Monkeypox case rates are now on the decline in San Francisco, after a summer outbreak that triggered city, state and national emergencies.
There were 702 total monkeypox cases in SF on Friday, according to the Department of Public Health dashboard. New cases, however, are now being reported at a slower rate than at the outbreak’s apparent peak in mid-July: last week, 46 cases were reported down from 139 at the beginning of August.
“We’re still seeing increases in the overall number [of cases], but the rate at which that is happening is slowed down,” said Dr. Susan Philip, Director of the Disease Prevention and Control Branch at the SF Department of Public Health.
“Of course, the most recent weeks are tentative as we’re waiting for case data to finalize, but we’re optimistic,” Philip said. City officials also noted that it would follow the California Department of Public Health’s new naming convention, advising the use of “MPX” or “Mpox” instead of “monkeypox”.
SF’s slowing new Mpox infections mirrors downward trends in California, across the country and even internationally. Infection rates have dropped significantly in metropolitan areas like New York and Chicago, and Los Angeles—the California city with the highest total case count—now reports fewer daily cases on average than it did in mid-July.
The latest wastewater analysis is also detecting lower amounts of Mpox in the eastern SF sewershed.
At the beginning of the month, samples from SCAN’s Southeast sewershed showed about 16,000 Mpox gene copies per gram of wastewater. Today, samples show nearly half the amount of Mpox gene copies: SCAN detected roughly 8,300 gene copies per gram on August 24.
City and State Officials Warn Against Easing Up Precautions
Though declining case rates and wastewater samples may indicate that the worst of the outbreak has passed, city and state officials remain cautious, especially as vaccines continue to be in short supply in San Francisco and California.
“We still don’t have enough vaccines to meet the demand that we have in San Francisco, and the need that we have,” said Philip. “Because we know that there are still potentially tens of thousands of people who could benefit from vaccines, we’re not saying that the risk is over or that people no longer have to think about impacts.”
State officials signaled their commitment to combating Mpox by announcing a $41 million emergency spending package over the weekend. The plan allocates millions of dollars in funding for the California Department of Public Health and for county health departments, with the goal of increasing patient access to vaccination clinics, testing and anti-viral treatments.
This news comes after Sen. Alex Padilla and other state and local health officials urged for increased vaccine supply across the state at a press conference on Thursday. San Francisco has received and distributed 24,318 JYNNEOS vaccines as of August 24, compared to Los Angeles’ 57,322 doses.
“One of the lessons we learned from the COVID pandemic was that a sustained period of limited vaccine availability early in a public health crisis is a recipe for disaster,” said Sen. Padilla.
Other SF officials remain critical of the federal government’s sluggish response to the outbreak, citing low vaccine availability and the disproportionate effect the outbreak has had on the LGBTQ+ community.
“The federal government’s response to this public health emergency has been inadequate and generally disappointing,” said District 8 Supervisor Rafael Mandelman at the same press conference Thursday. “We urge the federal government to expand access to the Mpox vaccine so every Californian who wants a vaccine can get one, and those of us who have gotten our first dose can get a second.”
Ongoing Effects on the LGBTQ+ Community
Updated case demographics show that gay men and those between ages 25 and 44 continue to report new infections at a higher rate than any other demographic. The majority of people testing positive have had sexual contact during the incubation period (69%), and white and Hispanic people comprise nearly three-fourths of all reported cases.
“As we’ve been saying throughout, [Mpox] is not related to sexual orientation or gender identity. It really is about networks where the virus was initially introduced outside of Africa,” said Philip.
DPH officials noted that their team intends to focus Mpox-related messaging on the populations most impacted by the virus—gay men, bisexual men, trans people and other men who have sex with men—especially as the stigma surrounding the virus continues to complicate messaging about vaccine accessibility, disease prevention and treatment options.
The state health department’s naming convention, for example, represented another equity-related effort to address concerns about the homophobic stigmas and racist connotations associated with the virus’s original name.
When (And How) Will SF Emerge From the Outbreak?
San Francisco’s health department is now looking to local community partners to encourage people to get vaccinated and to pursue an “equity-forward” approach to fighting the disease.
“We’re really moving at this point to leverage some of the relationships and vaccination capacity that we developed with community partners for Covid… to be able to give people access in their neighborhoods, in ways that are culturally appropriate and hopefully less stigmatizing,” said Philip.
Nonetheless, case count data has trended downward for only one week, and health officials warn that it might be too soon to say that the outbreak is nearly over. Multiple factors will contribute to public health officials’ assessment of risk in the future.
“It really is that combination of, first, case rates going down, but also that we’re able to fully vaccinate the people that could most benefit,” said Philip.