When a case of monkeypox was reported in Nevada’s Humboldt County in August, it was the state’s first detection of the virus in a rural area. Soon, cases were found in other rural counties — Nye, Lyon and Elko — creating another hurdle for a public health system stretched thin by the Covid-19 pandemic.
Experts say the response to the monkeypox virus in rural America may be affected by the epidemic’s legacy of complex resources and bitter politics, challenges that some worry could allow sporadic infections to gain a foothold.
“Your embers turn into a forest fire really quickly,” says Brian Castrucci, president and CEO of the De Beaumont Foundation, a national nonprofit focused on public health policy. “The challenge is: Do we have the infrastructure in rural America to respond adequately to monkeypox, Covid, whatever is on the horizon?”
In Humboldt County, local officials jumped in after reports of monkeypox. The local health board issued a news release advising residents to be cautious about physical contact and outlining what symptoms to watch for — painful or itchy rash, fever and headache, among others.
“I don’t think it’s something we should be afraid of,” county health officer Dr. Charles Stringham said in the news release, “but instead something we can all avoid by taking a few relatively simple precautions.” “
Local health officials are in a “primary prevention role,” Stringham said in an interview. It’s a role that includes educating the community about the virus, monitoring people who test positive, and checking in with local doctors.
State and local public health officials in Nevada said the response in Humboldt County, home to about 18,000 people, and similar efforts in other rural communities followed guidelines set by the Centers for Disease Control and Prevention. State and local health leaders meet monthly to discuss public health issues, which of late have included the monkeypox virus. They said they were confident of the local response.
Still, some residents of rural Nevada say they are confused about where to find the vaccine or whether the vaccine is available in their county.
Stevie Noyes, a resident of Winnemucca, Humboldt County’s largest city, who identifies as pansexual, said he doesn’t know where to go to get the monkeypox vaccine. She called a local retail pharmacy, where her family usually gets the vaccine, in early September and was told the pharmacy didn’t have the monkeypox vaccine. The pharmacist didn’t know where to find her in town.
Noyes, a 34-year-old hairdresser, said he is not urgently concerned about monkeypox because no other cases have been detected in the county. But, if the virus starts to spread, he said, members of the local LGBTQ+ community will turn to each other instead of local county or health officials.
County and health officials “take a lot of heat from the city” on the politics of responding to public health issues, Noyes said. “What I’m seeing a lot of is political influence where it controls what’s published and it controls the actions that are taken.”
Despite Noyes’ venomous rhetoric, Stringham said that in his experience, the monkeypox virus has not been difficult to respond to politically, especially compared to Covid.
CDC data show that non-Hispanic black and Hispanic men who have sex with other men are overrepresented in infections across the country. LGBTQ+ advocates say they are concerned that the government response is not reaching their communities even though they are disproportionately affected.
In major cities like Las Vegas, officials have partnered with LGBTQ+ community centers to promote awareness and distribute educational materials and vaccinations. But there is no similar center in Humboldt County, where 57% of voters opposed a ballot question in 2020 that would have overturned a provision of the state constitution that banned same-sex marriage. Statewide, the ballot measure was approved by 62% of voters.
Noyes said he is more concerned about prejudice than the virus and fears that because the virus is linked to men who have sex with men, it could spark retaliation against people who identify as LGBTQ+ in Humboldt County. “A lot of these people, the more you interact with them, the bolder and, I mean, eventually they become dangerous,” he said.
Some people in Winnemucca have been outspoken about calling monkeypox a “gay virus” and making jokes on Facebook, he said.
In late September, Noyes helped organize Winnemucca’s second Pride festival. Immunize Nevada, a non-profit organization focused on providing vaccines across the state, was there to provide information about Covid-19 and monkeypox.
“We hope to address it that way,” Noyes said.
Kristy Zigenes, program manager for the state’s immunization program, said responding to the monkeypox virus in rural areas requires precision. “If we put a clinic in a rural area, those people may not be ready to share with the world that they have participated in this behavior,” Zigenes said.
He added that public health officials have encountered people infected in Clark County, home to Las Vegas, who were not ready to share the names of their sexual partners or could not identify their partners during contact tracing. “I think it’s probably a bit overstated as far as case counts go in rural areas,” he said.
As of Oct. 26, there were 28,087 confirmed cases of monkeypox virus nationwide, according to the CDC, and Nevada had the second-highest number of infections with 298. Most of the state’s cases are in Clark County, where more than two-thirds of the state’s residents live, but cases have been reported in four rural counties.
While it’s unclear whether monkeypox has spread beyond the one case detected in Humboldt County, Stringham said he’s trying to send enough messages to keep residents informed, but not too much to cause burnout.
He said he thought resources would be better directed towards Covid prevention, adding that the situation could change.
To make matters more difficult, the community health nurse responsible for distributing vaccines from a state-run clinic in Winnemucca retired months ago, and her replacement, a nurse from Carson City, didn’t arrive until October.
“We’re operating in a bit of a deficit on that,” Stringham said.
In the interim, Zigenes said, Humboldt County residents who meet the eligibility requirements to receive the monkeypox vaccine should meet with an administrative assistant at the Winnemucca Community Health Nursing Services office, where 100 doses of the Genios vaccine are available. The state agency will then send someone to Humboldt County to administer the vaccine.
Experts say the gap is emblematic of the challenges faced by officials in rural communities across the country in responding to public health issues.
“The challenge is there may be people who are not seeking primary care, so cases are not being picked up,” Castrucci said. He added that the focus of resources on Covid or monkeypox could fall through the cracks on other health issues, especially given the lack of investment in local public health departments in rural America compared to departments in big cities.
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