Michele Zipkin is a reporter for the Philadelphia Gay News. Jason Villemez is the editor of the Philadelphia Gay News, where this story first appeared.
Philly health officials and leaders answer monkeypox questions at town hall
Here is a roundup of questions and answers from the Mazzoni Center town hall that help explain the current state of the monkeypox crisis and what people need to know going forward
Dusty Latimer, Dr. Shara Epstein, Sebrina Tate, and Jessica Caum spoke during the August 2 town hall on monkeypox (Philadelphia Gay News screen capture).
By Michele Zipkin and Jason Villemez
To spread awareness among the growing monkeypox crisis in the U.S. and worldwide, Mazzoni Center hosted a town hall on August 2 with city health department employees, community health leaders, and public officials. The town hall, hosted by Mazzoni Center president and executive officer Sultan Shakir, came after a July 28 press conference where LGBTQ leaders including Reps. Malcolm Kenyatta and Brian Sims made an impassioned demand for greater vaccine supplies for the Philadelphia region. In addition, Philadelphia FIGHT is hosting a community conversation on August 3 on monkeypox infection and vaccination.
Here is a roundup of questions and answers from the Mazzoni Center town hall that help explain the current state of the monkeypox crisis and what people need to know going forward. The questions came from attendees of the town hall and answers were given by panelists including Jessica Caum, program manager, Bioterrorism and Public Health Preparedness program for the Philadelphia Department of Public Health; Dr. Shara Epstein, infectious disease specialist, medical director of the Division of Disease Control for the Philadelphia Department of Public Health; Dusty Latimer, Physician Assistant at Mazzoni Center: and Jazmyn Henderson, organizer with ACT UP Philadelphia and Black and Latinx Community Control of Health. Rep. Kenyatta and Sebrina Tate of Bebashi Transition to Hope also spoke during the town hall.
Some exchanges have been edited for length.
Where are current vaccines coming from and why don’t we have enough?
Caum: The current vaccines are coming from something called the Strategic National Stockpile, a stockpile of medications and different supplies that would be used in an emergency. There is a limited amount of vaccine due to the fact that it is not a routine vaccine that is given.
The allocations are being made by the federal government. Right now the allocations are based on case counts. It doesn’t help us right now to get vaccine, that we have lowercase counts and some other jurisdictions. As of [Aug. 1], we had received 2,625 vaccines total; that is a very small amount of vaccine. [Aug. 2] we received our next shipment, which was 2,420 new doses of vaccine. We’ll have an opportunity to order additional vaccines on August 15. The total allocation right now that we are drawing down from is about 6,000 vaccines.
How can people go to get access to the vaccine?
Caum: For vaccine, we have a couple of things happening right now. We have some providers who have been identified as providers who work very closely with the high risk community. Those providers are receiving vaccine from us. We’re just getting this process up and running to get the vaccine out to providers.
Separately, the Health Department has been running vaccination clinics at William Way Community Center as well as Health Center One. Right now because the supply is so limited, we are only able to take vaccinations by appointment only.
If someone’s interested in getting vaccinated, what’s the first thing they should do?
Caum: I think they should review eligibility for who in Philadelphia can receive vaccine right now. We really do want to make sure a vaccine is going to people who are most high-risk. I would particularly emphasize that we keep vaccine in reserve for people who may be contacts of cases. We’re also trying to identify people who may be in social networks of contacts to offer vaccine.
How can people get access to testing and treatment?
Epstein: This is different than Covid in a lot of ways. The testing is not difficult and it’s now commercially available. Any provider can order the test and can do it in their office. It certainly requires PPE and some materials, but those are available now. We’re encouraging providers to open up testing more widely.
There’s a couple of treatments, but the main one that people are hearing about is tecovirimat. Unfortunately it’s still under a process called IND – “investigational new drug.” The federal government, the CDC, and the FDA have shortened the process considerably. It’s not like prescribing any other drug unfortunately, at this point. Several providers in the city have been really great and have been prescribing this drug even though it’s been difficult.
