It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
ANNENBERG PUBLIC POLICY CENTER OF THE UNIVERSITY OF PENNSYLVANIAp
IMAGE: WORRY ABOUT CONTRACTING MONKEYPOX OR COVID-19 OVER THE NEXT THREE MONTHS. ASKED OF 1,580 ADULTS ON THE ANNENBERG PUBLIC POLICY CENTER ASK SURVEY, JULY 12-18, 2022.view more
CREDIT: ANNENBERG PUBLIC POLICY CENTER
PHILADELPHIA – As Covid-19 cases surge across the United States dominated by a highly transmissible subvariant and worry about Covid persists, some in the public have begun to voice concern about the new health threat of monkeypox, according to a new Annenberg Public Policy Center national survey.
While 1 in 3 Americans worry about getting Covid-19 in the next three months, according to the July survey, nearly 1 in 5 are concerned about contracting monkeypox, a disease endemic in parts of Africa whose spread to 75 countries across the globe led the World Health Organization (WHO) to declare a global health emergency on July 23, days after the survey was completed.
The nationally representative panel of 1,580 U.S. adults surveyed by SSRS for the Annenberg Public Policy Center (APPC) of the University of Pennsylvania from July 12-18, 2022, was the seventh wave of an Annenberg Science Knowledge (ASK) survey whose respondents were first empaneled in April 2021. The margin of sampling error (MOE) is ± 3.3 percentage points at the 95% confidence level. See the appendix and methodology for additional information.
The survey answers such questions as: How worried is the public about becoming infected with Covid-19 or monkeypox? Does the public possess basic knowledge about monkeypox? How widespread is misinformation about monkeypox?
Highlights
Conducted amid escalating cases of the coronavirus BA.5 omicron subvariant and the spread of monkeypox cases, the survey found that many people (80%) had seen, read, or heard something about monkeypox in the past month, but many lacked knowledge about the disease:
19% of Americans are worried about getting monkeypox in the next three months.
30% of those surveyed are worried about getting Covid-19 over the next three months.
Nearly half (48%) are unsure whether monkeypox is less contagious than Covid.
Two-thirds (66%) either are not sure or do not believe there is a vaccine for monkeypox.
“It’s important that the public calibrate its concerns to the reality of the risk of Covid-19 and monkeypox and act appropriately,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center.
Monkeypox concerns
Monkeypox, a rare disease caused by an orthopoxvirus, is a less deadly member of the same family of viruses as smallpox, according to the Centers for Disease Control and Prevention (CDC). The disease, discovered in 1958, is typically characterized by rashes, according to the CDC, and is transmitted person-to-person by direct contact with the infectious rash, scabs, or body fluids, respiratory secretions, touching items that touched the infectious body fluid, by a pregnant person to a fetus through the placenta, or to and from infected animals. (For more information see this Q&A on monkeypox by APPC’s FactCheck.org.)
In the current monkeypox outbreak about 2,900 cases were reported in the United States as of June 22, and more than 16,000 cases have been reported in 75 countries, according to the WHO.
Among the survey findings:
Worry about contracting monkeypox: About1 in 5 of those surveyed (19%) are somewhat (14%) or very worried (5%) about getting monkeypox in the next three months, while 81% are not too (41%) or not at all worried (40%).
Women are more worried about contracting monkeypox than men: Though the vast majority of cases to date in the United States are among men who have sex with men, 23% of women worry about contracting monkeypox vs. 15% of men.
Covid-19: More Americans (30%) worry about getting Covid in the next three months, with 24% somewhat worried and 6% very worried.
Women are also more worried about Covid-19 than men: 33% of women are worried about contracting Covid vs. 27% of men.
Monkeypox knowledge
While many Americans are generally familiar with monkeypox, significant parts of the public lack important information about the disease – and how to protect themselves:
Knowing how monkeypox spreads: A large majority (69%) knows that monkeypox usually spreads by close contact with an infected person, though a quarter of those surveyed (26%) are not sure whether that is true or false.
Most do not know a monkeypox vaccine exists: In all, 2 in 3 Americans (66%) either are not sure (51%) whether a vaccine for monkeypox exists or do not think it exists at all (15%). One in 3 people (34%) correctly know that a vaccine for monkeypox exists. The Food and Drug Administration (FDA) has licensed a vaccine for preventing monkeypox infection and a vaccine licensed for smallpox is also available to prevent monkeypox infection, according to the CDC.
Which is more contagious: Monkeypox or Covid? More than a third of those surveyed (36%) know that monkeypox is less contagious than Covid-19. But 14% incorrectly say monkeypox is just about as contagious as Covid-19 and nearly half (48%) are unsure. The CDC says monkeypox “is not known to linger in the air and is not transmitted during short periods of shared airspace” but through direct contact with an infected individual or materials that have touched body fluids or sores or through respiratory secretions during “close, face-to-face contact.” An infectious disease expert, Anne Rimoin, told Vox monkeypox is “not as highly transmissible as something like smallpox, or measles, or certainly not Covid.”
Monkeypox and the Covid-19 vaccine: Most people (67%) say they think that getting a Covid-19 vaccine does not increase the likelihood of getting monkeypox, though over a quarter of respondents (28%) are not sure. There is no evidence to suggest this is true.
Are people who have had Covid-19 at higher risk? A third of people (33%) report that having had Covid-19 does not of itself put one at a higher risk of infection with monkeypox, though nearly two-thirds (63%) are not sure if this is true. There is no evidence to suggest that having had Covid increases the risk of contracting monkeypox.
