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Monkeypox in San Francisco: City Declares State of Emergency As 'Epicenter for the Country'

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Demonstrators standing outside a large building holds signs that say 'Nurses demand action' and 'Monkeypox is not just a gay thing'.
Demonstrators rally outside the San Francisco Federal Building on July 18, 2022, to demand a faster federal response to the recent monkeypox outbreak in the city, where vaccines and testing have been in short supply. (Marlena Sloss for The Washington Post via Getty Images)

San Francisco Mayor London Breed announced a state of emergency Thursday over the rapidly growing number of monkeypox cases in the city.

The legal action, which goes into effect Monday, allows officials to mobilize personnel and resources and cut through red tape to get ahead of the mounting public health crisis. City officials hope that the declaration will also pressure the federal government to increase the available supply of the monkeypox vaccine.

"We are at a very scary place," Breed said at a press conference held at City Hall on Thursday. "We don't want to be ignored by the federal government."

Earlier this week, San Francisco had to shut down its primary monkeypox vaccination clinic at SF General Hospital for the second time this month after it again ran out of doses, turning away long lines of people. The San Francisco Department of Public Health (SFDPH) said it was expecting to receive an additional 4,220 doses of the vaccine this week, bringing the total number of vaccines received to roughly 12,000 — about a third of the supply they've requested from the federal government.

"We have a solution in the vaccines and we want to make sure that everyone who is requesting a vaccine gets one," Breed said.

News of the declaration — which comes amid the ongoing COVID-19 pandemic — was welcomed by LGBTQ+ advocates who have grown increasingly frustrated by what they call a lackluster response from the city and the federal government to a virus that can infect anyone, but has so far primarily affected communities of gay and bisexual men, and men who have sex with men.

"We know the challenges of what happens in San Francisco when we put public health on the back burner," said Breed. "During the AIDS crisis ... San Francisco was virtually left on its own to fend for itself."

During the initial onset of the HIV/AIDS crisis in San Francisco during the 1980s, the majority of infections were among gay and bisexual men, and men who have sex with men. City Health Director Dr. Grant Colfax praised the way local care providers reacted to HIV/AIDS back then and said that response has informed the way San Francisco is responding to monkeypox now.

"As a gay man who came out and did my medical training during the peak of the AIDS epidemic," Colfax said, "I personally and professionally experienced the indifference, the homophobia and the stigma by the medical and public health institutions in regard to prioritizing HIV prevention and care."

"But San Francisco's community-driven and responsive care systems were a notable exception."


As of Thursday, the SFDPH reported a total of 281 confirmed and probable cases — more than a third of all reported cases statewide — with officials noting that actual case counts are likely higher, given the lack of testing availability. Nationwide, there are more than 4,600 reported cases, and 19,000 globally (in 76 countries), according to the Centers for Disease Control and Prevention (CDC).

Roughly a third of the cases in California have been detected in San Francisco, according to local health officials.

Members of the city's LGBTQ+ community expressed anger and frustration last week at a Board of Supervisors' Government Audit and Oversight Committee hearing on the monkeypox response, saying they were relying on social media because San Francisco health officials had not dispensed basic information on testing or vaccine availability.

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Much of the consternation stems from the dearth of available vaccines and testing capacity. Unlike COVID, the two-shot monkeypox vaccine has existed for years, but remains in extremely short supply nationwide, leaving disproportionately affected cities like San Francisco and New York unable to meet growing demand.

Supervisor Rafael Mandelman excoriated the department at the hearing, saying it was unclear why it could not staff phone lines, especially after telling people to call those phone numbers for information, even as the San Francisco AIDS Foundation was able to quickly staff an information hotline.

“It’s a bad look for San Francisco,” he said.

“San Francisco in the '80s pioneered a national model for the response to the AIDS crisis. We pioneered a model for the COVID crisis. But we are not pioneering a response to the monkeypox crisis,” said Tom Temprano, political director for Equality California, a statewide LBGTQ+ civil rights organization, at the hearing.

Monkeypox spreads through prolonged skin-to-skin contact, which can include sex, kissing, breathing at very close range and sharing bedding and clothing, officials said. It's related to smallpox, but is much less severe and "rarely fatal," according to the CDC, which says "over 99% of people who get this form of the disease are likely to survive."

Monkeypox symptoms are similar to those of smallpox, but generally much milder — often manifesting in painful skin lesions that can last from two to four weeks, according to the CDC.

Breed's public health declaration comes less than a week after the World Health Organization declared the disease a public health emergency, a designation it's only used to describe two other diseases: COVID-19 and polio. The Biden administration is expected to follow suit in the coming days.

“San Francisco was at the forefront of the public health responses to HIV and COVID-19, and we will be at the forefront when it comes to monkeypox," said state Sen. Scott Wiener, a Democrat who represents San Francisco. "We can’t and won’t leave the LGTBQ community out to dry."

This story includes reporting from The Associated Press.

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