When Johnny Rivera got his positive monkeypox result, he laughed at his doctor because his symptoms were undeniable at that point. The test was just a confirmation of what he already knew, he said at a webinar hosted on Thursday by the state Department of Public Health.
Four days before getting tested, he found his first lesion on July 11, which he initially thought was an in-grown hair; by the next day, the lesion had engorged and hardened. He was also experiencing other symptoms such as chills, headaches, abdominal cramps and swollen lymph nodes.
During the hardest part of his illness, he had a fever of up to 102.5 degrees lasting five days, rectal bleeding, nerve pain, cold and hot flashes and exhaustion.
On day six, Rivera started finding more lesions. He counted a total of 22.
“The lesions were really itchy and bothersome, but they were almost like my last concern,” he explained. “It was almost like these were a reprieve compared to the intense [previous] six days.”
Rivera was one of the first Connecticut residents to contract monkeypox and the numbers have steadily increased.
As of Friday, there were 11,177 confirmed monkeypox cases nationwide, according to the CDC. In Connecticut, 59 cases have been confirmed.
President Joe Biden officially declared monkeypox a public health emergency on Aug 4.
Dr. Ulysses Wu, director of infectious disease, chief epidemiologist and chief microbial steward of Hartford Healthcare, said that the rate of increase is more concerning than the current numbers.
“We’ve only had a handful of cases every year in the world,” he said. “So, clearly, this is something that is much bigger than previous years.”
How does it spread?
A person with monkeypox isn’t infectious until the first symptoms begin showing. After that, the virus can spread in many ways, but the primary method of transmission is through prolonged close contact, like during sex, said Wu.
The other transmission methods include respiratory secretion, skin-to-skin contact with infected body fluids or lesions and sharing items such as towels and linens. It can also spread through domestic pets, but he explained that these transmission methods are not as concerning.
In general, symptoms start within three weeks of exposure, but symptoms can show sooner.
Rivera got the virus from one of his sexual partners, who he had seen four days before. The pair met through the dating app Grindr; this was their second time. He explained that during June, his sexual activity increased.
“I played, I paid,” Rivera said.
At the time, his partner showed no symptoms and didn’t have any lesions but complained about feeling lethargic.
To minimize possible exposure, the DPH recommends washing your hands often, limiting sex partners, avoiding close skin-to-skin contact with people who have a monkeypox-like rash and avoiding touching their linens, towels, clothing, fetish gear or sex toys.
A person can only be tested for the virus if they have a rash consistent with monkeypox or have had close contact with an infected person. The DPH states that testing is available at the state Public Health Laboratory and five commercial labs.
What to do if you test positive
When symptoms begin showing, the CDC recommends immediately isolating from people and pets until all lesions have healed and a new layer of skin is formed, which can take upwards of a month.
If a person is required to leave for a medical check-up or an emergency, the DPH recommends wrapping up lesions, wearing long-sleeve shirts and wearing a mask around others.
The treatment available for active monkeypox is TPOXX, which is often used to treat chickenpox. TPOXX is still considered an experimental drug but was streamlined by CDC as safe for use.
However, Wu said that many people recover without medication for this strain.
The CDC monkeypox website has an extensive list of recommendations to prevent reinfection while in quarantine. This includes properly disinfecting tables and countertops, disposing of contaminated waste and cleaning bedding and towels.
Those without in-home laundry machines should coordinate with their local public health department.
Rivera recommends that people experiencing symptoms rely on their support system to get essentials without leaving quarantine.
“I thought going into it that I was going to do this solo, own my own, like any other problem that you would in your mundane life as an adult. I was rather optimistic that this was only going to last for a week or two,” he said. “Later, it was quite clear that this was going to be a long road and I needed to reach out to people and utilize all the resources I could.”
Close contacts, vaccines
The primary vaccine available in Connecticut is JYNNEOS. It is administered in two doses over four weeks. A person isn’t fully immunized until 14 days after the second dose.
There are currently 19 monkeypox vaccine distributors in the state. According to the Administration for Strategic Preparedness and Response, the state currently has 6,298 allocated doses of vaccine available.
“The problem is that we don’t have enough,” Wu said.
On Aug. 9, the FDA approved emergency use of the available vaccine to extend use. This allows providers to use a smaller dosage between the layers of the skin rather than underneath it.
Due to the limited supply, vaccine is mainly restricted to close contacts and people with a high risk of exposure.
Other vaccine eligible criteria include men 18 and up, transgender and/or gender non-conforming people who have sex with men and people with multiple sex partners.
According to DPH, the JYNNEOS vaccine is safe for people with HIV and atopic dermatitis.
Although a person is not infectious until they are symptomatic, Wu recommends those receiving the vaccine quarantine until they are fully immunized to prevent further spread.
“Vaccines are not 100%,” he said. “If you were exposed to somebody who had it and you had close physical contact and you received the vaccines, there’s no guarantee that you’re not going to get it. So it just really decreases your chances; but, if you develop symptoms, you could also expose somebody else.”
Lea Crown, director of the Meriden Department of Health and Human Services, said her staff is monitoring a handful of monkeypox cases in the city.
Following the infectious disease protocol used for COVID-19, the department is contact tracing both for people testing positive and any close contacts.
Crown said if someone tests positive, the department will check in with them to see how they are doing and if they need any essentials until they are out of quarantine. Then, the department will reach out to those identified as close contacts to check in and make a vaccine referral.
Crown also said they are connecting with other local health departments to find best practices for interviewing and creating workgroups to prevent further spread.
“This is obviously a new disease for us,” she said.
The department is also updating its numbers daily as more monkeypox information and statistics are released on its website and social media.
Public education to curb LGBTQ+ stigma
Rivera, who identifies as gay, said he had received nothing but support during his recovery; however, he recognizes that is not the case for others in the LGBTQ+ community.
According to the DPH, all of the Connecticut cases as of Aug. 8 are people who identify as male and almost all identify as LGBTQ+. However, anyone can contract the virus.
Rivera explained that one of his friends overheard a group of men making homophobic remarks in downtown Hartford. They remarked that they couldn’t understand why gay men were proud since they were spreading monkeypox.
“The [LGBTQ+] community, with good reason, is concerned that … [monkeypox] can be used to stigmatize the gay community and be weaponized against us to strip us of our rights,” Rivera said.
Wu said that one of the best methods of prevention and curbing stigma is through public education and easy access to monkeypox information.
“We are dealing mostly with a group that this is predominantly a cohort of [men who have sex with men] and because of that a lot of people think that [monkeypox] doesn’t concern them or that this is not a disease that they have to worry about nor do they have to be educated about,” he said. “Public health education only works when everyone is involved.”
However, he recognized the importance of getting monkeypox information to the LGBTQ+ community since the virus is circulating currently in that community.
To better inform LGBTQ+ people about the virus, Rivera documented his personal experiences on social media as a public service to other queer people. As a result, even his Grindr has become a platform to educate and inform.
Rivera also urges local queer bars to educate their patrons about the virus and its severity.
“If we could have a Trivia this or that or the other, I don’t see why [monkeypox education] can’t be done in a social setting,” he said.
To learn more about monkeypox and vaccine locations visit DPH’s monkeypox website.
Health Equity Reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists into local newsrooms. To learn more about RFA go to www.reportforamerica.org or to donate go to https://bit.ly/3dtcJdS.
Villalonga-Vivoni can be reached at firstname.lastname@example.org or 203-317-2448.