Derek Johnson-Dean, MPLS POX Taskforce (00:11:40):
Where’s my video? Well, hello, everybody. Thank you for coming. Why don’t we get started? I was trying to figure out how to share my screen, but apparently you can share your screen but you can’t see everybody. Thanks for coming. This is the Minneapolis Monkeypox Task Force First Forum and I appreciate Dr. Henry and Patrick and Lisa and Pam, who have agreed to present today. Got 13 people in the room. Why don’t we start?
Derek Johnson-Dean, MPLS POX Taskforce (00:12:17):
I will start. Again, my name’s Derek Johnson. I’m the executive director of Minneapolis Monkeypox Task Force. This started with some phone calls from people I hadn’t worked with in a while, wanting to find some information. In the process of getting a website, I have been kind of pulled in a couple of different directions and one of them is this forum today. I am going to just turn it over to our panelists and each panelist, if you just want to take a minute to tell us about yourself and how you’re connected to monkeypox in the Twin Cities.
Keith Henry, MD, Hennepin County/Clinic 555 (00:12:57):
I’ll go first. Keith Henry, I’m a physician that’s been involved with HIV care in the Twin Cities since 1984, first at St. Paul Ramsey Medical Center, back when it was a public hospital. Started the first HIV clinic in the state, then moved to Hennepin in 2001 and I’ve also been the medical director of Clinic 555, the St. Paul equivalent of Red Door Clinic since 1985. So basically last 40 years I’ve been involved with HIV in STD care and management, public health and research in the area.
Luisa Pessoa-Brandao, City of MPLS (00:13:36):
I can …
Derek Johnson-Dean, MPLS POX Taskforce (00:13:36):
Yeah, go ahead.
Luisa Pessoa-Brandao, City of MPLS (00:13:44):
I can go next. Luisa Pessoa-Brandao, I’m the director of public health initiatives at the Minneapolis Health Department and I supervise our epi and emergency preparedness group. And we have been trying to get some information out, participate, do some public radio shows, and so I have worked in public health and HIV both locally and internationally for many years and have been with the city now since July, 2019. Important to get information out and I’m happy to be here.
Derek Johnson-Dean, MPLS POX Taskforce (00:14:23):
Luisa, you have the longest title of anyone I know.
Luisa Pessoa-Brandao, City of MPLS (00:14:27):
Yeah, it’s actually different now.
Derek Johnson-Dean, MPLS POX Taskforce (00:14:29):
Oh, is it? Okay.
Luisa Pessoa-Brandao, City of MPLS (00:14:30):
It’s shorter.
Derek Johnson-Dean, MPLS POX Taskforce (00:14:30):
It’s shorter?
Luisa Pessoa-Brandao, City of MPLS (00:14:31):
Public health initiatives, yes. The city likes to do long titles. I’m not sure why.
Derek Johnson-Dean, MPLS POX Taskforce (00:14:35):
Long titles, very good. Okay. Pam or Patrick?
Patrick Ingram (00:14:41):
I’ll jump right in. Good evening. First, thank you, Derek, for having this space for us to have such a critical and important conversation around monkeypox this evening. My name is Patrick Ingram. I am a community health specialist at Red Door and I specifically work within our PrEP program. My work is centered around supporting clients to ensure that they have the tools and resources to support to start and continue a PrEP successfully. And my mission is focused on increasing PrEP uptake among communities of color, which has expanded to such efforts surrounding monkeypox in the middle of this public health emergency. My background is in HIV and public health related outreach prevention and programming. And prior to this role I was at the Virginia Department of Health, working as a disease intervention specialist. Thank you for having me this evening.
Derek Johnson-Dean, MPLS POX Taskforce (00:15:27):
You’re welcome. Thank you. Pam, go ahead.
Pam Layton, CNP, Red Door Clinic (00:15:33):
Hi, I’m Pam Layton. I’m a nurse practitioner here at the Red Door Clinic. I’ve been here for 16 years and with Hennepin County since 1996 in some capacity. We provide sexual healthcare here as well as family planning and some small amount of primary care issues and dermatology type things. That’s about it.
Derek Johnson-Dean, MPLS POX Taskforce (00:16:10):
That’s about it. Okay. So through the course of this conversation, hopefully we will be able to learn about cases of monkeypox in the state over some frequently asked questions. [inaudible 00:16:27] Scroll down a bit. Hold on. Talk about what to do if you think you’ve been exposed, ways to prevent and also reduce your risk. The Minneapolis Monkeypox Task Force is committed to harm reduction approaches, so we’ll be talking more about that later, also, talking about who’s eligible for vaccinations and suggestions for symptom management. Why don’t we just jump in? Anybody want to say anything before we start the panels? Okay. Why don’t we start with Dr. Henry? What is monkeypox and could you give us a brief history of it?
Keith Henry, MD, Hennepin County/Clinic 555 (00:17:12):
Sure. I’m anxious to be able to share my screen. Are you able to see this? I just brought up my screen PowerPoint slide. Can you allow the …
Derek Johnson-Dean, MPLS POX Taskforce (00:17:26):
I think you are. Okay. Hold on a second.
Tim (00:17:33):
[inaudible 00:17:33] Go ahead.
Derek Johnson-Dean, MPLS POX Taskforce (00:17:35):
Tim says go ahead.
Keith Henry, MD, Hennepin County/Clinic 555 (00:17:37):
All right. Can you see my screen at the moment?
Tim (00:17:40):
You have to hit the share screen.
Derek Johnson-Dean, MPLS POX Taskforce (00:17:41):
Hit the share … Me? Sorry.
Tim (00:17:46):
[inaudible 00:17:46].
Derek Johnson-Dean, MPLS POX Taskforce (00:17:46):
Yeah, so Keith, have you selected the screen to share?
Keith Henry, MD, Hennepin County/Clinic 555 (00:17:52):
Yeah, it’s on my screen.
Derek Johnson-Dean, MPLS POX Taskforce (00:17:54):
Your screen, okay. Hold on, let me go back. We did the same thing we did last time.
Tim (00:18:26):
Click the green button at the bottom that says share screen.
Derek Johnson-Dean, MPLS POX Taskforce (00:18:27):
Are you talking to me or …
Luisa Pessoa-Brandao, City of MPLS (00:18:34):
You may need to try to share again since it wasn’t enabled and now it is.
Keith Henry, MD, Hennepin County/Clinic 555 (00:18:39):
All right. I’ll be happy to do that.
Derek Johnson-Dean, MPLS POX Taskforce (00:18:41):
Thank you.
Keith Henry, MD, Hennepin County/Clinic 555 (00:18:42):
Share screen. Can you see it now or not?
Derek Johnson-Dean, MPLS POX Taskforce (00:18:49):
No. Oh, some … There it goes, Dr. Henry.
Keith Henry, MD, Hennepin County/Clinic 555 (00:18:59):
All right. Sorry. And I forgot to also mention introduction, I’m very happy to be on this call and hopefully other meetings will be very productive. This is a little bit of background about monkeypox. It’s very interesting as I’ve been reading about this, it was actually first described in, of all places, Denmark 1958. A virus isolated from monkeys in the lab that had been living in Copenhagen but it had contact with monkeys from Africa. So when they isolated the virus, they called it monkeypox. Get back to that because that term is very much a misnomer and is likely to be changed in the next year to a different name. They never [inaudible 00:19:49] so he had 12 years after the discovery in the lab before human disease was noted, and that was a young child in the Congo. The first non-African case wasn’t until 2003, another 33-year gap before it was noted outside of Africa, and that was in the USA from exposure to a prairie dog that had been imported from Ghana.
Keith Henry, MD, Hennepin County/Clinic 555 (00:20:14):
Basically, this virus, which is called monkeypox, is endemic in Africa. Basically two countries are the most impacted, the Congo where the type of virus there is called Clade 1. Two families of the monkeypox virus exists in Nigeria, Clade 2. Clade 1 is more virulent, which means it causes more disease and death, maybe tenfold more deadly than the Clade 2, which is, fortunately for humankind, the current outbreak is a Clade 2 virus. Some terms that might be useful for the audience going back in time, the smallpox virus is a relative of monkeypox and that’s called variola virus. There’s another relative virus called decennia, that’s in the same family of orthopoxviruses, that is attenuated form of smallpox virus, and that’s the strain that’s been used for vaccination against smallpox.
