Monkeypox cases are on the rise in Ohio. Here’s what you should know.

On August 4, the United States federal government declared the Monkeypox virus a national public health emergency.

Since then, New York, Illinois and California have also declared states of emergency in response to the virus — which has been predominantly transmitted between queer men.

In Ohio, case numbers are rising, but Dr. David Margolius — Cleveland’s newly appointed Director of Public Health — says the uptick in cases is not exponential like COVID-19, and that vaccinations are set to become more widely available in the coming weeks.

We talked to Margolius about how the virus is transmitted, why it’s primarily affecting queer men and what LGBTQ+ people in across Ohio can do to stay safe and healthy.

What is monkeypox?

“Monkeypox is a virus that is a cousin of smallpox.” Margolius says. “It has caused epidemics in the past. But this is the only time it’s caused a pandemic, where it’s spread across the world out of control.”

Monkeypox was first identified in humans in the 1970s, when a baby was infected in the Democratic Republic of Congo two years after smallpox had been eliminated in the region.

How is it transmitted?

While monkeypox is often contracted during sexual contact, it is decidedly not a sexually transmitted infection.

The virus spreads through close skin-to-skin contact, prolonged face-to-face contact and respiratory secretions like mucus or saliva.

Even without close physical contact, the virus can spread via surfaces and fabrics like towels, bedding or clothing used by a person who has already contracted the virus.

What are the symptoms?

“The most prominent symptom is this painful rash,” Margolius says.

While flu-like symptoms sometimes accompany or precede the rashes or lesions, it’s important to remember that flu-like symptoms won’t always appear when a person is infected.

“I think for a lot of people, it’s just going to be the painful rash,” Margolius says. “And it might just be inside someone’s mouth or anus.”

“A lot of the people that have been infected with monkeypox in this pandemic have been young and healthy,” he adds. “That’s probably why, in many cases, the rashes have been smaller or isolated to a single area on the body.”

The incubation period for the virus is anywhere between 5 to 21 days from exposure, but even after lesions appear on the skin, Margolius says they may be nearly impossible to distinguish from a pimple or an ingrown hair.

Symptoms typically last between 2-4 weeks.

Typically, monkeypox is not fatal, with a mortality rate between 3-6%. However, the virus can sometimes cause other medical complications like pneumonia and infections in the eyes or brain.

For mild symptoms, the Cleveland Clinic recommends rest, fluids, and using over-the-counter pain medication and warm oatmeal baths to help relieve skin discomfort.

What should you do if you think you’ve contracted monkeypox?

Since monkeypox can sometimes be difficult to identify, Margolius says it’s important to keep any new rashes covered: “That’s probably the best way to prevent transmission.”

If you know or suspect you’ve contracted the virus or been in close contact with someone who has, contact a healthcare provider or your local health department for more information about testing locations and availability.

Typically, testing includes blood work to check for the presence of monkeypox antibodies, as well as a tissue sample from an active rash or lesion.

If you don’t have access to a healthcare provider or cannot get tested, keeping rashes and lesions covered and limiting close contact with other people and animals is the best way to avoid spreading the virus.

Why are is monkeypox disproportionately affecting gay and queer men?

Researchers believe that elevated rates of monkeypox among queer men can be traced back to a single carrier who spread the virus among a queer community by chance.

“Probably somewhere down the line, someone with monkeypox happened to be in a high-contact network of gay men — or queer men or men who have sex with men — and that network of people have seems to have close contacts across the globe,” Margoliys says. “[The virus] spread quickly through that network and now it’s potentially going to spread to other networks.”

What can people do to keep themselves safe?

There are several ways to help curb monkeypox transmission, including covering new rashes, limiting close contact with people who have contracted the virus, consistent hand-washing and disinfecting items like blankets and clothing.

Some public health experts have also suggested that queer men temporarily limit their number of sexual partners in an effort to reduce transmission, but that sentiment has received pushback from gay and queer communities, particularly within the context of the AIDS epidemic.

