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. Cases were soon found in other rural counties — Nye, Lyons and Elko — which presented another hurdle for public health systems that had been strained by the covid-19 pandemic.

Experts say the response to the monkeypox virus in rural America may be affected by disparate resources and bitter politics that are a legacy of the pandemic, challenges that some worry could allow sporadic infections to take hold.

“Your ember becomes a wildfire really quickly,” said 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 adequately respond to monkeypox, to covid, to whatever is on the horizon?”

In Humboldt County, local officials moved quickly after monkeypox was reported. The local health board issued a news release encouraging residents to be cautious about physical contact and outlining what symptoms to look for — painful or itchy rashes, fever and headache, among others.

“I don’t think it’s something to be afraid of,” said Dr. Charles Stringham, the county’s health officer, in the news release, “but instead it’s something that each of us can avoid by take a few relatively simple precautions. “

See note
See note

Local health officials play a “primary preventive role,” Stringham said in an interview. It’s a role that includes educating the community about the virus, monitoring the person who tests positive and checking in with local doctors.

State and local public health officials in Nevada said the response in Humboldt County, home to nearly 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 have recently included the monkeypox virus. They said they were confident of local responses.

Still, some rural Nevadans said they were confused about where to find vaccines or whether vaccines were available in their county.

Stevie Noyce, a resident of Winnemucca, Humboldt County’s largest city, who identifies as pansexual, said she doesn’t know where to go to get a monkeypox vaccine. She called a local pharmacy, where her family usually gets shots, in early September and was told the pharmacy didn’t have monkeypox vaccines. The apothecary didn’t know where she could find one in town.

Noyes, a 34-year-old hairdresser, said she is not immediately concerned about monkeypox because no other cases have been found in the county. However, if the virus starts to spread, she said, members of the local LGBTQ+ community will rely on each other, not local county or health officials.

County and health officials are “taking a lot of heat from the city” about the policy of responding to public health issues, Noyce said. “What I see often is this political influence where it limits what gets released and limits the steps that are taken.”

Despite the venomous discourse Noyce has witnessed, Stringham said in his experience the monkeypox virus has not been difficult to respond to politically, especially compared to covid.

CDC data shows that non-Hispanic blacks and Hispanics who have sex with other men are overrepresented in infections nationwide. LGBTQ+ advocates said they were concerned that the government’s response was not reaching their communities, even though they were disproportionately affected.

In larger cities, such as Las Vegas, employees have in partnership with LGBTQ+ community centers to promote awareness and to distribute educational materials and vaccines. But there is no such center in Humboldt County, where 57 percent of voters opposed a ballot question in 2020, which struck down a provision in the state constitution that banned same-sex marriage. In the state, the vote was approved by 62% of voters.

Related stories

Noyce said she 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 retribution against people who identify as LGBTQ+ in the county Humboldt. “A lot of these people, the more you interact with them, the bolder and, I mean, ultimately dangerous they become,” she said.

Some people in Winnemucca are outspoken about calling monkeypox the “gay virus” and making jokes on Facebook, she said.

In late September, Noyce helped host Winnemucca’s second Pride Festival. Imunize Nevada, a non-profit organization focused on providing vaccines throughout the state, was there to provide information about covid-19 and monkeypox.

“We’re hoping to fight him that way,” Noyce said.

Christy Zygenis, program manager of the state’s immunization program, said the response to the monkeypox virus in rural areas requires nuance. “If we were to hold a clinic in, say, a rural area, not all of those people might be willing to share with the world that they’ve engaged in this behavior,” Zygenis said.

She added that public health officials have encountered affected people in Clark County, home of Las Vegas, who were unwilling to share the names of their sexual partners during the contact tracing or could not identify their partners. “I think it’s probably affecting rural areas a little bit in terms of what’s happening with the number of cases,” she said.

As of October 26, there were 28,087 confirmed cases of monkeypox virus nationwide. According to the CDC, and 298 in Nevada, placing the state in the second highest tier for transmission. Most of the state’s cases are in Clark County, home to more than two-thirds of the state’s residents, but cases have been reported in four rural counties.

Because it’s unclear whether monkeypox has spread beyond the one open case in Humboldt County, Stringham said he tries to provide enough messaging to keep residents informed, but not too much to cause burnout.

He said he thought resources would be better directed to covid prevention, adding that the situation could change.

To make matters more difficult, the community nurse in charge of distributing the vaccine from a state clinic in Winnemucca retired months ago, and her replacement, a nurse from Carson City, didn’t arrive until October.

“We’re operating at a bit of a deficit in that regard,” Stringham said.

During the interim period, Zynneos said, Humboldt County residents who were eligible to receive the monkeypox vaccine had to visit an administrative assistant at Winnemucca Community Health’s medical services office, where 100 doses of the Jynneos vaccine were available. The state agency would then send someone to Humboldt County to administer the vaccine.

Experts say that gap is emblematic of the kinds of difficulties officials in rural communities across the country face when responding to public health issues.

“The challenge is that there may be people who don’t seek primary care, so cases don’t get accepted,” Castrucci said. He added that focusing resources on covid or monkeypox could cause other health issues to fail, especially given the lack of investment in local public health departments in rural America compared to departments in larger cities .

This article was reprinted by khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

The story first appeared in News Medical

When monkeypox reaches rural communities, it collides with strained public health systems