Keith Henry, MD, Hennepin County/Clinic 555 (00:21:25):
These viruses are quite different from, let’s say, HIV. It’s got a 10 times larger genome than HIV, so it’s much more complex. It’s a double stranded DNA virus, again, for example, compared to HIV, single stranded RNA. And important for understanding why we’re seeing this outbreak now is the fact that worldwide smallpox vaccinations ended in 1980 after the last cases were successfully eradicated from planet Earth. Prior to 1980, people were getting vaccinated and smallpox vaccination has estimated to be 85% effective at preventing monkeypox. And that came from a study that was done back in 1988 in Zaire, where they were having endemic outbreaks of monkeypox. And they looked at spread from the patient with monkeypox to contacts, close contacts, and found that those that had been vaccinated against smallpox were 85% protected. That’s where the vaccination data really comes from.
Keith Henry, MD, Hennepin County/Clinic 555 (00:22:37):
I’m going to show you a photo of what Monkeypox looks like. That red blob there is one varian, one monkeypox varian. On the right is the natural host, which is not monkeys. It’s rodents, not monkeys, and that’s one reason why the name is likely to be changed. And before [inaudible 00:23:03] Minnesota, I thought it was important to really look at the international context because this is just like HIV [inaudible 00:23:11] problem in areas of the world that are resource poor. [inaudible 00:23:17] and since smallpox was eradicated, that whole family of viruses has not gotten much attention at all. So what you see here are cases of [inaudible 00:23:27] in the Democratic Republic of the Congo. Now, I just put red arrows to give you an idea. In 2020 there are 4,500 cases known and they don’t have lots of testing, lots of patients don’t get reported, so this is a very large underestimate. And then I’m just showing on the right, you can see the number of deaths that were reported in 2020, 150 plus, so a lot of it that was out there already. I’m going to also just show you worldwide now, a couple things here on this slide, global cases through 2020. And going back, again, to 1970, that decade, only 11 cases in the world reported. And remember, first non-African case was 2003, so all these first three steps of decades were all African and then there’s an increase. And remember, when smallpox vaccinations ended, at this arrow right here, that’s when smallpox vaccinations ended, which means that if there’s a case and you haven’t been vaccinated, they’re much more likely to spread that case to non-vaccinated people. That’s one of the explanations of why it took off in Africa.
Keith Henry, MD, Hennepin County/Clinic 555 (00:24:49):
And I just put this arrow here to look at what’s happening currently, where these color graphs show where in the world the cases are being reported from. The blue is Africa, the yellow of the Americas, and this pink is Europe. And again, this is July. We’re two or three months further down the road and if this was updated, this part would be hugely increased because of the large outbreak that’s occurring currently in the US.
Keith Henry, MD, Hennepin County/Clinic 555 (00:25:21):
And then I’m just showing this is the epidemic curve worldwide through September 18th, so pretty current. And the point of the slide is that you’ve seen this huge surge. The epidemic has really identified in Europe in May of 2022. And you see here the regions where it is being reported in reddish color is Europe and the blue are the Americas, mostly the United States. And noteworthy is the fact that the case rate has gone down recently in Europe, but not so much in the US, so I just want to give that background before we get the.
Keith Henry, MD, Hennepin County/Clinic 555 (00:26:03):
… in the US. So I just want to give that background before we get some specifics about transmission to put this into the context that there’s been a lot of monkeypox that we never heard about, basically, already, because it occurred in Africa. And with that we’ll move on to the next subject matter, but I can join in later on clinical issues.
Derek Johnson-Dean, MPLS POX Taskforce (00:26:22):
Okay, well, to either you or Luisa, sort of the next question is about, you mentioned COVID, could you talk about how Monkeypox first is like COVID? And then how it’s not?
Keith Henry, MD, Hennepin County/Clinic 555 (00:26:41):
Well, it’s a completely different family of viruses. COVID belongs to respiratory virus that’s spread easily through respiratory secretions. And also when a lot of mutations that are still controversial of how the strain COVID-19 emerged from Wuhan, China with an initial high mortality rate. So COVID-19 is much more easily spread through respiratory secretions. Meaning that if you’re in the room with somebody even six feet away, you can breathe in these secretions, the droplets, and become infected. Monkeypox requires direct contact, skin to skin, lesion to skin contact. So COVID-19 respiratory virus easily spread. Monkeypox requires direct contact.
Luisa Pessoa-Brandao, City of MPLS (00:27:37):
I have some slides on transmission if you want me to share data.
Derek Johnson-Dean, MPLS POX Taskforce (00:27:47):
Sure.
Luisa Pessoa-Brandao, City of MPLS (00:27:51):
Can you see my screen?
Derek Johnson-Dean, MPLS POX Taskforce (00:27:53):
Yep.
Luisa Pessoa-Brandao, City of MPLS (00:27:54):
Okay. So just as Dr. Henry was talking, the transmission is primarily skin to skin contact, or, also, respiratory droplets can be transmission, but you have to have prolonged close contact. And I think currently the CDC looks at, at least three plus hours of fairly close contact to look at someone being in close contact. So it’s not airborne transmission like COVID, and so not nearly as transmissible as COVID. The other possibility for transmission is through clothing or surfaces or objects that have been in contact with the rash, the monkeypox rash.
Luisa Pessoa-Brandao, City of MPLS (00:28:41):
And then also pregnancy, a pregnant woman can transmit to their child through the placenta during pregnancy, which is… It’s important for pregnant women, if they think they might be at risk, to be tested. And, also, because there’s some concerns about vaccination, but I leave that to the medical folks to talk a little bit more about that.
Luisa Pessoa-Brandao, City of MPLS (00:29:09):
So one of the things that we talked about is what do we need to know in terms of the transmission? And what to do? And there’s been a lot of talk about monkeypox. Is monkeypox a sexually transmitted infection? Or it’s not? And it is not considered a sexually transmitted infection. But can be spread through sex if one of the partners is infected. So given that, if you’re having sex, you’re likely having skin to skin contact. It is a way of transmission, but it is not the only way of transmission. And so it’s not considered and it’s not the necessarily primary form of transmission, for most cases of monkeypox.
Luisa Pessoa-Brandao, City of MPLS (00:29:54):
Symptoms start in within three weeks of exposure, and it can be spread from the moment symptoms start through when your rash resolves. And when we say the rash resolves, we mean that it’s completely healed and a new layer of skin has formed. Unfortunately, that process can take anywhere from two to four weeks. And while our current outbreak is in a particular community, anyone that is exposed can get it in. Anyone that has skin and has skin to skin contact can become infected.
Luisa Pessoa-Brandao, City of MPLS (00:30:37):
So the only other thing I have here is what can you do, or what should you do if you’ve been exposed? Immediately try to consult with an healthcare provider to see if you’ve been exposed, and you have been in close contact and you know that, can you get vaccinated? And then making sure that you’re monitoring your symptoms and get tested if you develop any symptoms. And if you do develop any symptoms like a new rash or flu-like symptoms, make sure you get tested. And until you get those test results, just avoid close contact, including sex, until you have those results. And if you’re going out, being around people, we are advising to wear a mask. So I mean in terms of transmission, it’s what I had. I don’t know if you had other questions around this or if other folks would want to add anything else.
Derek Johnson-Dean, MPLS POX Taskforce (00:31:38):
Yeah, we had a question that was, what is the window period for monkeypox? And maybe a good idea to define what window period is. I think you mentioned that.
Luisa Pessoa-Brandao, City of MPLS (00:31:51):
I think what I… Let’s see, let’s go back. I think I had it here. So once you’re exposed, if you’re going to develop symptoms, those can start within three weeks of exposure. It might start earlier, but that is sort of the timeline. And depending on whether your first symptom might be a rash or your first symptom might be something like flu-like symptoms, and so usually a rash will appear within one to four days after initial symptoms. When we are talking about the window here is when you might be infectious, and you’re infectious as soon as symptoms start. So right now where people are still trying to figure out if someone who doesn’t have any symptoms, can they be infectious, can they be passing the infection on there? We’re not completely sure.
