NEW BEDFORD — With the first case of monkeypox to be diagnosed in New Bedford confirmed earlier this summer by Greater New Bedford Community Health Center, local health care experts are cautioning to heed public health guidance, but also not to panic. Meanwhile, the city of New Bedford says its Health Department has determined there are still no reported cases among New Bedford residents.
According to Greater New Bedford Community Health Center CEO Cheryl Bartlett, the first monkeypox case to be confirmed in the city was diagnosed near the end of June, however, limited testing capacity has left several "presumptive" cases unconfirmed.
"We tell [symptomatic patients] that we presume it, but we just can't confirm it," Bartlett told The Standard-Times, noting there's been "a handful" of such cases. "Right now, DPH is having people in the high-risk category tested."
As far as calls to the Health Center from those with concerns about or seeking information on the disease, Bartlett said. "I would say that we’re seeing a fair number, but not anything overwhelming at this point."
But should there be more concern? According to some local health care providers, there is no simple "yes" or "no" answer, but the fact remains that monkeypox is still a rare, vastly non-deadly disease that requires no specific medical treatment to overcome in most cases.
How serious is monkeypox?
"First and foremost, monkeypox is not a severe disease," said Dr. Anthony Karabanow, infectious disease specialist for Hawthorn Medical Associates with privileges to practice at St. Luke's Hospital. "Hospitalizations have been few and I believe there have been no deaths up to this point. So we're not looking at an incapacitating illness, however this certainly can become widespread and it certainly can become a nuisance problem.
"But no, we're not looking at a COVID-like situation that's going to overwhelm our hospitals or our health care system.... We are looking at what essentially may become an endemic sexually transmitted disease."
On the topic of current guidelines and limitations around monkeypox testing, Karabanow said testing for local patients who are deemed appropriate for it should be available through their regular providers, but in most cases monkeypox is still far from being a feasible culprit even in patients deemed "high-risk" for the disease.
"I think what's important to understand is that not every rash today is monkeypox and not every rash deserves to be tested," Karabanow said. "Even among those who meet the criteria for us thinking about it, there are certainly things that are far more likely than monkeypox. Those include things like syphilis, herpes and shingles/chicken pox.
"We've certainly seen people with concern for monkeypox ... but I have yet to see a confirmed monkeypox case, and my understanding is that the Southcoast system has seen no confirmed cases."
How is it treated, and who's at risk?
"Certainly monkeypox can be a pretty painful condition to have ... and it can be disfiguring. They’re not fun, let’s say that," said Southcoast Health infectious disease specialist Dr. Richard Shen.
In a typical case of confirmed monkeypox, Shen said health care providers would do little other than advise patients on quarantining and other measures to support recovery while minimizing the risk of spread. "Most of the time it's just what we call supportive care. The rash should go away by itself," he said, noting antiviral medication is currently being studied for use in some monkeypox patients.
As far as vaccination, availability is still limited to only 14 sites in Massachusetts, including one in New Bedford, according to the state Executive Office of Health and Human Services' website. Given its sparse availability, Karabanow said vaccination priority is currently being given to those considered "high-risk." "Essentially we're focusing on, at this time, two groups of people: those that have confirmed exposure to monkeypox, and the so-called high-risk people — individuals who in the last 14 days have been having sexual contact within a group of people where there's known to be a risk of monkeypox. So that's typically, right now ... men having sex with men."
According to a report released by the CDC on Aug. 5, 99% of monkeypox cases in the U.S. occurred in men, "94% of whom reported recent male-to-male sexual or close intimate contact." But Karabanow says even those who don't fall under that demographic would be mistaken not to follow current medical guidance such as avoiding "high-risk" behavior such as having sexual contact with "unfamiliar or multiple partners."
"We should not put the burden solely on the MSM (men having sex with men) community.... Everyone should be aware, alert and receptive to these countermeasures," Karabanow said.
Raising awareness in LGBTQ + community
Dartmouth resident Andrew Pollock echoes that sentiment, and says his group, SouthCoast LGBTQ+ Network — which he is president of — is working to spread awareness both within and outside of the local LGBTQ+ community.
"We've been talking about it a lot and we thought we should take a leadership role," Pollock said of recent discussions among SouthCoast LGBTQ+ Network members. "Showing leadership, I think, can reduce the stigma. It hit our community first but it's not a gay disease."
In terms of stigmatization of LGBTQ+ individuals relative to monkeypox, Pollock says fortunately he hasn't experienced or heard of it being prevalent locally, but there is a level of concern that things may take a turn.
"It's still pretty new but from what I see there hasn't been any anti-gay rhetoric from anyone locally," Pollock said, though noting "it is a reasonable fear."
"We went through it with AIDS. I turned 18 in 1981 so I saw over 40 years of HIV, and we want to learn from the mistakes of the '80s and '90s and address this head on."
