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Like COVID-19, Monkeypox Is Heavily Affecting Bay Area Latinos. Are We Prepared?

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Two people photographed from behind walking down what is recognizably Mission Street in San Francisco, because of the New Mission theater sign in the background, in focus.
Pedestrians walk in San Francisco's Mission District. (Beth LaBerge/KQED)

Monkeypox has now been formally declared a public health state of emergency in California. And when the state released initial data on the demographics of confirmed monkeypox infections in July, the numbers revealed that two ethnic groups composed an overwhelming majority of cases: white and Latino residents.

White people represented 40.5% of cases in California, while Latinos formed 37%. The percentages roughly match up with the overall makeup of the state's population — 35% of Californians are non-Hispanic whites, while 40% consider themselves Latinos.

But in the Bay Area, a different picture is emerging.

As individual counties in the region share their own numbers on monkeypox cases, this more localized data shows that within the Bay Area, it's the Latino community that's being disproportionately affected by the virus.

On July 29, the San Francisco Public Health Department confirmed that Latinos made up over 26% of cases — despite representing only 15% of the city's population. That same week, Santa Clara County released its own data, which showed that over 50% of cases are among Latinos, while this population represents only 26% of the county.

The disproportionate nature of these numbers has alarmed both public health officials and Latino community organizers — some of whom say it's reminding them of COVID-19, and the asymmetrical impact that virus had on this population in the Bay Area.

The COVID-19 pandemic saw many community-led public health initiatives in predominantly Latino neighborhoods across the region, including San Jose's Eastside, Fruitvale in Oakland and San Francisco's Mission District. In the Mission, the Latino Task Force, a coalition of nonprofits and organizers, partnered with UC San Francisco and the city to bring testing and vaccination services to public transport hubs and food banks. These efforts helped make the COVID-19 vaccine easily accessible to essential workers, uninsured residents and immigrant families. So what lessons can be learned for the new public health challenge of monkeypox?

On Wednesday, KQED's Brian Watt spoke with Dr. Carina Marquez, associate professor of medicine at UCSF and one of the founders of Unidos en Salud — a partnership of the Latino Task Force, UCSF, UC Berkeley and CZ Biohub — to understand what lessons from the coronavirus pandemic can be applied to the way care providers respond to the monkeypox outbreak, and to hear more about monkeypox's disproportionate impact on Latino and immigrant communities.

The following interview has been edited for length and clarity.

BRIAN WATT: What do you make of these early signs of monkeypox spread among Latinos in parts of the Bay?

DR. CARINA MARQUEZ: This isn’t anything new. I think we saw early disparities by race/ethnicity emerged with the COVID-19 pandemic. We see them in other health conditions.

And so I wasn't surprised to see these disparities emerge early on. Of course, I was saddened by it.

What are groups like the Latino Task Force doing to help address this?

We're in a unique situation with monkeypox in that we have a vaccine, but it's very limited. When we were in COVID-19, we started the COVID-19 pandemic without a vaccine.

So with the monkeypox vaccine, we have to do everything we can to partner with community to get the word out on how to access the vaccine communities want to know what [the vaccine] is and whether they should trust it.

Education is the first thing and doing it with trusted messengers in the community is extremely important and certainly particularly important with the Latino community.

Then how you structurally access the vaccine is really important. My colleagues at San Francisco General Hospital have set up a really great low-barrier walk-up access clinic, but we know that this is not enough. The lines are really long. You have to know when to show up in line to get it. And then there may be a stigma associated with waiting in line.

As we’re thinking about vaccine distribution, partnering with community and using what we know has worked with the COVID-19 vaccine — in terms of using neighborhood sites or pop-up sites, to bring vaccines out of the health care system to the communities most impacted — I think are going to be a key part of an equitable response to vaccine distribution.

A family gets ready to receive a COVID-19 test in a large plaza.
A pop-up COVID-19 testing site near the BART station at 24th and Mission streets in San Francisco on Nov. 30, 2020. The site is part of the Unidos en Salud initiative, a collaboration between UCSF and the city's Latino Task Force. (Beth LaBerge/KQED)

I hear you saying that our experience with COVID-19 should have prepared us better for monkeypox. Do you think we are better prepared now than we would have been without COVID-19?