Luisa Pessoa-Brandao, City of MPLS (00:33:09):
We’re also still trying to understand if it can be spread through semen or vaginal fluids, and how often is it really spread through respiratory droplets? So, unfortunately, and I think this goes back to what Dr. Henry was saying, because this has been an infection that has been primarily seen in African countries, there’s just not the same amount of information, and there’s not been the same amount of attention paid to it. Which is an unfortunate, not necessarily, unfortunately, surprising because of how we see things happen, but because now it’s getting a lot of attention because of who it’s impacting in what countries it’s being diagnosed in.
Luisa Pessoa-Brandao, City of MPLS (00:33:57):
But, unfortunately, we could have had a lot more information had we been paying attention or had there been more research. So there’s a lot of things that are not known and that has a lot to do with where most of these cases have been identified to date outside of this current outbreak.
Derek Johnson-Dean, MPLS POX Taskforce (00:34:23):
Oh, okay. So what’s the other question? So another question was about, how is monkeypox different from chickenpox?
Keith Henry, MD, Hennepin County/Clinic 555 (00:34:39):
I’ll try to answer that. So it says pox in it, but it’s really a different family of viruses. So they have pox in it, but chickenpox, which is very easily spread, by the way, very easily spread and is a childhood disease that’s widespread and causes the characteristic chickenpox rash then sets up a latent state in the nervous system, and can be expressed as people get older or become immunocompromised as shingles. So it’s a different virus family, it has the word pox in it, different patient population, more easily spread, has a chronic disease state. So the thing that they really share is the fact that it says pox in it, but they’re really quite different viruses. And pox just kind of means rash, characteristic rash. So the clinical manifestation initially with chickenpox can look like the monkeypox rash, but that’s where the similarities really end, and they really behave very differently otherwise.
Derek Johnson-Dean, MPLS POX Taskforce (00:35:51):
Okay, thank you. So either Dr. Henry or Luisa, there was a question about early on people were told if they were exposed to somebody that they should take their temperature for 21 days, and to see if there’s any sort of spike. Is that something that is still recommended? What kinds of things if my roommate found out that he had monkeypox, what would you advise me to do?
Luisa Pessoa-Brandao, City of MPLS (00:36:28):
So that’s the three week monitoring, if you’ve been exposed and it’s monitoring for symptoms. I think because low grade fever and flu-like symptoms can be one of the symptoms for monkeypox, I think that was the idea. If you are not pretty well when you have even a low grade fever, you probably don’t need to be taking your temperature every day. But if you’re feeling like you might have something just to understand, taking your temperature is one way to catch if you’re having that fluctuation. Especially with the weather, when we have hotter weather more humid, you may not be able to as clearly feel that small change of temperature in your body. And so that is one of the reasons why that was a recommendation.
Luisa Pessoa-Brandao, City of MPLS (00:37:20):
So it would be a question of monitoring symptoms. So being aware of any changes to how you’re feeling and examining your body for any new rash, and knowing that the rash can be as something that looks as small as a mosquito bite. And I’m sure Pam and Patrick have examples from what they’ve seen in clinic, and so I will defer to them. There is a question in the chat around-
Derek Johnson-Dean, MPLS POX Taskforce (00:37:48):
Yes, go ahead.
Luisa Pessoa-Brandao, City of MPLS (00:37:49):
… intimate skin to skin contact as opposed to any skin to skin contact. So the piece that I was talking about, the skin to skin is really contact with a rash. And so if someone has a rash, they’re talking about dancing shirtless at a gay bar, so if you’re brushing against someone and they have the rash on their body, that is, that’s what is high risk is that contact with it. So I would say that if you’re dancing and you’re brushing against someone’s lesions, it is high risk.
Luisa Pessoa-Brandao, City of MPLS (00:38:23):
There’s not necessarily an amount of time where you’re brushing against, it’s the fact that you brush your skin against the rash that is the high risk. Probably, the more you are in contact with the lesions, the higher the probability or a higher exposure, so that sort of the dose of exposure. But I would consider when you’re dancing and rubbing against each other and having that kind of contact, that that would be a risk. So just wanting to answer the question in the chat.
Derek Johnson-Dean, MPLS POX Taskforce (00:39:02):
Thank you. So we’re rapidly going through the questions. Luisa, did you have any other slides that you wanted to talk about going to-
Luisa Pessoa-Brandao, City of MPLS (00:39:12):
I have some of the epi slides just to give a little bit of a numbers both for this-
Derek Johnson-Dean, MPLS POX Taskforce (00:39:19):
Could you do one thing first? How would you describe what is an epidemiologist? What do you do?
Luisa Pessoa-Brandao, City of MPLS (00:39:27):
Epidemiology is the study of disease and populations. And so as an epidemiologist you’re really looking at what is happening, changes in patterns of disease, and also trying to understand what is causing those changes, and what groups are impacted. Are you seeing differences by how groups are impacted and disparities in those numbers? And then, also, as part of it, how can you use the data to provide good messaging around prevention, around who needs to be getting the information and those kinds of things. So it can be very broad. I know that everybody heard about epidemiologists with COVID all of a sudden everybody was an epidemiologist as well. So it’s been an interesting time to be in the field.
Derek Johnson-Dean, MPLS POX Taskforce (00:40:28):
I can only imagine. Okay, so thanks, after that, so go ahead see.
Luisa Pessoa-Brandao, City of MPLS (00:40:33):
Okay, so I can just, let me see if I can do this again, share the screen again. It’s always a little bit of a… Let’s see if I can do this. All right, so can you see it?
Derek Johnson-Dean, MPLS POX Taskforce (00:40:53):
Yes.
Luisa Pessoa-Brandao, City of MPLS (00:40:55):
Okay. So I just wanted to do a little timeline, and I think Dr. Henry kind of talked a little bit, but just the timeline for the current outbreak. And as we said, monkeypox has been around for a long time, unfortunately, mostly concentrated in African countries, and therefore not gotten the attention that probably it should have, so that we would be better prepared to respond to a situation like where we are or any situation in other countries. But in terms of the current outbreak, the first cases, an initial case was diagnosed in the UK in May. The first case in the US was later in May, and the first case reported in Minnesota was at the end of June. So fairly quick spread from country to country.
Luisa Pessoa-Brandao, City of MPLS (00:41:48):
In July, WHO declared a public health emergency of international concern. Several states and cities in the US also declared public health emergencies. And finally in August, CDC declared a public health emergency in the US. And what a public health emergency does is that allows states and the federal government to use resources more easily, and to provide emergency use authorizations for, for example, the vaccine to be done differently so there’s more flexibility. And so at the beginning of August, they also did a emergency use authorization for an alternative regimen of JYNNEOS vaccine, because we were having such issues with vaccine supply. And so with the change, instead of one dose per vial vaccine, we were now able to get, I think it’s, hopefully, five doses of vaccine.
Luisa Pessoa-Brandao, City of MPLS (00:42:56):
And I will again defer to my colleagues at the Red Door, because they are actually providing the vaccine. So I think it went from one dose per vial to five doses per vial by changing the way it was given, the vaccine was given. And then by the end of August, oh, not quite the end of August, all states had reported a case. So within three months all states in the US had at least one case.
Luisa Pessoa-Brandao, City of MPLS (00:43:24):
So this is the CDC map for global cases. As of today we are over 63,000 cases, and the dots in blue are countries where historically monkeypox has been endemic. The countries in orange are where historically we have not seen monkeypox. And you can see that the majority of countries where we’re seeing this current outbreak is countries where previously we had not seen cases of monkeypox. In the US, this is the picture for states. And we could see that California, New York, Texas, Florida, those are the states with majority of cases. Minnesota is right in the middle in terms of cases. And as of today we were at 178 cases. And this is the curve for Minneapolis. So these are Minneapolis residents, cases in Minneapolis residents, and you can see that we had, it may appear that we are tailing down, cases are getting less, but we’re not really sure. It’s I think a little too early to tell. So we are at 178 cases in Minnesota, and 84 of those cases are among Minneapolis residents.
Luisa Pessoa-Brandao, City of MPLS (00:44:58):
And I think that’s it. So in terms of epi, I wanted to also say that we are seeing some disparities in the diagnosed cases, and while still in numbers, the majority of cases are among our white residents, we are seeing a disproportionate impact among African American and Black individuals as well as Hispanic. Where the percentage of cases, the percent that they are of the cases is much higher than what we’d expect if we were just looking at the population, so definitely some disparities there.
