The country’s first two cases were reported by Quebec public health officials on May 19.
Dr. Robert Pilarski, a general physician in Montreal, who treated one of those patients last week, said the individual likely got the virus from a sauna he recently visited.
“He actually got it from G.I. Joe. So this is the suspected epicentre of the epidemic,” Pilarski told Global News.
Another doctor, who did not wish to be identified, also said the source of Montreal’s monkeypox outbreak was Sauna G.I. Joe.
Government officials have so far stayed clear of confirming the origin of monkeypox in Canada due to concerns of privacy and stigmatization.
“As it was the case with COVID-19, we never confirm publicly outbreaks for both privacy and identification matters,” Jean Nicolas Aubé, a spokesperson for Montreal public health, told Global News in an emailed response.
“Rest assured that we always intervene directly with businesses or settings where an outbreak occurs or where our investigation could lead us,” Aube added.
Despite multiple attempts and inquiries from Global News about health regulations and tracing measures, there was no response from Sauna G.I. Joe by the time of publication.
Recent cases of monkeypox around the world have researchers scrambling to find out how the virus is spreading in countries that typically don’t see it.
Monkeypox, a rare zoonotic infectious disease, is usually found in certain parts of Africa, where it is endemic.
What started out as a small cluster of cases in Quebec is now being called a “serious outbreak” of the virus by provincial health officials.
As of Thursday, 25 cases have been confirmed in the province and about 20 to 30 suspected cases are under investigation.
The majority of confirmed cases in the province are tied to men aged between 20 and 30 years, who have had sexual relations with other men. There has been one case in a person under 18.
Monkeypox is not considered a sexually-transmitted infection, but the virus can survive on surfaces such as bedding and is transmitted through prolonged close contact.
“It’s not sexual activity as such that transmits it. It’s skin-to-skin contact that transmits it as far as we know at this moment,” said Dr. Michael Libman, a tropical disease expert and professor of medicine and infectious disease at McGill University.
Stigmatization and transparency
Cases of monkeypox started emerging in Europe earlier this month.
Montreal public health said it had alerted physicians about a week before the first cases were confirmed. It also contacted “local actors” and communicated advice on hand hygiene and environmental cleaning procedures, Aubé said.
According to social media posts, Sauna G.I. Joe hosted a sex party on May 19, the same day Canada confirmed its first cases of monkeypox.
During a press conference on Thursday, Quebec public health officials said they do not think it’s necessary to single out locations over fears of “stigmatization,” adding that there are now measures in place.
“The enemy is the virus, not the people affected,” said Dr. Luc Boileau, Quebec’s interim public health.
However, experts stress that there should be greater transparency and omitting key public health information can be problematic.
David Brennan, research chair in gay and bisexual men’s health at the Ontario HIV Treatment Network (OHTN), believes not disclosing information can have a negative impact on the community.
Hiding information could be interpreted as “men having sex with men is bad,” said Brennan.
There needs to be a culture shift and harm-reduction approach as has been the case in the past with sexually-transmitted infections, such as HIV/AIDS, added Nolan Hill, gay men’s health specialist at the Center for Sexuality in Calgary, Alta.
“I think it really does speak to this broader culture where we’re uncomfortable with the idea of sex and we’re uncomfortable talking about sex,” he said.
Outside of Quebec, only one other case of monkeypox has been confirmed in Toronto.
On Saturday, Toronto Public Health (TPH) identified two locations connected to possible cases of monkeypox: Axis Club and Woody’s bar.
Kerry Bowman, a professor of bioethics and global health at the University of Toronto, said these details matter, especially when it comes to higher risk settings.
“I would argue it is important to identify where it is coming from because if you don’t then people are not in a position to protect themselves,” he said.
However, disclosing that information comes with the “added responsibility” of not feeding into any prejudice, Bowman added.
Federal public health officials are working to finalize and release guidance on case identification, contact tracing, isolation as well as infection prevention and control.
The Public Health Agency of Canada says this updated guidance will be released in the next few days.
Deputy chief public health officer Dr. Howard Njoo said Thursday mass vaccinations are not yet needed, but people can avoid infection by maintaining physical distance, masking and hand hygiene.