A communication transmitted from Yi-An Huang, City Manager, relative to Awaiting Report Item Number 22-54, regarding the Cambridge Public Health Department's response to monkeypox

TO: Owen O’Riordan, Interim City Manager FROM: Derrick Neal, Chief Public Health Officer, Cambridge Public Health Department DATE: August 30, 2022 SUBJECT: Response to Policy Order #13, adopted August 1, 2022 Excerpt of Order: That the City Council go on record urging citizens to take further precautions as suggested by the CDC and the Cambridge Public Health Department in regards to monkeypox; and be it further that the City Manager report back on ways in which we can prepare for a monkeypox outbreak in our city (testing centers, vaccine distribution, public outreach initiatives, etc.) as soon as possible. OVERVIEW The Cambridge Public Health Department (CPHD) is responding to the current monkeypox outbreak in collaboration with local hospitals and health clinics, universities, community organizations, neighboring communities, and the Massachusetts Department of Public Health. Monkeypox is a disease caused by the monkeypox virus, which was first detected in 1958. The virus often causes a painful rash and flu-like symptoms. Infections with the strain of monkeypox virus identified in the U.S. outbreak are rarely fatal, and most people fully recover in 2-4 weeks. Since the outbreak began in mid-May, there have been 18,101 monkeypox cases reported in the U.S., including 280 cases in Massachusetts, as of Aug. 29. Locally, there have been fewer than 10 cases reported among Cambridge residents. One monkeypox death in the U.S. was reported by the state of Texas on Aug. 30. The monkeypox virus is much less contagious than COVID-19. Transmission primarily occurs through direct contact with body fluids and monkeypox sores. In this outbreak, most cases of monkeypox have been associated with sexual contact. Anyone who has been in close contact with someone who has monkeypox is at risk. At this time, national data from the CDC suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the current monkeypox outbreak. The Cambridge Public Health Department shares the concerns of many in the public health and medical communities that the current monkeypox outbreak, if not contained, will spread to the broader population, putting a larger number of people at risk for infection and serious complications from the disease. Those considered at highest risk for severe complications from monkeypox include young children (under age 8), people who are pregnant or immunocompromised, and people with certain skin conditions. In addition, CPHD is concerned that monkeypox may disproportionately impact communities of color, which is already evident in the national demographic data for monkeypox cases.

2 STATE AND LOCAL RESPONSE TO MONKEYPOX OUTBREAK Prevention CPHD is providing information to Cambridge residents about how to prevent or reduce exposure to monkeypox and what to do if they are exposed or have symptoms, as well as news updates as the outbreak evolves locally and statewide. The department is also engaging in targeted outreach in collaboration with community partners. Targeted Outreach to Populations Currently at Greatest Risk for Infection • Since July 2022, CPHD has been in close contact with Cambridge shelter staff to provide information and guidance on safe practices around monkeypox, so that staff can communicate to shelter guests and staff, and identify any cases or contacts who need additional support. • Since July 2022, CPHD has been in close contact with area universities to gather information on their monkeypox planning efforts for fall 2022. CPHD staff have facilitated meetings with Harvard University Health Services and MIT Medical to collaborate on isolation plans and share up-to-date best practices. CPHD staff have also met with staff from Hult International Business School, and have meetings planned with Lesley University and Longy School of Music. • CPHD is engaging with health care organizations (e.g., CHA, Fenway Health), community-based organizations, and others who serve as trusted messengers in providing education and outreach to communities at the highest risk of exposure to the monkeypox virus or who could experience severe infection from the disease. Outreach to the Public • Monkeypox News Alert: On Aug. 1, CPHD wrote a monkeypox update for the Cambridge community, which was shared on the city’s website and the daily email update to residents. • Monkeypox Social Media Posts: Since early July, CPHD has been posting monkeypox prevention, vaccine, and treatment information on its social media accounts (Twitter, Facebook, and Instagram). • CPHD phone information line ([phone removed], press 8). CPHD public health nurses are available to: o Assist residents who do not have a health care provider with determining their eligibility for testing and vaccination, and assist with identifying a provider via Cambridge Health Alliance if interested. o Provide guidance to individuals on how to isolate safely and effectively. • Monkeypox Web Page: CPHD is preparing monkeypox webpage that will include news updates; and prevention, testing, vaccination, and treatment information. Case Follow-up and Contact Tracing Monkeypox is a reportable communicable disease in Massachusetts. The Massachusetts Department of Public Health notifies CPHD whenever a Cambridge resident tests positive, so that CPHD can initiate case investigation and contact tracing and support residents in isolation. On July 26, 2022, the Massachusetts Department of Public Health transitioned primary case investigation and contact monitoring responsibility to local boards of health. At this time, CPHD staff, in partnership with the North Suffolk Public Health Collaborative, are: • Initiating case investigation calls and providing guidance to people who have tested positive for