Higher risk for people working with animals? Asked if the CDC advises that people who work with animals are at a higher risk of monkeypox, less than 1 in 10 respondents (9%) say yes. A third (34%) say no, while over half (57%) are not sure. Although the current outbreak involves human-to-human transmission, a 2003 outbreak in domesticated prairie dogs led to 47 U.S. human cases. Monkeypox can infect a range of mammals, including monkeys, anteaters, hedgehogs, prairie dogs, squirrels and shrews. Infected animals can spread the virus to people and it is possible that people who are infected can spread the virus to animals, says the CDC, which lists among higher-risk people who might consider vaccination “laboratory workers who handle culture or animals with orthopoxviruses.”
Higher risk for men who have sex with men? When asked whether the CDC advises that men who have sex with men are at a higher risk of infection with monkeypox,a third of those surveyed (33%) said yes. Two-thirds (66%) either said this is false or they did not know. The WHO says cases outside Africa in this outbreak have been mainly among men having sex with men, while cautioning that there is no evidence to suggest it will remain confined within those groups. In a Washington Post interview, CDC Director Rochelle Walensky said men who have sex with men are “the community most at risk.”
“The time to reduce susceptibility to misinformation about monkeypox is now,” Jamieson said. “It is critically important that public health professionals offer anxious individuals accurate information about the ways in which this virus is transmitted and infection prevented. Vaccinating those who are at highest risk should be a national priority.”
Monkeypox misinformation and conspiracy theories
“As one would expect, conspiracy theorists have incorporated monkeypox into their pre-existing beliefs that, instead of emerging through natural processes, a spreading virus must have been bioengineered, intentionally released to accomplish a political objective, or is the byproduct of exposure to a pervasive new technology such as 5G,” said Jamieson.
Most Americans reject conspiracy theories alleging that monkeypox was bioengineered in a lab or was intentionally released. However, here, too, the Annenberg ASK survey found that worrisome numbers have either accepted one of four conspiracy theories or are unsure whether they are true or false.
Bioengineered in a lab: Over half of those surveyed (54%) reject as false the idea that monkeypox was bioengineered in a lab, though a third (34%) are not sure if that is true or false and 12% say this is probably or definitely true. There is no evidence of this.
Of the small minority who believe that monkeypox was bioengineered in a lab, 56% say the lab was in China; 16% say the United States; 15% Russia; 12% some other country.
Intentional release (asked of a half-sample, MOE = ± 4.7 percentage points):Over half (56%) said that it was definitely or probably false to state that monkeypox was intentionally released, though 30% were not sure and 14% thought that was probably or definitely true. There is no evidence of this.
Released to help Biden (asked of a half-sample, MOE = ± 4.7 percentage points): 71% reject as false the statement that monkeypox was intentionally released by scientists to deflect attention from the failures of the Biden administration. However, 19% said they were not sure whether this is true or false, and 10% said it was probably or definitely true. There is no evidence of this.
Caused by exposure to 5G: A large majority (78%) correctly said it is false to assert that monkeypox is caused by exposure to a 5G signal, though 21% were not sure.
The Annenberg Public Policy Center(APPC) was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels. APPC is the home of FactCheck.org and its SciCheck program, whose Covid-19/Vaccination Project seeks to debunk misinformation about Covid-19 and vaccines, and increase exposure to accurate information.
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From the Annenberg Public Policy Center ASK survey of 1,580 U.S. adults, July 12-18, 2022.
CREDIT
Annenberg Public Policy Center
CAPTION
From the Annenberg Public Policy Center ASK survey of 1,580 US. adults, July 12-18, 2022.
CREDIT
Annenberg Public Policy Center
Study finds important differences in monkeypox symptoms between current and previous outbreaks
Findings should help clinicians spot infections earlier
A study published by The BMJ today identifies important differences in monkeypox symptoms between the current outbreak and previous outbreaks in endemic regions.
The findings are based on 197 confirmed monkeypox cases at an infectious disease centre in London between May and July 2022.
Some of the common symptoms they describe, including rectal pain and penile swelling (oedema), differ from those described in previous outbreaks.
As such, the researchers recommend that clinicians consider monkeypox infection in patients presenting with these symptoms. And they say those with confirmed monkeypox infection with extensive penile lesions or severe rectal pain “should be considered for ongoing review or inpatient management.”
According to government data, as of 18 July 2022, there were 2,137 confirmed cases of monkeypox in the UK. Of these, 2,050 were in England and almost three quarters (73%) were in London.
All 197 participants in this study were men (average age 38 years), of whom 196 identified as gay, bisexual, or other men who have sex with men.
All patients presented with lesions on their skin or mucosal membranes, most commonly on the genitals or in the perianal area.
Most (86%) of patients reported systemic illness (affecting the entire body). The most common systemic symptoms were fever (62%), swollen lymph nodes (58%), and muscle aches and pain (32%).
And in contrast with existing case reports suggesting that systemic symptoms precede skin lesions, 38% of patients developed systemic symptoms after the onset of mucocutaneous lesions, while 14% presented with lesions without systemic features.
A total of 71 patients reported rectal pain, 33 sore throat, and 31 penile oedema, while 27 had oral lesions, 22 had a solitary lesion, and 9 had swollen tonsils.
The authors note that solitary lesions and swollen tonsils were not previously known to be typical features of monkeypox infection, and could be mistaken for other conditions.
Just over a third (36%) of participants also had HIV infection and 32% of those screened for sexually transmitted infections had a sexually transmitted infection.
