Everything We Know So Far About Monkeypox

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The Biden administration has declared a public health emergency.

Monkeypox, which was discovered in unusual clusters in the U.K., Spain, and Portugal in the spring, is gaining ground in the U.S. Here’s the latest.

First U.S. death due to monkeypox confirmed

The Los Angeles Department of Public Health has officially confirmed the first U.S. death from monkeypox. The CDC, which also affirmed the link on September 12, noted in a press release that the victim was severely immunocompromised.

“Persons severely immunocompromised who suspect they have monkeypox are encouraged to seek medical care and treatment early and remain under the care of a provider during their illness,” it said.

In an email to CNN, Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center, explained that the person’s “impaired immune system could not control the virus once it entered his body, the virus multiplied in an uncontained fashion and it likely spread to several organ systems, causing their malfunction.”

Man with monkeypox dies in Texas

Texas health officials confirmed yesterday that a man diagnosed with monkeypox has died. The man, who was from Harris County, was reportedly “severely immunocompromised.” It is still unknown whether the virus caused his death.

John Hellerstedt, DSHS Commissioner noted in the press release that monkeypox is a “serious disease, particularly for those with weakened immune systems.”

“We continue to urge people to seek treatment if they have been exposed to monkeypox or have symptoms consistent with the disease,” he added.

Biden administration declares public health emergency

The Biden administration has officially declared monkeypox a public health emergency. The move will free up emergency funds and expedite vaccine distribution — as well as allow health agencies to collect more data on the virus’s spread.

“We’re prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” Department of Health and Human Services Secretary Xavier Becerra said in a Thursday briefing.

More than 6,600 likely or confirmed cases have been detected across the U.S. since the first case was identified in mid-May, and the government has come under fire for its apparently lackluster response before now. One major point of contention was the three-week delay between the first monkeycase being identified and the bulk ordering of monkeypox vaccine — which the government owns and stores in Denmark.

Last month, the World Health Organization declared monkeypox a public health emergency of international concern. This is defined as “an extraordinary event” that constitutes a “public health risk to other States through the international spread of disease” and “to potentially require a coordinated international response.”

California and Illinois declare a state of emergency

California and Illinois both declared a state of emergency over monkeypox on August 1. Illinois Gov. J.B. Pritzker stressed that the decision makes “all available public health resources” available to combat the virus.

This came as the White House confirmed that Bob Fenton and Demetre Daskalakis will be announced on August 2 as national monkeypox coordinator and as deputy. Per NBC, Dr Fauci has endorsed the pair as an apt choice to tackle the spread of the disease: Fenton helped lead the country’s coronavirus vaccination effort as Federal Emergency Management Agency acting administrator, and Daskalakis is director of the CDC’s HIV prevention division.

New York and San Fransisco sound the alarm

New York has declared monkeypox an imminent threat to public health amid rising infections.

“This declaration means that local health departments engaged in response and prevention activities will be able to access additional State reimbursement, after other Federal and State funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities,” Dr. Mary T. Bassett, the state health commissioner, said in a statement announcing the move.

San Francisco meanwhile has declared a state of emergency. As of Wednesday, 261 people in the city had confirmed or probable cases of the disease, out of 800 in California and 4,600 nationwide. The new status will allow health providers more flexibility to offer a swift response. The news is extremely welcome following what LGBTQ advocates have called a lackluster response to the virus from the city so far.

“San Francisco was at the forefront of the public health responses to HIV and COVID-19, and we will be at the forefront when it comes to monkeypox,” said state Sen. Scott Wiener, according to NPR. “We can’t and won’t leave the LGBTQ community out to dry.”

“At the cusp” of an epidemic

The U.S. has failed to contain monkeypox, and is probably only detecting a “fraction of the cases,” former FDA commissioner Scott Gottlieb told CBS on July 17. He warned that cases outside the community of men who have sex with men aren’t being picked up, and the country is repeating many of the mistakes seen with Covid-19.

“We’re probably detecting just a fraction of the actual cases because we had for a very long time a very narrow case definition on who got tested,” he explained. He added that the “window” to control monkeypox has probably closed.

Gottlieb stressed that, similarly to the early days of the coronavirus, the definitions of cases and who gets tested are very narrow. The vaccine rollout has also not been aggressive enough.

“By and large, we’re looking in the community of men who have sex with men and STD clinics,” he said. “So we’re looking there. We’re finding cases there. But it’s a fact that there’s cases outside that community right now. We’re not picking them up because we’re not looking there.”

According to the CDC, there are now more than 1,800 monkeypox cases in the U.S. and more than 12,500 globally. New York has the highest number of confirmed cases by state at 489, followed by California with 266.

“It’s on us to look after our own

Gay men with Monkeypox have shared their experiences of the disease, which for some has caused “debilitatingly painful skin lesions.” This outbreak, which can transmit to anyone, has so far mainly affected men who have sex with men. Vigilance is key — one man who spoke out urged “don’t be afraid to say something” if you spot a symptom.

Those who contract the disease face the daunting prospect of a three-week quarantine — and that’s if they can obtain confirmation they’ve caught it. Mark Hall, a 41-year-old nurse practitioner, described the difficulties he had in getting tested for Monkeypox in New York, despite assiduous efforts.

