Today, Explained - Monkeypox!?!?

Episode Date: May 26, 2022

Good news: Epidemiologists don’t think monkeypox will be as bad as Covid-19. Bad news: We stopped vaccinating people against this type of disease decades ago. Vox reporter (and resident epidemiologist) Keren Landman explains. This episode was produced by Haleema Shah, edited by Matt Collette, fact-checked by Laura Bullard, engineered by Paul Mounsey, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained   Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Okay, so you've been worrying about COVID-19 for like two years or whatever it is at this point, and now there's this monkeypox thing? Take your stinking paws off me, you damn dirty ape! WHO's Dr. Rosamund Lewis said there are over 250 confirmed and suspected cases of monkeypox in at least 16 countries. I don't want to freak anyone out here. It's almost certainly not going to be as bad as COVID. It's not particularly new, and we've already got vaccines that can prevent spread. All that being said, no one was asking for another thing to worry about, but here is yet another thing.

What in the H-E double hockey sticks is monkeypox? And how are we going to deal with this thing now? I'm Sean Ramos from That Is Ahead on Today Explained. Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. It's Today Explained. I'm Sean Ramos-Ferrum.

I'm here with Karen Landman, who is a senior reporter on health and science here at Vox and a physician and an epidemiologist. Karen, did I get it all right? You did, Sean. Great job. Welcome to the show. The president's talking about monkeypox. The World Health Organization is talking about monkeypox. So it seemed like high time we talk about monkeypox on the show. How worried should the world be about monkeypox, so it seemed like high time we talk about monkeypox on the show. How worried should the world be about monkeypox, Karen? First of all, I think we're all primed to worry quite a bit about any new pathogen that we are not used to seeing on the scene here in the U.S. and in Europe. But this is fundamentally a

different situation than when COVID came on the scene. This is a smallpox-like illness, but it's not nearly as virulent. It doesn't cause nearly as bad a disease as smallpox did, and it doesn't spread as easily from person to person as smallpox did. So it's not likely to lead to the kind of mass deaths that we saw with COVID-19. So I don't think we would expect to see a whole lot of deaths due to monkeypox in places where we have good access to hospital care. When we see monkeypox in the U.S. or in Europe, it's usually in sporadic cases where it kind of travels with a return traveler from Nigeria or some other place in Central or West Africa where there is a lot of monkeypox circulating, either among animals and occasionally in little

outbreak situations among people. But we don't usually see the kind of person-to-person spread that we seem to be seeing in Europe and in the United States, leading to the kinds of numbers of cases that we're seeing now. Italy and Sweden have become the latest countries to confirm cases, following Britain, Portugal and Spain. Tonight, a potential case of monkeypox is being investigated at this New York City hospital after the U.S.'s first case of the year was confirmed Wednesday in Massachusetts,

a man who'd only recently traveled to Canada. And we're still not seeing, like, bananas numbers like we do with COVID, right? We're still seeing relatively small numbers of monkeypox? Yeah, that's absolutely right. I mean, as of Tuesday morning, there were 270-odd suspected and confirmed cases of monkeypox worldwide. that high a number. You know, you could imagine, given that there's some probable transmission happening that is not being detected, that it could be a much higher number than that. It could be in the thousands. But we haven't actually seen those numbers turn up yet. And if I'm understanding you, this is traveled from Africa to Europe and North America, is that correct? That's usually the way it moves. Right now, at least one travel-associated case that is part of this outbreak, that sort of has happened at the same time as this outbreak.