Overall, 20 (10%) of participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling. However, no deaths were reported and no patients required intensive hospital care.
Only one participant had recently travelled to an endemic region, confirming ongoing transmission within the UK, and only a quarter of patients had known contact with someone with confirmed monkeypox infection, raising the possibility of transmission by people with no or very few symptoms.
The authors acknowledge some limitations, such as the observational nature of the findings, the potential variability of clinical record keeping, and the fact that the data are limited to a single centre.
However, they say these findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries.
They write: “Understanding these findings will have major implications for contact tracing, public health advice, and ongoing infection control and isolation measures.”
And they call for continued research to inform infection control and isolation policies and guide the development of new diagnostics, treatments, and preventive measures.
The World Health Organization (WHO) has announced plans to find a new name for the viral disease informally known as ‘monkeypox’ which, says the world body, is “discriminatory and stigmatizing.”
WHO Director-General Tedros Adhanom Ghebreyesus, in a briefing on the matter, said the virus is no longer behaving as it did in the past and therefore should be renamed. But a public narrative persists in suggesting the current outbreak is linked to Africa, West Africa or Nigeria, noted a group of 29 biologists and other researchers. That builds on an existing stigma, although the virus has been detected without a clear link to Africa.
The majority—84%—of confirmed cases are from the European region, followed by the Americas, Africa, Eastern Mediterranean region and Western Pacific region.
“The most obvious manifestation of this is the use of photos of African patients to depict the pox lesions in mainstream media in the global north,” the researchers said.
Ahmed Ogwell, deputy director of the Africa Centers for Disease Control and Prevention, and more than a dozen infectious disease experts in the U.S. and Europe are soliciting suggestions for a new name using the website virological.org.
“We are removing the distinction between endemic and non-endemic countries, reporting on countries together where possible, to reflect the unified response that is needed,” the WHO said in its outbreak situation update dated June 17 but sent to media on Saturday.
As for what the virus should be called, the scientists suggest starting with hMPXV, to denote the human version of the monkeypox virus. Rather than geographic locations, they say, letters and numbers should be used, based on order of discovery. In that system, the lineage behind the current international outbreak would be dubbed B.1.
The Geneva-based UN health agency is due to hold an emergency meeting on June 23 to determine whether to classify the global monkeypox outbreak as a public health emergency of international concern—the highest alarm the U.N. agency can sound.
It has been reported in 39 countries so far in 2022, and most of them are having their first-ever cases of the disease, according to the WHO. Worldwide, it says, there are around 3,100 confirmed or suspected cases, including 72 deaths. The normal initial symptoms include a high fever, swollen lymph nodes and a blistery chickenpox-like rash.
Between Jan. 1 and June 15, 2,103 confirmed cases, a probable case and one death have been reported to the WHO in 42 countries, it said.
World Health Network declares Monkeypox a pandemic
Cambridge, Jun 23: The World Health Network (WHN), a coalition of scientists formed against the Covid-19 threat, has declared the Monkeypox outbreak a Public Health Emergency of Global Concern.
With 3,417 confirmed Monkeypox cases across 58 countries, the WHN noted that the outbreak will not stop without concerted global action. "Even with death rates much lower than smallpox, unless actions are taken to stop the ongoing spread-actions that can be practically implemented-millions of people will die and many more will become blind and disabled, it said in a statement.
According to the WHN, the essential purpose of declaring a pandemic is to achieve a concerted effort across multiple countries or over the world to prevent widespread harm. "There is no justification to wait for the Monkeypox pandemic to grow further. The best time to act is now. By taking immediate action, we can control the outbreak with the least effort, and prevent consequences from becoming worse. The actions needed now only require clear public communication about symptoms, widely available testing, and contact tracing with very few quarantines. Any delay only makes the effort harder and the consequences more severe", said Yaneer Bar-Yam, PhD, President of New England Complex System Institute and co-founder of WHN.
Although most cases have been in adults, any spread among children will lead to much more severe cases and more deaths, the WHN said. Infections of animals, especially rats and other rodents, but also pets, will make it much more difficult to stop. Passively waiting will lead to these harms without any compensating benefit, the statement added.
"The WHO needs to urgently declare its own Public Health Emergency of International Concern (PHEIC)-the lessons of not declaring a PHEIC immediately in early January 2020 should be remembered as a history lesson of what acting late on an epidemic can mean for the world," said Eric Feigl-Ding, PhD, Epidemiologist and Health Economist, and co-founder of WHN.
Many scientists doubt any such declaration would help to curb the epidemic, since the developed countries recording the most recent cases are already moving quickly to shut it down.
Last week, WHO Director-General Tedros Adhanom Ghebreyesus described the recent monkeypox epidemic identified in more than 40 countries, mostly in Europe, as “unusual and concerning.” Monkeypox has sickened people for decades in central and west Africa, where one version of the disease kills up to 10 per cent of people infected. The version of the disease seen in Europe and elsewhere usually has a fatality rate of less than 1% and no deaths beyond Africa have so far been reported.
“If WHO was really worried about monkeypox spread, they could have convened their emergency committee years ago when it reemerged in Nigeria in 2017 and no one knew why we suddenly had hundreds of cases,” said Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory groups. “It is a bit curious that WHO only called their experts when the disease showed up in white countries,” he said.
More than half of Canadians confident in monkeypox response, but 55% worried about spread: poll
More than half of Canadians confident in monkeypox response, but 55% worried about spread: poll – Jun 17, 2022
Until last month, monkeypox had not caused sizeable outbreaks beyond Africa. Scientists haven’t found any mutations in the virus that suggest it’s more transmissible, and a leading adviser to the WHO said last month the surge of cases in Europe was likely tied to sexual activity among gay and bisexual men at two raves in Spain and Belgium.
