The Daily - How Worried Should We Be About Monkeypox?

Episode Date: June 16, 2022

Cases of the monkeypox virus are spreading in many countries where it has rarely, if ever, been seen before, including in the United States.Although there are a lot of unknowns about the illness, the rapidly rising number of infections has caused alarm bells to sound among public health agencies.Guest: Apoorva Mandavilli, a reporter for The New York Times, with a focus on science and global health.Want more from The Daily? For one big idea on the news each week from our team, subscribe to our newsletter. Background reading: In the U.S., the monkeypox outbreak has grown to around 80 cases. Globally, there have been about 2,000 confirmed cases.The outbreak poses a “real risk” to public health, the World Health Organization said.Here’s what to know about monkeypox and the risks it poses.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, the story of the other virus now threatening the U.S. and the plan to try to contain it. I spoke with my colleague, Apoorva Mandevili, about what we now know about monkeypox. It's Thursday, June 16th. Apoorva, a few days ago, you came to us and you said,

I think it's time to do an episode on monkeypox, which we take seriously, especially given the scale of public health challenges that we already face right now. So why did you say that to us? Why is now the right moment to talk about this disease? There are a few different reasons I thought we should probably talk about monkeypox now.

One is that public health agencies, you know, in the United States, the CDC, but also the World Health Organization, are very concerned about this virus being seen in all these countries where it normally has never been seen before. Health experts say it's the worst outbreak in the Western Hemisphere since 2003. Health experts say it's the worst outbreak in the Western Hemisphere since 2003. It's an unusual situation because we have a high number of cases in many countries. And the numbers are rising really, really quickly. So, for example, the World Health Organization first heard about monkeypox cases in the UK on May 13th, almost exactly a month ago. And just a few weeks later, here we are. exactly a month ago. And just a few weeks later, here we are. Out of abundance of caution,

the CDC is upgrading guidance for monkeypox, elevating it to a level two. With other cases reported in New York, Florida, Colorado, Illinois, and Utah. Globally, we are at almost 2,000 cases and another 2,000 that are being evaluated. Wow. In the United States, we now have 84 cases in 17 states and the District of Columbia. So those numbers have gone up very fast. And yet, it is actually still early enough to contain. If people find out what this virus is, if they are quick to seek help when they start to see symptoms, if we all sort of do our part, we could still contain this virus before it gets out of control. Because it's early.

Because it's early enough. Well, let's establish some very basic information about monkeypox. What exactly is it? I have to say the only thing I really know about it is that given its name, it obviously seems to have originated with monkeys. Yeah, you know, that's actually not possibly the case. It's a bad name in many ways because it was first identified in monkeys, but we don't actually know what its natural reservoir is.

And it's actually most often transmitted by rodents. So there is actually quite a big push right now from public health experts to try and rename it. But for the moment, it's called monkeypox. And like the name sort of sounds, it is actually very closely related to smallpox, which we have not seen anywhere in the world since 1980. It has that sort of blistery rash that you've seen in pictures of smallpox, pus-filled blisters all over the body, but it's much, much milder than that. And how did this virus come to be? Where did monkeypox originate? So the virus was first identified in monkeys, which is where that name comes from, in lab monkeys in Denmark. But then

the first case in people was identified in 1970 in this nine-month-old baby in the Democratic Republic of the Congo. From that point on, they started to see cases in the DRC. And then a few decades later, they also started to see cases in West Africa, in Nigeria in particular. And so it was clear that the virus had started to pop up in human populations every once in a while. Most of the time, it seemed like just from animal to person. So it was seen in only these African countries for quite a long time. And then in 2003, there was a shipment of Gambian pouched rats that came to the United States. And then they infected prairie dogs, which a lot of people have as pets. So there were about 71 people altogether by the end who got monkeypox in the U.S., in Midwestern states, from these prairie dogs.