And a whole lot of other cases, most of the other cases, are among gay and bi men, men who have sex with men, many of whom are linked by having been in the same place at the same events at the same time. None of those seem to be linked to the travel cases. So there may have been some transmission that has not yet been detected that sort of does link those two groups of people. Where was this event? So there are several events. There was a sauna. That's sort of the European term for a gay bathhouse. So a bathhouse used for adults for sex, usually by queer men. In Spain, that's responsible for most of the cases. There was a gay pride event in the Canary Islands

that I believe has been linked to several cases or thought to have been linked to several cases. And also a gay fetish event in Antwerp that's called Darklands. And that has also been linked to several cases. So the people who run those events have already reached out to attendees and done a lot of work to do case finding. But those are some of the events to which and places to which some of these clusters are linked. You said this is sort of like a smallpox type disease, but now we're talking about it being related to gay sex. Is this sort of like an STD? What's the deal? I actually talked to John Brooks

at the CDC. He's one of the leads in the investigation on this. He said, you know, what defines an STI, they call it an STI now, sexually transmitted infection, is a disease that requires sex to be transmitted. So gonorrhea and chlamydia are sort of the classic examples of this. But there are also a lot of diseases that do not meet that definition that can be transmitted during the kind of close contact that happens during sex. So like meningitis is an example of that. You know, there have been outbreaks of meningitis among, also among gay and bi men, just due to the close contact within that community that happens during sex. So not

really technically transmitted during the biologically defined sex, but during the close contact that sort of surrounds all of that. If monkeypox is being transmitted during sex, it's more likely just because of the close contact that goes along with sexual activity, not necessarily because of the biological act of intercourse. What are all the ways monkeypox can spread between people? Most of the spread happens from contact with the sores. Open sores have a pretty high number of viruses in them, and so they're pretty infectious. It can also be spread through respiratory droplets and possibly aerosols. But John Brooks during the CDC press conference said that usually happens because there are undetected sores in the mouth and

throat. And so when somebody, before they have an open sore on their visible skin, may have a sore in their mouth or throat, may cough or breathe heavily around another person and transmit it that way. So really the sores are where the transmission comes from in monkeypox. Okay, so it's not like COVID-style transmission where, you know, 15 minutes in a closed quarter, you're definitely going to get it or something like that? Right. No, it's a very different type of transmission. And you do not, you're so unlikely to catch this during just casual contact with somebody. So it makes it a lot easier to protect yourself if you are, you know, out and about in the world. The CDC this morning wants to calm the public fears over how the monkeypox virus is transmitted.

The agency emphasizing that it does not spread easily through the air like COVID-19. Monkeypox is primarily spread through sustained physical contact, such as skin-to-skin touch or someone with an active rash. The kind of contact that you need to have to transmit this really needs to be skin-to-skin or contact with an item that a person's sore has had contact with. So what's unique about this virus compared with many others, including COVID, is that it lives for a long time on surfaces. So there have been cases of transmission, for example, to the person cleaning the bedding of an infected person because they had contact with fluid that leaked from the sores onto that bedding.

So, you know, you do need to have contact precautions around somebody that you know to be sick with this in order to prevent transmission. But that's a very different kind of practice than not sharing airspace, as you can imagine. It could spread through aerosols, just to be clear here, but not nearly as likely as something like COVID. That's right. And it's just not nearly as likely for this particular pathogen to spread through aerosol as it is to spread through skin contact. How long has this disease been around and not, you know, been studied that closely? Well, good question. Monkeypox was first identified in the late 1950s when it was found to be infecting research animals, which were monkeys, which is why it has its name. But it usually lives in small rodents, usually in West and Central Africa, and is kind of burbled up in small outbreaks, usually chains of maybe one to three people, usually household members in that part of the world since then. And only recently, maybe since 2017,

have we started to see a whole lot of human-to-human transmission, and that has been in Nigeria primarily. An 11-year-old boy living in Agoura was infected by the monkeypox disease. He and his family have been quarantined at the Niger Delta University Teaching Hospital. It kind of started with a big rainfall event that caused both people and animals to flee to higher ground. And so there's just a lot more contact between humans and the animals where this disease more naturally circulates. And there have been more and more transmission events and clusters in Nigeria such that there have been now 450 human cases in Nigeria, and a lot of those have been spread from humans to humans. And what are the symptoms like?

