San Francisco quietly pulled out of contact tracing for monkeypox weeks ago

SAN FRANCISCO — Despite experiencing one of the largest outbreaks of monkeypox in the nation, the San Francisco Department of Health has abandoned contact tracing — a standard public health practice in the fight against viral illnesses — for those who have been infected, this news agency has learned.

The revelation comes amid successive declarations of public emergencies over the monkeypox virus by federal, state and San Francisco Mayor London Breed, whose director of public health announced in late July that he was “imperative that we quickly mobilize the resources of the city” to curb its spread.

But San Francisco has never publicly announced whether it is tracing the contacts of infected residents to detect and control the spread of an outbreak of monkeypox that has affected hundreds of people, and the emails obtained by this agency from Press reports indicate that health department officials are reluctant to answer questions. on their strategy. It turns out that for this city, contact tracing — a key undertaking at the start of the COVID-19 pandemic, and an approach that epidemiologists say should work well against monkeypox — plays only one small role.

While the department was investigating all known cases in the “early days of the outbreak,” many interviewees were unwilling or unable to share the names of their partners, according to city health officials. Health officials say the virus is spread through skin-to-skin contact primarily through sex.

“This has made contact tracing difficult for all known cases,” the health department said in an email. “We have pivoted our strategy to focus our case investigation efforts on specific groups that might signal something new in epidemiology. We are currently conducting case investigations and contact tracing for young people under the age of 18; anyone who could become pregnant and pregnant people, among others.

SAN FRANCISCO, CALIFORNIA – JULY 20: People line up outside General Hospital in San Francisco, Calif., waiting for an injection of the monkeypox vaccine, Wednesday morning, July 20, 2022. (Karl Mondon/Bay Area News Group)

The virus, however, massively affects men who have sex with men. Although San Francisco doesn’t say what percentage of monkeypox infections it tracks down, its description of its new strategy suggests the answer is just a small portion of them.

Some epidemiologists question this approach. “It’s extremely important to let exposed people know who they’ve had an encounter with,” said Dr. Scott Roberts of the Yale School of Public Health.

The shift in strategy, San Francisco officials said, happened about a month ago.

The department said of the 386 cases reported on August 2, 72% of those affected have been interviewed by health officials and an additional 9% are awaiting interviews. But the agency did not provide figures on how many potentially exposed contacts they received — or reached — from those interviews. According to the ministry, it is now asking infected people to tell their sexual partners that they should seek medical care, rather than trying to contact those partners themselves. Those the department contacts receive resources to fight the virus and are prioritized for vaccination.

By Sunday, the city had added 58 cases to its tally, bringing the total to 444 people.

Santa Clara and Alameda county health departments — which are also dealing with large outbreaks of monkeypox — both said in responses to this news agency that they are interviewing everyone who tests positive for the virus to to identify contacts who may have been exposed. Alameda included in its response that “it may be difficult to obtain information for contacts exposed to monkeypox due to the intimate nature in which exposures may occur.”

In their public statements on the fight against monkeypox, San Francisco officials said they were trying to quickly get a vaccine currently in short supply across the country — and stressed they were working with the LGBTQ community in the city, which has been disproportionately affected by the virus.

But emails from mid-July obtained through a public records request show infighting among senior San Francisco health officials over how to shape the narrative on contact tracing.

“Please weigh in – don’t want to say too much or ask more questions,” Amy B. Garlin, medical director of the agency’s Communicable Disease Control Department, wrote in a July 21 email asking colleagues to review his answer to this question. news organization. Shortly after, health worker Susan Philip endorsed the response, which stated “we are doing contact tracing for monkeypox”, with no indication which was only true in a fraction of the cases.

Later in the day, Stephanie Cohen, medical director of the San Francisco City Clinic, weighed in on the email exchanges. The municipal clinic specializes in sexually transmitted infections and is actively involved in the agency’s response to monkeypox.

“I think this answer puts too much emphasis on contact tracing,” she wrote. “We are reducing (case investigators) and encouraging people to self-refer to partners, right? I think the answer should be more in line with our strategy… I don’t think we should say, “we are doing contact tracing for monkeypox”.

Garlin did not respond to a request for comment regarding his communications with his colleagues.

Epidemiologists have said in interviews that contact tracing would be effective in stopping the spread of the virus, but acknowledged its challenges.

UC Berkeley epidemiologist Dr. John Swartzberg said that because the incubation period for monkeypox is weeks, rather than days for COVID, it’s easier to cut off the spread by identifying the potentially infected individuals. It’s also easier to determine who may be at risk of catching monkeypox, which involves intimate contact between people, rather than COVID which spreads through the air and could infect multiple people in a public space.

San Francisco Mayor London Breed gestures during a press conference after declaring a state of emergency for monkeypox as San Francisco Chief <a class=Health Officer Dr. Grant Colfax looks on at City Hall in San Francisco on Thursday, July 28, 2022. The mayor announced a legal state of emergency Thursday over the growing number of monkeypox cases. (AP Photo/Eric Risberg)” width=”6000″ height=”275″ data-sizes=”auto” src=”″ srcset=” 620w, 780w, 810w, 1280w, 1860w”/>
San Francisco Mayor London Breed gestures during a press conference after declaring a state of emergency for monkeypox as San Francisco Chief Health Officer Dr. Grant Colfax looks on at San Francisco City Hall on Thursday, July 28, 2022. (AP Photo/Eric Risberg)

However, Swartzberg agreed that contact tracing could be difficult in some cases, as people infected with monkeypox may be reluctant to reveal their sexual partners to public health officials, some people may not know people’s real identities. with whom they have sex and public health. departments are already under-resourced in light of the ongoing COVID pandemic.

Others, like Roberts of the Yale School of Public Health, said the tricky symptoms of monkeypox make contact tracing all the more important.

“One problem with monkeypox is that you have flu-like symptoms,” he said. “The rash can be confused with other STIs like syphilis or herpes. So many people may not know they’ve been exposed.