“We knew that Pride was coming up,” he said. “Why were we not increasing testing capacity earlier, knowing this was going to be a problem?”

High-risk men are now eligible for shots in NYC

Monkeypox shots are available in New York City to men over the age of 18 who’ve had sex with multiple or anonymous men in the past 14 days. “Anyone can get and spread monkeypox, but most cases in the current outbreak are among gay, bisexual or other men who have sex with men,” the city’s health department said on June 23. 

“Men who have sex or other intimate contact with men they met through dating apps or social media platforms, or at clubs, raves, sex parties, saunas, or other large gatherings may be at higher risk of having been recently exposed,” it added.

Similar action has already been taken by the U.K.’s Health Security Agency and Canada’s Public Health Agency. 

The two-shot, FDA-approved inoculation available in New York is called Jynneos — and it’s effective against both monkeypox and smallpox.

The symptoms are different than before

The CDC has adjusted its guidance on monkeypox symptoms as cases swell rapidly across the U.S. Instead of the typical widespread rashes, patients are seeing localized lesions that are progressing differently than those seen in previous cases.

In the past, patients have experienced, a fever, swollen lymph nodes, headaches and muscle aches, before noticing a rash that begins on their face or in their mouth then spreads to their hands, feet, and other body parts. In the newest cases, many patients are experiencing a rash around the genitals, anus, or mouth first.

“In some instances, patients have presented with symptoms such as anorectal pain, tenesmus, and rectal bleeding,” says the CDC. “Clinicians should perform a thorough skin and mucosal (e.g., anal, vaginal, oral) examination for the characteristic vesiculo-pustular rash of monkeypox; this allows for detection of lesions the patient may not have been previously aware of.”

Here’s how the spread developed

According to the Massachusetts Department of Public Health, a man who traveled to Canada was infected with the virus, which is rarely seen outside Africa, in May. He was treated in the hospital. A New York City resident also tested positive for the virus that month, and other presumptive cases were investigated in Broward County, Florida, per Axios.

Researchers are still trying to get the bottom of how and why the disease is spreading now, but there is one potential explanation.

A leading advisor for the World Health Organization recently suggested that the outbreak of the rare disease is the result of a “random event” of sexual transmission at two raves held in Belgium and Spain. To the Associated Press, Dr. David Heymann said, “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.”

President Biden addressed the situation in May in conversation with reporters at an air base in South Korea. When asked if he thought the smattering of cases were a concern, he replied, “It is a concern in that if it were to spread, it would be consequential.”

While this situation might feel terrifyingly similar to those early days in 2020 when something called the coronavirus was popping up in hospitals across the country, there’s reason to remind yourself to be calm. After all, monkeypox is a virus that has been studied for decades, NBC News reports, and we already have ways to treat it. For that reason in particular, we’re in a much better position medically than we were in 2020 when COVID-19 was a completely mysterious illness.

Here’s how to identify monkeypox’s distinctive rash and fever — and the latest info on how it’s transmitted. 

What is monkeypox?

Monkeypox belongs to the poxvirus family, which also includes smallpox. It’s been infecting humans since 1970, predominantly in the Democratic Republic of the Congo and Nigeria. Cases are typically associated with travel to West Africa.

Per the CDC, cases of monkeypox last between two and four weeks, following an incubation period of roughly one to three weeks. The first symptoms to appear include fever, headaches, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. About one to three days (but sometimes longer) after a fever has developed, the patient will develop a rash. This usually starts on their face before spreading to other body parts, including genitalia. The monkeypox rash evolves through several stages, including pustules and scabs, before the lesions fall off the patient’s body.

Cases of monkeypox are rare but can be dangerous. One in 10 cases in Africa reportedly results in death. As NBC notes, monkeypox is easily confused with chickenpox, syphilis, or herpes, but can be distinguished thanks to the fluid-filled vesicles (blisters) that appear on sufferers’ hands.

How is monkeypox transmitted?

Monkeypox isn’t easily passed between people, but there are several key ways that the disease can spread. According to the CDC, this typically occurs when someone makes contact with the virus from an animal, human, or contaminated materials. The virus enters the body via broken skin — even through entry points too small to see —  the respiratory tract, or the mucous membranes in the eyes, nose, and mouth.

Transmission can occur from infected animals through bites or scratches, or when preparing meat from wild animals. Human-to-human transmission mainly happens via large respiratory droplets, which requires prolonged face-to-face contact, since the droplets can’t usually travel more than a few feet. Monkeypox can also spread among humans via direct contact with body fluids, blisters, or scabs, and indirect contact with lesion material, for example through contaminated clothing or bed linen.

Though it’s not usually thought of as a sexually transmitted disease, a pattern has been identified in recent cases showing monkeypox occurring more often in men who have sex with men — and it can be transferred through direct sexual contact.

“Many of these global reports of monkeypox cases are occurring within sexual networks,” Inger Damon, Director of CDC’s Division of High-Consequence Pathogens and Pathology told the press. “However, healthcare providers should be alert to any rash that has features typical of monkeypox. We’re asking the public to contact their healthcare provider if they have a new rash and are concerned about monkeypox.”