To date, the U.S. Centers for Disease Control and Prevention has confirmed more than 3,300 cases of monkeypox in 42 countries where the virus hasn’t been typically seen. More than 80% of cases are in Europe. Meanwhile, Africa has already seen more than 1,400 cases this year, including 62 deaths.
David Fidler, a senior fellow in global health at the Council on Foreign Relations, said WHO’s newfound attention to monkeypox amid its spread beyond Africa could inadvertently worsen the divide between rich and poor countries seen during COVID-19.
“There may be legitimate reasons why WHO only raised the alarm when monkeypox spread to rich countries, but to poor countries, that looks like a double standard,” Fidler said. He said the global community was still struggling to ensure the world’s poor were vaccinated against the coronavirus and that it was unclear if Africans even wanted monkeypox vaccines, given competing priorities like malaria and HIV.
“Unless African governments specifically ask for vaccines, it might be a bit patronizing to send them because it’s in the West’s interest to stop monkeypox from being exported,” Fidler said.
WHO looks into reports of traces of monkeypox found in semen
WHO looks into reports of traces of monkeypox found in semen – Jun 15, 2022
WHO has also proposed creating a vaccine-sharing mechanism to help affected countries, which could see doses go to rich countries like Britain, which has the biggest monkeypox outbreak beyond Africa _ and recently widened its use of vaccines.
To date, the vast majority of cases in Europe have been in men who are gay or bisexual, or other men who have sex with men, but scientists warn anyone in close contact with an infected person or their clothing or bedsheets is at risk of infection, regardless of their sexual orientation. People with monkeypox often experience symptoms like fever, body aches and a rash; most recover within weeks without needing medical care.
Even if WHO announces monkeypox is a global emergency, it’s unclear what impact that might have.
In January 2020, WHO declared that COVID-19 was an international emergency. But few countries took notice until March, when the organization described it as a pandemic, weeks after many other authorities did so. WHO was later slammed for its multiple missteps throughout the pandemic, which some experts said might be prompting a quicker monkeypox response.
“After COVID, WHO does not want to be the last to declare monkeypox an emergency,” said Amanda Glassman, executive vice president at the Center for Global Development. “This may not rise to the level of a COVID-like emergency, but it is still a public health emergency that needs to be addressed.”
Canada issues travel notice as monkeypox cases spread
Canada issues travel notice as monkeypox cases spread – Jun 8, 2022
Salim Abdool Karim, an epidemiologist and vice chancellor at the University of KwaZulu-Natal in South Africa, said WHO and others should be doing more to stop monkeypox in Africa and elsewhere, but wasn’t convinced that a global emergency declaration would help.
“There is this misplaced idea that Africa is this poor, helpless continent, when in fact, we do know how to deal with epidemics,” said Abdool Karim. He said that stopping the outbreak ultimately depends on things like surveillance, isolating patients and public education.
“Maybe they need vaccines in Europe to stop monkeypox, but here, we have been able to control it with very simple measures,” he said.
By HealthDay News This electron microscopic image depicts a monkeypox virion. On the left are mature, oval-shaped virus particles, and on the right are immature virions. Photo by Cynthia S. Goldsmith, Russell Regnery/CDC/Wikimedia Commons
After adding, and then deleting, a recommendation that U.S. travelers wear masks to protect themselves from monkeypox, the U.S. Centers for Disease Control and Prevention still says that those traveling to countries where the disease is spreading and "other people who may be in close contact with a person who has been confirmed with monkeypox" should consider wearing masks.
Why the new guidance? The advice comes as experts say the monkeypox virus can sometimes spread through the air, at least over short distances, but it's not clear exactly how much that contributes to the spread of the disease.
When it updated its guidance last week for travelers, the CDC advised: "Wear a mask. Wearing a mask can help protect you from many diseases, including monkeypox."
But in a statement released Tuesday, the agency said it "removed the mask recommendation from the monkeypox travel health notice because it caused confusion," The New York Times reported.
The CDC still advises monkeypox patients to wear a surgical mask, "especially those who have respiratory symptoms," and also asks other household members to "consider wearing a surgical mask" when in the presence of the person with monkeypox.
As of Wednesday, the United States had confirmed 35 cases of monkeypox in 12 states and the District of Columbia. Worldwide, more than a thousand people have been diagnosed with the disease since the first case in the outbreak was reported on May 13, and at least another thousand cases are under investigation, the Times reported.
In previous monkeypox outbreaks, most cases occurred among people who had close contact with an infected person or animal, but airborne transmission was still the only explanation for some cases.
But in media and public briefings, health officials have not specifically discussed the possibility of airborne transmission of the monkeypox virus or the use of masks for protection, according to the Times.
Still, monkeypox does not spread easily, unlike pathogens such as coronavirus or flu virus.
Monkeypox infection requires "really close sustained contact," Andrea McCollum, the CDC's leading expert on the virus, told the Times.
"This is not a virus that was transmitted over several meters," she explained. "That's why we have to be really careful how to frame this."
When the Times asked McCollum whether health officials should make the possibility of airborne transmission more widely known, she replied, "It's a fair point to make, and it's something we certainly should consider moving forward."
Planning for potential airborne transmission of monkeypox is particularly important in hospitals, Dr. Donald Milton, an expert on viruses at the University of Maryland, told the Times.
