Science Vs - Monkeypox: What's Going On?

Episode Date: August 2, 2022

Monkeypox has been spreading around the world. So … what exactly is this disease? How worried should we be, and how can people stay safe? We talk to Dr. Carlton Thomas, Professor Chloe Orkin and Professor Yan Xiang. Check out our transcript (with 147 citations!): https://bit.ly/sciencevsmonkeypox  And if you are looking for another great podcast on this, check out A Bumpy Ride. It’s by Leo Herrera, and it’s really beautiful. This episode was produced by Wendy Zukerman, Michelle Dang, Meryl Horn, Courtney Gilbert, Rose Rimler, Nick DelRose, and Disha Bhagat. Additional help from Ekedi Fausther-Keeys. We’re edited by Blythe Terrell. Fact checking by Erica Akiko Howard. Mix and sound design by Sam Bair. Music written by Bumi Hidaka, Emma Munger, Bobby Lord, Peter Leonad and SoWylie. Thanks to the researchers we got in touch with for this episode, including Dr. Agam Rao, Professor Asma Khalil, Professor Siddappa Byrareddy, Professor Preeti Malani, and Dr. Hugh Adler. Special thanks to LeRoy G. Robinson, Jr., Randy Tigue, Nick Lem, The Zukerman Family and Joseph Lavelle Wilson.  And thanks so much to everyone who spoke to us about their experience with monkeypox. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet. So we were on a break working on new episodes for the next season. But then, well, something came up. The numbers keep rising, but not necessarily for COVID-19. Monkeypox is spreading all across the globe, including here in the United States. Monkeypox. Monkeypox. Monkeypox. Monkeypox. This outbreak really got going in early May. It turned up in the UK, but then the numbers for monkeypox started ticking up and up. Eleven more cases in England. By mid-May, new cases were being spotted all over. In Portugal, Spain.

Australia, Israel and Switzerland are the latest to report a presence of the virus. Eventually, hundreds turn to thousands. Why so many people are developing monkeypox is perplexing scientists. The vast majority of people who have gotten sick are men who have sex with men, but not all. Two more children have been infected in Indiana, a total of four now in the US. There are more than 23,000 cases in more than 70 countries and territories. And this all led the World Health Organization to say that this outbreak represents a public health emergency of international concern. And this disease, monkeypox, it can be awful.

Stories of people suffering are being shared all over the internet. We heard some of the worst cases from Dr. Carlton Thomas. He's a gastroenterologist and queer health educator on social media. The pain has been described as a shard of glass corkscrewing up your ass for 10 days straight with no relief, or a potato peeler going round and round and round in your ass. Oh, God. This one guy said his penis was so swollen and his foreskin was so swollen around his penis that he couldn't even have urine escape. And he had to go to the hospital

and get a catheter put into his penis, which was probably one of the worst experiences of his life, I would imagine. One of my most recent Instagram and TikTok posts is the audio of a guy crying in the bathroom because it hurts so bad. I can't even describe the pain. of a guy crying in the bathroom because it hurt so bad. I can't even describe the pain.

He's got the shower running and he's crying and he's screaming. I'm like shaking. No, this is not okay. God, I wouldn't wish this on anybody. It's just heart-wrenching. And I have pictures and videos that will forever haunt me of how bad this is. Horrific, what people are going through, the amount of suffering and pain. Today on the show, what the hell? Is it always this bad? How is this disease spreading?

And how can we stop it? Science vs. Monkeypox is coming up just after the break. It's really not important to me to have a lot of things to show off, fancy cars, you know, a giant home. Those things are just not part of who I am. But I've been coached and I've learned through my advisor that it's not one size fits all. Everyone has their

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Please be alert as trains can pass at any time on the tracks. Remember to follow all traffic signals, be careful along our tracks, and only make left turns where it's safe to do so. Be alert, be aware, and stay safe. Welcome back. Today on the show, the monkeypox outbreak. Monkeypox is a virus which science has known about for about half a century.

