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San Francisco declares state of emergency over monkeypox

San Francisco Chronicle logo San Francisco Chronicle 7/28/2022 By Rachel Swan

San Francisco officials declared a public health state of emergency Thursday in response to the growing spread of monkeypox cases across the city.

The declaration allows Mayor London Breed and other city officials to marshal resources and personnel to confront the intensifying monkeypox outbreak. As of Thursday, the mayor said, the city has seen 281 people with monkeypox infections. Health officials said they anticipate that figure will only grow in the coming days and weeks.

The rapid monkeypox surge in San Francisco has collided with a scarcity of available vaccines. To date, city officials said they’ve received about 8,200 doses of the Jynneos vaccine, which is intended to prevent monkeypox and smallpox in adults.

“We want the flexibility to be able to use our resources to best serve the public and protect health,” San Francisco Health Officer Susan Philip said Thursday. “We also want to affirm our commitment to the health of our LGBTQ communities in San Francisco, as we have historically always done as a city,” she added, referring to the population most impacted by monkeypox so far.

Philip emphasized that she was not planning to call for any closures or restrictions, a posture that distinguishes this emergency declaration from the health orders issued throughout the COVID-19 pandemic.

Perhaps more worrying than the sheer amount of infections was the trajectory, which “continues to go up,” Philip said, “as we know there are more cases that have yet to be diagnosed.” Testing has increased, she indicated, but not enough to make it universally accessible.

“If there were any other community that was disproportionately impacted by monkeypox the way the gay community has been impacted, this whole country would be up in arms,” Breed said during a news conference Thursday.

Standing with city health officials, Breed criticized what she called a sluggish federal response to the outbreak, and referenced the darkest days of the AIDS pandemic in San Francisco when the city was left to virtually fend for itself.

The mayor said the local emergency declaration “will allow us to continue to support our most at-risk, while also better preparing for what’s to come.”

“Our COVID-19 response has taught us that it is imperative that we mobilize city resources rapidly,” said Dr. Grant Colfax, director of the Department of Public Health, joining the mayor at a Thursday evening news conference. He said the fight was personal for him as a gay man who came out and did his medical training during the peak of the AIDS pandemic.

Also criticizing what he’s called a sluggish federal response, Democratic state Sen. Scott Wiener told the news conference, “What the experts told us would happen has happened.” More vaccines are needed, and fast he added. Across the government, “we are rowing in the same direction, we just need to row a lot faster,” he said. He also said earlier that the federal response has improved somewhat.

Wiener said he is writing to Secretary Xavier Becerra of the U.S. Health and Human Services Department seeking more flexibility for states and counties to redirect COVID-19 funds toward monkeypox vaccines and treatment.


Video: San Francisco declares public health emergency due to monkeypox (CBS SF Bay Area)

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With the current case count, San Francisco and Los Angeles appear to be the two most worrisome hotbeds of the monkeypox outbreak in California, which, as of July 21, had the second-highest number of reported cases in the nation, after New York, according to the Centers for Disease Control and Prevention. Currently the two cities are “neck-in-neck,” with roughly the same number of infections according to Philip.

The city requested an initial supply of 35,000 doses — although Breed said the need is really 70,000 — and will prioritize vaccines for men and trans people who have sex with men, who currently, officials say, are the most vulnerable to infection of any population in the city. Within those communities Latino men have seen a disproportionate number of cases, a disparity that Philip attributes to the virus spreading through networks.

She attributed the national shortage of vaccines to a limited supply chain from one global manufacturer, Jynneos, which is based in Denmark. It provides vaccines for a federal stockpile that gets distributed to states, and in turn to cities.

The Department of Public Health said it will focus on distributing the first vaccine doses to as many at-risk people as possible, holding off appointments for second doses until the city receives enough supply to accommodate them. New York City adopted this strategy to deal with supply constraints, though the Food and Drug Administration and Centers for Disease Control and Prevention have not endorsed the method.

Declaring a state of emergency allows the city to access funds from the state and federal government reserved for emergencies and to broaden public awareness about the outbreak.

The emergency declaration will take effect Monday, city officials said.

While monkeypox is not a new disease, recent cases exploded in many countries at once. San Francisco reported its first case on June 3, and infections rose quickly, prompting concern among health officials still trying to manage the COVID-19 pandemic.

The illness causes a rash or sores on the skin that resemble blisters or pimples, along with flu-like symptoms. It appears to be transmitted by intimate contact including kissing, sharing bedding or clothes, or potentially, breathing in close proximity. It appears to be far less contagious than COVID-19 and poses less risk to the general population. Although many cases resolve on their own, in rare instances, monkeypox can become serious.

“It is spread by very close skin-to-skin contact, or very close face-to-face contact, so that large droplets or saliva can spread this,” Philip said, distinguishing monkeypox from COVID-19, which can proliferate through the air over a distance.

Tyler TerMeer, chief executive officer of the San Francisco AIDS Foundation, applauded San Francisco’s swift action but criticized the federal government for not declaring its own federal state of emergency.

“Community-based organizations like San Francisco AIDS Foundation have been ringing the alarm for many weeks now about the crisis that our community is once again in,” TerMeer said. Referring back to the 1980s AIDS epidemic, he said, “We are once again in a moment of federal public health failure to cisgender and transgender men as well as nonbinary folks who have similar social and sexual networks.”

Monkeypox lesions can cause intense pain and have has sown fear and panic among people who are hearing about the illness or watching friends fall ill, TerMeer said.

Supervisor Rafael Mandelman said health officials in San Francisco have been fairly effective at distributing vaccines by comparison to federal efforts. Nonetheless, he criticized the city for “making people wait for hours and hours in line” at San Francisco General Hospital and Trauma Center.

In the past several weeks, Mandelman has held a hearing, a news conference and a town hall on monkeypox, and wrote a legislative resolution calling on the Centers for Disease Control to step up its acquisition of vaccines. Mandelman is gay and represents the city’s Castro district, one of the most prominent LGBTQ enclaves in the country.

“We’ve seen that there has been benefit in the COVID situation, and in some of the public health context around the Tenderloin, that the city is able to move more quickly — able to move in the ways I wish we could move all the time — when we declare something to be an emergency,” Mandelman said.

San Francisco AIDS Foundation has provided 840 vaccinations at its clinic in the Castro and has 130 doses left on hand, according to TerMeer, who added that the waitlist of 7,300 people far dwarfs the number served.

Forty years ago, he said, the AIDS Foundation set up a hotline “because people were living in fear and concern about something new that was happening in their community.” Today, a similar climate prompted the foundation’s newest hotline, he said — this time focused on monkeypox.

San Francisco Chronicle staff writer Chase Difeliciantonio contributed to this report.

Rachel Swan is a San Francisco Chronicle staff writer. Email: rswan@sfchronicle.com Twitter: @rachelswan

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