The many unknowns of monkeypox -- including the primary method of transmission -- were discussed at a conference last week organized by the World Health Organization.
"It's very ambiguous what the true or dominant route of transmission is, and some of that can be addressed in animal models," Nancy Sullivan, a researcher at the U.S. National Institute of Allergy and Infectious Diseases, said at the conference, the Times reported. "Probably that needs to take a front seat for some of the laboratory research."
More information
Visit the U.S. Centers for Disease Control and Prevention for more on monkeypox.
Public health experts, including within the Biden administration, are increasingly concerned that the federal government’s handling of the largest-ever U.S. monkeypox outbreak is mirroring its cumbersome response to the coronavirus pandemic 2½ years ago, with potentially dire consequences.
As a result, they said, community transmission is occurring largely undetected, and the critical window in which to control the outbreak is closing quickly.
“It’s been unbelievably challenging,” said Lauren Sauer, director of the Special Pathogens Research Network within a government-funded consortium of medical centers focused on pathogens training and education. “It felt like January 2020 all over again.”
As monkeypox cases rise in Europe and other parts of the globe, health authorities are expressing concern about the unusual uptick. (Video: Alexa Juliana Ard, Meryl Kornfield/The Washington Post)
More than 150 monkeypox cases have been identified in the United States since May 19, federal officials said this week, and more than 3,300 cases have been detected in 42 countries around the world.
The rapidly rising global case counts have prompted the World Health Organization to convene an emergency committee on Thursday to assess whether the monkeypox outbreak represents a public health emergency of international concern — the agency’s highest-level warning, which currently applies only to the coronavirus and polio.
But as other nations have ramped up their efforts to track and prevent the spread of infection, experts say the United States has moved too slowly to expand access to monkeypox testing and vaccinate people at highest risk. The government’s failure to clearly and urgently communicate the symptoms and risks associated with monkeypox, a disease spread by close contact that can lead to fever, pain and a visible rash, has left gay and bisexual men, who are disproportionately contracting the virus, especially vulnerable, public health experts say. The plodding U.S. response so far raises doubts about the country’s preparedness for the next pandemic, some administration officials say.
Communication about whom to test, when to test them and what monkeypox symptoms look like has been dismal, said Sauer, a public health expert at the University of Nebraska Medical Center.
Frustrations are running particularly high because, unlike the coronavirus, monkeypox has been studied for decades by global and U.S. experts who know the tools, strategies and vaccine protocols that can limit spread.
A group marching with Intermountain Healthcare waves to onlookers during a parade at the Utah Pride Festival in Salt Lake City on June 5. (Alex Goodlett for The Washington Post)
Biden administration officials on Wednesday said that they have amply prepared for a monkeypox outbreak, touting the government’s efforts to acquire more vaccine doses, warn the public about the emerging outbreak, and begin distributing tests to commercial labs across the country this week. They also insisted their response reflected lessons learned from fighting coronavirus, such as waiting to distribute the “right test that works” to laboratories after federal officials distributed flawed coronavirus tests in early 2020.
“All this work takes weeks to get it done right,” said Raj Panjabi, who leads the White House’s global health security efforts, reflecting on the “humility” that he said officials have tried to apply to monkeypox after struggles in containing the coronavirus and other outbreaks.
Clinicians, patients and some administration officials have faulted the Centers for Disease Control and Prevention for testing criteria that they say are too narrow and have resulted in long waits — sometimes multiple days — in identifying positive cases. Under the current framework, physicians who want a test for an individual suspected to have monkeypox must first consult with a state epidemiologist. State public health officials say that protocol helps identify people at highest risk so doctors can recommend isolation and take other steps to prevent community spread.
And just as in early 2020, when the coronavirus first menaced the United States, federal officials at first limited monkeypox testing to a network of several dozen public health laboratories — and did not authorize thousands of commercial laboratories and hospitals to perform their own testing, too.
Monkeypox testing is handled by 86 mostly state and local public health labs, with capacity for more than 8,000 tests a week, according to the CDC. But an official of a large city health department who is working directly on monkeypox response said that number is misleading, because the labs are not concentrated around the major metropolitan areas where the bulk of infections are detected.
Without better access to tests, which involve swabbing a lesion, it is impossible for public health officials to know the true prevalence of the disease.
Monkeypox has repeatedly emerged in Central and West Africa for decades, but the current outbreak has been occurring in countries that have not previously reported infections, raising concern about how and why the disease appears to be gaining a foothold in countries including Britain, Germany, Portugal and Spain.
The response has also been hindered by U.S. physicians’ lack of familiarity with the disease. The CDC initially publicized decades-old photos from more severe outbreaks in Africa, instead of the more subtle rashes detected in the recent global outbreak. The United States was far slower than Britain and Canada to distribute updated education materials, only recently sharing photos showing what the rashes look like on fair skin, said David Harvey, executive director of the National Coalition of STD Directors.
“One of the things that worries me right now is that we are seeing cases pop up in many countries, and we are also seeing numbers being reported in places that are much more aggressive in their surveillance than what we’ve seen here,” said Jennifer Nuzzo, an epidemiologist at Brown University’s School of Public Health.
While monkeypox has been spreading mostly among men who have sex with men, the disease is not specific to any one group. “If a woman doesn’t have a particular known risk factor, and some woman shows up in urgent care, what’s the likelihood that she is going to get found?” Nuzzo said.
In most cases, monkeypox symptoms disappear on their own within a few weeks. But for those who are pregnant, children and people with weak immune systems, the disease can lead to medical complications, including death, according to the WHO.