Luisa Pessoa-Brandao, City of MPLS (00:45:43):
So we need to make sure that the message is getting out in terms of also vaccination and who is at risk. I know that my team, we’ve tried to do some radio shows with Spanish speaking radio and Somali radio and KMOJ to get at different communities who might be impacted, and may not be… Trying to get the information out, so that it’s also to the general population. So that’s what I have, and I’m happy to take questions or we can move on, so that Pam and talk about prevention and vaccination and that.
Speaker 1 (00:46:22):
And Bill asked if, is this mainly [inaudible 00:46:25]-
Derek Johnson-Dean, MPLS POX Taskforce (00:46:27):
I’m sorry. So there’s a question in the other areas of the world, is this affecting mainly the MSM community?
Luisa Pessoa-Brandao, City of MPLS (00:46:36):
So in Europe and in the current outbreak, yes, it is still mostly men who have sex with men. And males, I think the last time I had looked make up about 90% of the cases at this time.
Keith Henry, MD, Hennepin County/Clinic 555 (00:46:54):
Well, I just mentioned that prior to this outbreak it was often in somewhat younger people. The average age in the first several decades was around 10, and then there may have been some mutations that took place and it kind of was slowly getting older and older, starting to overlap the ages of sexual activity, even prior to the current worldwide epidemic. So in Africa it had quite a different epidemiology and still does compared to the outbreak we’re currently experiencing.
Derek Johnson-Dean, MPLS POX Taskforce (00:47:30):
So I just want to share what we’re tracking on the Minneapolis POX about just the numbers in Minnesota. Can you guys see that?
Speaker 1 (00:47:43):
Yes.
Derek Johnson-Dean, MPLS POX Taskforce (00:47:43):
Okay. So as I’m looking at this Luisa, I mean can you glean anything from this? It sort of looks like things are not plateauing at all. Is this [inaudible 00:48:04]-
Luisa Pessoa-Brandao, City of MPLS (00:48:03):
So that’s cumulative cases, so that is always going to be going up. I mean we’re seeing a-
Derek Johnson-Dean, MPLS POX Taskforce (00:48:11):
Yeah, exactly.
Luisa Pessoa-Brandao, City of MPLS (00:48:11):
… fairly steep… We’re seeing a very steep increase. I mean what I would expect is that, hopefully, soon if we are able to get more vaccine out, we’ll start to see what New York and California and some other states that have had more vaccine distribution are starting to see, which is both change in behaviors but also just the curve, while still going up, starting to plateau.
Luisa Pessoa-Brandao, City of MPLS (00:48:41):
We are definitely still on an upswing and unfortunately don’t have… But I think the last time I looked at positivity rate for the US we were still at something like 25%, meaning that for every four people that get tested, one is positive, which is extremely high. I don’t know if you guys recall, but when we were talking about COVID, a 5% positivity rate was a cause of concern. So a 25% positivity rate is cause for concern. And that still shows that we need more people to be tested so that there’s still a lot of people out there that are at risk and maybe have been exposed and that are not getting tested. We do have more access to testing. In the beginning, I think part of why our numbers were also slow in growth was that we didn’t have much availability of testing and that has changed. So I think that is one most people should be able to get tested. The other piece is testing is better once you have a rash, really the testing is by getting a scrape of the rash, and that’s how you test. And so sometimes people may not realize or may not see a rash, and they have other symptoms. So really important to consult with the healthcare provider if you think you might have been exposed and to look at that. And get tested.
Derek Johnson-Dean, MPLS POX Taskforce (00:50:16):
I have two more questions for Luisa, then we’ll move on. The other one is, can you talk about what occurred, and what I’m hearing people say, “Oh, monkeypox isn’t an issue anymore, it’s kind of going away.” Could you talk about what was happening in New York and California that kind of brought the numbers down?
Luisa Pessoa-Brandao, City of MPLS (00:50:36):
I wouldn’t say that it’s not an issue in those places. I think-
Derek Johnson-Dean, MPLS POX Taskforce (00:50:40):
Yes.
Luisa Pessoa-Brandao, City of MPLS (00:50:42):
… what happened in those places was one, their cases were about a month and a half behind, and they had large communication initiatives, and a lot of vaccination events. So what has been seen, and so one is uptake of vaccination among the MSM has been high. And then the other piece is that there has been some change in behaviors and people have taken the harm reduction, the prevention messages to heart, and try to figure out a way to minimize risk of exposure.
Luisa Pessoa-Brandao, City of MPLS (00:51:36):
We know how to prevent monkeypox. It is not like COVID, where, yes, you’re wearing a mask but someone is not, someone else is not, and it’s out there and transmission is much easier. So we know how it gets transmitted, that skin to skin contact, so you know how to make sure that you’re minimizing your risk and having that-
Luisa Pessoa-Brandao, City of MPLS (00:52:03):
Make sure that you’re minimizing your risk and having that conversation with your partners, getting vaccinated. So I think that there’s been communication and people have changed their behavior somewhat. Although still what we’re seeing even in those cities is yes numbers are coming down, but there’s again, significant disparities and we need to be careful to say that we’re getting it under control because it might be under control, the overall picture, but in certain communities it may not be exactly under control.
Keith Henry, MD, Hennepin County/Clinic 555 (00:52:37):
I would just add that many times an epidemic like this, the highest risk people get infected early. And if they’re getting infected early, then the pool of non-infected is at lower risk. And then if you have aggressive education and vaccination, then you see a peak and then somewhat of a plateau. And that’s what happens with many of the highest risk people, manifest it and then they’re no longer at risk because they’ve had it already. So that’s another issue that plays into it in certain populations.
Patrick Ingram (00:53:11):
I’d like to also jump in here if possible. I think a couple of things for consideration. What we do know, the science suggests that vaccination while important, isn’t foolproof. There is still a window of opportunity to be exposed and subsequently infected with Monkeypox. And so the participant who talked about being at a club, I think community should be cognizant that even if you’ve had one vaccination, you are still at risk to be diagnosed with Monkeypox and we have seen that in our clinic.
Patrick Ingram (00:53:46):
While one dose of vaccination does significantly decrease the severity of symptoms, it’s still happening. I think that most importantly, especially as it relates nationwide as well as in Minnesota, is that although we are seeing high uptake of the vaccine among gay, bisexual and other men who have sex with men, that’s predominantly white men. So I think there should be considerable conversation about disparity as it relates to uptake among folks of color.
Patrick Ingram (00:54:20):
I pulled some data from Red Door specific vaccination and testing that we’ve had so far with folks within the Minneapolis region. And so out of 39 positive cases that we have so far in every Minneapolis zip code, 20% of that number are black, 20% of that number is Hispanic or Latinx. And although 46% of that number is white, again understand that folks of color make up a significantly less percentage of the population for Minneapolis.
Patrick Ingram (00:54:53):
And so I think that even when we look at vaccination rates, out of the total number of vaccinations that we’ve had so far for individuals who reside in Minneapolis, at Red Door that’s been 1,959. Of that percentage only 4% are black and 5% are Hispanic or Latinx. And so significant efforts need to be made to increase uptake among a vaccine for Monkeypox among communities of color. But more importantly, conversations in education and trust.
Patrick Ingram (00:55:24):
We’ve seen significant disparity among African American and Latinx communities as well as other communities of color. And these are only exacerbated when we are dealing with outbreaks, epidemics, and pandemics. We have historically seen this within STIs like syphilis and HIV and more recently with Covid 19. And so Monkeypox is no different in the state of Minnesota. We’re seeing large number of African Americans and Latinx folks being diagnosed. And again, they’re representing smaller percentages of the total state population. And we’re seeing that same figure within Hennepin County in Minneapolis. And one of the things I’d love to say is that we are acknowledging this disparity and we’re addressing it and working hard to focus on this and looking at this in an equitable lens. And from the beginning of this outbreak, staff have pressed a leadership and sometimes in some uncomfortable ways, but have pressed leadership to have this focus.