How was vaccine allocation determined?
Caum: Allocations have been really based on the kind of providers who are working with the community that we’re looking to serve. Providers were asked, ‘if you have vaccine, how many people could you vaccinate in a week?’ So we made allocations based on what we’ve heard back from providers as far as how quickly they could [administer] vaccine. I think the goal here now is while we have vaccine, to get it out as quickly as possible. We have a lot of work to do here and we really want to engage many more providers in this process.
One of the other things that I think we would like to do as a department would be to identify organizations that may be able to host us to offer a Health Department-run clinic, provide a venue and would be able to have ties to the community that we’re trying to reach and can be trusted messengers for vaccination, and build vaccine confidence and do all of those things. That is something that we’re definitely open to. Vaccine supply is of course very limited, but definitely something that worked well for us during Covid, helped us to address equity issues.
How do you differentiate between a diagnosis of scabies, herpes and monkeypox?
Latimer: The way that we’re approaching it at this point, we’re scanning contacts via telephone or via electronic communication – we actually asked them to send us electronic pictures. Even with really good smartphone cameras, it is really difficult to differentiate based off of an image. It typically does require people to come in for testing for us to make that differentiation. I’ve definitely swabbed things that I was certain were going to be positive that weren’t, and vice versa. So at the end of the day, this looks a little bit different in everybody that it shows up in. The only way to really know is to get folks in it to get them tested.
Epstein: We need to test more people. We really need to test widely and we need to encourage more providers to test widely. Testing is not limited laboratory-wise, the labs have plenty of capability to receive the tests and run the tests. So anyone with a rash that could be monkeypox should be tested. It shouldn’t be limited to the LGBTQ community or anything like that…. Some of these lesions can be very subtle. People come in saying, “oh, I think it’s just my normal acne,” and they’re testing positive. I’m really encouraging more people to seek out tests and providers to do it, of course.
If a person were vaccinated against smallpox as children, is that vaccination still valid today?
Epstein: We have heard around the country and around the world of people who had received their smallpox vaccines — I think it was 1972 we stopped vaccinating — and have tested positive for monkeypox now. So people who received their smallpox vaccine that long ago should still receive their monkeypox vaccine now.
Should I get tested before getting vaccinated if I have concerns about monkeypox exposure?
Epstein: This is different than a lot of other infections that we’ve dealt with. The vaccine when given after exposure can actually prevent a disease. There’s really no tests right now that we can do unless you have symptoms, but if you’re exposed and don’t have symptoms, that’s the perfect time to get vaccinated. Ideally within the first four days after exposure, but up to the first 14 days, it can either prevent infection or decrease symptoms significantly.
What can a person do on a daily basis to better protect themselves from risk of infection?
Latimer: That’s a huge question. It’s close contact, and it tends to be a little more extended close contacts. The conversations that I’m having with my patients are about paying attention to the kind of daily risks that we’re taking and limiting what we can.
Epstein: If you live in a household with someone who has monkeypox, trying to separate from that person as much as possible. If you share a bathroom with that person, cleaning the bathroom in between people using it, and just generally keeping high-touch surfaces clean. Covering lesions can help prevent spread to other people. Continuing to wear a mask – there’s really not a lot of respiratory spread, but to be extra careful and prevent yourself from getting Covid in the meantime can’t hurt.
Are there any mutual aid or volunteer efforts set up to support folks who are ill and isolating? It seems like a lot of people will need help with interrupted incomes, errands, etc.
Caum: That’s a great question and comment, and something that we started to discuss internally today. I don’t have an answer for that, but something that we recognize, that if a person has to isolate and has to be out of work, that could be very disruptive. That’s something we need to consider and see what we can do as we did some things for Covid.
How long should you isolate after testing positive for monkeypox and if based on resolution of rash, about how many days on average?
Epstein: Yeah, good question. So, it can be a long time. It is based on resolution of rash and that kind of take a while, a few weeks, which is really difficult. And you know, I think that question about mutual aid and other services, to get people the things they need while they’re isolating is really important and something we’re really thinking about.
