Joan Sullivan has cold symptoms and pimple-like rashes on her body, and zero idea yet whether it is because of monkeypox.
The 29-year-old Minneapolis flight attendant struggled for five days to seek testing from the Minnesota Department of Health and two designated clinics in the Twin Cities. While clinics are urging testing for men who have sex with other men — the risk group making up almost all the state's 55 known infections — Sullivan said she worries this focus could miss possible cases like hers that fall outside the norm.
"I care and I want to do the right thing but that was my fourth phone call and I had no result or test scheduled or anything like that," she said. "If that was me at 19, I would be done."
Monkeypox is not considered a sexually transmitted infection, though 94% of the initial cases in the U.S. public health emergency involved young men with recent sexual or close intimate contact. The virus has mostly spread through physical contact with fluids from infected individuals or with contaminated sheets, towels or other surfaces.
While severe cases have been rare, Minnesota is increasing access to testing and vaccine in an attempt to slow the virus before it becomes widespread and reaches vulnerable populations such as the elderly.
The Red Door Clinic in Minneapolis and Clinic 555 in St. Paul were promoted last week as testing locations to provide easy and familiar access to the primary risk group of men who have sex with other men. However, any clinician can swab rashes on suspected patients and send the samples to the state public health lab or commercial labs such as Mayo Clinic for results.
The state in mid-July informed doctors that they don't need permission to collect and submit samples for testing. The state has adequate lab capacity to process tests, but clinics have limited openings and sometimes triage patients with high exposure risks even over patients who have suspicious rashes but lower exposure risks, said a written statement from Health Department spokesman Doug Schultz.
"Just as we have said that anyone can get monkeypox, anyone can get tested for monkeypox if they meet clinical guidelines," said the statement, which noted that two of Minnesota's cases are female.
The collection process is somewhat complex, requiring sterile synthetic swabs rather than cotton. "Poor sampling techniques have resulted in indeterminate results for multiple samples collected over the last few weeks," the state said in its alert to doctors.
After failing since Thursday to reach anyone at Red Door or Clinic 555 to schedule testing, Sullivan went Monday to her primary care clinic. A provider swabbed lesions and sent the specimens to the state lab, with results expected almost a week after she first sought testing. She received a call from the Red Door Clinic later that day.
Until this year, the monkeypox virus was considered endemic in portions of Africa and mostly spread from animals to people rather than person to person. It produces typical cold symptoms but also pimple-like rashes that can be painful and itchy and lead to other complications, such as blindness if they form near the eyes.
Unlike the coronavirus that causes COVID-19, the monkeypox virus is unlikely to spread through airborne transmission or respiratory droplets — unless someone spends hours in close contact with an infected person who has lesions in and around the mouth.
Minnesota by summer's end expected 7,600 courses of monkeypox vaccine, which are reserved for people at high risk of exposure because of work or sexual activities, or who have been in close contact with someone who may have been infected.
Sullivan said she wonders if she was infected while working on recent flights to England or California, or during long layovers. One person in her close social network has reported symptoms as well, though.
"Everyone in the bubble has kind of locked into their own home until we figure out who are the sick ones," said Sullivan, who also took a COVID-19 test, which was negative.
A week into her illness, Sullivan complained about the "worst acne flareup in years," she said. A sexual partner, who works as a paramedic, suggested it could be monkeypox. In her isolation, Sullivan has entertained herself and others with TikTok videos, including one on mittens and other strategies to stop scratching her rashes. One update netted 130,000 views.
Sullivan said she hoped the state would clarify testing procedures for doctors and that clinics across Minnesota would hasten their collection of samples to stay ahead of the outbreak.
Red Door has been busy since it was promoted as a monkeypox testing site but has no restrictions on testing people with likely infections, said Allison Thrash, a spokeswoman for Hennepin County Public Health, which operates the clinic. "It's possible that some people are not getting through to us immediately, but everyone who calls does get a call back."