Wow. Then, you know, after that, we've seen a couple of cases here and there. There was one in Texas last year. There were a couple in the U.K. in 2018, but pretty much always in people with some sort of history of travel to Africa. to Africa. This time, we are seeing it in a lot of people who have never been to Africa and who have no travel history at all. And it's been in a lot of countries, 30-some countries at this point, where we've never seen monkeypox before. Hmm, which, and now I'm sounding like someone who's talked a lot to you about COVID, it seems we're talking about community spread. It does indeed seem like we're talking about community spread. And that especially seems

that way when we hear about people who don't know where they got it. You know, if there's no obvious place that they caught their infection, that's always a sign that it might already be spreading in the community. And that's why they don't know where they got it. it might already be spreading in the community, and that's why they don't know where they got it. Okay, so let's talk about the nature of how we think monkeypox is spreading right now in this moment. This is actually something quite unusual about this outbreak also, because, you know, in African countries, when we've heard about monkeypox before, it's usually been in somebody who went hunting or ate, you know, bush made of certain kind or used medicinal products that were derived from animals. But this time what we're seeing is spread mostly among gay, bisexual or men who have sex with men.

Pretty much 98% of the cases in the UK, for example, are in that population. Very few women and almost no cases really among kids. So how do public health officials believe that the virus is now spreading through this population in this latest outbreak? So we know that when there's transmission between people, it usually is because of close contact. So, you know, somebody touches another person's rash and comes into contact with that pus that's inside the blisters or maybe you know sharing linens or other things that have that same pus on them the contaminated materials this time what it looks like is that the close contact in most cases actually has been sexual contact so there were these very large parties that happened in Europe

and one in particular in Spain that researchers think a lot of men went to and had many partners. And so even a few infected people had the opportunity to spread it to a lot of people because there was a lot of kissing and sex and just a lot of close, close contact. So are doctors starting to think of monkeypox in this moment

as having the qualities of an STD, of a sexually transmitted disease? You know, it's presenting like that right now in this particular population, but we don't actually know if it's a sexually transmitted disease. We don't know whether it spreads through sperm or through vaginal secretions. What we know is that it spreads through close contact, and this kind of sexual contact is close contact. So for the moment, we should still be looking at it just as a virus that spreads through close contact

and that could be the case in any demographic. And what does a monkeypox infection do to a person? How sick does it make them? What's the typical experience of this infection? It begins with respiratory symptoms, actually. So people may develop a cough, a sore throat, cold-like symptoms, body aches, and then they start to develop this rash. And one thing that's very unusual about this rash is that you see it on the palms of your hands and the soles of your feet before it spreads everywhere else.

And people generally are contagious as long as they have those blisters, you know, until those blisters dry off and fall off. And in this particular outbreak, we're actually seeing fairly mild symptoms. So it's possible that some people have a very mild version and don't even know they have it. But I do want to say that's not always the case because we know that in Africa, for example, the version of this monkeypox virus that we're seeing right now in this outbreak has had a mortality of something around four to six percent. Wow. That's high. It's high, but in context. This is in West Africa. It's mostly in kids or in immunocompromised people with, you know, people with not very good access to health care. It's possible that this disease is actually very different in different countries based on the health of the population and the access to health care. In the past, monkeypox has had a very high mortality rate.

You're describing an infection as it presents in a place like the U.S. right now as mild. In the people that it's being seen in right now, because most of the people who have monkeypox right now are men between 20 and 50, who are not the ones at high risk. And we have not actually seen any deaths so far. In the U.S.? In the U.S. or actually in any of the countries outside of Africa where the virus is now circulating, we haven't seen a single death. So how can the spread of monkeypox be limited in a place like the U.S. right now, knowing what we know about how the virus is spread?

Very good old-fashioned principles of public health. So the very first one is contact tracing, which we heard about during COVID. The experts really just reach out to the patients and ask, whom have you been in touch with? Who has had close contact? And then they contact those people and make sure that they're looking for symptoms.

And then they can also use this approach called ring vaccination, where basically you vaccinate all of the close contacts of a patient as a precautionary measure to make sure that the virus doesn't even get a chance to take hold in them. But ring vaccination with what vaccine?