Patrick Ingram (00:56:20):
And it is focus on ensuring that we are holding space for bipart and marginalized communities. And so one of the examples that I love to step in and talk about is the fact that our prep team has worked to really dive in to reaching out to these communities. Our prep team sees folks ranging from individuals who are within their LGBTQ+ community as well as folks who either inject drugs and or engage in sex work. And so we’ve reached out to over 700 of our clients who receive prep in under two weeks, and we’re able to get over 400 folks vaccinated.
Patrick Ingram (00:56:57):
And our total clinic numbers currently right now have been that we have been able to successfully administer 4,625 doses of vaccine. And that’s representative of more than 75% of vaccination efforts that are taking place within the state. And so again, I stress that partnerships and working with community is important and Red Door is working on that.
Patrick Ingram (00:57:20):
But for anybody on this call, I say that we really need to band together and more importantly have co-ownership and a response not only during a public health emergency such as Monkeypox, but continuously working towards STIs, HIV, and other disparities that impact communities of color on an everyday basis. And if you’re listening or you’re on this call, you have not reached out or you’re interested in collaborating with Red Door or any of us, please reach out. I’ll put my information in the chat. We want to ensure that we can get shots in the arms.
Patrick Ingram (00:57:53):
I think that’s the priority in the message that I’d love to bring to this conversation tonight, as a primary prevention method. But there is disparity, the data doesn’t lie, and it’s really important that we focus efforts on increasing uptake of vaccine amongst communities of color.
Keith Henry, MD, Hennepin County/Clinic 555 (00:58:12):
I’m just going to add something to what Patrick said.
Derek Johnson-Dean, MPLS POX Taskforce (00:58:14):
No, no and then I want to hear from Pam, go ahead Dr. Henry.
Keith Henry, MD, Hennepin County/Clinic 555 (00:58:19):
As far as HIV status also, persons that are testing positive for Monkeypox are overrepresented being HIV positive. A recent CDC study just published in the last month, 38% of persons during a time period that tested positive for Monkeypox were HIV positive. And for the African Americans that tested positive for Monkeypox, 63% were HIV positive. For Hispanics, it was 41% and for white it was 28%. Again showing how you have the cumulative disparity concentrated, and this is another classic example of that. So again just to mention that all the HIV clinics should be aggressively vaccinating for Monkeypox if they’re not doing so already.
Derek Johnson-Dean, MPLS POX Taskforce (00:59:16):
Thank you Dr. Henry. Pam, what are you guys seeing in the clinic? You guys were the first clinic to diagnose and doing most of the vaccinations.
Pam Layton, CNP, Red Door Clinic (00:59:29):
Yeah June 24th we had our first case, I actually saw that patient here in clinic. And we were seeing things that we had never seen before. Doing this for 16 years you can look at a lesion and get a sense of what’s going on, and it just was different this time. So it’s just built, and we have just mobilized our resources and our staff to really attack this outbreak right now. And just to piggyback on some of the data that was given, we have Red Door specific, information.
Pam Layton, CNP, Red Door Clinic (01:00:14):
22% of our positive cases are HIV positive, so that’s our statistic. And the other part of this is 35% of the positive cases have had a STI diagnosis within the past 12 months as well. So I think we’re the right place to be really addressing this, and people have a comfort level coming to the Red Door that we’re really happy about. And we’re really trying to take care of the patients that are coming here and address the symptoms in a really aggressive and human kind of way.
Derek Johnson-Dean, MPLS POX Taskforce (01:01:02):
Pam, can you humanize this?
Pam Layton, CNP, Red Door Clinic (01:01:07):
Yeah. So when people come in they’re miserable, they have lesions on their face, on their hands, it can be very upsetting. Not to mention if you have proctitis, which is terrible rectal pain. We also have people with mouth sores and sores in their throat. Some people can just get a few lesions, but some have lesions from head to toe. So we’ve really made an effort to supply supportive care to these clients and we are actually stocking those in the clinic for people who are uninsured. We have lidocaine, all different strengths, ointment and also oral suspension if people want to make a magic mouthwash for the oral lesions that they have. And for the proctitis we’re utilizing Gabapentin, it helps with nerve type pain. We’re also using a narcotic that won’t increase constipation, which narcotics historically can do. So we also have our stock in Colese to help with bowel movements so it’s easier.
Pam Layton, CNP, Red Door Clinic (01:02:48):
And also Domeboro Soaks to put in your bath water, so you can sit and helps soothe and take away some of the itching. We’re also sending prescriptions to the pharmacy for things like Vistaril to help with sleep, to help with itching and discomfort if Benadryl isn’t helping, and we’ve stocked Benadryl here as well. So we’re giving patients these supportive care packs so to speak, to help with their symptoms. There’s also TPOXX which is an antiviral medication, but it’s not for everyone, it’s really reserved for the people that have a severe case.
Derek Johnson-Dean, MPLS POX Taskforce (01:03:38):
Pam, may I ask? So I’ve heard that before, “Not for everyone.” What does that mean? Are there side effects or…?
Pam Layton, CNP, Red Door Clinic (01:03:45):
Well the thing of it is, it’s an experimental drug for Monkeypox. It’s not specifically indicated for Monkeypox, it’s more for Smallpox. But people have used it and they’re getting good results with it. When you are prescribed it here, there’s a consent form you have to sign. You’re signing up to be part of this experimental drug. And we’re learning as we go, we truly are. And all of the information… Our clients have been amazing. We work with our disease investigators here very closely and they’re doing partner and getting contact information so we can get contacts in and get them vaccinated as soon as possible.
Pam Layton, CNP, Red Door Clinic (01:04:43):
We’re also giving information to the Department of Health. The patients are interviewed three weeks after they start TPOXX, so we can get the information on the disease progression. Did it slow it down, did your symptoms get better? At what day did this happen? And there’s a diary that they’re filling out and that goes to the Department of Health as well.
Pam Layton, CNP, Red Door Clinic (01:05:08):
So we’re really trying to get as much information as we can and our disease investigators get really detailed histories of where our patients have been and their contacts and things like that, and their social situations. And the Department of Health has been great in trying to provide assistance to people, get people food and necessities in their home when they’re isolating. And so it’s identifying those people and making sure that they get the things that they need. So it really has taken an effort from everyone to slow this thing down.
Derek Johnson-Dean, MPLS POX Taskforce (01:05:53):
And what were things like at the clinic as far as number of patients before Monkeypox versus after? I used to work at Red Door, so the numbers that I’m hearing, 150 people you’re vaccinating a day.
Pam Layton, CNP, Red Door Clinic (01:06:14):
Yeah so when I talked about mobilizing our efforts, we have four nurses full time that we have brought in that are vaccinating people every 10 minutes. One day we vaccinated over 180 people in one day. There are appointments that you can get same day. In the beginning, no it was not the same. That’s when we were doing the intramuscular or the IM shot, and using a whole vial of the vaccine. And we had to use it sparingly. So if it was for people who were contacts or had more than two partners in the past two weeks, there are certain criteria.
Pam Layton, CNP, Red Door Clinic (01:06:55):
But now that we’re doing the intradermal, we’ve multiplied that by five, we’ve opened it up to everyone. If you are MSM, come and get your vaccine, you can get one that day or the next day, that’s how many appointment slots we have. Next month we might go down to three nurses. We’ve seen a little bit of hesitancy with some of our patients too, around getting vaccinated. So that’s I think probably on the heels of Covid, which is…
Derek Johnson-Dean, MPLS POX Taskforce (01:07:40):
Yeah I’ve been on social media and a lot of the other apps and I got a lot of questions in the beginning. Where should I go for a vaccination? And it’s just flat line. And talking with people, they’re like, “It’s not going to kill me, so I’m not going to worry about it.” Pam there’s a question for you. A question for Pam. What are the questions and concerns you are hearing from patients in the clinic? What do you tell them to reassure them? And what do you do for symptom management?
Pam Layton, CNP, Red Door Clinic (01:08:13):
So yeah I talked a little bit about the symptom management, for the itching, the pain, the pain medicine, the Lidocaine. Covering the lesions to minimize any scarring that might happen. Let’s see… But the other thing is resuming sexual activity. You become not contagious once the lesions have completely healed, the scabs have fallen off and you have new skin. This can be up to four weeks. But like I said we’re learning as we go. They’re thinking semen, the bodily fluids still may be a reservoir for this infection. So what the CDC is currently saying, even after all your lesions are gone, to minimize your bodily fluids for eight to 12 weeks after you’ve been cleared by the Department of Health.