The first case they saw was in monkeys, hence the name monkeypox. But actually, this virus can infect lots of different animals. Rats, squirrels, shrews. And yeah, you and me. It's endemic in some countries in Africa, and when people get infected, the virus spreads to your lymph nodes, ultimately moving to the skin, where it creates these lesions or pus-filled blisters.

And they are packed with the skin, where it creates these lesions or pus-filled blisters. And they are packed with the virus, which can then spread this from one person to another. But here's what's really strange. Usually, monkeypox doesn't really spread that much between people. Like in past outbreaks of this, someone got it, generally from an infected animal, maybe spread it to one person, maybe another, and that was it. It was pretty rare to spread from person to person to person like we're seeing now. And one doctor who's been trying to work out what is happening here is Professor Chloe Orkin. She's an infectious disease doctor at Queen Mary University of London.

Chloe specialises in HIV care, and a few months ago she started to see cases of monkeypox at the clinic that she works at in East London. So, yeah, as a doctor who's been working in HIV for my whole career, obviously I could see that this was something that was affecting men who have sex with men and very upsetting. She got to work. And one of the things that she's helped sorting out is to find out how bad this virus is for people. Like those horror stories we heard from Carlton. How often is that kind of

thing happening? Chloe looks at the map of where cases are popping up around the world and she starts reaching out to doctors in those places. And I said, are you looking after anybody with monkeypox? And sometimes they would say, no, but my friend is. And then they'd say, no, but my friend is. And I'd just keep writing emails until eventually I found somebody who was looking after people. It was the most complex and difficult thing I've ever done and also the most wonderful because I'd wake up in the morning to emails from every country, 16 countries, and it just escalated. And we ended

up with 16 countries involved and 43 different centres and literally hundreds of different doctors collaborating. Chloe ended up putting together a study of some of the first patients who got monkeypox in this outbreak. It included more than 500 people. They were almost all men, almost all were gay or bisexual. And here's what she found. In some cases, people got these very general viral symptoms like fever, fatigue, headaches. But then there was this big thing, she kept saying.

What was the most common symptom? So the majority of people presented with genital skin lesions. It could be, you know, in the bottom, it could be on the penis. Around 70% of the people in Chloe's study had lesions around their anus or genitals, but they could be found in lots of places, on their face, legs or hands. And some of them are very, very tiny single lesions and that makes it difficult because it can look like many things. But in the majority of cases, they look like blisters, similar to chicken pox, and then they become sort of pussy and then they scab over.

That's the normal way in which the lesions look. Chloe says that in past outbreaks of monkeypox, people often reported hundreds, sometimes thousands of lesions all over their body. But that doesn't seem to be happening here. About two-thirds of the people in Chloe's study had less than 10 lesions. But these lesions, they can be super painful,

particularly when they're in people's butts or mouths. In Chloe's study, around 100 people, or 20%, went to the emergency department. Well, it's excruciating. They're describing excruciating agony like they've never experienced in their lives. What causes that pain, that, like, incredible pain? OK, so it's like a deep sore

or multiple deep sores. So I'm trying to think of, so you know what, you know if you get a cold sore? Yes. So if you can imagine multiple painful sores like that inside the mouth, you know, which are swollen and open and sort of pussy and, you know, that right going down the back of your throat so that, you know, all of the surrounding tissue is really red and inflamed and painful. You know, imagine it like a terrible sore throat that's so bad that you can't swallow. But monkeypox wasn't this terrible for everyone. On the other side of the spectrum, sometimes people are presenting with such minor findings, just single lesions, very, very minor, tiny little lesions. We had, you know, in 10% of people,

just a single spot that you wouldn't even notice. Like in Chloe's study, about one in 10 people only had a single lesion. And out of more than 20,000 people in this outbreak so far, only a handful have died. Our next question is, how is this thing spreading? There's some talk out there that monkeypox has gone airborne. And we do know that it can spread through our saliva.

