San Francisco has demanded more vaccines and treatment options for its growing cases of monkeypox — but the city has all but abandoned an age-old method of containing outbreaks: contact tracing.
U.S. health officials declared monkeypox a national health emergency last week, as did city officials in California and San Francisco, and while it’s usually not fatal, no one wants to get infected. by the parent of smallpox, with its painful lesions that can lead to scarring.
City public health officials estimate that San Francisco, with 472 cases — 36% of the state’s 1,310 cases — has the highest per capita rate in the country.
At first, the practice of tracking down those exposed to a fast-spreading disease and then isolating or treating them seemed like a good idea. Health officials relied on it early in the COVID-19 pandemic as cases surged.
But San Francisco public health officials said when they tried to track down every person exposed to monkeypox — mostly men who have sex with men — it didn’t work.
“Many people were unwilling or unable to share partners’ names and contact information,” health officials said in a statement.
So about a month ago, health officials changed tack and started urging people with monkeypox to do their own contact tracing. The city’s health department is quick to say it’s still doing monkeypox contact tracing – but said it’s mostly limited to children under 18 and pregnant women.
In contrast, a survey in several Bay Area counties — Alameda, Santa Clara, San Mateo, Contra Costa and Marin — found that all continued to do contact tracing for anyone who tested positive for monkeypox. .
But the number of cases there is in the single or double digits, compared to hundreds in San Francisco.
Marin County has up to seven cases — but only about half were willing to reveal the identity of any partner, no matter how kindly public health officials asked or how insistently they explained that they would keep the information private, said Dr. Matt Willis, the county’s top public health department official.
“That’s still true for sexually transmitted disease contact tracing,” Willis told The Chronicle. “We ask about sex and the type of sex they have.”
Willis said people are often willing to talk about their most intimate moments.
“But when it comes to naming their partners, there’s often a moment where it’s clear they’re ambivalent about having more conversation,” he said.
A common approach to making people feel more comfortable is to role-play the conversation health officials would like to have with the infected person’s partner(s) — and it can work. But not always, Willis said, and usually people just say they’d rather contact their partners themselves.
Yet contact tracers are better able to help the partners they reach, as they can provide appointments and information, and even treatment. A smallpox antiviral can sometimes be used for people who are already sick, and others can get vaccinated. But the drugs are lacking.
Arnab Mukherjea, a public health expert at Cal State East Bay, expressed surprise that San Francisco would put pauses on contact tracing, regardless of performance.
“If someone refuses to release another person’s name, you can’t force them,” Mukherjea said. “But if good contact tracing gets you five contacts instead of 15, that’s better than letting it go unhindered.”
He said contact tracing may be more effective with monkeypox than with COVID, which is transmitted by air droplets. People can’t be sure who they got the coronavirus from, unlike monkeypox, which is usually spread through skin-to-skin contact.
Still, tracking down all the partners of someone infected with monkeypox can take hours, especially if they don’t pick up their phones, Willis said.
“So I can imagine if, like San Francisco, you have close to 500 cases — and you’re not getting high output anyway — I can see how resources can be better placed elsewhere,” he said. he declares.
Even so, the fact that the San Francisco Department of Public Health largely gave up on contact tracing was not something officials would readily admit, according to an article this week in Bay Area News Group, publisher of the Mercury News. and the East Bay Times. The news agency obtained internal emails revealing that they were reluctant to tell the full story to the public.
According to the newspaper, San Francisco health officer Susan Philip endorsed a public response that said, “We are doing contact tracing for monkeypox” — but didn’t say how little they were doing. Stephanie Cohen, medical director of the City of San Francisco clinic, disagreed, saying the response “places too much emphasis on contact tracing,” the emails cited by the agency showed. Press Agency.
The statement SF officials sent to The Chronicle on Monday acknowledged that they were focusing on young people and pregnant women.
Nanette Asimov is an editor for the San Francisco Chronicle. Email: nasimov@sfchronicle.com
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