California, New York and Illinois declare outbreak an emergency

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California Governor Gavin Newsom (D) speaks with reporters after a meeting with House Speaker Nancy Pelosi, D-California, at the United States Capitol, Friday, July 15, 2022.

tom williams | CQ-Roll Call, Inc via Getty Images

California Governor Gavin Newsom declared a state of emergency on Monday over the fast-spreading monkeypox outbreak, the third U.S. state to do so in days.

Newsom said the emergency declaration would help support the state’s vaccination efforts. Demand for vaccines has exceeded supply as infections rise. Staff at sexual health clinics and other sites struggled to keep up with the influx of people seeking vaccinations.

California is mobilizing personnel from its emergency medical services to help administer the vaccines. Newsom said the state is working at all levels of government to slow the spread through testing, contract research and community outreach.

California’s declaration comes after Illinois declared a public health emergency earlier Monday. New York declared a state disaster emergency in response to the outbreak Friday night.

The United States has reported nearly 6,000 cases of monkeypox in 48 states, Washington DC and Puerto Rico, according to the Centers for Disease Control and Prevention. The outbreak has spread rapidly since Boston health authorities confirmed the first US case in May.

California, Illinois and New York – home to the three largest cities in the country – have reported 47% of all confirmed monkeypox infections in the United States. New York is the epicenter of the outbreak in the United States, with nearly 1,400 cases confirmed as of Monday.

Monkeypox is rarely fatal and no deaths have been reported in the United States so far. But some patients suffer excruciating pain from the rash caused by the virus. Scientists and public health officials fear that monkeypox could permanently circulate in the United States if the outbreak is not contained.

The WHO declared monkeypox a global health emergency last month. More than 19,000 cases of monkeypox have been reported in at least 78 countries, according to WHO data. The outbreak is unusual as the virus is spreading widely in North America and Europe. In the past, monkeypox spread at low levels in West and Central Africa where rodents and other animals carried the virus.

Monkeypox is mainly transmitted through skin-to-skin contact during sex. Gay and bisexual men are currently most at risk of infection, according to public health officials. About 98% of patients who provided demographic information to clinics identified themselves as men who have sex with men, according to the CDC.

But health officials have repeatedly pointed out that anyone who gets monkeypox through physical contact with someone with the rash that characterizes the disease or contaminated materials such as towels and sheets. Last month, the CDC confirmed the first two U.S. cases of children catching the virus, likely through transmission within their families.

Monkeypox can also be spread through respiratory droplets when an infected person has sores in their mouth, but this requires prolonged face-to-face interaction, according to the CDC. Physical contact is the main mode of transmission, according to health officials.

US weighs public health emergency

The Biden administration is considering whether to declare a public health emergency in the United States, according to senior federal health officials. This would help mobilize resources for state health officials battling the outbreak. The last time the United States declared a public health emergency was in response to Covid-19 in January 2020.

Congressional and local community lawmakers have criticized the pace of the federal government’s response, but Health Secretary Xavier Becerra said last week that the Biden administration had done everything it could to increase resources for fight against the epidemic. Becerra said states must do more to prevent transmission and Congress must approve funding to support the outbreak response.

The Department of Health and Human Services has delivered more than 330,000 doses of monkeypox vaccine to state health departments since May. HHS made an additional 786,000 doses available to states and other jurisdictions on Friday. But some clinics administering the vaccines say they still haven’t received enough shots to meet current demand.

The Food and Drug Administration approved the two-dose Jynneos vaccine in 2019 for people at high risk of exposure to monkeypox or smallpox. Jynneos, made by Danish biotech company Bavarian Nordic, is the only FDA-approved monkeypox vaccine in the United States.

The United States now has the capacity to perform 80,000 tests per week after integrating several commercial labs last month, according to the CDC. But the number of confirmed infections in the United States is likely understated because people can’t get tested until they develop a rash, which can take several weeks in some cases. Clinicians dab the rash to get the sample for testing.

The United States also has 1.7 million courses of the antiviral treatment tecovirimat in the national strategic stockpile. Doctors can use tecovirimat to treat monkeypox, but it requires an extra layer of bureaucracy because the drug is only approved for smallpox. The CDC cut red tape last month to make it easier for doctors to prescribe tecovirimat.

Monkeypox belongs to the same family of viruses as smallpox, but it causes a much milder illness.

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