3 monkeypox, including how to safely isolate from household members to prevent spread and access health care and social services. • Identifying all high-risk contacts of people who have monkeypox and directing them to resources to receive a monkeypox vaccine when appropriate. Staff follow contacts for the duration of the 21-day monitoring period, and if they become symptomatic, staff facilitate testing at a health care location. • Connecting people in isolation to community resources including short-term financial assistance and food delivery from community organizations including Cambridge Economic Opportunity Committee (CEOC) and Jewish Family & Children’s Services, as well as connection to longer-term services, such as registering for SNAP, MassHealth, and other services where appropriate. Testing Testing is most appropriately conducted in health care settings, as the current available tests require swabbing of lesions, and often includes concurrent testing for other potential diagnoses. Monkeypox testing differs significantly from that for COVID, requiring more clinical training and privacy, for example, than walk-up clinics could provide. CPHD will help facilitate access to testing and help slow community spread by: • Posting up-to-date information on how residents can get tested. • Ensuring that residents understand what they should do while waiting for their test results and offering guidance to symptomatic residents on isolation protocols while waiting for test results. • Facilitating testing at health care clinics for known contacts identified through case investigation. • People should seek testing from their primary care provider. If residents do not have a provider, they can contact the Cambridge Public Health Department for guidance: [phone removed] (press 8). To become a Cambridge Health Alliance patient, residents can call [phone removed]. Treatment There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections. Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, such as patients with weakened immune systems. These antiviral medications are currently only available from the Strategic National Stockpile as options for the treatment of monkeypox. Massachusetts providers planning to treat a patient with these medicines must contact the state health department to arrange access to the drug. Vaccination Vaccine allocation is currently managed at the federal and state levels. At this time, the state has not allocated vaccines to local health departments, and there is no indication from state health officials that municipalities or local health departments will be allowed to stand up monkeypox vaccine clinics. The Massachusetts Department of Public Health is coordinating the distribution of federal allocations of the monkeypox vaccine in the Commonwealth. There is an extremely limited supply of the vaccine in the country. Massachusetts has received several allocations of vaccine from the CDC, but additional vaccine supply is not expected by the federal government until fall 2022.

4 Here is a brief summary of state actions taken to address vaccination of high-risk populations: • Vaccination is available to individuals who live or work in Massachusetts and meet the CDC’s current eligibility criteria. • As of August 29, 2022, there were 14 health care sites offering vaccination across the state, including multiple sites in Boston and one or more sites operated by Cambridge Health Alliance. Vaccine is currently available at the CHA Malden Care Center and will be available at CHA Cambridge Family Health (237 Hampshire St.) starting in early September, pending vaccine supply. Additionally, the state has activated mobile providers to assist in vaccine administration. For the most up-to-date information, see monkeypox vaccination sites in Massachusetts. • To ensure that the maximum number of individuals eligible for monkeypox vaccination receive protection, the Massachusetts Department of Public Health issued an updated advisory effective August 18 for Massachusetts monkeypox vaccine providers to begin administering the vaccine intradermally (into the skin) in most people aged 18 years and older. CONCLUSION CPHD’s current monkeypox response follows the traditional public health containment strategy of prevention, harm reduction, and case follow-up and contract tracing, in collaboration with public health partners and health care providers who perform testing and prescribe treatment. Unlike the virus that causes COVID-19, the monkeypox virus is not novel and is well-understood by medical researchers. In addition, monkeypox testing, vaccine, and treatment protocols are well-established. CPHD will continue to monitor and respond to the current outbreak, and is prepared to make adjustments in its approach if conditions change.