If the vaccine is not provided after infection, what is the treatment after exposure and how effective is it? Are there side effects to the vaccine?
Epstein: If a person is exposed and doesn’t have any symptoms, vaccine is the best thing. And by exposure, we really mean skin to skin contact. That can be sexual; that can be social – kind of dancing or other kinds of contact; that can be taking care of a child. So if there’s no symptoms after an exposure, vaccine is the best way to prevent infection. Once there’s symptoms, then a person should be tested for monkeypox. Depending on a couple of factors, including the person’s past medical history, how bad the infection looks and the places where the person [was exposed], a decision about whether to give treatment would be discussed with that person.
As far as side effects from vaccine, [they are] similar to other vaccines – fevers, chills for a day, swollen glands, stuff like that.
Can you get monkeypox multiple times?
Epstein: No, we don’t think so. Certainly not in any kind of short term – months to a couple of years.
How does being HIV positive impact monkeypox, or vice versa?
Epstein: If a person is undetectable with good immune function, I don’t think we’ve necessarily seen worse disease. Although there’s been a lot of cases but not a huge number yet, so we’re still monitoring this closely. We think people who are HIV positive and immune suppressed with low CD4 counts have more severe disease. It’s extra important that those people be offered treatment for monkeypox.
How long before the vaccine is effective after someone gets the shot?
Epstein: Because the vaccine can be given as post-exposure prophylaxis after you’ve been exposed, that would lead us to believe that the vaccine is somewhat protective right away. But we have studies that show that your immune response to the vaccine is similar to your immune response to another, older smallpox vaccine at 14 days post vaccination. So we think that at 14 days you probably have even better protection than immediately. There’s not a lot of vaccine that’s been given out in the country, so we’re still learning and waiting for data on this.
General thoughts on who should be vaccinated first:
Henderson: If we’re going to protect communities that are most at risk, the people that should be protected first need to be sex workers, especially those who are doing survival sex work. Homeless people should be getting vaccinated first, because they’re out here in the streets. The city won’t do nothing about putting them in a place where they’re safe; the least they could do is make sure that they’re protected from as many viruses and pathogens as possible. What I would do, is I would start with the populations who are always at risk for everything. So Black and Brown folks, homeless folks, poor people, sex workers — these would be the people that I would be out here talking to. These well-to-do folks who can get sick and sit out of work for a month and not miss a beat, they’re not the ones who are at risk. It’s those of us who are considered essential workers, those of us who are on the front lines, always.
I’m a massage therapist. I’m practicing protecting myself from my clients from communicable disease – clean surfaces and linens and good hygiene. I always scan each client before working for comfort. Is there a chance monkeypox virus does not present as a rash but it’s still contagious through contact?
Epstein: I think you’re doing all the right things. Intact skin without any lesion, without any rash is really not where the virus is living. It’s unlikely to get infected that way. But these lesions again can be mild and present kind of looking like acne sometimes. So I really hear your concern and the risk you feel you’re putting yourself at.
Latimer: Wear gloves. I don’t know what massage therapists specifically do, but this would be a great time to.
Are places like public libraries, where materials, spaces and more are shared, be a concern at this point?
Epstein: We really aren’t seeing transmission in those kinds of spaces. It’s technically possible to transmit on surfaces, but just much less likely. We’re really not seeing it. It’s really those places where you’re kind of bumping up skin to skin with other people that are highest risk spaces and situations. If you’re taking care of someone or you’re kind of in very close contact with them, same same idea.
If you can get symptoms within two weeks of exposure, but you’re eligible for the vaccine within two weeks of exposure, can you receive the vaccine if you have any potential symptoms?
Epstein: Once you have the symptoms, there’s really no reason to vaccinate; the vaccine won’t do anything for you at that point. So it’s a little bit of a race against time. You really want to try and get the vaccine as soon as you can after exposure.
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