Here’s a story you might not know. In July 2015, a woman went to her doctor in Fairbanks, Alaska, concerned about several small sores on her hands and some body-wide muscle pain. After some tests at a local hospital, it was determined that the woman was infected with orthopoxvirus, the type of virus that contains most of the diseases historically known as “smallpox.” What’s more, this was a never-before-seen virus, a new orthopoxvirus which was given the name “Alaska smallpox”.
Apparently, the discovery of a new virus in the same family as the smallpox virus, which caused 300 million deaths in the 20th century alone, was alarming. However, over the next six years, the total number of Alaskan smallpox cases rose to … four.
As it turns out, Alaskan pox is unlikely to spread from person to person, and is spread through contact with one of the many animals that people in Alaska seem to be involved in handling. Seven years later, we’re still not sure which animal it could be. This is a good example of how a disease can be new, closely related to the deadliest disease in history, and still be harmless. In this case, even small lesions caused by the disease seem to heal properly within a couple of weeks.
Smallpox is the biggest killer in human history. Alaskan pox is a temporary inconvenience for some people. And, big surprise, most smallpox viruses fall somewhere in between, and most of those that can affect humans are much closer to the Alaskan smallpox pole.
So what do we know about monkeypox?
As far as the smallpox virus goes, monkeypox is actually pretty bad. It can cause very serious damage anywhere on the body that leaves the kind of disfiguring scars that helped make smallpox viruses so feared in the past. These lesions can be painful. They can cause blindness if they occur in the eye area. If you know someone who has bad shingles, think about it. Only worse. Somewhere between 1% and 4% of those infected, usually young children or adults with compromised immune systems, will die from the disease (and yes, that’s a wide range). Although monkeypox can be harmful, most cases of monkeypox are much milder—they can come and go with few symptoms.
It is absolutely true that monkeypox can be spread by respiratory droplets. It can also be spread by contact with respiratory droplets or fluids from lesions left on surfaces, and the virus can remain viable on surfaces for several days. Maybe even weeks.
However… most of the warnings and most of the information about this scary graphic being circulated has little to do with how monkeypox actually spreads from person to person. The warnings about this image, and many of those in the media, stem from past experience dealing with outbreaks of monkeypox … among monkeys. Anyone who has read Richard Preston’s fascinating and terrifying book Hot zone he has some idea of how monkeys are treated and housed, especially those used in medical tests, and how difficult it can be to contain really scary bugs once they start to spread in rooms with angry, highly stressed and faeces-throwing rooms, urinating , the biting primates who definitely didn’t want to be a part of your damn experiment.
It’s no surprise that health officials recommend more serious equipment for entering a room with racks of sick monkeys than for your afternoon run to Sav-a-Lot. Do no feel like it’s time to switch from the N95 mask to something dustin hoffman could wear Outbreak.
The biggest problem with monkeypox isn’t that it’s airborne, and it certainly isn’t sex, gay or otherwise. It’s just that monkeypox is mostly spread by contact, and the period of infection is so, so long. Basically, anyone can spread monkeypox as long as they have lesions that can last for weeks. They can even spread the disease a week or two after the last dried and unsightly scab drops.
The number of cases currently known in the United States is exactly what can be prevented through contact tracing and quarantine. The problem is the length of this quarantine. Symptoms last about three weeks on average, but can last up to a couple of months. People diagnosed with monkeypox should be isolated during this period with a good safety margin of seven to 10 days after the last lesion has cleared. And every surface in the house needs a strong bleach scrub before anyone else touches anything.
The number of cases of monkeypox in the United States is certainly at a level where local, state, and federal agencies can and should provide housing for those infected so that they can not only receive adequate treatment but also remain safely isolated. Except, of course, in Florida, where Governor Ron DeSantis is sure to draft an executive order to add monkeypox to every classroom.
The fact that the number of cases in the US has doubled in the past week is cause for concern. Monkeypox can be deadly, it can be terrifying even if it is not fatal, and children are one of the groups most affected by the infection.
