PROVINCETOWN – Dr. Andy Jorgensen knew he was in a race against time.
By early June it was clear the outbreak of monkeypox, a relative of smallpox that is rarely fatal but causes a painful rash that can last for weeks, was spreading through the gay community. First came reports of it in the Canary Islands. Then the UK. Then Montreal.
Jorgensen, the chief medical officer of Outer Cape Health Services, worried Provincetown would be next. And it was only a matter of weeks before the summer’s first real crowds would pile off the highway and the ferry dock into the crowded bars and nightclubs of Commercial Street for Independence Day weekend.
With memories of last summer’s headline-grabbing COVID outbreak still fresh, Jorgensen knew the community needed to act fast.
Though Provincetown is vulnerable to monkeypox, public health officials and advocates say the LGBTQ+ haven is also uniquely prepared to handle public health threats by reactivating networks built up during the AIDS epidemic and put to the test during the coronavirus pandemic, when the Delta variant triggered the first known major outbreak of COVID-19 among a highly vaccinated group of people there last summer.
“This isn’t our first day at the rodeo,” said Christopher Casale, Jorgensen’s colleague at the Outer Cape clinic.
Though monkeypox cases continue to be overwhelmingly concentrated among men who have sex with men, experts stress sexual orientation is not linked to the virus; everyone is susceptible. The first transmission event likely took place by chance at a party attended by gay men. Because the virus has mainly been spreading through intimate contact, it has mostly remained in that community.
Under clear blue skies last week, Casale strode out of the health center in shades, a leopard print shirt, and matching shoes to walk four patients through the vaccination process in the clinic’s back parking lot.
He was running Provincetown’s sixth vaccine clinic in a week. In that time, they had given 700 first doses of the Jynneos monkeypox vaccine, which consists of two doses given four weeks apart, and 140 more appointments were scheduled for that day. It was a “Herculean” feat, Casale said.
Gates had trawled through Instagram, individually messaging people to invite them to town halls and to get vaccinated. Community leaders enlisted bartenders and drag queens to spread information further, Gates said.
Now, during Bear Week, when thousands descended on Provincetown to celebrate the culture of the bearded and burly gay men known as “bears,” officials and activists exuded a clear-eyed calm and said they could keep everyone safe.
Meanwhile cases continue to rise across the country. The Centers for Disease Control and Prevention said Friday that 1,814 people have tested positive for monkeypox. In the Commonwealth, the total was 51, according to the CDC.
Those numbers are probably undercounts, said Dr. Cassandra Pierre, associate hospital epidemiologist and medical director of public health programs at Boston Medical Center, which began vaccinating against monkeypox two weeks ago.
In the earlier days of the outbreak, testing was slow and sparse. But on Friday, the CDC announced it had ramped up testing capacity from 6,000 per week to 70,000. CDC Director Rochelle Walensky said the federal government had delivered 156,000 doses of Jynneos to the states and is making 131,000 more immediately available for order. Seven million doses will be available by next year, she said.
Massachusetts last week nearly tripled the number of locations that will offer the monkeypox vaccine from four to a total of 11 sites stretching from Provincetown to Springfield. The Massachusetts Department of Public Health said that, as of the end of the day Thursday, there were 1,600 doses of the vaccine administered by the first four clinics that had opened — three in Boston and one in Provincetown.
Close contacts of someone with monkeypox and those who had multiple sexual partners in a jurisdiction known to have had monkeypox transmission are eligible for the vaccine. The shots work even in the early stages of infection.
While monkeypox is not considered a sexually transmitted infection, it is largely spreading through intimate contact right now. Pierre, of Boston Medical Center, said the number of reported sexually transmitted diseases among men who have sex with men is typically highest in July and August, making this “not just a high risk population but a high risk time of year.”
Doctors at the three Boston sites said each clinic had been inundated with hundreds of calls a day seeking the shots.
“This reminds me of the early vaccination days from COVID in that people are so grateful to be here and getting this vaccine,” said Dr. Kevin Ard, director of the sexual health clinic at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School. “The vibe is very positive.”
Fenway Health in Boston, which received 250 doses of the monkeypox vaccine July 7, had exhausted its supply by the time its second shipment, of 400, arrived just six days later.
Meanwhile, in Provincetown, the summer season and many residents’ livelihoods hang in the balance.
Most businesses make 80 to 90 percent of their revenues during the ten-week summer season and many residents make much of their income during the same period, said state Senator Julian Cyr.
“This was kind of our glimmering hope season,” said Trevor Pittinger, the associate director of the Provincetown Business Guild. “I think it’s going to be fine, but it is scary for the businesses that have struggled the past three, four years.”
One Provincetown man in his 30s, who works in the entertainment industry and asked not to be named due to privacy concerns, has already lost income due to the illness. He tested positive for monkeypox after sleeping with someone who later tested positive for the virus.
His symptoms started with a sore throat, but when he noticed an unusual pimple, he requested a monkeypox test. Since the positive result, painful lesions have spread across his body and he has been in quarantine for weeks, waiting for them to heal. Recently, he was prescribed tecovirimat, an FDA-approved antiviral also known as TPOXX. The drug has been difficult to come by, and the patient had to go through a lengthy process to obtain it.
“I’m feeling way better than when I was in the height of monkeypox hell,” he said. At one point, his lymph nodes became so swollen he could barely breathe for three nights.
Provincetown is suffering from a serious staffing shortage brought on by a housing crisis, so losing even a single employee to a lengthy quarantine can have serious implications for workers and businesses.
Monkeypox has not kept visitors away from Provincetown for now. Many of the town’s hotels are once again filled, Pittinger said.
Sitting near the bar at the The Crown and Anchor last Wednesday afternoon, co-owners Jonathan Hawkins and Paolo Martini said that after two seasons marred by a virus, they were determined not to let the new one ruin a third summer.
The Crown and Anchor hosted the very first community meeting about the virus. They trained their employees to spot symptoms and made sure staff who are eligible were vaccinated. When one of the staff contracted monkeypox, they sat everyone down to talk it through.
They, too, are hopeful this summer won’t be like the last two. But they can’t afford to rely on hope; they know Provincetown must be proactive.
“That’s what I appreciate about this community,” Martini said. “It seems like we learned something.”