to deliver a message about protecting the community without create alarm or stigma. More generally, organizers and health officials don’t want to put a damper on Pride celebrations and their positive messages about sexual identity.
In recent weeks, in conjunction with attorneys and partners in the LGBTQ community, federal and local health officials have begun making social media posts, writing fact sheets and posting images of what the smallpox looks like to help people know where they should pay attention.
Pride rallies also come at a crucial time when there is still a chance that aggressive public health actions could control monkeypox, but increased contact during the celebrations could lead to additional spread of disease, especially if people not be informed about the virus.
“We need everyone to step up their game because if we want to master it, we need a real performance across the board†Gregg Gonsalves, a longtime AIDS activist and epidemiologist at the Yale School of Public Health, said in an interview. “We’re on the borderline between containment and sustained spread, and containment would be better.”
The focus of health officials now is to provide information about how the disease is transmitted — primarily through skin-to-skin contact — and to urge people to seek care if they have a rash or feel unwell. While the messages are primarily aimed at the gay and bisexual community, public health officials also emphasize that anyone can become infected.
While the current risk to the general public remains low, it could increase if the virus settles in the United States and other countries outside Africa and infects a larger group of people, the WHO warned in a recent update. The organization is also working to change the name of the virus, which they believe may increase the stigma surrounding it.
Still, many health experts warn that public health messages, now largely online, need to move faster and that education alone will not be enough to contain the outbreak.
All aspects of the monkeypox response — from education to case identification to isolating those infected — need to be stepped up, said Dr. Carlos Del Rio, chair of the Division of Global Health at the Rollins School of Public Health at Emory University and incoming chair of the Infectious Disease Society of America.
“To contain this, we must act quickly,” he said. “I wish we did more.”
Testing for the virus still remains rare in the United States. As of June 7, the Centers for Disease Control and Prevention had conducted 297 tests for the orthopox virus, the family of viruses to which the monkeypox belongs.
Public health experts warn that the CDC’s centralized approach could discourage more widespread testing, creating echoes of the testing debacle that delayed the country’s response to Covid-19 in February 2020.
Testing is currently in two phases: About 70 public health labs across the country are allowed to perform an initial orthopoxvirus PCR test, but the definitive diagnosis of monkeypox is only made by the CDC lab in Atlanta. Commercial labs still can’t test for the virus. There is also no rapid or antigen test for monkeypox, although one could be developed, as it was for Covid, said Dr. Jay Varma, the director of the Cornell Center for Pandemic Prevention and Response.
“With no intention of throwing light on this, we have once again been caught with our pants down by a global pandemic that we were unprepared for,” said Mark Harrington, the executive director of the Treatment Action Group and long-time AIDS researcher. activist, who pushed for improvements in testing at a monkeypox webinar hosted by the President of Manhattan on Monday.
Some aspects of the federal response have been praised by the LGBTQ community. For example, the CDC recently released a sex-positive fact sheet on social gatherings and safer sex, which, rather than telling everyone to stay home, includes specific tips for avoiding monkey pox, such as keeping your clothes on during sex and not kissing.
“Some people are concerned that this is happening during Pride,” says Dr. Demetre Daskalakis, director of HIV/AIDS Prevention at the CDC and a leader of the agency’s monkeypox control. “I can not imagine a better time to get out about something like that.”
The 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 participate. “And for clubs that have parties that have closer physical contact, or for people who enjoy being with others in an intimate way, they need to be given the information about what to look out for and how to get help.”
While there has been a growing urgency for education, there has been less of scaling up other aspects of the response, such as better access to testing and vaccination for those who consider themselves high-risk, said Joseph Osmundson, a microbiologist at New York. University, which is part of a group of gay and queer activists who regularly talk to decision-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 creating messages for sex party promoters to distribute to those in attendance, including photos of monkeypox lesions.
“When I talk to my friends in the queer community, we want intervention,” said Dr. Osmundson. “We don’t want monkeypox. The spaces where we meet for fun and companionship, we don’t want to close them, number one. And we like to go into those areas with as little worry as possible and as little risk as possible.”