So could it be floating around in the air, coming out when we talk to each other? Well, a preprint study that got a bit of buzz tested the air in the hospital rooms of 15 monkeypox patients in the UK, and it found that in five of them, virus samples were in the air. And I know we're getting a bit of deja vu here from the early days of COVID, but if this was as contagious as COVID, we'd know by now. Think about it. Some of those thousands of infected people would have spread it to their parents, co-workers. Many were traveling when they got this. They would have given it to hotel

workers and other tourists. But we're not really seeing that. And what about surfaces? Well, we know from lab studies that monkeypox can be a sturdy bastard. Viruses like it can survive on surfaces for a while, in some cases, maybe even months. And in the UK a few years ago, scientists think that a healthcare worker got monkeypox from handling infected bed linen. That all sounds pretty bad. So I asked Chloe about it. How do we think about that? Because on one hand, the fact that it can survive on bed sheets, clothes, when you tell

people, oh, it could survive on surfaces, then everyone's like, it could be everywhere. Yeah, and that's right. There's a fear of that, theoretically, but that would be very unlucky, you know, in terms of spread to people who weren't having sexual contact. It was vanishingly rare in our trial. Almost nobody got it that way. Right. In Chloe's study of hundreds of people, they think that the vast majority of them didn't get this through surfaces or just talking to someone. There was a much clearer explanation. Chloe reckons that 95% of the people in her study probably got monkeypox through close sexual contact. 95%. I think if we think about how it's transmitted, it's transmitted from contact, it's skin-to-skin contact with a lesion. The lesions are very, very infectious.

The virus is in those lesions. So when they break open, the virus can get into someone else's body, say, through broken skin or fleshy, moist bits like a mouth or a butt. But it's not just the lesions that might be able to spread this when we have sex. Something else might be going on here. Chloe's team tested 32 samples of semen and found DNA from the monkeypox virus in 29 of them. Now, that doesn't mean that it is transmitting that way because we don't know that

the virus is infectious and can transmit from semen. But based on other viruses like Zika, once you find it in the semen, it's quite likely that it can transmit. And indeed, what we're finding is we're finding lesions which appear to be at the site of inoculation, like where the virus is actually entering the body. For example, if someone ejaculated right into the back of your throat. Chloe says it's too early to know for sure if this is being spread through semen. But big picture, what does all of this tell us? Well, while it's possible to get infected through surfaces,

like sharing bed linen or even someone's clothes, and maybe even talking really closely to someone. And we do think that three people in Chloe's study and a couple of kids in the US got this through household transmission. Generally speaking, though... Unless you're having sexual activity, you are, you know, very, very, very low risk.

Still, though, out of an abundance of caution, if you've got monkey po very, very low risk. Still, though, out of an abundance of caution, if you've got monkeypox, the CDC recommends isolating and avoiding all personal close contact until the symptoms have fully cleared up, which could be several weeks. OK, next up, if you are infected, when do you start to get contagious and when do you stop? Well, Chloe has started piecing together an answer for this because for around two dozen people in her study,

they were able to basically pinpoint when they got it and who they got it from. Because there was an absolute description of I went to a party, I had sex with three people. After that, I had no sex with anybody. Five days later, I noticed X. And then I took a photo of it, and then I showed it to the doctor, and then the next day I experienced this, and the next day I experienced this, and the next day I experienced this. And we have some doctors who actually was able to send serial photographs,

and they took samples, PCR samples, from the lesions on day one, day three, day five, whatever. So it was quite clear what the evolution was. So with this level of detail, they saw that the average time between getting infected and showing symptoms was about seven days. But it was pretty variable, like the shortest time was just three days and the longest was almost seven days. But it was pretty variable, like the shortest time was just three days and the longest was almost three weeks.

And based on the evidence that we have now, Chloe doesn't think that you're infectious before you've got symptoms. As far as we know, it becomes infectious at the time of the first lesion. And that's different from COVID. The bad news is that because some people just have mild symptoms, at the time of the first lesion. And that's different from COVID. The bad news is that because some people just have mild symptoms, say only a few lesions. That means that if people have got very few symptoms,

they're able to pass it on because they don't know they're unwell and there's no reason to just stop behaving as normal. Right. And then, curiously, in your study, there was this time lag between the first lesion to getting more, which surprised me. It was, on average, five days because you really might miss one little bump. What's happening there? Why is there that time lag? It's possibly the inoculum, the place where the virus goes in.