Pam Layton, CNP, Red Door Clinic (01:09:26):
And the other message we’re trying to give people too… We’re an ally to this community that’s being largely infected with Monkeypox and we’re really trying to make all of our efforts to support people, but we also have to give a realistic message too. 95% of the cases have been through sexual contact. We know that, that’s what the data is saying to us okay. Limit your number of partners, limit group exposure with sex. You just have to get down to it at a certain point. And we don’t want to stigmatize any group or anything, but we also have to be really clear and look at the data. Oh the lights in the clinic just went out.
Derek Johnson-Dean, MPLS POX Taskforce (01:10:22):
It’s eight o’clock isn’t it? Some other questions, are you administering vaccinations out of the clinic at the moment?
Pam Layton, CNP, Red Door Clinic (01:10:30):
Every 10 minutes, yes.
Derek Johnson-Dean, MPLS POX Taskforce (01:10:33):
Outside of the clinic?
Pam Layton, CNP, Red Door Clinic (01:10:33):
Outside of the clinic.
Patrick Ingram (01:10:35):
So I can dive into that a little bit, and I apologize for the darkness. Our initial efforts were more stationary, we were vaccinating in the clinic, and Red Door recognizes that people have work life balances. And before I get to that point, I just definitely want to reiterate that we are offering same day appointments. So it is not difficult at this time to reach out, contact us at 612 543 5555, and talk to a person of staff and get an appointment same day. Mondays all the way through October, we have evening clinics up until 6:00 PM where we are seeing folks. We acknowledge that during the regular workday it’s hard to get in to be seen, so we are offering that as well. And we listen to community. So if demand is high Monday evenings, Red Door is in the position as well as our leadership is in a position to expand that time slot to 8:00 PM. So it just really depends on demand and I would love to be in a position to do that.
Patrick Ingram (01:11:36):
Although we are not currently doing any kind of external testing off of site, our leadership is having discussions about that. So it is in consideration it’s just in planning, it takes time. And if you all aren’t aware, Aliveness Project is doing a Monkeypox vaccination clinic tomorrow at their location. That’ll be between the hours of 9:00 AM to 12:00 PM and then again 3:00 PM to 7:00 PM and that’s first come, first served. So again, the Aliveness Project tomorrow will be vaccinating. So community partners-
Derek Johnson-Dean, MPLS POX Taskforce (01:12:12):
Do you know what their criteria is? Because Red Door is different than Clinic 555 and then other clinics?
Patrick Ingram (01:12:19):
Yeah. I don’t know their particular criteria at this time, but what I can do, I can attempt to look at that and I can definitely get that information back to you for sure.
Keith Henry, MD, Hennepin County/Clinic 555 (01:12:28):
Can I just add, Clinic 555 has the same criteria as Red Door and we have walk in capacity and we feel like we’re being underutilized. So over in St. Paul, you can [inaudible 01:12:41] we’ll be able to handle it very easily at 555.
Derek Johnson-Dean, MPLS POX Taskforce (01:12:46):
So Dr. Henry the last information that I have, the criteria at Clinic 555 is you either had to be HIV positive on PrEP and exposure and they were… Not anymore?
Keith Henry, MD, Hennepin County/Clinic 555 (01:13:01):
No, we’ve adopted the Red Door criteria.
Derek Johnson-Dean, MPLS POX Taskforce (01:13:05):
Okay. Okay, very good. That’s good to know, we’ll change that on the website then. Question about-
Pam Layton, CNP, Red Door Clinic (01:13:16):
Our positivity… Oh sorry, I was just going to add-
Derek Johnson-Dean, MPLS POX Taskforce (01:13:20):
No go ahead, please go ahead, go.
Pam Layton, CNP, Red Door Clinic (01:13:23):
Our positivity rate is higher than the state, I think it’s because of what we do at our clinic. So we’ve tested 175 people and we’ve had a 38% positivity rate here out of our clinic, so that is significant.
Derek Johnson-Dean, MPLS POX Taskforce (01:13:48):
This is a question, is there a role for incentivizing vaccinations?
Patrick Ingram (01:13:53):
That’s a great question. I think that at this point, that is something that our prevention team is consistently discussing. And I know that again, with that particular level of planning, it does take time and resources. But in the meetings that we’ve had with community members, that is something that comes up consistently, especially when we dive into more marginalized communities and communities of color. They want something, if they’re going to be giving their arm or their time and effort, they want to be compensated for that and I think that’s fair.
Patrick Ingram (01:14:24):
But again, one of the things that I suggest is, community feedback is real and it’s valuable and it’s tangible. So if you are a community member and you feel like you should be compensated with some level of incentive, by all means provide that feedback because it goes a long way. Like I said, at Red Door we take community feedback seriously. We’ve had consistently over the years focus groups and customer combat comments and feedback that we leverage. And I think in general, any organization would do the same. At this point, we’re not at the position of doing that. But again, its continuous discussions. And if that is to change we would definitely ensure that Derek, your organization is made aware of that as well as our community partners, as well as the overall community.
Derek Johnson-Dean, MPLS POX Taskforce (01:15:10):
Okay, good. There’s a question here about, are different marginalized communities aware of how Monkeypox is primarily spread? I know in the couple of presentations that I have done at organizations predominantly of color, what I have heard is that the first information that they had about Monkey Box was actually me coming in. So I don’t know if Pam, Patrick, or anyone else has any comment on that?
Patrick Ingram (01:15:45):
I can take a stab-
Luisa Pessoa-Brandao, City of MPLS (01:15:45):
I just wanted to-
Patrick Ingram (01:15:45):
Oh go ahead, I’m sorry.
Luisa Pessoa-Brandao, City of MPLS (01:15:50):
Oh no I was just going to say, that’s what we’ve been trying to do through the Minneapolis Health Department. We’ve reached out to some of our community partners that work in communities that may not be getting the information, because we wanted to get out accurate information. And a lot of people were thinking this was like covid. And so really getting out the information of how it’s transmitted, how it is spread so that people could have accurate information.
Luisa Pessoa-Brandao, City of MPLS (01:16:21):
So we’ve been trying to do that through partners that we work with, [inaudible 01:16:25] Clinical Partners, and meeting with different groups like school nurses. And we were at the Trans Equity Summit last week and like I said, doing some of the cultural radio shows to ensure that that information is getting out. But I’ll pass it on to Patrick.
Keith Henry, MD, Hennepin County/Clinic 555 (01:16:49):
Oh, we lost Patrick. Anything else?
Patrick Ingram (01:16:54):
I’m still here. So yeah I would say in our conversations with folks, especially with communities of color and marginalized communities, there is work to be done to get that information out there. Our clinical team and our outreach team has done tremendous work to ensure that folks are educated and made aware of Monkeypox and its impact on our community. But again there’s a different level, especially with the particular percentage of the folks who have not had vaccination yet, there is a level of lower health literacy.
Patrick Ingram (01:17:27):
And so it’s about making those efforts to just ensure that we’re meeting people where we’re at. We’re talking with people about Monkeypox at a level that they understand. And really being sex positive. One of the things that I acknowledge is that sex is pleasure, but one of the things that our prevention staff does a really good job at doing even outside of Monkeypox as it relates just overall sexual health, is talking about harm reduction and its strategies. Again although the primary strategy is vaccination, like I’ve said before, and we have plenty of it at Red Door, we talk about harm reduction techniques…
Patrick Ingram (01:18:03):
… and we have plenty of it at Red Door. We talk about harm reduction techniques such as condoms, eliminating exposure to fluid exchange, normalizing conversation about sexual history and previous diagnoses of STIs. More importantly, more than anything, at this point, we’re counseling clients that come through the door about the benefit of being mindful of sex, circuit, and even fetish parties, having conversations about how to reduce your harm if you were to attend those events. Inviting people to dive into kink, engaging in latex or leather to cover up skin, if they’re concerned about being exposed to monkeypox in these scenarios. Telling folks if they’re traveling, to be just mindful, especially when we had market dates, just telling people to be mindful of bathhouses or locations that have group sex. We just try to meet people where they’re at and we do a great job at that. I encourage anyone, if you want to dive deeper into conversations about how you can reduce your harm as it relates to STIs, or even monkeypox, to stop by Red Door, ask for somebody on the prevention staff and we’d be more than happy to chat with you about ways that you can reduce your harm.