A team from the Centers for Disease Control and Prevention researches the monkeypox virus in the Congolese village of Manfouete on Aug. 29, 2017. (Melina Mara/The Washington Post)
Two federal officials involved in the monkeypox response said there are “significantly” more cases across the United States that are being missed because testing for monkeypox had not been expanded beyond the network of public health laboratories.
“If we don’t move aggressively now, monkeypox is going to be that much harder to eradicate later — or it could even become endemic” in the United States, said one of the administration officials, who is among more than two dozen across the Department of Health and Human Services and the White House tasked with combating the outbreak and who spoke on the condition of anonymity because they are not authorized to speak to the media. Many of the same teams have been working on the coronavirus response.
On Wednesday, administration officials said they were authorizing five major commercial laboratories to test for monkeypox starting in early July, a dramatic expansion of capacity. That could allow labs to conduct tens of thousands of additional tests a week. Health-care providers will be able to send specimens directly to the commercial labs for testing without having to first consult with state health officials to determine whether testing criteria are met. Activists say the move was overdue.
About 10 monkeypox tests per day were being performed nationwide in early June, even as other countries such as Britain were performing far more, a senior administration official said Wednesday. While laboratory testing ramped up last week, only about 700 total tests had been conducted as of June 17, the official said.
Before the CDC made its test widely available to commercial labs, the agency needed to update testing protocols, establish agreements with the five labs and ensure personnel had personal protective equipment and vaccinations to protect against infection, according to a senior public health official who spoke under Biden administration ground rules that they not be named.
One man who sought testing on June 13 in New York City for potential monkeypox symptoms — flu-like illness and swollen lymph nodes — was initially advised by a physician that he did not have the disease and did not need a test, said Joseph Osmundson, a virologist at New York University, who spent several days trying to help the individual obtain a test. The man had recently returned to New York from Portugal, where he said he had casual sex with other men. Health officials have advised clinicians to look out for travel-associated cases from Europe, and in situations in which men have had sex with men.
But the man told The Post his efforts to obtain a test were repeatedly rebuffed — even after he was found to have “abnormal HPV-like lesions” that weren’t readily visible.
“The pain has been like someone stabbing me from inside — I couldn’t sit, I couldn’t sleep,” said the man, who spoke on the condition of anonymity to protect his privacy. He said he went to four different providers, including a major New York City hospital, before an urgent care clinic collected a specimen on Monday. He said he finally received his results on Thursday afternoon, 10 days after he first sought testing. The results: positive.
Osmundson said he was aware of a dozen similar cases in which people with possible monkeypox symptoms were being rebuffed.
“The CDC is very narrowly defining criteria for testing, and the [New York] Department of Health is not going outside those criteria. So if you don’t check off on every single one of the boxes, based on CDC, you don’t get access to testing,” Osmundson said.
Michael Lanza, a spokesman for the New York City Department of Health and Mental Hygiene, confirmed that providers must contact the agency to evaluate the case and determine whether testing is necessary. He said officials have not denied testing requests except in cases with no rash or no known risk factors.
James Krellenstein, co-founder of PrEP4ALL, an HIV-care nonprofit that has pressed state and federal officials to expand testing, said that “no one can confidently say if the outbreak is under control or not.”
“I’m extremely, extremely frustrated,” Krellenstein said. “It’s as if what happened in covid in February of 2020 never happened. This is not the first time, and to see CDC, HHS [and other officials] make the same errors over again is inexplicable, considering how large the cost was in 2020.”
An employee with Jynneos manufacturer Bavarian Nordic works in a laboratory in Martinsried, Germany, on May 24. (Lukas Barth/Reuters)
Public health experts also have criticized U.S. officials for not proactively vaccinating high-risk individuals against the virus, even as other nations have moved more aggressively to do so. Health officials in Britain announced a strategy Tuesday to offer vaccinations to some gay and bisexual men at higher risk of exposure, and New York City officials on Thursday opened a vaccine clinic to those who may have been recently exposed. While U.S. officials have stockpiled two vaccines that are effective against monkeypox, there is a limited supply of the vaccine that is specifically authorized to prevent monkeypox, Jynneos.
U.S. officials “need to have very serious planning conversations” about proactively vaccinating people at high risk for disease, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists. She said individuals who should be prioritized include men who have sex with men, sex workers, lab personnel conducting monkeypox testing, and health-care workers expected to provide direct care for monkeypox patients.
Of the two vaccines that are effective against monkeypox, Jynneos is in high global demand. The other vaccine, ACAM2000, is older and was approved to prevent smallpox. While it is effective against monkeypox, it can cause serious side effects and cannot be used for people with severely weakened immune systems or eczema, according to the CDC.
Senior public health officials said Wednesday that they are considering potential strategies for proactive vaccination. Current CDC recommendations call for vaccinating those at high risk after an exposure.
Inger Damon, the CDC’s top orthopoxvirus expert, said at a briefing with reporters that federal officials have yet to receive information from state and local health departments on the number of Americans vaccinated against monkeypox.
Krellenstein, who joined a call with senior administration officials on Tuesday to discuss the U.S. monkeypox strategy, said the administration could not answer questions about vaccine uptake.
“That’s very concerning, because we do need to be making sure that this vaccine is going into arms,” Krellenstein said, adding that the lack of clarity echoed the CDC’s data problems from the coronavirus response.
Officials say they also are worried about possible supply chain bottlenecks with the vaccine, a problem that emerged during the coronavirus pandemic as countries competed for resources to fight the virus, and hard-hit nations such as India moved to ban exports of coronavirus vaccines.
