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As the World Health Organization and New York City officials plan to assess Monkeypox as a potential public health emergency, Manhattan Borough President Mark Levine led a virtual community forum to address concerns from New York’s LGBTQIA+ population, while outlining the facts and clarifying misconceptions surrounding the virus.
Levine invited Wafaa El-Sadr, director at the Center for Infectious Disease Epidemiologic Research at Columbia Mailman School of Public Health, Jay Varma, Professor and Director, Cornell Center for Pandemic Prevention and Response, and Mark Harrington, HIV/AIDS researcher and director of the Treatment Action Group to share recent findings on the disease’s transmission and to address the risks of stigmatization for those who contract it.
“We’re trying to balance between making sure people have the information that they need to protect their health, but also not to generate a level of alarm that is disproportionate to the level of the problem,” said Dr Varma on the forum.
A rash virus that presents similarly to smallpox (though in a milder format), Monkeypox has been endemic for decades on the African continent. It is spread primarily through close, skin-to-skin contact and exposure to infected towels and bedding. The virus has recently spread to Europe and North America, with 65 recorded cases in the US across 18 states — and 11 likely cases identified in NYC.
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Most patients in recorded US cases experienced mild symptoms in addition to the rash, such as fever, muscle aches, fatigue, and chills and did not require hospitalization. Even with mild symptoms, however, rashes can last from two to four weeks before resolving.
Dr El-Sadr presented findings from the Center for Disease Control (CDC), adding that while initial reports indicated infected patients had recently traveled abroad, recent case recordings suggested that patients had contracted the virus without having left the country.
Additionally, in a study of patients who contracted the virus in early May, 16 of 17 patients identified as men who have sex with men. While the virus is not technically determined a sexually transmitted disease, the close skin-to-skin contact suggests that it has been primarily transferred through sexual contact.
“It’s presenting itself in a way that lends itself to increasing numbers in the United States,” added Dr Varma. “What we have seen is that the rash has presented around the genital area and is harder to immediately identify before transmitting to other partners,” he explained. “Very few people interviewed could recall having sex with a partner who definitively had a rash,” making contract tracing harder and introducing the possibility of underreported virus data.
While antiviral treatments are available and most US patients have recovered without the need for hospitalization, Dr Varma said there are still concerns over the risk of complications: “There appears to be more than one strain of the virus and it is quite infectious. It can be associated with other complications — damage to eyes and brain, so that’s the reason to be cautious,” he added.
“I do think that people in the US, and in New York City need to be concerned . Right now we are raising the alarm among the gay, bi, and MSM community because that’s where the infections have been concentrated,” said Dr Varma. “There’s nothing about this though that makes it a ‘gay disease’ in any way — it just so happens that this is the community that was unlucky enough to have this spread first,” he added, reiterating that anyone can become infected, regardless of sexual orientation.
“There’s a lot that we don’t know,” added Harrington. “But this isn’t a new disease. It reflects the inequity that the world has dealt with for centuries with respect to diseases that affect mainly the poor.”
Harrington, Varma, and El-Sadr all emphasized the global need to rethink the language around the virus, which has been deemed derogatory and racist. “Monkeypox doesn’t even come from monkeys, and it feeds into racist stereotypes,” said Harrington. The WHO has determined that it will rename the disease in light of stigmatization.
“I also want to emphasize that the stigmatization of diseases doesn’t just happen for LGBTQ people, it happens for people of color, it happens for sexually active people, it happens for women, it happens for Africans, it happens for Asians — when we talk about infectious diseases, I would recommend that we move away from the kind of stigmatizing language that we have in the past,” Harrington added.
“My quest is for more and better science and more and better information,” he said, asking the officials on the call to advocate for increased local testing and availability of vaccines, which have already been developed.
Drs Varma and El-Sadr recommended that everyone frequently check themselves for rashes, and ask their healthcare providers for testing if needed. Anyone who tests positive for the virus should seek treatment until any and all lesions on the skin are resolved.
Despite the disconcerting uncertainty of another virus breaching New York and the West Side, officials said that lessons learned from the AIDS and COVID-19 pandemic will serve as valuable tools in fighting this next threat.
“Unlike with AIDS in 1981 and COVID-19 in 2020, we do have treatment and we do have vaccines that work,” said Harrington. “How quickly can we roll out better testing and use the tools that we do have?”