And then it sort of spreads inside the lymph nodes and then you get subsequent lesions. Oh, so once it hits, so say it starts whatever on your arm, once it gets to the lymph nodes, that's really when it starts hitting the rest of your body. Okay. Once you start getting lesions, you are infectious. When do you stop being infectious? Once the scabs have fallen off. Is it certain that people aren't infectious after the scabs fall off?

That's what we currently think. To the best of my current knowledge and my understanding, once the lesions fall off, you're no longer infectious. That's what we currently know. Right. And then what if in the semen, do we know when it stops being in the semen? Yeah, that's really difficult. We don't know how long it lasts in semen and we don't know if it's infectious in semen. So if you've been infected, when can you start having sex again?

Once all of the lesions have fallen off. And if you, you know, at this point in terms of the semen, I would suggest people use condoms for a while, at least 12 weeks. Yeah, that's 12 weeks after the lesions fall off. This number doesn't really come from cold, hard data, but it's what the World Health Organisation is recommending right now. And a big question that's been popping up is who's most at risk of getting a really serious case here? At first, Chloe was really worried about her patients with HIV, but she actually

found that in her study, for the men with HIV who were taking medication and had their condition under control, they ended up doing just as well as the men who didn't have HIV. But if you do have HIV and it's not well controlled, getting monkeypox could be really bad. There are other groups that doctors are concerned about too, like other people who are immunocompromised, children and pregnant people. For pregnancy, it's thought that monkeypox can cross the placenta and infect a growing fetus. And in the past, pregnant people who have gotten monkeypox

have sometimes lost their babies. So experts are watching this super closely. But the thing to keep in mind is that a lot of the data that we have on this comes from a different version of monkeypox to the one that's now spreading around the US and Europe. And we know just generally that that version is nastier than the one we've got. So bottom line here at Science Versus, we think it's just too early to know how dangerous this outbreak is going to be. We do know that one pregnant woman in the US did get infected and had a healthy baby. Two kids in the US that got this about a week ago were treated and are doing well. We just heard about two more kids that have been infected.

We don't yet know how they're going. So here's where we're at. This virus is spreading mainly through sexual contact right now and mostly among gay and bisexual men. But it may not stay that way because, you know, a lot of us have sex. And Chloe says that this could very possibly start spreading fast in straight people. For example, if it enters into the commercial sex worker population, that is quite an active heterosexual network. If it enters into

sort of swinger groups, you know, people, heterosexual groups that are having multiple sexual partners, it could spread through those groups as well. It's a disease of humans. It's not a disease of Africans. It's not a disease of gay people. It's a disease that's spreading within the gay community at the moment. And if you get some strange lesion, bear in mind that there's a global pandemic of monkeypox.

After the break, this virus is mutating. Should we be worried? No, too basic. Hi there. Still no. What about hello, handsome? Who knew you could give yourself the ick? That's why Bumble is changing how you start conversations. You can now make the first move or not. With opening moves, you simply choose a question to be automatically sent to your matches. Then sit back and let your matches start the chat. Download Bumble and try it for yourself.

Welcome back. Today, we're looking at this big monkeypox outbreak. Our next question is, why is this happening now? Because as we mentioned, this virus has been around for a long time, mostly popping up in Central and Western Africa. And yet, we've never seen an outbreak like this. So to find out what's going on, we called up a guy who knows this virus super well. So meet Yan Xiang, a microbiology professor at UT Health San Antonio, and he's been studying pox viruses for over 20 years. He says of all the viruses, monkeypox is actually his favourite.

Why is it your favourite virus? Everything I know about immunology, I learn from study viruses. So that's why it's my favourite virus. And all we want to talk about is how they scare the crap out of us. That's right. That's right. Yan's been studying monkeypox for so long that he remembers the first time it hit the US. It was in 2003. Oh, yeah, that's a very interesting story, actually.