I think in some ways we are still in our COVID-19 response. In San Francisco, we still have a number of highly used neighborhood vaccination sites, community partnerships, both with [UCSF] and the San Francisco Department of Public Health, where we're working together to address equity.

We have a lot of room to go, but we can use these relationships and these sites to increase vaccine access. The limiting issue right now is the number of vaccines available, and I hope that that changes quickly. I know many people are advocating for increased vaccine supply.

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You mentioned the importance of trust — building trust. I was reading one media report on this topic that suggests, "Hey, you gotta go on Spanish-language radio and make sure that the word is out there." Do you feel like that's happening enough? And what is the best way to build trust?

Absolutely. So I think messaging coming from trusted sources is absolutely critical. So we cannot stop at just doing Zoom town halls. We need to be on Spanish-language radio. We need information that is in Spanish, and delivered by trusted community sources, both by community groups as well as Spanish-speaking health care professionals.

The other thing, in addition to radio and town halls: The "ground game" is really important. So that person-to-person discussion can be had with trusted community members at community-based organizations who are talking to people all the time. Having those conversations is also critical to increasing vaccine uptake and trust in the vaccine.

In the Latino community, we have many people who are uninsured who may not feel comfortable going to a health care center to get the vaccine. So having those conversations with trusted community members can increase that trust and is a critical piece of the response.

How can Latinx parents or caregivers talk about monkeypox with kids when they're talking about sexual health?

I’m a parent of young children. I think that this is part of the bigger conversation about the importance of talking about sexual health with youth in an age-appropriate way. And we have to be very clear about how it transmits, and what it looks like, and when to get tested and who should get vaccinated. But I think just being honest is the best policy.

What conversation should a family have after a loved one tests positive for monkeypox? I'm thinking about the case of a large sort of multigenerational family, living together in the same space.

We hope that these conversations are filled with compassion and love for the family member.

The other big question you’re bringing up is that with monkeypox, the recommended isolation is quite long. It can be, oftentimes, a month. You have to wait until the lesions scab over and new skin grows. So oftentimes, we're talking about being out of work and having infection control precautions within the house for one month.

We as a society need to think about, as we did with COVID-19, how we support people who have to isolate and who don’t have sick pay. And again, this sick pay comes up over and over again and certainly [is] extremely important for Latino households.

The other question is about being in multigenerational households or large households, or if you're in a shelter or single-room occupancy hotel with other roommates. With COVID-19, we had hotels, places where people could go to be able to isolate safely. That certainly should be part of the discussion about what the city offers for people living in very crowded circumstances to try to limit spread.

Secondly, we know that household transmission can occur. We are still trying to understand exactly how much, and thinking about the best ways to protect against that.

Are there some common themes about monkeypox, misinformation that you and the groups you're working with are hearing on the regular? Something that just keeps popping up out there that just needs to be immediately debunked?

One of the biggest things that we need to keep addressing is the stigma associated with [monkeypox].

Certainly, while anybody could be affected with monkeypox, we are certainly seeing that this current outbreak is predominantly affecting men who have sex with men, gay, bisexual men and trans people. [We should continue] to mention that without making it sound like we are saying, "Oh, it's a gay disease." Continually mentioning who's most infected helps us to direct resources to the community that is most affected, and most needs it.

I think there's a lot of questions about how it's transmitted. Really emphasizing right now that the predominant mode of transmission is close contact — mostly through sexual encounters — is important so that people know what their risk is.

It's not to say that not everyone can be at risk, but we need to know who’s at highest risk right now. And so I think the questions about transmission, risk groups and addressing stigma are some of our top priorities.

Now that the entire state of California is under a public health emergency from monkeypox, what difference does this make to expanding testing and vaccination?

Declaring this a public health emergency was the right thing to do so that we can have the resources to respond in a swift manner.

I will say, I have taken care of many patients with monkeypox. I'm one of the clinicians who is delivering TPOXX for the most severe cases, and seeing patients suffer with this disease — the pain that it causes — is heartbreaking.

We have tools to address this outbreak and we need to do it swiftly. This public health emergency is one of the pieces that will allow us to do it. We have a lot of work to do, especially in terms of addressing it equitably. But this is one component to get us there.

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