An outbreak of monkeypox has spread to nearly a dozen countries and infected more than 100 people worldwide, and there’s confusing, conflicting information coming out of the Biden administration on just how worried you should be about the disease.
So, more than two years into another pandemic that’s already killed a million people as once-extensive mitigation efforts have slowly eroded into a philosophy of “Let it rip,” how big of a problem is this one? Here’s what you need to know.
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What is monkeypox?
Monkeypox is an infectious disease from the same family as smallpox, which existed as one of the biggest threats to humanity for hundreds of years and killed 300 million people in the 20th century alone. Smallpox was officially eradicated in 1980, following a global vaccination and case-tracking campaign.
The first human case of monkeypox, which is markedly less lethal than smallpox, occurred in the Democratic Republic of the Congo (DRC) in 1970. Though the disease is endemic in countries in west and central Africa—there were more than 1,200 cases and 57 deaths in the DRC in the first four months of 2022, according to the World Health Organization—outbreaks outside of that region are extremely rare. There were two separate cases in the U.S. last year among people who’d both traveled to Nigeria, but no one else was infected.
The first and only sustained outbreak in the U.S., prior to this one, happened in 2003 and was linked to an import of African rodents from Ghana to Texas. Dozens of people were infected, mostly in the Midwest. But although two children had “serious clinical illness,” according to the CDC, no one died.
What are the symptoms?
The incubation period—time between the moment the infected person contracted the illness and the onset of symptoms—is usually one to two weeks, though it can last up to 21 days. In contrast to the airborne COVID-19, monkeypox is spread through contaminated surfaces like beds, according to the WHO, and extremely close contact such as sexual intercourse.
A top infectious disease expert suggested Monday that raves in Spain and Belgium may have contributed to the outbreak, according to the Associated Press. “We know monkeypox can spread when there is close contact with the lesions of someone who is infected, and it looks like sexual contact has now amplified that transmission,” Dr. David Heymann, a former WHO epidemiologist based in London, told the AP.
The symptoms of monkeypox are similar to chicken pox, which used to infect millions of Americans annually before the introduction of a vaccine in 1995. Fevers, headaches and muscle pains, exhaustion, and swollen lymph nodes are all common symptoms in the beginning of the illness, followed by a rash that can last between two and four weeks, according to the CDC.
There are two strains of monkeypox that originated in different regions in Africa; the one responsible for the current outbreak is the West African strain. Up to 3.6 percent of people who’ve contracted that West African strain have died, according to the World Health Organization. As UCLA epidemiologist Anne Rimoin told the Atlantic last week, experts “haven’t seen fatalities in people who’ve had monkeypox in high-resource settings” like Europe and the U.S.
How did this outbreak happen?
The first case in the United Kingdom was confirmed by the World Health Organization on May 7, in a person who had recently traveled to Nigeria. But since those first cases, the virus has spread rapidly throughout western Europe and the U.S., with more than 100 cases documented in a dozen WHO member states so far, the organization said.
More than two dozen people have been diagnosed with monkeypox in the U.K., Spain, and Portugal. On May 18, Massachusetts public health officials confirmed that a man who recently traveled to Canada had been diagnosed with monkeypox, and urged doctors to consider diagnoses of smallpox in patients with unexplained rashes who’d recently traveled to countries with suspected cases or men who recently had intercourse with other men. A Massachusetts man who’d recently traveled to Canada was diagnosed last week.
Officials in Florida and New York have also reported cases.
Should you be worried about monkeypox?
Though there’s uncertainty surrounding the current outbreak and what’s driving it, the situation is far different from the ongoing COVID-19 pandemic. For one, monkeypox has existed for more than a half-century, giving doctors and public health officials an enormous head start, which they didn’t have on COVID-19. There’s also no evidence to suggest the current outbreak of monkeypox is airborne, a huge driver of infections.
President Joe Biden said during a press conference in South Korea Sunday that the spread of monkeypox was “something everybody should be concerned about.” On Monday, Biden walked that back and said that he doesn’t think the monkeypox outbreak “rises to the level of the kind of concern that existed with COVID-19” and that quarantines weren’t likely.
We also already have vaccines for monkeypox. The smallpox vaccine is extremely effective at preventing transmission of monkeypox, according to the CDC, but the vaccines mostly fell out of use (except for military personnel and people working with the virus in laboratories) when smallpox was eradicated.
But in 2019, the FDA approved a two-dose smallpox and monkeypox vaccine called JYNEOS. After the first case in Massachusetts was confirmed, the federal government placed a $119 million order for 13 million freeze-dried doses of the vaccine to be delivered in 2023 and 2024.
The other pandemic is still happening, btw
While global attention turns to the monkeypox outbreak, COVID-19 is still stretching U.S. healthcare infrastructure past its breaking point, due to yet another wave driven by the latest surging sub-variant of Omicron.
Cases in the U.S. are up more than 50 percent over the past two weeks with more than 100,000 cases being reported each day and approximately 25,000 people currently hospitalized, according to the New York Times. Due to the prevalence of at-home testing, official totals are probably a “severe undercount,” as one epidemiologist told the Washington Post last week.
So far, the increase in cases hasn’t been accompanied by a drastic increase in deaths, though approximately 300 are being reported each day in the U.S.—six times as many monkeypox deaths in the DRC for the first four months of 2022 combined, for reference.
Booster shots were approved last week for children over the age of 5, and the CDC “strengthened” its recommendation that high-risk people, including the immunocompromised and people over the age of 50, should get a second booster shot if it’s been more than four months since their first. “With cases increasing, it is important that all people have the protection they need,” CDC Director Dr. Rochelle Walensky said in a statement.
Officials have warned that another winter outbreak is likely, but Congress has yet to pass another COVID funding bill, jeopardizing the response. Dr. Ashish Jha, the White House coronavirus coordinator, said last week that there won’t be enough money to provide testing and vaccines for all Americans if that happens.
“We have to plan for a scenario where we don’t get any more resources from Congress,” Jha told CNBC. “I think it would be terrible. I think we would see a lot of unnecessary loss if that were to happen.”
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