At that time, there was an importation of African rodent as exotic animals, including a Gambian giant rat. The Gambian pouched rat. Yeah. Oh, my gosh, it's huge. Yeah. It is a giant rat. Giant rat, yes. It's like bigger than someone's huge. It is a giant rat. Giant rats, yes. It's like bigger than someone's head.

Yeah, yeah. So these mammoth rats that got imported into the US, well, some of them had monkey pox. The rats were put into an exotic pet facility near some prairie dogs, which got infected too. The prairie dogs were then sold to some families in the Midwest as pets. And here's where the infections happened. So those kids actually got infected with monkeypox. Oh. Yeah.

Did it spread to school friends or anything? There are no sustained human-to-human transmission in that case. The virus didn't really spread from person to person. Basically, everyone who got sick from that outbreak got it directly from their infected prairie dog. And this is generally how monkeypox has been acting in Africa too. So when Jan started hearing about all these people getting monkeypox that hadn't traveled to Africa, he was like... That is really strange. And it looks like there's a sustained human-to-human transmission. That is also unusual. So what's changed?

Why is it spreading all over? There's a lot of talk online that this virus has mutated recently and that we're dealing with a radically new form of monkeypox. And there is some science that backs this up. This virus has been mutating a lot more in recent years. In one study from Nigeria, they found that over the last five years, the mutation rate is 10 times higher than what we'd normally expect for a monkeypox virus.

And researchers have genetically analysed the virus that is swimming around the US and Europe right now. And Yan has seen that there are some changes that could be concerning. Like, we know that if pox viruses lose certain genes, they can become more dangerous. And with this monkeypox that's been circulating right now... We have started to see some gene loss in the new variant. But our current understanding of the pox virus biology

will not allow us to predict what kind of gene loss in monkeypox can lead to a more dangerous virus. We don't know. Yan says it's way too early to know whether these mutations are a real problem. From what he's seen, though, he doesn't think they're responsible

for this new global outbreak. I'm not totally convinced. There are mutations, but we don't know the meaning of those mutations. Plus, Yan says that there's a simpler explanation for why this is happening now. It's a one-two punch. The first is that monkeypox is close cousins with the smallpox virus. Yes, that smallpox virus that killed millions of people. Well, the thing is, a ton of us used to have immunity against smallpox because we vaccinated against it. After we eradicated smallpox, though, around 1980, we basically stopped doing this, which means... A new generation of people, they don't have the vaccine. They don't, they never received the vaccine for smallpox. So they don't have the immunity against those virus.

You know, we thought pox virus is all under control. You know, we got rid of the smallpox. But then suddenly, you know, monkeypox kind of emerged. Okay, so that's the first thing. Waning immunity to smallpox, which we think also means waning immunity to monkeypox. Second punch, super spreader events. So people have started traveling and partying again. And Dr. Carlton Thomas said that as monkeypox cases were just ticking up, there were a bunch of big parties where this thing could have easily spread. There was a fetish festival in Belgium called Darklands, which is a leather and fetish festival where a lot of

gay and bi men go. They reported on May 20th that there were three positive cases of monkeypox from Darklands, Belgium. The same people that go to this fetish festival in Belgium go to a similar fetish festival at the end of May in Chicago, Illinois, called International Mr. Leather. I am a very sex positive person, but this really concerned me. After the festivals in May, there were a bunch of pride celebrations where folks got together. I said, oh, oh, you know, this is this has a potential to explode.

And lo and behold, it has. So here's what scientists think happened. A few people got monkey pox in a country where this is endemic. And then they either went to one of these parties or passed it to someone else who went to one of those parties. There was some canoodling and bam. And the fact that this is spreading through sexual contact, it actually isn't that surprising because we already knew that lesions were turning up on genitals. Doctors in Nigeria had seen this for years.