Further, research shows that abstinence-based education efforts are not effective in preventing the spread of disease.

Instead, the Centers for Disease Control recommends using condoms and dental dams to help limit transmission during sexual contact.

Is there a vaccine? Where can people find one?

Because the virus that causes smallpox is so similar to the Monkeypox virus, smallpox vaccinations prevent monkeypox with around 85% efficacy.

In 2019, a new two-dose vaccine with higher efficacy was developed to prevent monkeypox infections.

The doses are administered one month apart, and are not considered fully effective until two weeks after receiving the final dose.

Though the vaccine’s availability is still limited based on statewide case numbers, Margolrius says Cleveland Public Health — along with other health departments across the state — will receive an increased supply of vaccinations against the virus in the coming weeks.

He says the health department plans to work with hotspots across the city, where cases are carefully tracked.

“We’re working hard to be out there and vaccinate the community,” Margolius says. “Today, the vaccines [we had] went to our healthcare partners, with the idea that they know who their sickest patients are and who is high risk for catching monkeypox, so they can proactively reach out to their clients and an offer them a vaccine as opposed to putting it up a website and just attracting the people who have the fastest internet connection.”

“Now that our supplies have gotten a little bit better and we’ve got our own supply, we’re going to go out to those hotspots and offer vaccines, get the word out a little,” he adds.

The Columbus City Health Department hosted an Instagram Live Monkeypox Q&A to help combat disinformation around the virus, but vaccine registration is currently closed.

In Hamilton County, Cincinnati residents can still register for vaccinations via Hamilton County Public Health if they meet certain high-risk criteria.

In Cuyahoga County, vaccine registration is still open for clinics set to take place August 23 and August 26 at the Cuyahoga County Board of Health.

Additionally, the LGBT Center of Greater Cleveland is offering a walk-in Monkeypox vaccine clinic on August 24.

What is the treatment for monkeypox?

“If you have a severe disease like HIV or have a certain type of skin condition, like maybe severe eczema, there is an antiviral medication you can take called TPOXX,” Margorlius says.

However, most people who contract the virus will never need to seek medical treatment.

“If you don’t have severe disease or if you’re not at risk for severe disease, really what we’ve seen across the globe and across the country is that [monkeypox] is self-limiting,” Margolius says. “It does get better on its own.”

It is, however, important to isolate as a means of limiting transmission once you’ve been diagnosed.

Why are LGBTQ+ people talking about the connections between monkeypox and HIV/AIDS?

In 1981, the CDC published an article identifying a “rare lung infection,” in five gay men living in California.

By 1990, more than 100,000 Americans had died of complications related to HIV/AIDS — most of them gay men and other LGBTQ+ people — while the federal government did little but watch on.

Margolius completed his residency at San Francisco General Hospital, famously home to the first AIDS special care unit in the country, and says his familiarity with the history and context of the AIDS crisis made the delayed response to the Monkeypox virus particularly difficult to watch.

“I know that history,” he says. “It took too long for the WHO and the White House to issue state of emergency. Then our government, the federal government, to declare Public Health Emergency, as we knew cases were rising across the globe, that had a lot of bad shockwaves. It just brought up bad memories of [the AIDS epidemic].”

Even more disheartening, Margolius says his team could only look on as major cities in other states were able to offer vaccinations.

“Please know that we’ve been working with the community,” he says. “Members of our team are part of the LGBTQ+ community, and those who aren’t, are allies. We hope things will get better and we know things will get better with increased vaccine supply.”

“Folks are sensitive to not wanting to propagate stigma [against LGBTQ+ people],” he adds. “But the vaccine response should never be slowed down for that hypersensitivity.”

Going forward, Margolius encourages LGBTQ+ people to reach out with feedback, because combating infectious diseases is a community-oriented process: “It’s a ‘Nothing about you, without you,’ kind of mindset.”

Ignite Action: