Here's what you need to know about monkeypox : Consider This from NPR This week the Biden administration declared the monkeypox outbreak a public health emergency.

And as the number of cases in the U.S. continues to climb, there's a lot of confusion about the disease, how it spreads and who's most at-risk.

NPR health correspondents Pien Huang and Michaeleen Doucleff join us to discuss the current outbreak.

In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

As U.S. Declares Monkeypox A Public Health Emergency, What To Know About The Risks

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KYLE PLANCK: Monkeypox is the worst pain I've had in my life.

MARY LOUISE KELLY, HOST:

Kyle Planck is a 26-year-old grad student in New York City studying infectious diseases. He got infected with monkeypox in early July.

PLANCK: I haven't had a ton of super-painful experiences to compare it to, but it's definitely for me, personally, the worst that I've gone through, and especially because it was, like, an internal sort of pain. It was very - really hard to deal with.

KELLY: Planck had lesions in different stages on his body. He spent several days bedridden.

PLANCK: And before that, I had had a really high fever, and I was taking warm baths, like, five or six times a day because that was one of the only things that made me feel better. So if I had to rate that, I guess my pain was at, like, a seven or eight out of the worst pain I could ever imagine. And it came and went throughout the day.

KELLY: As someone who studies infectious diseases, Planck was pretty familiar with monkeypox virus, but still, getting infected took him by surprise.

PLANCK: Those things, combined with being a gay man in New York City, I think I had more awareness than the average person. So even though I knew about it, I didn't think I was going to get it. So when I actually did, I was very shocked.

KELLY: Kyle Planck is one of more than 7,000 people in the U.S. who have contracted monkeypox since May, when the first cases linked to the current outbreak started to emerge. The United States now has more cases than any other nation, and public health officials say the official count is almost certainly an underestimate. And as the number of cases has grown from dozens to hundreds to thousands, criticism has grown, too - criticism that the Biden administration's response has been too little too late. Vaccine availability is limited. Treatments have been hard to get, despite the country's large stockpile. This week, the administration stepped up its response and declared monkeypox a public health emergency.

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XAVIER BECERRA: I want to make an announcement today that I will be declaring a public health emergency on monkeypox.

KELLY: That's Health and Human Services Secretary Xavier Becerra speaking to reporters on Thursday.

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BECERRA: 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.

KELLY: Declaring a public health emergency opens up more resources for a federal response and gives the administration more flexibility to coordinate across agencies. The announcement comes after New York, Illinois and California have already declared a state of emergency, mirroring similar city-level emergency declarations made last week in New York City.

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ERIC ADAMS: We are pivoting and shifting based on the crisis...

KELLY: And in San Francisco.

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LONDON BREED: By sounding the alarm, what we're saying is this is not going to be ignored, that this is a public health crisis, that we are in desperate need of vaccines to support the people of San Francisco.

KELLY: Lawrence Gostin is a professor of public health law at Georgetown University. He says the Biden administration's announcement that monkeypox is a public health emergency is long past due.

LAWRENCE GOSTIN: But I'm really heartened after a very sluggish and painfully bureaucratic response thus far. I can see a certain urgency in the administration that I hadn't seen before.

KELLY: It's a fast-moving infectious disease that has crossed borders. And while, yes, in most cases, it is not fatal, Gostin says this is a textbook case for an emergency.

GOSTIN: The stakes are huge. The window for containing monkeypox is very narrow, and it's closing. And so if we don't get it under control, we'll have endemic monkeypox in the United States for many years to come.

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KELLY: CONSIDER THIS. The Biden administration has now declared the monkeypox outbreak a public health emergency. As the number of cases continues to climb, we'll take a look at how the virus is spreading and what you need to know about the risks. From NPR, I'm Mary Louise Kelly. It's Friday, August 5.

It's CONSIDER THIS from NPR. Before Kyle Planck got infected with monkeypox, he tried to get the vaccine.