It's something that we talked about with Jan. Oh, yeah, yeah. No, it has been published. They have described, you know, lesion around genital areas. Before this outbreak? Yeah, before this outbreak. Okay, our final question. What can we do about it? Well, if you're infected, for most people, this will clear up on its own. The CDC told us that it's looking like the lesions

take about two or three weeks to heal. And in Chloe's study, 95% of the people didn't get anything other than pain meds. There is an antiviral, though, that was made for smallpox. It's called tecovirumat or TPOX. Eight people in Chloe's study got it and ended up doing well. Here's Chloe. It's hard to know whether it would have turned the corner anyway,

but clinicians are saying that they think it's reducing the severity. So that's important, but it's been quite difficult to actually get these released to treat people. Yes, a doctor told me yesterday that in you, in the US, if you need TPOX, they have to call the CDC. It's not just at your local pharmacy. Yep, that's right. We're hearing from the CDC that it's about to get easier to access. And something that people are worried about is that the monkeypox lesions could leave their mark for a long time. When people get lesions on their face, a big concern is scarring. How often does scarring happen? I think the scarring can happen, but what we are seeing is that the lesions scab over and then when the scabs fall off, you can often get, you know, a scar for a period of time, but that tends to resolve like chickenpox. I can't guarantee

it will be in every single person, but in general, that's what we would expect. Is it something people should do to try to avoid scarring? I mean, you shouldn't go and sunbathe when you've got scars because then they can make it worse. And the fact that monkeypox can be so awful has made folks desperate for anything that might help stop it, in particular, vaccines. Now, unlike when COVID broke out, we actually have vaccines. These jabs weren't meant to protect us from monkeypox,

they were made for smallpox. The government started developing them after September 11, in case terrorists use smallpox in an attack. And it seems that they can help us against monkeypox. One study found that those who were vaccinated against smallpox were five times less likely to get monkeypox than those who weren't. But these vaccines that we've got, they are not a chastity belt against monkeypox. In fact, we don't even know how well they work. I talked to Carlton about this.

He's the doctor who's been talking all about monkeypox on social media. Now what remains to be seen is, is it going to be effective? You know, this is one of the first times we've ever preventatively vaccinated a group of people for monkeypox. So is it going to work? And when are the antibody levels enough after that one shot to say, okay, go have sex again and do your thing? A number that's being quoted over and over again is that the vaccines are 85% effective. But that actually comes from a study that wasn't even using the vaccines that we have now, just a similar one. So the vaccine that people are mainly getting now is called Jinius, and it's a weakened version of a virus that's

related to monkeypox. It's kind of been hacked away so it doesn't replicate in your body. Now, we actually don't have results from big clinical trials where it's been tested against monkeypox, the kind of thing that we had for our COVID vaccines. Instead, scientists reckon that this is going to help here because they've looked at this vaccine in the lab, doing stuff like trying it on animals or measuring people's antibodies after they get the jab. And they've also been tested for safety. Now, the other thing to note here is that Jinius normally needs two doses, but for now, lots of places are only doing one for the simple reason that there's just not enough to go around. Even with all of these caveats, though,

it does seem like the vaccines can help you if you're at risk. In fact, even if you've been exposed to monkeypox, we think the shot can help soon after. The only problem now is getting one. What is it like to get a vaccine right now in America? It's like getting a gold circle Beyonce ticket. Oh, wow. I mean, I don't know exactly what that means,

but it sounds hard. It's really, really hard. So it's like winning the lottery. Rollout of this vaccine has been super frustrating. The U.S. used to have millions of it in its national stockpile, but they expired, which meant that at the start of this monkeypox outbreak, there were only some 2,400 doses on US soil. By July 27th, they'd shipped out just over 300,000 doses, which is not meant for everyone in the US. For example, they're focusing on people who think they've been exposed or those who are having sex with multiple partners. The government says that it's got a lot more coming. But for now, it's been very difficult to get these vaccines.

When Carlton heard about one becoming available in his area, in San Diego, he jumped on it. I texted my husband, I texted all my friends. I put it up on social media all at the same time to just try to get it out there. And I was on hold for two hours and I finally got through and got an appointment. So you got vaccinated? Yeah, yeah, I got vaccinated. Yeah, I got vaccinated in my tricep right here.