So this is interesting because the FDA did approve a vaccine for smallpox and monkeypox. And the U.S. has actually invested quite a bit in vaccines for smallpox because we've been worried about it as a potential bioterrorism threat. So we have a whole bunch of vaccine and a whole bunch of drug just in case of that kind of attack. So you're saying that a biowarfare stockpile of vaccine against smallpox is

suddenly very useful in this new outbreak of monkeypox? Yes, because they're actually very closely related viruses. So we have in the U.S., you know, emergency stockpile about 100 million doses of a more modern version of the vaccine that was used to eradicate smallpox. And then we have this other vaccine called JYNNEOS that was developed specifically for smallpox and monkeypox and approved in 2019. Okay, what you're describing is how the spread is limited among people who have close contact with somebody who has monkeypox. What about for the larger population? Or is there not a concern yet about that larger population? Yeah, I mean, there is a

chance that this virus could get out of that population, right? Especially the longer it goes on, because a lot of those men live with other people. They live with women, they live with kids, they live with older people. And we know that the virus spreads to close contact. But in a very small number of cases, it looks like it could also be airborne. So if somebody's sharing the same airspace for a significant period of time, they could get infected. And so those are cases that we're not necessarily accounting for when we just talk about sexual contact or close physical contact. And how significant a threat is the airborne spread of monkeypox? I want to be very clear and say that, you know, airborne is not the kind of

airborne that we talked about when we were talking about the coronavirus or measles. This virus does not seem to travel long distances or stay in there for really long periods of time. It is not the major route of transmission. But the experts that I've been talking to are saying that it is capable of being inhaled if you're at somewhat close range of a patient and you're sharing the same airspace for some significant amount of time. So that means a household contact, for example, who is in the same room for some period of time with the patient. And the CDC has said that healthcare workers who are interacting with patients should wear masks. So people at short-range contact with the patients. So you keep describing the greatest risk as someone being very close to someone with

monkeypox. I'm not hearing you say that your average person walking around the world has all that much to fear in terms of getting monkeypox. Is that right? I think that's fair. I think the average person does not have that much to fear. What experts are more concerned about is patients who don't quite know that they're infected because maybe their symptoms are mild are then transmitting it to other people. And then it sort of fans out from there so that, you know, we still do see it spread to several hundred or several thousand cases in this country. several thousand cases in this country.

But, you know, if we do all the right things, we are going to contain this outbreak. So it's just that we're going to see the numbers get a lot worse before they get better. We'll be right back. So let's talk about treatment for just a moment. You mentioned ring vaccination as a way of preventing people from potentially getting the virus if they're in close contact with someone who has it. But let's say in the coming weeks, dozens if not hundreds of people in a place like the U.S. suddenly get monkeypox, ring vaccination didn't stop it. What kind of treatment options are there? So there are a couple of drugs available.

And when you look into them closer, it's really just one because the second one is very toxic. But there is a drug called T-pox that has been shown to be somewhat effective in reducing the sort of length of illness and the severity. And we do have quite a lot of doses of that in the United States, and we could get many more if we wanted them. But again, so far in this outbreak, we haven't really seen the kind of very severe cases that would need that kind of intervention. we haven't really seen the kind of very severe cases that would need that kind of intervention. Historically, the kind of monkeypox cases that we've seen would need to be hospitalized. But in this case, most people are actually recovering at home. So this may self-resolve in many cases.

This may self-resolve in many cases. Really, the thing we're worried about more is how many people the patient will spread it to before they get better. So has the government issued any guidance on quarantining or containment the way we have with COVID for people who get monkeypox? Or is it just not widespread enough for the government to have done that? They are asking patients to isolate at home so that they don't have much chance to spread it to anybody else. And then they are also asking people to stay away from their pets if possible and, you know, to avoid wild animals because we don't really want to take the chance that the virus would jump into those animals. Wow. And then potentially jump out of them back to humans in a different form. Potentially. But also we don't want it to find a new home in those animals because then it would just stick around forever.

Got it. just stick around forever. Got it. Apropos, to the degree that so far in the U.S., and it seems like in many different countries, this outbreak has been concentrated among gay men, how are public health agencies in those countries, especially in the U.S., thinking about communication to those communities?