The good news here is:
1) It’s extremely unlikely that you’ll catch rabies through the air unless you actually come into contact with someone who is infected,
2) Orthopoxviruses of all types tend to be “non-viable”.
They are DNA viruses, and most are very simple (variola viruses have only 200 to 500 base pairs). This means that not only are specific monkeypox vaccines nearly 100% effective, but vaccines against any other smallpox virus can be expected to be highly effective in preventing monkeypox. Compared to the 30,000 rungs of the COVID-19 RNA, these viruses tend to be much more stable and much easier to stop. The orthopoxvirus vaccine not only stops a severe infection, it also stops the infection from starting.
After all, this is how vaccination began. In 1796, the English doctor Edward Jenner did some impressive detective work. He realized that “skin like a milkmaid” was not just a saying, but that young women who grew up working in dairies actually had smooth skin, unblemished by the smallpox scars that were so common at the time. He put this observation together with the knowledge that milkmaids often contracted a mild case of cowpox as children, which usually only resulted in sores on the arm. Jenner realized that this apparently protected them from the disfiguring and deadly smallpox infection.
Then he did what any good scientist would do when he didn’t have caged monkeys in a comfortable room: Jenner turned a 9-year-old boy into a test subject. The good doctor first took some material from the wound on the sweeper’s hand, cut a couple of scrapes into his gardener’s son’s hand, and rubbed it into the good old pus. Then he waited a few months and deliberately exposed the kid to smallpox. The boy did not develop smallpox.
In any case, most people today are not vaccinated against smallpox. That’s because the effectiveness of the smallpox vaccine and the inescapable nature of the virus allowed us to drive this villain to extinction. But the smallpox vaccine is still available, so it is possible to carry out vaccination campaigns, especially in areas where there have been outbreaks.
There is also a specially developed vaccine against monkeypox Jynneos vaccine, 190,000 doses of which have been withdrawn from the strategic national stockpile to be administered to those in close proximity to known cases. More of these vaccines will certainly be needed, and more will come, but production levels are low because there has never been much demand.
Monkeypox can also be treated with antiviral drugs.
Monkeypox is unlikely to explode into a nationwide epidemic or global pandemic. A good example of this is the fact that monkeypox is already endemic in several African countries, but has rarely caused more than a few clusters of disease in any given year. There have been outbreaks in the past, including in the UK and the US, but none were really large. (A cluster of 71 cases in the United States in 2003 began with a girl bitten by a prairie dog. Don’t b**k with prairie dogs.)
When COVID-19 first appeared, it had a basic reproductive rate of R0 number – about 2.5. As each new and more infectious variant has appeared, this number has steadily increased. The latest omicron variants are estimated to have a truly terrifying R0 of over 18. COVID-19 may now be the most common disease we know.
Monkeypox is estimated to have R0 from 0.8 to 1.0. This means that, on average, a person with monkeypox infects one other person. R0 Such a value means that the spread of the disease can certainly be stopped before it becomes widespread—if authorities do good case tracking and people cooperate in effective quarantine.
Should you be worried? Yes. That’s a perfectly reasonable answer. Should you be worried that the US is about to experience a second COVID-level pandemic even before we finish the first? Also yes…but not monkeypox. It is clear that we will be living with Covid-19 for years or decades, as both individuals and governments seem to have accepted that 200,000+ deaths and millions of people with long-term disabilities each year is a high price for the chance to enjoy a date night at Applebee’s.
We will face a new, rapidly spreading disease where every day could mean millions of lives. Monkey pox, right?
Wear a mask outside, more for COVID-19 than monkeypox. Wash your hands. If you know that some people in your area are infected, take this into account and consider wearing disposable gloves or carefully using bleach-containing wipes, such as the handle of a grocery cart. But don’t start shopping NASA’s surplus for leftover moonsuits. Unless you want one. Those things are cool.