A MARTINEZ, HOST:
The Biden administration has declared monkeypox a public health emergency. Scientists still have some big questions about the current outbreak, such as why is the virus spreading so quickly? But unlike the early days of COVID-19, they're not starting from scratch because monkeypox has been studied for years. And we're going to talk about what we do know, including some of the myths that have popped up about monkeypox, with two NPR health reporters, Michaeleen Doucleff and Pien Huang. All right, so so far, it sounds like health officials are pretty sure that most monkeypox cases are connected to sexual contact. Michaeleen, should people be thinking about this as basically an STD?
MICHAELEEN DOUCLEFF, BYLINE: Yeah. You know, several doctors I spoke to say yes. Right now, monkeypox is an STD because recent data in the U.S. with this outbreak show that it's spreading like an STD. That is, it's spreading primarily through physical contact during sex. However, right now, the CDC and the WHO do not classify it as an STD. Now, in the U.S., with this outbreak, about 98% of cases are in queer and gay folks and their sexual networks, in particular men who have sex with men. And there's a big unknown here. And that's whether or not monkeypox transmits through semen as well as physical contact. Evidence is growing that that is probably the case. But - and this is really important - monkeypox doesn't only spread during sexual contact. It can, in rare occasions, also spread through a few other routes. So right now, it's not just an STD. It's more than that.
MARTINEZ: Yeah, because I've definitely heard of people being worried a bit about getting it from a handshake - I'll raise my hand on that. I'm one of them - or even touching someone in a public restroom or something. Are there other ways the virus can be spread?
DOUCLEFF: Yeah. So here's where there's been a lot of confusion and some inaccurate information. So, yes, it is possible for the virus to transmit nonsexually - so through face-to-face interactions with someone or by touching a contaminated surface, as you said. But data show this is exceptionally rare. The virus is really bad at spreading this way. So it takes prolonged interaction or a lot of the virus. And the risk through these routes is very, very low. You know, part of the reason this has been so confusing is that, historically, monkeypox transmitted only through these other routes. It didn't spread through sex. So outbreaks were really small and went away quickly because it didn't spread very easily. But then in 2017 or so, the virus' behavior changed, and it started spreading more easily between people because it started showing up in people with high-risk sexual behavior.
MARTINEZ: So, Pien, can we say that we're talking about something that's not nearly as contagious as, say, COVID?
PIEN HUANG, BYLINE: Yeah, exactly, A. I mean, as Michaeleen just mentioned, the primary way that it's spreading from person to person is when, you know, the monkeypox lesions that someone has are filled with - that are filled with virus get rubbed vigorously against another person's skin or mucous membranes. And that is just not casual contact. I spoke with Dr. Peter Chin-Hong, an infectious disease doctor at UCSF, and he says you're not likely to get it from trying on a jacket at a thrift store or brushing up against someone with the monkeypox rash at a festival.
PETER CHIN-HONG: I mean, you'd have to, like, brush against them like a scrubbing brush to then make an abrasion in your skin for that monkeypox to then come inside you and then cause a lesion on your arm, which we haven't really seen in this outbreak.
HUANG: Experts say it probably does take hours of repeatedly touching the virus on surfaces or breathing in the particles to get infected. And that's like living with someone.
DOUCLEFF: Yeah, just to add to that, you know, even when you are living with someone with monkeypox, your risk is actually still not very high. So data right now in the U.S. shows the chance of spreading monkeypox within a household, not through sex, is really only about 1%.
MARTINEZ: One percent, OK. Now, Pien, do we have an idea of when a person is infectious and most likely to spread the disease?
HUANG: Yeah, absolutely. I mean, the CDC breaks the disease course down into three parts. You know, the first part is the incubation period when someone is infected but isn't feeling it yet. And it's not clear if people can spread it in this phase. Then there's a phase that a lot of people go through, or some people do, where they start to feel sick. They might have a headache. They might have a fever. And the CDC says that they're possibly contagious during this phase. And then there's the rash stage, the third stage, where they get lesions on their body, and that's when they're definitely contagious. You know, so for now, the guidance for monkeypox patients is to isolate for the two to four weeks that they're showing any kinds of symptoms, whether it's a fever or whether it's a rash, and to stay away from people and pets in the house. And if they do need to leave the house, to cover those lesions and to wear a mask.
MARTINEZ: So, Pien, then what are some reasonable precautions that people should be taking to avoid catching this?
HUANG: Well, it all starts with taking a personal risk assessment. You know, are you a person at high risk. Right now, as Michaeleen said, most of the cases are concentrated in gay and bisexual men and trans people. And most of them are found in people who have sex with multiple partners. So if you are a member of this group, the No. 1 thing you can do is get vaccinated as soon as you can.
MARTINEZ: Michaeleen, I know vaccines are still hard to come by in many places. What should people do if they can't get a shot yet?
DOUCLEFF: Yeah. You know, I was talking to Joseph Osmundson about this. He's a biologist at New York University, and he's been helping lead the effort to stop the outbreak. He says right now, people who are part of queer sexual networks need to be aware of what activities put them at risk.
JOSEPH OSMUNDSON: Right now, those are, you know, encounters with folks you don't know well, who you can't have conversations with about risk or places where people meet for sex. In particular, you know, some 30% of cases or so seem to be associated with saunas and other places where folks meet for sex.
DOUCLEFF: And he also emphasizes that if you're not part of this group, part of gay and queer sexual networks, your risk right now is very, very low.
MARTINEZ: OK. Now, finally, both of you have reported on this since the U.S. outbreak began more than two months ago. What are some of the key questions that you're following and actually hoping to get answered? Pien, let's start with you on that.
HUANG: Yeah, I mean, I have a lot of questions right now. I think a lot of people do. But one of the main things that we really want to know is how much does this spread from people who don't have symptoms yet or who don't ever get symptoms? You know, asymptomatic or presymptomatic spread is still an open question. Another is for people who have had monkeypox. One question that they're asking doctors a lot right now is when can I start having unprotected sex again? Because it's not clear how long the virus stays in semen and how much it spreads that way. Now, these are important questions because they get to a bigger issue, which is, you know, are we giving people useful advice that they can follow and advice that really helps stop the spread?
MARTINEZ: yeah. What about you, Michaeleen?
DOUCLEFF: Yeah. You know, that last point is so key, right? Like, what is going to stop the spread? What is going to end this outbreak or could end this outbreak? And for me, there's one huge question, and that's about the vaccine. You know, will this vaccine be effective enough to slow down transmission? There are some signs that that might be true, but this vaccine takes time to work. And right now, there is still little vaccine broadly available. And we actually have very little data about how effective the vaccine is. So we need to get more information on this vaccine. And like Pien says, we need to get information that people can use and implement to reduce their risk and reduce the spread.
MARTINEZ: NPR's Michaeleen Doucleff and Pien Huang, thank you both.
DOUCLEFF: You're welcome.
HUANG: You're welcome.
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