Derek Johnson-Dean, MPLS POX Taskforce (01:19:24):
Questions are coming in fast and furious, this one is related. My doctor says I should wait for sexual activity until I am vaccinated, however my doctor is telling me that I’m not at risk enough to get a vaccine. I have a camping trip with a friend, we’ve been waiting for two years to be intimate, and I want to be able to be able to abstain. What are my options? What I’m gathering is, it sounds like this individual is meeting somebody… Dr. Henry, we having conversations before saying that everyone just needs to go in and get vaccinated. That would be great, but not everybody has access to it, so making sure that we have messages for people who either can’t access vaccinations or, for whatever reason, have decided that they’re just in a position that they’re just not going to wait.
Derek Johnson-Dean, MPLS POX Taskforce (01:20:40):
I’ve gotten a lot of emails from people saying that they really appreciate two of the links on our website that really talks about harm reduction and really gets away from, “Stop having sex.” I asked about 20 gay men, “What is the one thing that you have heard about monkeypox, as it relates to you as a gay man?” Everyone said that the message is, “Stop having sex.”
Luisa Pessoa-Brandao, City of MPLS (01:21:12):
I would say think of other ways that you can be intimate that maybe will reduce risks, some of the things that Patrick mentioned, joint masturbation, so that you’re together but you’re not having that skin-to-skin contact. Having honest conversations and talking about the risk that you have been at and that your partner might have been at. So, some of those pieces, I think we are also thinking harm reduction, telling people not to do something has not proven effective ever.
Derek Johnson-Dean, MPLS POX Taskforce (01:21:50):
Ever.
Luisa Pessoa-Brandao, City of MPLS (01:21:50):
So, really thinking about how to do that in a way that you can have that conversation and to still be able to be intimate, especially in a situation like that, and if you’re concerned about getting the vaccination or you don’t want to get the vaccine at this time, but-
Keith Henry, MD, Hennepin County/Clinic 555 (01:22:12):
Derek, I wanted to show a few photos to monkeypox a little bit. So, we talk about the sex part, but I want to share the screen to give people an idea of lesions that are infectious that are not located anywhere near the groin. I’m trying to get my screen up. Let me see if I can do that or not.
Derek Johnson-Dean, MPLS POX Taskforce (01:22:36):
I see it, yep.
Keith Henry, MD, Hennepin County/Clinic 555 (01:22:39):
Do you see it?
Derek Johnson-Dean, MPLS POX Taskforce (01:22:39):
Yeah.
Keith Henry, MD, Hennepin County/Clinic 555 (01:22:42):
So, these are just some oral lesions. I’m going to go through different areas of the body. This one looks like just an angular cheilitis with the red arrow, but these are some of the oral lesions that have been reported. These were from an international study from the supplement in the recent Neumo Journal paper. Here are some very subtle ones, hand. They’re still getting positive monkeypox out of that. Hair lesions, it might be almost like a pimple or a seborrheic. And then day six, again, they’re recovering from monkeypox, from these lesions.
Keith Henry, MD, Hennepin County/Clinic 555 (01:23:27):
I’m just going to show one more slide. Very subtle, showing an evolution, this is day 5, day 9, day 22. There’s still a lesion there, so that would still be infectious, they’re still recovering it. Here are just some finger lesions. So, again, nowhere near the genital area, so you just have to think in terms of skin lesions. I believe Pam was talking about some of the unusual areas and the diffuse, but sometimes these are the only lesions people have had, I should point that out, and it could evolve further. So, again, the discussion needs to be a little bit broader than simply avoid genital contact, that’s my point.
Derek Johnson-Dean, MPLS POX Taskforce (01:24:22):
So, Pam, from what you guys are seeing, are these some typical presentations? Did we lose Pam? Is anybody there?
Patrick Ingram (01:24:35):
I think Pam needs permissions to be able to get on and share video and audio. But in the meantime, what I can say is that, in this particular scenario, I would have that person please call us at Red Door. Again, one of the great things about being able to utilize more vaccination is that we are in the best position to be able to slowly begin to open up eligibility. One of the things that we’ve heard is that folks really had some criticism and feedback about being asked about number of partners they’re having sex with as it relates to eligibility for vaccination, and so we’re not diving into those specifics. We’re following the guidance that we’re obtaining from MDH, which are people who have been exposed to monkeypox, who living with HIV, men who have sex with men, those who are trans, and others who are at high risk.
Patrick Ingram (01:25:29):
At Red Door, we are leveraging, as well, we recognize risk surrounding folks who engage in sex work and those who are folks who inject drugs. The thing is, if you meet that criteria, by all means, give us a call, reach out to us, and we want to see you because we want to vaccinate. The only thing I would say, before I pass it to Pam, is that just be cognizant of the fact that it depends on when your camping trip is. So, if you’re getting vaccinated today and you’re going camping this weekend, recognize that the vaccine hasn’t been able to do its job. It hasn’t been able to build up an immune response, so understand that there still is risk associated with acquiring monkeypox.
Patrick Ingram (01:26:15):
Those images are fantastic. Be on the lookout for things that look similar to that, have great conversations with this particular partner. If you’ve waited this long, it sounds like that there’s great level of connectiveness, so talk to one another. Again, I think that one of the things that we shouldn’t be doing is forcing people to stop sex, but I think it’s important and critical to understand that abstinence is a powerful tool. But understand that there are different methods that you can utilize to reduce your risk, if that’s just not an option for you.
Derek Johnson-Dean, MPLS POX Taskforce (01:26:51):
Pam, I was asking, I don’t know if you saw the slides that Dr. Henry had. Would you say that those are some typical presentations that you-
Pam Layton, CNP, Red Door Clinic (01:27:00):
Very typical, especially the ones on the hand. We had a guy where his only symptom was one of those pustular lesions on his toe. I had a guy with a lesion on his thumb that tested positive. So, yes, we are seeing diffuse, but we’re also seeing just a couple, one or two on the hands, for sure.
Derek Johnson-Dean, MPLS POX Taskforce (01:27:27):
And then, Pam, could you, or somebody, speak to a number of hospital… Last I looked, there were four hospitalizations. What are people being admitted for?
Pam Layton, CNP, Red Door Clinic (01:27:46):
Mainly for pain control, I think, it’s the proctitis. I had a young guy in here with the proctitis and I almost started crying, he was just sobbing. But he also, after we got his positive monkeypox results back, he also had rectal chlamydia and gonorrhea, as well. So, I think it’s probably the pain management. I think he was on the borderline there.
Keith Henry, MD, Hennepin County/Clinic 555 (01:28:21):
Clinicians got a letter from Rachel Lewinsky from the CDC basically talking about proctitis, severe lancinating pain, defecation is painful, and possible dysuria. It may required catheterization, oral pharyngitis, limited oral intake. Pain control has been the most common reason for hospitalization nationally and people tend to overlook that.
Derek Johnson-Dean, MPLS POX Taskforce (01:28:46):
Well, so much so that I think, at first, those hospitalization, I don’t know whether they were just coded as pain or whatever, but I was talking to people who were in the hospital and MDH was saying, “No one’s been hospitalized,” so it’s interesting that they’ve finally done that. So, we’re going to start wrapping up. I think we’re-
Pam Layton, CNP, Red Door Clinic (01:29:10):
Well, can I say one thing, Derek, that’s important, especially with the new booster coming out for COVID?
Derek Johnson-Dean, MPLS POX Taskforce (01:29:16):
Yeah.
Pam Layton, CNP, Red Door Clinic (01:29:17):
You can get a monkeypox vaccine and a COVID vaccine, there is extremely low risk. What the risk has been, why they haven’t done them together, is myocarditis.
Derek Johnson-Dean, MPLS POX Taskforce (01:29:32):
Which is?
