Monkeypox
Warning: I am NOT a doctor. I have ZERO expertise on this matter. You’d be better off going to your personal doctor for medical advice. To satisfy my own curiosity, however, I wanted to investigate what we now know about monkeypox. Since I was going to do it anyway, I thought I might as well share what I found with my readers. My sources are the CDC, the WHO, and mainstream media articles. Those seem better choices than your favorite crank on Twitter. (Although I may count as that crank.)
First, don’t panic. Second and third, also don’t panic.
Fourth: notice I use “seems” a lot in this piece. I don’t love waffling language but information on monkeypox is still developing and I wanted to keep a heavy note of “I’m not totally sure about this” in my writing. Again, talk to your doctor if you have real concerns.
Quick Summary
Monkeypox is rare. It is difficult to transmit and almost always seems to require close personal contact, often sexual contact. Around 98% of the victims of the current outbreak seem to have been male, mostly men who have sex with other men. In the unlikely event you catch it, it can be very painful but there have been no fatalities (so far) in the United States. Unlike COVID, it is slow to mutate so we probably don’t need to fear an “Omicron” variant.
What is it?
This section is mostly from the World Health Organization but confirmed by newspaper reports.
Monkeypox is a virus that is usually transmitted through close physical contact. Up until recently, outbreaks are believed to have involved the transport, handling, or eating of small animals (mostly squirrels and rats, not monkeys). Monkeypox originated in tropical parts of central and west Africa. The first known human victim was detected in 1970. This year’s outbreak seems to be the first where there has been significant human-to-human transmission.
The symptoms of the disease usually occur about 1 to 2 weeks after exposure. The course of the disease usually lasts 2 to 4 weeks. Symptoms include fever, rashes, and lesions, which crust up and eventually fall off. The lesions are why it’s called a “pox.” While someone has symptoms, they are contagious. Monkeypox is similar to smallpox in nature but less contagious and less dangerous. There have been no fatalities in the United States. There have been fatalities in other countries (including Spain, India, and Brazil). Once the lesions are gone, the patient is believed to be no longer infectious.
Monkeypox is a DNA virus, not an RNA virus, and those tend to evolve far more slowly. COVID is an RNA virus, thus prone to more rapid mutations. In other words, the virus we’re dealing with is probably the same one we’ve been dealing with for decades.
Who’s getting it?
According to an August 5, 2022, Center for Disease Control (CDC) report, there had been 2,891 cases reported in the United States through July 22. (There are more now. The CDC count as of August 8 was 8,934. New York had the most reported cases, at 1,960.) Where the report had information, 99% of the cases involved men, and 94% of those reported having male-to-male sexual or close intimate contact. Four percent reported no such contact (but people do sometimes lie).
This does not mean only men who have sex with men can catch it! Some of the spread does involve non-sexual contact. People other than men who have sex with men have caught monkeypox. The CDC advises that anyone with matching symptoms or who has had close physical contact with someone who has caught it should be tested.
An August 4 New York Times article (“How Serious Is Monkeypox?”) reports that there are 25,000 confirmed cases worldwide. That same article reported a study showing “that 98 percent of monkeypox cases were among men who have sex with men.”
Note: Some folks on Twitter have been annoyed by the “men who have sex with men” label. This label has been standard for many years. You can’t just say “gay and bisexual men” because some men who don’t think of themselves as gay or bisexual still may have sex with other men. The “men who have sex with men” label is a bit cumbersome but accurately describes men at particular risk.
How do you catch it?
Primarily, monkeypox is caught through prolonged intimate contact. Obviously, sexual contact would be intimate, but close contact of any sort seems a possible vector. It may be possible (although unlikely) to catch it by other kinds of contact, including touching the sheets or clothing of someone who’s infected. It is also theoretically possible it could spread via respiratory droplets, although if this has happened it seems to be very rare at this time. Almost all current cases seem to be from close contact, mostly sexual contact. (The Wall Street Journal calls the possibility the virus could spread through the air “unsubstantiated.”)
While monkeypox is more transmissible than HIV, the chances of catching it from non-intimate contact still seem very low. At this point, it seems foolish to worry about things like touching something that an infected person might have touched, unless you are living with them and having prolonged contact.
According to the Wall Street Journal:
infectious-disease experts say patterns of transmission in this outbreak have been consistent with the need for close contact, rather than airborne spread. If the virus could easily spread through airborne transmission, they say many more cases outside the LGBT community would be expected.
Here are what some of the lesions can look like:
The risk to most people remains very low. Again, from the WSJ:
“At this moment in terms of acquiring monkeypox, I wouldn’t change my behavior,” said Dr. Chin-Hong, noting that the calculation would be markedly different for someone in an at-risk group.
If you are a man who has sex with men, of course, changing behavior might be wise. Trying to get the vaccine (see below) or reducing the number of sexual partners until you receive it seems sensible. New York City’s Department of Health and Mental Hygiene is very clear about this:
Anyone can get and spread monkeypox. The current cases are primarily spreading through sex and other intimate contact among social networks of gay, bisexual and other men who have sex with men (MSM); transgender people; gender-nonconforming people; and nonbinary people. People in these social circles who have multiple or anonymous sex partners are at a high risk of exposure.
Is there a cure?
The smallpox vaccine seems to be at least 85% effective at preventing monkeypox. Those under 40 or 50 are more vulnerable because smallpox had already been eradicated when they were receiving their infant vaccinations. There is a new smallpox vaccine called Jyunneos that is approved for use to prevent monkeypox. It can also be used even after someone has caught the virus to reduce the severity of their symptoms. There are currently supply shortages of the vaccine and so its use is being restricted to those at high risk of catching monkeypox or those who have just caught it.
There is an anti-viral drug, TPOXX, on the market but supplies in the United States are limited. Because its benefits are unclear, it is being used only in more severe cases.
In most cases, the disease is handled via over-the-counter medications and lots of rest. Obviously, the patient should stay isolated until the lesions are gone. Once the lesions have disappeared the individual is probably “cured.” I wrote “probably” only because there still seems to be some question as to whether someone can still transmit the virus even if they have no symptoms.
Further thoughts
In general, there have been a number of articles saying that the US response to monkeypox has been slow. The Economist called it “underwhelming.”
The American response to monkeypox should have been swifter after covid-19. Public-health officials could have provided support while the disease was abroad, to help contain it. Once it reached America, testing should have been available quickly. Vaccines should have been distributed more efficiently to high-risk groups.
We seem to be doing better now, but it’s not reassuring how slow we were to react. We’re lucky that monkeypox is a relatively mild threat.
On a lighter note
The best monkeypox moment came from a New York Times reporter, Benjamin Ryan. Responding to poorly informed tweets like this one…
…Ryan issued his own corrective tweet, with one unfortunate typo:
Ryan was a great sport about his “men who have sex with me” typo, saying whatever brought more attention to accurate facts was good. Also, typos are easy. I made the exact same mistake in this piece, but luckily caught it before I hit “send”!
Sources:
May 19, 2022, WHO overview: Monkeypox Key facts
August 5, 2022, CDC Report: “Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022”
August 4, 2022, New York Times, “How Serious Is Monkeypox?”
August 8, 2022, Wall Street Journal, “What Is Monkeypox? What to Know About Symptoms, Vaccines and How It Spreads”
July 27, 2022, The Economist, “America’s response to monkeypox has been underwhelming”