Since we think these vaccines are going to work, but don't know exactly how well, Carlton is being careful right now. At the moment, he's in Greece for his 50th birthday. Well, I went to a gay nude beach today in Mykonos, surrounded by the most beautiful men in the world. And I just smiled and looked. Didn't touch a soul. Didn't come close to anybody. And it's just not worth it because I'm telling people, hey, don't do this. Don't do that. So while I'm in Mykonos, I'm in my room on Friday night at 845 right now. And you're talking to me.

Talking to you rather than going out and partying because it's honestly not worth it. It's not worth the risk for me. Mykonos will always be here. But right now, I need to focus on setting an example and keeping myself and my family protected. So that's what I'm doing. And by the way, if you got a smallpox vaccination decades ago, while you are not totally protected from getting this, it might help you. But chicken pox is a totally different virus. Don't be fooled by the word pox. As Carlton and I were finishing up our chat, we got to talking about how people often put these morals on top of viruses. This happened through the HIV AIDS epidemic. A lot of gay men just experienced a ton of stigma

and for some of the people that Carlton is talking to right now well they just feel like we're right back there there's a whole stigmatization and shame a lot of a lot of shaming and coming at these people for having monkeypox because they're being labeled as a whore that deserved it. And nobody deserves monkeypox. It's just a virus. It's just an infection. Viruses and infections are not meant to punish people. They just happen.

I mean, I was doing some of the same things that the people that got monkeypox were doing when they got monkeypox. I just happened to be a couple of weeks behind them. And then I realized what was happening and I stopped. They're just having sex. They're just having sex. It's just sex is natural and normal and healthy. Yes. And you don't deserve to be punished for that in

any way. Okay. So here's where we're at with this monkeypox outbreak. These early cases caught us off guard and left a lot of people worried about how to stay safe. Right now, the science is suggesting that this can be serious and painful, but for a lot of cases, they will clear up on their own. And it sounds like the tools that we have to fight this, TPOX, our vaccines, they should be easier to get soon. Tomorrow, we're going to release an interview with Dr Anthony Fauci about what went wrong here, why it felt like the response was so slow,

and where he thinks this outbreak is going next? That's Science Versus. Your call has been forwarded to an automatic voice message system. At the tone, please record your message. Hey Meryl, I called you about the citations. Okay, thanks. Hello? Hi, Meryl Ha hod producer at science verses hi wendy i just left a message on your about the citations i know it didn't ring i don't know what happened oh no did i leave did i leave a message about citations on someone else's voicemail?

I think so. Oh, well. So how many citations are there, Meryl? Oh, well, there are 147 citations. 147. And if people want to find them, where should they go? They can look at our show notes and then follow the links to the transcript. Excellent. Thank you.

I think that's all. Yeah. All right. Great. Thanks so much, Meryl. Thanks. Bye, Wendy. Bye. If you want to hear more about monkeypox, then we really, really recommend this podcast called A Bumpy Ride. It's by Leo Herrera and it's just really beautiful. So check it out, A Bumpy Ride.

This episode was produced by me, Wendy Zuckerman, Michelle Dang, Meryl Horn, Courtney Gilbert, Rose Rimler, Nick Delrose, and Disha Bagat. Additional help from McKeddie Foster-Keys. We're edited by Blythe Terrell. Fact-checking by Erica Akiko Howard. Mix and sound design by Sam Baer. Music written by Bumi Hidaka, Emma Munger, Bobby Lord, Peter Leonard, and Sir Wiley.

Thanks to the researchers we got in touch with for this episode. Really appreciate you jumping on the phone at the last minute. A big thanks to Dr Agam Rao, Professor Asma Khalil, Professor Siddhartha Birareddy, Professor Preeti Malani, and Dr Hugh Adler. And a special thanks to Leroy G. Robinson Jr., Randy Teague, Nick Lem, the Zuckerman family, and Joseph Lavelle Wilson.

I'm Wendy Zuckerman. Back to you later.