A growing number of states have declared monkeypox a health emergency as cases of the infectious virus ticks closer to 6,000 across the country. 

California Gov. Gavin Newsom, a Democrat, on Monday declared a state of emergency to free up additional resources to combat the virus, writing in a statement that his administration is “working urgently across all levels of government to slow the spread of monkeypox, leveraging our robust testing, contact tracing and community partnerships strengthened during the pandemic to ensure that those most at risk are our focus for vaccines, treatment and outreach.”

“We’ll continue to work with the federal government to secure more vaccines, raise awareness about reducing risk, and stand with the LGBTQ community fighting stigmatization,” he added. 

As of July 28, at least 827 cases of monkeypox had been detected in the state, though those figures are likely to rise as testing is further expanded. Currently, California is able to process roughly 1,000 tests per week. 

Well over half of the cases in California have been identified in Los Angeles and San Francisco. As of July 28, the state’s CDC website listed 261 monkeypox cases in Los Angeles and 257 in San Francisco, which rose to 400 and 310, respectively, by August 1. 

California’s statewide emergency mandate followed similar declarations issued by New York Gov. Kathy Hochul and Illinois’ Gov. J.B. Pritzker, both Democrats. 

Pritzker’s announcement came early Monday, when the governor said monkeypox is a “rare, but potentially serious disease that requires the full mobilization of all available public health resources to prevent the spread.” 

"That's why I am declaring a state of emergency to ensure smooth coordination between state agencies and all levels of government, thereby increasing our ability to prevent and treat the disease quickly,” Pritzker added. “We have seen this virus disproportionately impact the LGBTQ+ community in its initial spread. Here in Illinois we will ensure our LGBTQ+ community has the resources they need to stay safe while ensuring members are not stigmatized as they access critical health care."

Like in other states, the declaration frees up additional resources to combat monkeypox. Illinois’ state of emergency will remain in effect for 30 days. According to the CDC, there are approximately 500 confirmed cases of monkeypox in the state.

New York was the first state to issue an emergency declaration over the virus on July 29, with Gov. Hochul noting nearly a quarter of the total cases across the country are located in New York. As of Monday, the state had reported ​​1,573 cases of monkeypox. 

"More than one in four monkeypox cases in this country are in New York State, and we need to utilize every tool in our arsenal as we respond,” she wrote. “It's especially important to recognize the ways in which this outbreak is currently having a disproportionate impact on certain at-risk groups. That's why my team and I are working around the clock to secure more vaccines, expand testing capacity and responsibly educate the public on how to stay safe during this outbreak."

Cities both in New York and California had already declared emergencies over the virus. 

Last Thursday, San Francisco Mayor London Breed and the city’s Department of Health issued a citywide emergency declaration over the rapidly rising cases of monkeypox in the city, saying the move will “expedite and streamline the availability of resources” to address the virus. 

“San Francisco showed during COVID that early action is essential for protecting public health,” Breed wrote in a statement at the time. “We know that this virus impacts everyone equally – but we also know that those in our LGBTQ community are at greater risk right now. Many people in our LGBTQ community are scared and frustrated. This local emergency will allow us to continue to support our most at-risk, while also better preparing for what’s to come.”  

The emergency order – which will free up additional city resources, streamline staffing needs and create an informational campaign to raise awareness about the disease – went into effect on Monday, August 1. 

Also on Thursday, New York State Health Commissioner Dr. Mary Bassett classified monkeypox as an imminent threat to public health across the entire state. 

"This declaration means that local health departments engaged in response and prevention activities will be able to access additional State reimbursement, after other Federal and State funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities,” she wrote in a statement. 

The order covers all “monkeypox prevention response and activities” the state may take between June 1 and December 1.

New York City Mayor Eric Adams issued yet another decree on Monday, issuing an “emergency executive order declaring a local state of emergency.”

Other states have faced mounting pressure to declare states of emergency over monkeypox. On Monday, Florida’s commissioner of Agriculture and Consumer Services Nikki Fried – who is running as a Democrat for governor – called on Gov. Ron DeSantis to issue such an order.

“While we are likely to see monkeypox cases continue to increase over the coming weeks, the state can – and must – take immediate action to limit the impact of this outbreak by declaring a state of emergency,” Fried’s letter read in part, noting that Florida ranks fourth behind New York, California and Illinois in total state caseloads at 422. “Putting in place a strong, statewide emergency response that coordinates and leverages our county health departments will help Floridians access vaccines and other resources to protect themselves and others from the spread of monkeypox.”

And a growing chorus of lawmakers have pressed the Biden administration to declare a nationwide state of emergency over the virus – including New York Rep. Carolyn Maloney, a Democrat, who on Friday penned a letter to the White House saying “more needs to be done to ensure that we contain the spread of monkeypox and address the health risk it poses,” particularly for the highest-risk groups.

“With the COVID-19 crisis, we learned that a robust testing and vaccine program is critical to stopping the spread of the virus,” she said. “That is why I request that the Biden Administration use every tool at its disposal to ensure that adequate testing is available so that we can track the spread of monkeypox and treat those who are infected.”

But there has yet to be an official health declaration from the administration, though the White House on Tuesday did tap Robert Fenton, current FEMA administrator for Region 9, as the White House monkeypox response coordinator, with Dr. Demetre Daskalakis of the CDC named as his deputy.

Last Friday, Daskalakis told Spectrum News that “every policy consideration is being discussed” at the highest levels of government. 

“I don't have any specific update or news about whether we're heading toward an emergency declaration,” he said in an interview with Spectrum News’ Julia Benbrook. “But I also want to emphasize on the local level, as well as on the national level, this is something that we're approaching with great urgency, whether there's a declaration or not.”

On Friday, White House press secretary Karine Jean-Pierre pointed to the Department of Health and Human Services as the entity in charge of deciding whether to declare a public health emergency, saying she will “leave it to them to make that decision.” 

Last week, the World Health Organization declared the monkeypox outbreak a public health emergency of international concern, and there are now more than 23,000 cases identified across 80 countries. The United States currently has the highest caseload of any country at over 5,811, followed by Spain with 4,298 cases and Germany with 2,677 cases, per CDC data.

The only two states in the U.S. that have so far not identified a single case of monkeypox are Montana and Wyoming. 

WHO director-general Dr. Tedros Adhanom Ghebreyesus said while the outbreak “can be stopped,” doing so would require added precautions – primarily from gay, bisexual and other men who have sex with men, in which nearly 98% of cases have been identified so far. 

“For men who have sex with men, this includes, for the moment, reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed,” Dr. Tedros Adhanom Ghebreyesus said Wednesday. 

While the current outbreak is largely among men who have sex with men, health officials say anyone can be at risk of contracting the virus – which spreads primarily through direct contact with an infectious rash, scab or body fluids. 

“Monkeypox is something that can affect anyone,” Daskalakis said in part, noting that it is particularly important to ensure the most at-risk groups have access to adequate information. 

“It's a disservice to everyone to not make sure that we get general information out because we need our medical providers to be alert,” he added. “If you see a rash in someone that doesn't make sense, even if they're not gay, bisexual or another man who has sex with men, it's important to think about monkeypox.”