How bad could monkeypox get in the Bay Area? Experts weigh trajectories

More than two months after the first case was detected in the United States, an outbreak of monkeypox virus is continuing to spread quickly nationwide and in the Bay Area, mostly among gay and bisexual men, and is showing no signs of slowing down.

New cases could continue to rise at a faster pace for weeks, if not longer, and eradicating the disease altogether may prove difficult, infectious disease experts and local health officials say, though the exact trajectory is hard to predict. How quickly high-risk people can get vaccinated in large numbers — as well as how much behavioral changes can mitigate transmission in communities where it’s spreading the most — will shape how well and how fast the outbreak can be wrested under control.

A limited supply of monkeypox vaccine has fueled concerns that the disease could spread further into the LGBTQ community and into the wider population, though that hasn’t happened yet.

“Judging by the curve of the outbreak, we’re definitely on the increasing phase,” said Dr. Bela Matyas, public health officer for Solano County. “I anticipate we’ll continue to see this will rise for a while longer because I don’t see evidence of cresting yet.”

Eventually, he said, “It’ll crest and start to come back down. The real question is: Will it remain endemic in this community because we can’t get rid of it? Or will we be able to successfully get rid of it?”

In San Francisco, the jurisdiction with the second-highest number of infections in California after Los Angeles County, cases are roughly doubling each week — prompting the city Thursday to declare monkeypox a local state of emergency. As of Wednesday, the most recent day for which there is data, there were 281 confirmed and probable cases in San Francisco — up from 141 just over a week ago and 60 a week before that, according to the city Department of Public Health. The US epidemic curve is similarly rising, reaching about 4,900 cases to date.

Monkeypox in the Bay Area

“We’re still in a phase of increasing spread,” said Dr. Stephanie Cohen, medical director of San Francisco City Clinic, who is helping manage the public health department’s monkeypox response.

Monkeypox, a less severe cousin of smallpox, is an old virus that has been endemic in West Africa for years. The current outbreak is worrisome because it’s circulating in large numbers in parts of the world that don’t typically see many infections.

For a public collectively traumatized by SARS-CoV-2 — a virus that caused deadly disease before it was tamed by vaccines — the spread of monkeypox may sound scary. But experts say there are key differences that may be reassuring: The version causing the current epidemic is less severe than the one circulating in West Africa. Among the thousands of cases in the US, no one has died, and the vast majority of patients don’t need hospitalization, although the lesions caused by the virus can be uncomfortable and even debilitating if they’re on or near the eyes, mouth , urethra or rectum because they make daily activities painful.

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