Jynneos is produced by Bavarian Nordic in Denmark — and is the only vaccine approved by the Food and Drug Administration to prevent monkeypox. Some pandemic experts have warned that if the outbreak worsens, European officials could institute an export ban on Jynneos and limit shipments abroad.
The United States currently has more than 65,000 doses of Jynneos, a two-shot vaccine, immediately available in its Strategic National Stockpile, officials said. The federal government has also requested that 300,000 additional government-owned doses be soon shipped to the United States, and has ordered another 500,000 doses to be delivered later this year.
Public health experts and activists are clamoring for more-proactive vaccinations in high-risk communities, warning that the outbreak could be amplified as the gay community celebrates Pride Month and if clinicians miss opportunities to diagnose probable cases of monkeypox.
“I had four close contacts that likely could have been avoided if I’d gotten my early diagnosis,” said the New York City man who was forced to visit four providers to get tested. He said he decided on his own to isolate when his symptoms worsened, because he worried about the virus spreading, undetected, through the gay community. “Hopefully we can prevent that with the vaccine,” he said.
Health officials have confirmed more than 3,500 cases of monkeypox in 44 countries, including many where the disease does not typically occur, like the United Kingdom, Spain, Portugal, Germany, Canada, France and the United States.
As of June 23, the Centers for Disease Control and Prevention have confirmed 173 cases of monkeypox in 24 U.S. states and Washington, D.C.
On May 22, President Biden addressed the highly unusual cases, stating that “it is a concern in the sense that if it were to spread it would be consequential.” After more than two years of living through a pandemic, it is understandable that the news of a new virus spreading across the globe could cause alarm, but health experts say that monkeypox is unlikely to create a scenario similar to that of the coronavirus, even if more cases are found. “As surveillance expands, we do expect that more cases will be seen. But we need to put this into context because it’s not Covid,” Dr. Maria Van Kerkhove, the World Health Organization’s technical lead on Covid-19, said in a live online Q. and A. on May 23.
Monkeypox is not a new virus, and it is not spread in the same way as the coronavirus, so we asked experts for a better understanding of the pathogen — and how the disease it causes is different from Covid-19.
How contagious is monkeypox?
People typically catch monkeypox by coming into close contact with infected animals. That can be through an animal bite, scratch, bodily fluids, feces or by consuming meat that isn’t cooked enough, said Ellen Carlin, a researcher at Georgetown University who studies zoonotic diseases that are transmitted from animals to humans.
Although it was first discovered in laboratory monkeys in 1958, which gives the virus its name, scientists think rodents are the main carriers of monkeypox in the wild. It is primarily found in Central and West Africa, particularly in areas close to tropical rainforests — and rope squirrels, tree squirrels, Gambian pouched rats and dormice have all been identified as potential carriers.
“The virus has probably been circulating in these animals for a very, very long time,” Dr. Carlin said. “And for the most part, it has stayed in animal populations.”
The first human case of monkeypox was detected in 1970 in the Democratic Republic of Congo. Since then, the virus has periodically caused small outbreaks, though most have been limited to a few hundred cases in 11 African countries.
But human-to-human transmission of monkeypox virus is pretty rare, Dr. Van Kerkhove said. “Transmission is really happening from close physical contact, skin-to-skin contact. So it’s quite different from Covid in that sense.”
The virus can also spread by touching or sharing infected items like clothing and bedding, or by the respiratory droplets produced by sneezing or coughing, according to the W.H.O.
That may sound eerily familiar because in the early days of the pandemic many experts said that the coronavirus also had little human-to-human transmission beyond respiratory droplets and contaminated surfaces. Later research showed that the coronavirus can spread through much smaller particles called aerosols with the ability to travel distances greater than six feet. But that doesn’t mean the same will turn out to be true for the monkeypox virus, said Luis Sigal, an expert in poxviruses at Thomas Jefferson University in Philadelphia. The coronavirus is a tiny, single-stranded RNA virus, which may have aided its ability to become airborne. The monkeypox virus, however, is made of double-stranded DNA, which means that the virus itself is much larger and heavier and unable to travel as far, Dr. Sigal said.
Other routes of monkeypox transmission include from mother to fetus via the placenta or during close contact during and after birth.
The majority of cases this year have been in young men, many of whom self-identified as men who have sex with men, though experts are cautious about suggesting that monkeypox transmission may occur through semen or other bodily fluids exchanged during sex. Instead, contact with infected lesions during sex may be a more plausible route. “This is not a gay disease, as some people in social media have attempted to label it,” Dr. Andy Seale, an adviser with the W.H.O.’s H.I.V., Hepatitis and S.T.I.s Program, said during the May 23 Q. and A. “Anybody can contract monkeypox through close contact.” What are the symptoms and how bad can a monkeypox infection get?
Monkeypox is part of the same family of viruses as smallpox, but it is typically a much more mild condition, according to the C.D.C. On average, symptoms appear within six to 13 days of exposure, but can take up to three weeks. People who get sick commonly experience a fever, headache, back and muscle aches, swollen lymph nodes and general exhaustion.
About one to three days after getting a fever, most people also develop a painful rash that is characteristic of poxviruses. It starts with flat red marks that become raised and filled with pus over the course of the next five to seven days. The rash can start on a patient’s face, hands, feet, the inside of their mouth or on their genitals, and progress to the rest of the body. (While chickenpox causes a similar-looking rash, it is not a true poxvirus, but is caused by the unrelated varicella-zoster virus.)