So it usually starts with a flu-like illness, you know, some fever, chills, muscle aches, headache. And then within a couple of days, it'll progress to a rash. And that rash looks a lot like chicken pox, which doctors traditionally described as sort of a dew drop on a rose petal, which means it's kind of a wet-looking but clear blister on a reddened base. And so, it'll look like that for a couple of days and then progress to being a more pussy-looking blister. And that'll pop. And then usually within two weeks from the onset of the blister, they start to crust over. The infectious period is thought to start with the onset of rash, although there's also some

discussion of the possibility that infectivity starts, that someone can be contagious when they start having the fever and the muscle aches, in part because there may during that period be rash inside the mouth and throat that is not really detected by the person who has it. Sounds kind of gnarly. Who's most vulnerable here? Until 2017, we mostly saw bad outcomes among small children and babies babies who were also the primary people who got infected with this. So what that portends for us is that people with some level of immunocompromise are at higher risk for a bad outcome from a monkeypox infection, even with this West African, less severe version of monkeypox.

Does it have lasting effects? It can, of course, if it causes severe disease, you can have outcomes from severe disease, including death. But also even mild disease, if you have substantial rash, it can leave some pretty significant scarring, which can be, you know, a cosmetic problem for some people. And I think what we're learning with COVID, there can be post-viral effects that we have not yet identified. So I think there may be, there are some consequences that we know about, and then there are some that we may not yet know about. Should people be concerned that this could turn into another COVID? So we're seeing it in places and among a community that actually has a lot of resources to stop its spread. This is a containable situation, particularly in the countries like where we are seeing these outbreaks that are happening across Europe, in North America as well.

Both the general public and public health have a lot of practice washing their hands, washing potentially touched or infected linens or clothes, wearing gloves, wearing masks. I think, you know, masks are a lot less important for preventing transmission here, but contact precautions are something that many of us who had never heard about those things before COVID now know very well. I think we're actually in a pretty good position. But, you know, if there is a whole lot of transmission going on that's undetected, and there are chains of transmission that public health authorities are not able to catch, then, you know, this may become something that kind of burbles at a low level, uncontrolled in the general population in countries where it

didn't circulate before. That is a possibility. But for it to cause the kind of widespread, severe disease and death that COVID caused, that seems right now unlikely. How to prevent monkeypox in a minute on Today Explained. Thank you. it easy to share unlimited photos and videos directly from your phone to the frame. When you give an AuraFrame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an AuraFrame for himself. So setup was super simple. In my case, we were celebrating my grandmother's birthday, and she's very fortunate. She's got 10 grandkids. And so we wanted to surprise her with the AuraFrame. And because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody.

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If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Well, I tracked down Marcel and get this. He's healthy, he's happy, and he's right here in New York filming Outbreak 2, The Virus Takes Manhattan. You're kidding! This is amazing.

I know. I finally get a part on TV and the monkey's making movies. Today, Explained, Sean Romsom here with Karen Landman, senior reporter on health at Vox. Karen, how do we prevent the spread of monkeypox? Contact tracing is the start of prevention efforts. Fortunately, there is no known asymptomatic transmission with monkeypox.

So that means that in the period before a person starts to have those flu-like symptoms, we don't think they're transmitting. And if you may recall from COVID, that was a real problem. A real difficulty in COVID is that you had to go back and think, in the days before I was sick, you know, who did I have contact with? We don't really have to do that with monkeypox in the same way. So, contact tracing is the beginning of all prevention efforts with monkeypox. And then once you know who has been infected and who those contacts are, you first get them to stay home. And then in some places, they're starting to vaccinate those people. What vaccination? They're vaccinating these folks with smallpox vaccine. And the smallpox vaccine, many of us have either not really had to think about or even really know about. But a large number of humans living in the world where smallpox was

a problem until about 1980 have been vaccinated for smallpox. And my mom's got the scar. Yeah, yeah. So there was quite a bit of immunity as a consequence. We still have smallpox vaccine in, often in like national strategic stockpiles, for example, where we keep it in case some country has a smallpox isolate that they might want to weaponize, for example, for like a bioterrorism attack. The old smallpox vaccine that they might want to weaponize, for example, for like a

bioterrorism attack. The old smallpox vaccine that was used, by the way, is not the kind of one we would use now. It was a live virus vaccine. It was weakened, but it could replicate in people who had severe immunocompromise. And we would not want to use that as eagerly as we might want to use a safer virus for folks with immunocompromised. And so a new, safer smallpox vaccine, and it is called JYNNEOS, I believe is the brand name. And JYNNEOS is a non or all the particularly close contacts to prevent them from either developing infection or transmitting it. And ideally, you do that within four days of infection. How much of the world is still getting a smallpox vaccination of some kind? None.