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As part of an effort to do just that, Pollock said on Wednesday, Aug. 24, SouthCoast LGBTQ+ Network plans to hold a virtual symposium with local health care professionals. Discussion will focus on four main topics: history of monkeypox, symptoms, contagion/spread, and vaccinations/harm reduction.
In the meantime, Pollock says the group has been doing what it can to spread information via social media. "We've been posting on Facebook encouraging people to get vaccinated," he said. "I got one. I figured if I'm going to be pushing it, I should get it."
New Bedford at forefront of vaccination
Seven Hills Behavioral Health in New Bedford is still the only source in Bristol County where people can receive monkeypox vaccines. Seven Hills Program Director of Community Health Services Connie Rocha-Mimoso said demand has been "steady" since opening up appointments in July.
"We've done a little over 400 vaccines so far. ... We do anywhere between 25 and 40 a day," Rocha-Mimoso said. "I believe for the next month and a half we have over 300 appointments."
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Seven Hills has been following current guidelines in terms of prioritizing vaccine patients, Rocha-Mimoso said, adding that scheduling may depend on circumstances on a case-by-case basis. "If you say you've been exposed and you just found out, most likely we'll get you in today or tomorrow," she said, noting those with less imminent risk factors may be scheduled further out. "Our hope is that people who are at risk will get this vaccine and be proactive."
City: Still no New Bedford residents confirmed
New Bedford city spokesperson Mike Lawrence said Wednesday that despite the case diagnosed in New Bedford, local health officials have yet to see any confirmed monkeypox cases among New Bedford residents. "[Greater New Bedford Community Health Center] are a regional health center," he said of the case diagnosed in the city.
In a written statement provided by Lawrence, Health Department Director Damōn Chaplin said: “The New Bedford Health Department is working closely with the Massachusetts Department of Public Health to monitor the situation and provide local response. ... The Health Department is remaining up to date on prevention, testing, and vaccination guidelines, and will collaborate with local healthcare providers and community partners to support residents if needed.”
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But even in the absence of deadly cases of monkeypox in the U.S. and with its status as "a rare disease" on both the national and local levels, Dr. Karabanow said there is potential to repeat history if the general public neglects guidance on recommended preventative measures.
"As with many diseases — particularly COVID and HIV — I think there's one catastrophic failure of thinking: Just because the disease seems to be located in a certain geographical area or is confined to a certain group of people that you don't have to worry about it," he said. "Basically what we know is diseases that start elsewhere or within well-defined groups of people inevitably spread into the general community."
More things to know
MONKEYPOX SPREADS THREE WAYS: Hawthorn Medical infectious disease specialist Dr. Anthony Karabanow says monkeypox "theoretically has three modes of transmission": skin-to-lesion contact, secondary contact (via bedding, clothing or other material that has come in contact with a lesion), and through the respiratory system — though he notes skin-to-lesion contact is known to be the predominant mode.
ANIMALS CAN BE A SOURCE OF SPREAD: Just as experts have advised COVID patients not to handle their household pets to prevent spread, Dr. Karabanow says those with monkeypox should follow the same rule, as they can likewise leave traces of the disease on an animal, potentially causing someone who later comes in contact with that animal — or something it touched — to become infected.
SYMPTOMS CAN BE 'PRODRONE' DURING ONSET: According to Southcoast Health infectious disease specialist Dr. Richard Shen, it is possible for those infected with monkeypox to present viral-like symptoms first before the appearance of a rash, while in other cases, it is the opposite. Symptoms may include fever and headaches, he said.
BIDEN HAS DECLARED MONKEYPOX A PUBLIC HEALTH EMERGENCY: On Thursday, President Joe Biden declared the current monkeypox outbreak in the U.S. a public health emergency, which will allow the federal government to act more quickly on implementing response measures, according to USA TODAY.
REPORTING MONKEYPOX IS REQUIRED: According to information from the Massachusetts Department of Public Health, reporting is required both by health care providers who make a diagnosis and the laboratory that does the testing. Mass. DPH receives laboratory reports and the results are made immediately available to local health boards electronically. If a provider reports a case to the local health board, the board is required to report it to Mass. DPH.
WANT A VACCINE? CALL SEVEN HILLS: To make an appointment in New Bedford or inquire about the monkeypox vaccine, call Seven Hills at 774-634-3725, Monday through Friday, between 9 a.m. and 5 p.m. Seven Hills Behavioral Health is located at 1173 Acushnet Ave.
For more info on the SouthCoast LGBTQ+ Network's symposium on Aug. 24, 5 p.m., check the organization's website at www.sclgbtqnetwork.org.
This article originally appeared on Standard-Times: Monkeypox diagnosed in New Bedford; City suggests it was non-resident