PLANCK: I attempted to get a vaccine the first day they were available in New York. I was unable to get an appointment and then I was going to walk in, but then by the time I did that, they had already allotted all the doses. And they weren't taking walk-ins anymore.

KELLY: Planck is not the only one. Appointments for monkeypox vaccines nationwide have been getting booked within minutes. Put simply, demand is high, supply is limited, and the virus has been spreading a lot faster than officials anticipated.

PLANCK: But the reality is that there are not enough vaccines for the demand, and until that problem is fixed, people are going to continue contracting this. And so it's like, what do we do at that point?

KELLY: The administration says they are making progress, though. They've shipped more than 600,000 vaccine doses to states. They also say they're stepping up their education and outreach to help patients access testing and treatments. One way they're doing that is by creating a White House response team. President Biden this week tapped a seasoned emergency response official to manage the government's handling of the crisis. Robert Fenton is the new White House monkeypox coordinator.

ROBERT FENTON: He talked about the need to scale the production and distribution of vaccines, which we're working on, making testing more convenient, access to treatments, and really, the biggest one is gauging, educating, empowering communities impacted or at risk of contracting the virus.

KELLY: Biden also tapped Dr. Demetre Daskalakis to serve as Fenton's deputy. Daskalakis is the director of the CDC's Division of HIV Prevention. He has deep roots working in LGBTQ communities.

DEMETRE DASKALAKIS: It's an opportunity for us to really be clear and to leverage the emergency to move faster and also work, as we have been, to make sure our messaging is tight and is intentionally designed not only to be stigma-free but to counter stigma.

KELLY: This is important because most cases in the U.S. are concentrated in the gay and queer community - primarily among men who have sex with men. They make up the vast majority of the confirmed cases in the U.S. Even as the administration ramps up its response, there are questions as to whether the window of opportunity to contain the outbreak is closing. To talk that through, I'm joined by two NPR health correspondents, Pien Huang and Michaeleen Doucleff. Hi, team.

MICHAELEEN DOUCLEFF, BYLINE: Hello.

PIEN HUANG, BYLINE: Hey, Mary Louise.

KELLY: All right, Michaeleen, a question or two to you first. When I say cases are rising, how fast? How quickly is the outbreak growing?

DOUCLEFF: Yeah. So right now in the U.S., the outbreak is growing exponentially, and that means the country is reporting more and more new cases each week. Now, the total number of cases right now is still very low. We've detected just over 7,000 cases, but that number has been doubling each week. And that shows that the outbreak is not under control at this point. And if that trend continues, we'll reach 10,000 cases soon, and many more by the fall.

KELLY: And I can't help but think back to the beginning of the COVID pandemic, and there was so much confusion about how it was spreading. We were all Clorox-wiping our groceries and our mail, and it was a while before we realized that wasn't really necessary. With monkeypox, do we have a better handle on exactly how people are getting it?

DOUCLEFF: Yes. I think, in general, we do have a better handle on it. There are a few gaps in our knowledge, but so far we do know how the virus is primarily spreading, and that's through physical contact during sex. A study came out recently in the New England Journal of Medicine looking at about 500 cases of monkeypox in the U.S. and other countries. And in 95% of cases, the person caught it through contact during sex. Almost all those cases were in men who have sex with men and with multiple partners. They had an average of five different partners in a three-month period. And so far, this is also the general pattern that we're seeing in the U.S.

KELLY: And that New England Journal of Medicine study that you cited that said in 95% of cases the person caught it through sexual contact - that leaves some other cases - you know, other ways that monkeypox might spread - maybe from - I don't know - breathing it, touching contaminated objects. Should we be worried about that?

DOUCLEFF: Yeah. So I think monkeypox can also definitely spread within a household. That is really true. And it can spread through contaminated sheets or towels. You know, it can also spread by being up close with somebody face-to-face for a long period of time. So that's through saliva - like, when someone's coughing or sneezing. But to be really clear here, monkeypox doesn't spread easily these ways. In fact, Dr. Ali Khan at the University of Nebraska Medical Center says most people don't need to worry about catching monkeypox in regular public places.