Pam Layton, CNP, Red Door Clinic (01:29:34):
An infection around the heart, but it’s very low risk for both, so getting them together, the CDC now is saying that is okay, you can do that. So, as we get people in here to give them their monkeypox vaccine, we’re also vaccinating people for a lot of other things, for HPV, hepatitis B, and now, with the COVID boosters coming, we can do that, as well, at the same time,
Derek Johnson-Dean, MPLS POX Taskforce (01:30:03):
I think you just answered this question. It says, “Have people coming in for monkeypox testing vaccination also been connected to services like PrEP, STI testing, or vice versa?”
Pam Layton, CNP, Red Door Clinic (01:30:15):
Oh, absolutely. Yes, yes, yes.
Derek Johnson-Dean, MPLS POX Taskforce (01:30:20):
We’ve been talking a lot about the patients at Red Door, but this is just for the group, if you land at the Red Door, you’re going to be treated well, you’re going to feel like you’re heard, you’re going to get help with symptoms. That’s not happening elsewhere. Honestly, if you look at some of the information of medical providers responding to monkeypox, it’s actually rather sickening.
Pam Layton, CNP, Red Door Clinic (01:30:55):
I’ve had several patients come here, they leave their primary care or leave the emergency room and they’re coming to the Red Door. They’ve been given no type of supportive care, which that’s not okay. This can be very uncomfortable.
Derek Johnson-Dean, MPLS POX Taskforce (01:31:19):
I just have to say, from everyone that I have talked to, the community has said that they owe Red Door a just tremendous amount of gratitude, of feeling like they could just show up and they’re all coming in masses. You guys did a really good job of sorting it out and making sure that everyone got in.
Pam Layton, CNP, Red Door Clinic (01:31:42):
Well, every single day-
Derek Johnson-Dean, MPLS POX Taskforce (01:31:43):
So, I’m talking with people, what they’re been told is, “Make sure that you tell Red Door, thank you,” so thank you.
Pam Layton, CNP, Red Door Clinic (01:31:52):
That’s awesome. We’ve appreciated the cooperation of all of the patients that we see, as well. It’s a partnership, and they’re giving so much to the medical community and to the CDC, so it’s awesome. And we are, we are here for these clients as we’re getting through this outbreak. Every day, we have a nurse practitioner who is just focused on monkeypox. She takes all the symptomatic monkeypox that day, all the calls and the patients that come in that day, so we’re really making an effort.
Patrick Ingram (01:32:33):
I will say two things. In line with that, our staff has been working overtime. This has not been easy. There have been long days that me and my colleagues sit back with the nurse practitioners after 4:30, well until the evening, because we care. It takes people who really care, especially to be there for folks in the middle of something like this. A special shout-out to our front desk staff, the folks who are handling these calls. At times, when we first began vaccination, we had thousands of calls and the voicemails that they had to dive into, and we just really appreciate folks’ patience as we responded. I think it just shows that it takes a village and this village is full of people that care.
Patrick Ingram (01:33:28):
For folks who are, I say this as somebody who’s been living with HIV for 10 years, who is Black, who is gay, and has struggled navigating health systems, I think it’s about being empowered to speak up for yourself and telling it like it is. So, if you’re dealing with a provider that’s not meeting your need, you should not be paying them, you should not be running your insurance through them. I think you have to be empowered enough to find a provider that’s going to take the time to listen to you, openly and actively hear you, and address your concerns with a specific plan that meets you where you’re at. If you’re not able to obtain that, by all means, in the interim, we would love to see you at Red Door, come by and stop by. But that should be the standard for anyone trying to access any level of care, whether they’re white, Black, queer, straight, non-binary, trans, regardless, you should be getting empathetic care that’s centered around you.
Derek Johnson-Dean, MPLS POX Taskforce (01:34:23):
And then one of the questions that I will answer is, well, this was two weeks ago and there’s only 125 cases, well, it’s only 178 cases. Well, if you or your loved one is one of those 178, you really want to make sure that they’re getting really good care. When you hear about the symptoms and the suffering, I just don’t know how you’re not motivated to want to do something. So as we’re getting ready to leave, as we’re getting ready to close here, could each one of you go through and say one thing that you hope the audience has taken away from this forum?
Pam Layton, CNP, Red Door Clinic (01:35:08):
I can start. I hope that everyone on this call knows that the Red Door can be a resource for you. If you need information, if you want our regimen and what we’re doing for supportive care for our patients, we’re happy to share that with you. We have a clinical lead who is available to do a lot of those things.
Luisa Pessoa-Brandao, City of MPLS (01:35:42):
I hope that the information that we shared was helpful and that it answers some of the questions that people might have, and if it brought up additional questions that you reach out to one of us. I will be putting my information in the chat. We’re here to answer questions and help in any way that we can.
Derek Johnson-Dean, MPLS POX Taskforce (01:36:02):
And then, just to let you know, I’m going to follow-up with a survey and we’ll have all of our contact information in that survey, so people will be able to get that. We’re also recording this and we’ll have a transcript available, at some point. Dr. Henry, one thing you would hope people would take away from this?
Keith Henry, MD, Hennepin County/Clinic 555 (01:36:25):
Sure. Clinic 555, I think, is being underutilized, and so-
Derek Johnson-Dean, MPLS POX Taskforce (01:36:30):
Is he frozen? It looks like he’s frozen. Ope, there you are.
Keith Henry, MD, Hennepin County/Clinic 555 (01:36:37):
Clinic 555 is being underutilized. I think Positive Care is doing the same sort of supportive, sensitive approach to our HIV-positive population. I continue to be frustrated about the disparities that history keeps repeating itself time and time again. My whole career, I’ve watched this, and we need to rethink a lot of healthcare. You’re only as good as your weakest link, that’s one of my famous sayings, lectures. It doesn’t take much to drive patients away from healthcare and everybody should be aware of that, because we’re really still doing a pretty lousy job with communities of color. I’m frustrated.
Derek Johnson-Dean, MPLS POX Taskforce (01:37:25):
And Patrick?
Patrick Ingram (01:37:27):
Thank you. So, the major thing is vaccination, get vaccinated. I think that’s going to be the most impactful thing. And then just be cognizant of what monkeypox looks like and acknowledge that there’s a disparity out there of folks of color. Ask yourself this question, what can you do to help address the need for uptake among folks of color to get ahead of this and lessen the burden on folks of color, as it relates to monkeypox?
Pam Layton, CNP, Red Door Clinic (01:37:58):
And thank you to Derek, I want to say that.
Derek Johnson-Dean, MPLS POX Taskforce (01:38:02):
Thank you. Thank you.
Pam Layton, CNP, Red Door Clinic (01:38:04):
You have started this. And I’m amazed at how it’s grown and your passion for this work. I’ve worked beside you and I know how awesome you are and how connected you are to your community and just what a good friend and person you are, so I’m really thankful that you’re doing this
Derek Johnson-Dean, MPLS POX Taskforce (01:38:27):
As I’m looking, I think everyone is in the position that they need to be right now to make some change. I was telling people, if I were working in the field, there’s no way you’d have to get approvals and all these things to be able to get some of the stuff that we’ve done. So, the one takeaway that I would want is for people to know that the Minneapolis Monkeypox Taskforce is here as a resource. Obviously, we’re very committed, three volunteers here in the room. I view our role as trying to figure out what’s the gap? Maybe we can fill the gap or we can actually have build a bridge to have somebody else do that. We are working pretty hard on trying to get some vaccinations. St. Cloud is doing a vaccination clinic and that will be on the website tomorrow.
Derek Johnson-Dean, MPLS POX Taskforce (01:39:23):
Actually, Patrick and anyone else, there is another Pride fest in Columbia Heights on October the 8th, and I would love to share the booth with somebody, so we’ll talk more about that, as well. I think that’s it. Anything else? You guys want to say anything? No, no, no, no. Oh, I also want to say that on October 16th, I’m planning to have another forum. I’ve been in Minnesota all of my life and I’ve heard about the disparities that exist. I’m tired of hearing about them. I’m tired of talking about them. I want to get a group of people who we can actually take some steps, try some things. Try some things, maybe they fail, but we have to try something, we have to do something to start thinking out of the box. So, that’s it, thank you very much, and have a good evening. Thank you, everybody. Bye.
Pam Layton, CNP, Red Door Clinic (01:40:21):
Thank you.
Patrick Ingram (01:40:22):
Thank you.
Luisa Pessoa-Brandao, City of MPLS (01:40:22):
Bye-bye.