It's been really tricky. I think it's been a very, very tricky balance for them to strike because they It's been really tricky. I think it's been very, very tricky balance for them to strike because they want to alert that community. They want all these men to be aware, but at the same time, they don't want to give the message that this is a virus that only affects gay men because that's not true either. And they also don't want to stigmatize that population. You know, that's a big mistake we made at the beginning of the AIDS epidemic where we made assumptions about the virus, but we also really stigmatized men who have sex with men. And public health authorities are trying very hard this time to arm men with information and yet not stigmatize them and not spread the myth that this is not going to go

beyond that population. So what does that look like, that balancing act so far? This is Pride Month. It's June, right? There are lots and lots of gay pride events all over the world. There are lots of parties, lots of celebration, lots of people close together, close contact, lots of opportunities for the virus to spread. And so public health experts are trying to work with the organizers of some of those events and try to get the message out. You know, Grindr has had a couple of public service announcements.

This is a gay dating site. This is a gay dating site, correct. And, you know, they are really trying to do outreach through community groups so that as many men in that community as possible really understand the risks. But again, at the same time, we want to make sure that nobody's under the impression that this is just a gay man's disease, because that's not true. We want everyone to know what this virus

is and what this disease looks like. So finally, Apoorva, the weird thing about talking about a new public health threat at this moment we're in is that we're already dealing with a huge public health threat, which is COVID-19. And so it's very tempting to draw a lot of parallels between the two, to wonder if we're overreacting or underreacting, which are questions we're still asking about COVID. But for a lot of reasons that you've laid out, these are not the same kind of public health threat, COVID and monkeypox. So how do you think about the two of them in your head at this moment? Or are you trying to keep them as far apart as possible? I mean, comparisons are inevitable because I am still writing about COVID and now I'm writing about monkeypox. And, you know, for a lot of people, I think the coronavirus was the first virus they paid close attention to. It's the reference point for a lot of people.

So, you know, for example, when we talk about monkeypox being airborne, it's natural to immediately say, you know, it's airborne in ways that the coronavirus is, and is not airborne in the ways that coronavirus is. So it's an inevitable place to go when we're talking about this virus. I do worry, though, that because we're coming off of COVID and we're coming off of these horrific two and a half years that we've had,

that people just don't want to hear about another virus. So even though... Right, there's fatigue. There's so much fatigue. But, you know, we don't want to be so fatigued that we don't pay attention to a virus that actually is important. We did that with COVID. We know what happens when we bury our head in the sand and pretend that the problem is somewhere else in some other people and is never going to affect us. You know, in public health, there's this idea of a precautionary principle, which means you don't wait until you have all the information before you act.

You sort of look at what information you do have and you take the most precautions you can to prevent that. With COVID was because we waited so long to get as much information as we could. We missed the window of time to really prevent that virus from ravaging our country. Exactly. With that virus, we repeatedly didn't take it seriously enough until things went out of control. And we don't want to repeat that with this virus. Milipurva, thank you very much. We appreciate it. Thank you.

We'll be right back. Here's what else you need to know today. On Wednesday, in its most forceful attempt so far to lower inflation, the Federal Reserve raised interest rates by three-quarters of a percentage point, its biggest increase since 1994. The Fed hopes that making the cost of borrowing higher will pull money out of the economy, dampen consumer demand, and eventually lower prices. But the higher interest rate also risks tipping the economy into a recession.

And a major new report has found that the number of abortions in the U.S. is on the rise, reversing a three-decade decline. In 2017, the report found 18.4% of pregnancies ended in abortion. In 2020, that number rose to 20.6%. The increase came as many Republican-led states made it harder to get an abortion, and as conservatives have gotten ever closer to overturning Roe v. Wade. Today's episode was produced by Nina Feldman and Michael Simon-Johnson, with help from Rob Zipko.

and Michael Simon-Johnson, with help from Rob Zipko. It was edited by M.J. Davis-Lynn, contains original music by Rochelle Bonja, Chelsea Daniel, and Marion Lozano, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderland. That's it for The Daily. I'm Michael Bilboro.

See you tomorrow.