As of last week, Evanston has reported a total of seven monkeypox cases and no hospitalizations among local residents, according to the city’s Director of Health and Human Services Ike Ogbo. 

Director of Health and Human Services Ike Ogbo

As of Monday, Aug. 22, the U.S. has registered more than 15,000 cases, including over 950 in Illinois alone.

The illness, which stems from the pox family of viruses, causes flu-like symptoms of fever, chills, aches and fatigue, and individuals with monkeypox typically develop painful lesions around their face, hands and genital area. In this current outbreak the vast majority of cases globally have occurred in gay, bisexual and other men who have sex with men. 

Both Illinois and the United States have declared monkeypox public health emergencies, and health departments across the country are working to administer a limited supply of smallpox vaccines that provide effective immunity to monkeypox.

Right now, close contacts of known positive cases and sexually active men who have sex with men are eligible for vaccine doses.

However, Evanston does not have its own allocation of vaccines, so local health authorities are working with the Cook County Department of Public Health to provide doses to eligible people, Ogbo said.

Additionally, the Biden Administration has announced plans to split each vaccine dose into as many as five doses to provide some level of protection to more people until the country is able to obtain a steadier supply of shots.

Evanstonians who meet the criteria for vaccination should call Evanston 311 at 847-448-4311, according to the health department’s monkeypox web page. Additionally, tests for the virus are now available through commercial labs including Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics and Sonic Healthcare, according to Ogbo.

Monkeypox as a sexually transmitted infection

Last week, Northwestern University Professor Steven Thrasher, who studies the impact of viruses like HIV and COVID-19 on marginalized populations, published a paper in Scientific American titled Monkeypox Is a Sexually Transmitted Infection, and Knowing That Can Help Protect People.” 

An electron microscope image showing monkeypox virions in a sample of human skin. Credit: Centers for Disease Control and Prevention

In the article, Thrasher uses data from studies coming out of Europe to argue that health authorities should treat monkeypox as a sexually transmitted infection in order to target the most vulnerable populations and expedite vaccinations and drug treatments. For example, he references a study from the United Kingdom that found 196 of 197 cases in London in late July were among men who have sex with men. 

Yet, white men are more easily accessing vaccines, Thrasher wrote, so Black and Latino men are making up an increasing percentage of monkeypox cases. As a result, health officials across the country should use that data to spread awareness about who is at the highest risk for infection and to divert vaccines and treatment to those communities, according to Thrasher.

“The research is clear: while 1 to 6 percent of cases of MPX in the U.S. may be transmitting in other ways, 94 percent of infections are moving sexually among self-identified men who have sex with men, especially among Black and Latino men,” Thrasher wrote. “This is nothing to be ashamed of or to hide; it is something to be addressed to protect people who deserve the dignity of a proactive campaign that centers our needs during a public health emergency.”

Northwestern’s impact

In the meantime, Evanston is also gearing up to welcome back thousands of undergraduate and graduate students attending Northwestern in just a few weeks. Earlier this month, the university published guidance for students regarding the virus and its spread, noting that students who test positive will be required to isolate off campus. 

“Based on information provided through these discussions about the nature of the virus and its spread, we do not expect a large number of monkeypox cases on campus,” the university’s post stated. 

However, a number of experts across the country have highlighted how colleges, in particular, commonly feature tight-knit social and sexual networks where viruses can spread quickly and easily. Evanston health leaders are currently working with Northwestern health officials to determine the best steps for responding to monkeypox cases moving forward, Ogbo told the RoundTable.

“At this juncture, it is difficult to ascertain whether there would be a spike in cases in Evanston due to Northwestern students returning to campus,” Ogbo said.

“This is why complying [with] the public health directives regarding monkeypox is important. As mentioned, we are monitoring the monkeypox situation in Evanston closely and have continued to prepare to keep everyone safe.”

Public health response failures

Despite efforts made by the U.S. Centers for Disease Control and Prevention, local public health departments and others, a monkeypox outbreak that initially seemed like it could be contained has now ballooned into a bigger problem.

Dr. Anu Hazra of the Howard Brown Clinic

One of the main causes for the current outbreak is a general lack of funding and infrastructure for public health in the United States, according to two doctors treating monkeypox patients in the Chicago area. 

“What we are seeing is a consistent failure of our public health system to really serve the needs of its people, and you can’t put that all on the CDC or local health departments,” said Dr. Anu Hazra of Howard Brown Health. “What COVID showed is that we have a dilapidated infrastructure of public health in this country, and a lot of public health departments are really just getting by. Any stressor on that public health system essentially collapses that entire structure.”

As a result, the nation has a limited supply of vaccine doses and a limited number of investigational antiviral drugs to prescribe to sick people, while other countries, like Canada, have successfully established emergency operations to send resources to the places that need them the most.

For instance, back in July, Montreal had the worst outbreak of monkeypox cases in Canada, but cases are already declining now because health authorities there made vaccines widely available and sent out messages encouraging highly vulnerable populations to get vaccinated, Hazra said.

And because the available antiviral drug – tecovirimat or TPOXX – is also scarce and only an investigational therapy, doctors have to turn away sick patients who are looking for treatment. 

“Patients are not trusting you, as a provider, because you say ‘Yeah, the drug works. I’d like to give you the drug, but you’re not sick enough.’ So now, you have lost the trust of the patient because if you’re that patient, no matter what you’ve got, it’s the worst illness for you at that time,” said Dr. Vishnu Chundi of Metro Infectious Disease Consultants.

“And a lot of these patients have lesions … It’s so painful that they’re bleeding, and you say ‘Well, I have another patient who’s sicker, so I’m going to give it to them.’”

Both Hazra and Chundi expressed concern about the virus potentially jumping into the heterosexual population if authorities are unable to slow the current spread, but they also said they hope the situation will improve as providers and public health leaders work out their response plans.

“It’s only a matter of time before sexual networks overlap, and we can potentially see this moving into other populations,” Hazra said. “And we definitely don’t want to wait until that happens before really maximizing the interventions that we have in hand.”

Duncan Agnew covers Evanston public schools, affordable housing, City Hall and more for the RoundTable. He also writes long-form investigations, features and the morning email newsletter three times a...