ALI KHAN: Do not go wash your vegetables because somebody with, you know, monkeypox may have touched, you know, the apples. So this isn't I went to the restaurant and got infected or - you know, this isn't casual contact. The data is pretty clear. This requires pretty close, intimate, skin-to-skin contact with somebody who's infected.

KELLY: All right. So Pien Huang, let me bring you in here because you have been reporting on the Biden administration's response. Given that we seem to know so much more about how this is spread than we did in the early stages of the COVID pandemic, why is the U.S. struggling to get it under control?

HUANG: I mean, I think that's a really fair question. You know, from the get-go, there have been concerns that the U.S. has been slow to act and starting off with a more wait-and-see approach. You know, testing and treatments were initially hard to get. Data has been scarce and scattered. And even now with the vaccine rollout, you know, the federal government is now making more than a million vaccines available, but they can't tell us exactly how many people have been vaccinated or really how many people need to be vaccinated to get this outbreak in check. Dr. Melanie Thompson is a longtime HIV physician in Atlanta, and she says one of her patients summed it up like this.

MELANIE THOMPSON: It feels like it's the beginning of AIDS in the early years. Nobody's ready. Nobody wants to treat you, and nobody knows where to go to get help.

HUANG: Now, over the past few weeks, some of these issues with access to testing and treatments have started to improve, especially in places like New York and San Francisco, where there have been a lot of cases. But a lot of this reminds people of the same problems we had with COVID.

KELLY: Yeah.

HUANG: You know, the U.S. has this patchwork public health system, and the states and federal governments have trouble working together, and it shows.

KELLY: It sounds like you're saying we haven't learned some of the lessons we should have and wish we had from these last few years.

HUANG: Yeah, that's exactly right. I mean, after all, the basic tools for ending an outbreak are the same ones that have been used for centuries, but health experts say the same mistakes are repeated over and over because they're caused by old problems that haven't been fixed. Here's Dr. Thompson from Atlanta again.

THOMPSON: For one thing, we don't have a unified health system, so many people don't have access to routine health care. Our public health systems have been underfunded for decades, and they have been decimated by COVID.

HUANG: So instead of being more prepared, at this particular moment, the system is more depleted and broken than it was, even before the pandemic.

KELLY: Oh, gosh. A final question, I guess to both of you - Michaeleen, you first - which is, with COVID, we are, I think, coming to an acceptance that the virus is here to stay - that we're never going to stamp out every case. It's early days for monkeypox in the U.S., but does it seem like that will be the case for monkeypox as well?

DOUCLEFF: You know, unfortunately, I think our window of opportunity might have already closed with monkeypox or is closing very quickly. I think the problem is is that we are still playing catch-up with this virus. We don't have a good grasp on how big this outbreak is and where transmission is actually occurring. Vaccines have been extremely slow to roll out. Several cities are giving only one dose right now instead of two doses because the supply is so low. And even if there were enough doses, right now, we don't know how well the vaccine will stop transmission.

HUANG: OK. I mean, this is Pien here. I'll just jump in and say that all of this is true, but I actually have some hope. You know, we have been talking about how case counts are going up, but monkeypox doesn't spread as fast as COVID, and we already have vaccines and antivirals against it. So the best-case scenario here is that the vaccines are highly effective, and they reach the people at risk. We also still don't know how well this virus will spread in the broader population, so it might actually not be contagious enough to really sustain a much larger outbreak.

DOUCLEFF: And, you know, Mary Louise, like, what's at stake here is actually pretty big. You know, if we don't stop this in the next few months, we could have a whole new disease on our hands to deal with.

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KELLY: NPR health correspondents Michaeleen Doucleff and Pien Huang.

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KELLY: It's CONSIDER THIS FROM NPR. I'm Mary Louise Kelly.

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