Going to a Club or Festival? Monkeypox Risk In Crowds is Relatively Low, Experts Say

With the ongoing COVID-19 pandemic and San Francisco’s monkeypox outbreak, health risks are on the minds of Bay Area residents—including those with tickets to music festivals, concerts and other large gatherings.

Due to rising monkeypox cases, San Francisco Mayor London Breed announced a state of emergency on Thursday. It goes into effect Aug. 1, and empowers the mayor’s office to mobilize personnel and resources to fight the outbreak.

• What questions do you have around monkeypox?

The monkeypox virus spreads primarily through close physical contact, including skin-to-skin contact where infected lesions are present, prolonged, face-to-face contact (including close conversations) via respiratory droplets, and sharing items like clothing or bedding. So far, the outbreak has disproportionately affected men and trans people who have sex with men. But monkeypox can impact anyone, and with large gatherings coming up—including the Dore Alley queer fetish fair (July 31), the Blue Note Jazz Festival in Napa Valley (July 29-31) and the Outside Lands music festival in Golden Gate Park (Aug. 5-7)—it’s important to learn the risks before you go. KQED spoke with medical experts about how to best navigate the ongoing situation.

Gathering in crowds is still relatively safe

Dr. Peter Chin-Hong, a professor and infectious disease physician at UCSF, says people should be aware of what he describes as the different tiers of monkeypox transmission risk. High risk includes prolonged, skin-to-skin contact, including sexual contact. Medium risk includes prolonged contact with sheets or bedding that a person with lesions may have used. Medium-to-low risk includes respiratory droplets. And low risk includes touching shared surfaces on transit, the gym and other public spaces.

Packing into a large crowd at a club, concert or festival “is a low risk, but it’s not a zero risk at this moment,” Chin-Hong says.

“At the end of the day, the most efficient way to get monkeypox isn’t going to a music event,” he explains. “It’s from skin-to-skin contact over several hours with an open sore in an intimate contact situation.”

San Francisco Health Officer Dr. Susan Philip says people who develop symptoms such as unexplained rashes or are feeling sick should avoid large gatherings. “Cover the areas with clothing or with bandages so that the skin [with the rash] is not exposed to other people,” she says. “And wear a mask and go see a provider for evaluation, because cases are increasing.”

The San Francisco Department of Public Health offers an informational toolkit which includes posters about monkeypox that event producers can download and display at gatherings.

Masking helps reduce risk

At a festival or gathering, “you’re much more likely to get COVID than monkeypox,” Chin-Hong says. Masking helps reduce risk of both. While N95, KF94 or K95 masks have proven effective in reducing COVID-19 transmission, Chin-Hong says, a surgical mask or simple cloth mask can protect you from monkeypox.

Even at clubs and festivals, where people tend to lean in close to talk over the music, Chin-Hong says respiratory transmission is relatively low-risk. “[Someone] must be shouting at you for hours, probably, for that to occur,” he says, adding that kissing would create a higher risk of transmission through saliva than conversation.

Although simply standing in a crowd creates a low risk of transmission, wearing clothes that cover the skin can be another form of protection. “If people are concerned about monkeypox, it’s good to keep some distance between them and other people in crowds,” says Philip. “To wear clothing that covers the skin is also another way to protect themselves.”

The biggest risk is intimate contact

While going out on the town in and of itself isn’t a high risk, intimate behaviors before or after a show can be, Chin-Hong explains. “If somebody has an open sore and you have a break in the skin, that’s probably the most efficient way to get it,” he says. “That’s why people getting together in intimate ways is so efficient, because even though it’s not always transmitted through bodily fluids and sex per se, rubbing up against somebody can cause micro abrasions, and therefore you can get exposed in that way from an open sore.”

Additionally, people who travel to events and stay in someone’s home or at an Airbnb should ensure the sheets have been washed properly. “Those are simple things I think people can feel some agency over,” he says.

Vaccine availability will increase

The monkeypox vaccine offered in the U.S. right now is called Jynneos, which is also used to prevent smallpox. The CDC recommends that the monkeypox vaccine be given to a person within four days of the date they were exposed to monkeypox, for the best chance of preventing onset of the disease. (If a person gets the vaccine between four and 14 days of being exposed, the vaccine may reduce the symptoms of monkeypox, but may not prevent the disease altogether.)

San Francisco has so far received 12,000 vaccine doses, and 4,000 of those have come in the last few days. Long lines for vaccine doses have frustrated those attempting to get their shot. But Philip says more doses are on the way. “We asked as a city for 35,000 vaccines as a starting point for what we need,” Philip says. “We feel that the total number we need would be closer to 70,000. And so we’re making our need known, and the emergency declaration is going to be a way of really reinforcing that.”

There are currently 10 vaccine sites in San Francisco. Eligible people include men and trans people who have sex with men; sex workers of any orientation or gender identity; people who might have been exposed to monkeypox within the past 14 days; and laboratory staff and clinicians at risk of occupational exposure.

While many who’ve already endured a pandemic are fearful of another virus spreading in the community, Chin-Hong says there’s reason to be optimistic that monkeypox can be contained.

“This is not like the early days of COVID where we didn’t have a lot of tools,” he says. “We actually do have a PCR test, we do have a vaccine, and we’re getting more and more of it. … And we do have drugs for people who are seriously ill. So in the event that you did get exposed, all is not lost.”

What other questions do you have about monkeypox?

Do you have a question about monkeypox and can’t find an answer in this story, our guide to where to find a monkeypox vaccine near you, or in our explainer on monkeypox symptoms and how the virus spreads?

You can use the box below to submit your question. What you send us will make our reporting on monkeypox stronger, and help us decide what to cover here on our site and on KQED Public Radio.

Please know that we can’t reach back out directly to everyone who asks a question, and we can’t give out individual medical advice. If you’re concerned about monkeypox or another health matter, we urge you to reach out to your health care provider, or a local community clinic if you don’t have insurance. (See our list of community clinics in your county.)