Step by step, the disease was pushed back to the very last case, Ali Mao Malin. It's not necessary to vaccinate people against smallpox anymore because it's been eradicated. Smallpox was no more. On the 8th of May, 1980, Dr. Halfgan Marla, Director General of the World Health Organization, signed a certificate of eradication. So there's no point in vaccinating people broadly for a disease that's not causing a whole lot of death. And what about treatment if you actually get the monkeypox? So most people don't really need a particular drug directed at killing the virus or stopping

its spread. Most people do fine just taking care of themselves at home, drinking lots of fluids, controlling any fever symptoms with pain and fever medicines, and getting through it themselves. That way, most people don't require hospitalization but are currently being hospitalized, I think, often just to prevent spread while other sort of contingencies are managed. But there are a couple of medicines that are being explored or have already been approved for use in people with this infection. One is called T-pox. It's sort of the brand name for tecovirimat. There's some evidence from human trials in the Central African Republic that are promising. So that's a good thing. And there's also another drug called brinsendofovir. And that also seems to show

some efficacy treating monkeypox. But honestly, I think most of the people, if you have a healthy immune system, most people will be able to manage this as just an infection that goes away by itself, but just has some unpleasant symptoms while it's making its way through you. Is there anyone out there right now saying we should have never stopped vaccinating people for smallpox? Because if we hadn't, this monkeypox thing wouldn't have happened? I haven't heard that particular perspective. I have seen, there was a study published well before this particular outbreak, sort of other places to put the resources that you previously put towards smallpox vaccination. So whether it's other vaccination campaigns or other disease prevention campaigns. The 10-year campaign cost $300 million, a real bargain. The world saves each year $1,000 million on vaccines and care for sick alone.

Since 1980, when smallpox was eradicated, the amount of travel that people are able to do and that people do has changed quite a bit, has gone up quite a bit. And we're also seeing enormous changes in the border between humans and the wild animals where this disease normally circulates, right? Climate change has accelerated. Deforestation has accelerated. Conflict, although conflict has always been present, you know, at least since colonialization throughout various parts of West and Central Africa, that has been a really active dynamic over the last few decades. So all of this has brought humans in increasing contact with the reservoirs of this infection. And so this maybe accelerated monkeypox's arrival into this niche that smallpox previously occupied.

But these trends that we're talking about, deforestation, you know, humans moving more and more into previously unoccupied territory, climate change, travel, these trends don't seem to be going anywhere. Does that mean that monkeypox is just the latest in a host of new diseases we're going to be coming into contact with? I mean, it is the latest, but if you'll recall, there is a coronavirus that also kind of jumped species and has caused a fair bit of havoc. So yeah, yes, absolutely. I mean, coronavirus obviously was not the first either. There are a lot of diseases that we don't often have to think about in the U.S what could contribute to their persistence is, you know, changing climates here. So, for example, think about dengue. Dengue is a disease caused by a mosquito-borne virus that generally lives in the tropics, right? You need a certain kind of

mosquito to transmit dengue. And for a long time, you didn't see that mosquito in the United States. But you'd occasionally see those mosquitoes and occasionally dengue virus being transmitted by them in places like Key West or in Hawaii, rarely. And public health, thankfully, was able to control those episodes. But as we see climate conditions changing, I think there's certainly a risk that we'll start to see a little bit more of this dynamic evolving in the future. Karen Landman is a senior reporter on health and science here at Vox and a physician and an epidemiologist. You can read her at Vox.com.

Our show today wouldn't have been possible were it not for the efforts of Halima Shah and also Matthew Collette, Laura Bullard, and Paul Mounsey. It's Today Explained. Thank you.