A worldwide monkeypox outbreak

The global monkeypox outbreak is now a public health emergency both in the US and globally, with more than 38,000 cases currently reported across 93 countries as of August 17. Health authorities worldwide are still struggling to get it in check: According to the World Health Organization, cases increased by more than 19 percent in the past week.

They’re also struggling to figure out how to talk about what it takes to transmit the infection. During an Infectious Disease Society of America press briefing last week, the director of a large LGBTQ health clinic delivered what’s become a standard talking point among health authorities: “Skin-to-skin contact is causing transmission of this virus” in the context of sex, he said.

The US declared monkeypox a public health emergency this month, but the decision may have come too late. Though states are now required to report cases, and commercial labs have an approved test, a testing bottleneck persists, and cases — which passed 10,000 confirmed cases this week — are likely still being underreported. Any effective public health response to an infectious disease is dependent on having accurate data. If the virus spreads to other populations, such as college dorms — where cases have already been reported — the testing bottleneck could ultimately make it impossible to contain the spread. Reliable demographic information is key to making the right choices for allocating limited tests and vaccines.

All of this feels like an uncanny echo of the early mishandling of Covid-19. Limited access to testing, a hobbled federal infrastructure to track cases, and the general lack of communication among different agencies and states complicated the federal government’s ability to make evidence-based public health decisions. Reporting lags on rising cases meant that lockdowns began too late to save tens of thousands of lives. Similarly, certain communities uniquely at risk, like Black and Hispanic people who lacked access to health care, were suffering higher rates of severe illness and death from Covid before policymakers had any way of knowing where to direct public health outreach.

A full month before the World Health Organization declared monkeypox a global health emergency, my gay friends in my group texts had already figured out how to get vaccine appointments, what to do if we were exposed, and where to find the best research on risk and vaccine efficacy. These were the same group chats that once contained gossip, lunch orders, and gentle ribbing between friends, but now, we’d also often devote minutes and blocks of text to a virus that we were struggling to find any information about.

It was June, and at the time, monkeypox had been spreading in Europe and was primarily affecting men who have sex with men. New York City Pride — and the numerous parties and celebrations that come with it — was about to start, but according to New York City health officials, the number of cases in New York was very low. The caveat: Those were the same city health officials who underestimated Covid-19.

The worldwide monkeypox outbreak that began in early May has so far led to more than 7,500 infections in 57 countries, with more than 600 of them in the US. Behavioral strategies are critical for preventing monkeypox transmission — check out the Centers for Disease Control and Prevention’s (CDC) refreshingly straightforward advice about cleaning fetish gear! — but with case counts still rising, vaccination against the virus is more urgently emerging as an important tactic for stopping its spread.

Monkeypox generally causes several days of flu-like illness and lymph node swelling followed by a blister- or pimple-like rash. While the version of the virus causing the current outbreak is rarely lethal, its lesions can be extremely painful and may leave scars.

Monkeypox, a viral disease transmitted through close skin contact that causes flu-like illness and painful rashes, has already infected nearly 19,000 people worldwide, most of them gay and bisexual men. Last week, it was declared a global public health emergency.

As anxiety about the virus mounts, Americans are increasingly frustrated that they don’t yet have widespread access to a vaccine called Jynneos that’s been approved by the Food and Drug Administration for preventing monkeypox transmission and disease. And some are asking why public health authorities aren’t also offering them a different vaccine it has in greater supply, one created to prevent smallpox but that also has a protective effect against monkeypox: ACAM2000.

On Saturday, July 23, World Health Organization Director General Tedros Adhanom Ghebreyesus declared the spread of monkeypox to be a public health emergency of international concern (PHEIC), the organization’s loudest alarm bell signifying an emerging outbreak.

Since early May, more than 16,000 cases of monkeypox have been identified across more than 60 countries. Disease caused by the monkeypox virus typically involves a few days of fever and lymph node swelling followed by a rash, which can leave scars. Most cases in the current outbreak have resolved without hospitalization or the need for medication. As of July 20, there have been five deaths, all of them in Africa.

As the number of global monkeypox cases rises above 1,300, we’re getting a clearer picture of how the infection is playing out for individuals. For the most part, it’s been pretty manageable: Affected people get clusters of small, painful bumps or blisters — often in the genital area after sexual contact — which are accompanied by fever and lymph node swelling. Often, the rash spreads to the arms, legs, and face.

While monkeypox is known to leave behind scarring that can cause cosmetic problems, the less virulent West African version of the virus that is currently circulating is rarely lethal. As of June 2, none of the people involved in the current outbreak have died, in countries where the disease is not endemic.

In the past few weeks, more than 350 cases of monkeypox — a viral disease that’s a much milder cousin of smallpox — have been reported in more than 20 countries worldwide. That’s a surprise, and an unpleasant one. Monkeypox has surfaced periodically in the Congo Basin and in West Africa since its discovery in the 1950s, but past outbreaks haven’t involved cases in this many countries, or this degree of apparent person-to-person spread.

Still, because as far as we know from past outbreaks monkeypox usually isn’t very contagious and a good vaccine already exists, it ought to be possible to contain even this apparently larger outbreak. Hence many public health officials have emphasized, in their communications about monkeypox, that people shouldn’t worry or overreact.

As of May 26, the global monkeypox case count tops 350, with cases spread across 23 countries. It’s easy to get a little shpilkes while wondering, what exactly are we in for? How big will this outbreak get, and how long will it be around?

In the early days of any outbreak, epidemiologists try to answer these questions by first asking a different one: Is this virus containable? That is, can its spread be stopped before it gets out of control?

On Wednesday, May 18, the CDC confirmed a case of monkeypox in a Massachusetts man who had recently traveled to Canada.

It wasn’t the first time the US had seen a case of monkeypox, a virus related to smallpox that causes flu-like symptoms and a rash, and can sometimes be deadly. Occasionally, public health authorities identify single cases in people recently returned from West or Central Africa, where the disease is more common.