Once an individual’s pustules scab over, in two to four weeks, they are no longer infectious, said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada.
Children and people with underlying immune deficiencies may have more severe cases, but monkeypox is rarely fatal. While one strain found in Central Africa can kill up to 10 percent of infected individuals, estimates suggest that the version of the virus currently circulating has a fatality rate of less than 1 percent.
And the easily identifiable rash of monkeypox, as well as its earlier symptoms, could be considered beneficial. “One of the most challenging things about Covid has been that it can be spread asymptomatically or pre-symptomatically, by people who have no idea that they’re infected,” Dr. Rasmussen said. “But with monkeypox it doesn’t appear that there is any pre-symptomatic transmission.”
Still, as the recent outbreak of cases has shown, there are plenty of opportunities to transmit monkeypox in the first few days of an infection, when symptoms are nonspecific, Dr. Rasmussen said.
What to Know About the Monkeypox Virus
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What is monkeypox? Monkeypox is a virus endemic in parts of Central and West Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
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What are the symptoms? Monkeypox creates a rash that starts with flat red marks that become raised and filled with pus. Infected people may also have a fever and body aches. Symptoms typically appear in six to 13 days but can take as long as three weeks after exposure to show, and can last for two to four weeks. Health officials say smallpox vaccines and other treatments can be used to control an outbreak.
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How infectious is it? The virus spreads mainly through body fluids, skin contact and respiratory droplets, though some experts suggest that it could occasionally be airborne. Typically it does not lead to major outbreaks, though it has spread in unusual ways this year, and among populations that have not been vulnerable in the past.
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Should I be worried? The likelihood of the virus being spread during sexual contact is high, but the risk of transmission in other ways is low. Most people have mild symptoms and recover within weeks, but the virus can be fatal in a small percentage of cases. Studies also suggest that older adults may have some protection from decades-old smallpox vaccinations.
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Is monkeypox similar to Covid? Health experts say that monkeypox is unlikely to create a pandemic scenario similar to that of the coronavirus. While Covid-19 is a tiny RNA virus that can spread through aerosols, monkeypox is a larger DNA virus that is transmitted mostly through close physical contact and has a much smaller mutation rate than RNA viruses.
Do I need to worry about a rising threat?
The good news is that there is no evidence yet to suggest that the monkeypox virus has evolved or become more infectious. DNA viruses like monkeypox are generally very stable and evolve extremely slowly compared to RNA viruses, Dr. Sigal said. Scientists are sequencing the viruses from recent cases to check for potential mutations, and will know soon if the infectiousness, severity or other characteristics have changed, he said. “But my expectation is that they will not be any different.”
Nevertheless, experts have some explanations for the recent increase in monkeypox cases. Research has shown that incidences of humans contracting viruses from contact with animals — also known as zoonotic spillovers — have become more common in recent decades. Increasing urbanization and deforestation means that humans and wild animals are coming into contact more often. Some animals that carry zoonotic viruses, like bats and rodents, have actually become more abundant, while others have expanded or adapted their habitats because of urban development and climate change.
“There’s more opportunities for relatively rare pathogens to get into new communities, find new hosts and travel to new places,” Dr. Rasmussen said.
Despite a brief pandemic lull, people are also traveling more frequently and to more parts of the world than they did just a decade ago. And while many of the new monkeypox cases are puzzling because patients did not have a history of direct travel to endemic countries in Africa, epidemiologists may uncover an indirect travel connection as they race to complete contact tracing in the coming weeks.
“The main risk for people these days with regards to viruses remains Covid,” Dr. Rasmussen said. “The good news there is that a lot of the same measures that will reduce your risk of Covid — social distancing, wearing masks in public spaces, practicing good hand hygiene and surface disinfection — will also reduce your risk of getting monkeypox.”
What is the treatment for monkeypox?
If you get sick, the treatment for monkeypox generally involves symptom management. Two antiviral drugs — cidofovir and tecovirimat — and an intravenous antibody treatment originally developed for smallpox could be used to manage monkeypox as well, though they have only been studied in the lab and animal models.
There is also a vaccine that the Food and Drug Administration approved in 2019, for people 18 and older, that protects against smallpox and monkeypox. But health officials stopped routinely vaccinating Americans against smallpox in 1972, when the disease was eradicated in the United States, and smallpox vaccines and treatments are now stockpiled mainly for national security purposes.
“The sporadic monkeypox outbreaks that have occurred in the past haven’t been enough to warrant restarting the smallpox vaccination program,” Dr. Rasmussen said. Health officials in the United States and other countries have begun using some of the stockpiled vaccines and treatments to prevent the spread of monkeypox from patients to their health care providers and close contacts, according to the C.D.C.
If you have a new rash or are concerned about monkeypox, the C.D.C. urges people to contact their health care provider. The agency has asked doctors to be on the alert for signs of the telltale rash, and says potential monkeypox cases should be isolated and flagged to them. Doctors also should not limit their concerns to men who identify as gay or bisexual, or patients who have recently traveled to Central or West African countries.
“It’s really hard to put a timeline on when this will be contained, or how easy it will be,” Dr. Rasmussen said. “But we have the pharmacological tools, in combination with the classic isolation and quarantine procedures that have helped contain monkeypox outbreaks in the past. We can contain it again. The key is going to be identifying all the cases.”
A version of this article appears in print on May 26, 2022, Section A, Page 9 of the New York edition with the headline: A Primer on Monkeypox, and How This Virus Differs From Covid-19.
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