If you happened to be scrolling through Twitter last week, you may have noticed #MonkeypoxIsAirborn trending. The hashtag revealed a fierce debate over the transmissibility of monkeypox, and what measures the general public should be taking to protect themselves against an outbreak that on Thursday was declared a public health emergency.
Shortly after it began trending, Twitter pulled the hashtag from the “What’s Happening” sidebar. A representative from the platform told Rolling Stone that the trend was “temporarily removed” for review, and that Twitter is working with “public health authorities, NGOs and governments, and other authoritative sources to elevate credible info and add context to content across the service” in order to curb the spread of misinformation on the platform.
But it wasn’t just this one instance. Since the Covid-19 pandemic began, social media has come under intense scrutiny for the role that it plays in disseminating potential misinformation. Platforms like Facebook and Twitter became hotbeds for inaccurate news about the virus, vaccines, safety guidelines, and potential treatments. Experts are now wary of making mistakes in the rollout of monkeypox guidelines that could open the floodgates once again, all while navigating a minefield of anxiety-fueled public commentary over another public health crisis.
The trending hashtag begged the question: Is monkeypox an airborne illness? The answer is, as of now, unclear. In fact, the current monkeypox outbreak has posed new challenges to researchers who’ve been studying the disease for decades. The reaction to the trend signals a tension between a limited existing base of knowledge about the virus, and the public’s desire for concrete answers.
“We need to be humble about what we know and what we don’t know about this virus,” Dr. Rimoin, an epidemiologist who’s studied monkeypox for over two decades, previously told Rolling Stone.
With the public clamoring for answers and officials cautious about jumping to conclusions before having adequate research, we turned to experts to learn more about what they know — and don’t know — about the current monkeypox outbreak.
What is monkeypox?
Monkeypox is a zoonotic virus of the same family as smallpox that causes a rash consisting of painful bumps, which blister and scab over as they heal. Symptoms of a monkeypox infection usually start within three weeks of exposure to the virus. Its characteristic rash is often (but not always) preceded by flu-like symptoms such as fever, chills, body aches, and swollen lymph nodes. Researchers have cataloged multiple strains of monkeypox throughout its history, and it appears that the current global outbreak is being driven by a relatively mild strain of the virus, with a lower morbidity rate than other variants.
Historically, outbreaks have been limited to rural areas of Central and West Africa, where individuals may come into contact with infected wildlife. Notably, this is not the first time the United States has experienced an outbreak. In 2003, 71 cases of monkeypox were identified in the Midwest after imported rats carrying the virus infected domestic prairie dogs.
The 2022 outbreak has been characterized by its rapid spread through social interactions and international travel. As of now there are 6,617 confirmed cases in the U.S. “The size, rapid increase, and global mobility of cases have made it challenging to identify infected individuals and their contacts across national borders,” says Dr. Stephen Morse, professor of epidemiology at Columbia University’s Mailman School of Public Health.
“Classically, monkeypox doesn’t last long in human infection,” Morse adds, noting that in past outbreaks, monkeypox typically “fizzled out after a few cycles of human-to-human transmission.” Researchers are working to establish if they’re dealing with a monkeypox variant (or variants) that are better adapted to multiple human-to-human transmission cycles. A study in Nature Medicine, found that the virus is likely a more transmissible mutation of one identified in a 2019 outbreak in Nigeria.
Who can get monkeypox?
Anyone can get monkeypox, regardless of sex, gender, or sexual orientation, but as of now the spread of the virus has primarily affected communities of men who have sex with men (MSM).
Because this outbreak has transmitted primarily through close, sustained physical contact, the disease has spread through interconnected social circles. A person’s individual risk level is currently dependent on the amount of interactions with at-risk social circles and spaces.
MSM includes men who are gay, bisexual, transgender, or otherwise, who engage in sexual activity with other men. In addition to MSM, sex workers, adult entertainers, and some healthcare providers and researchers are also considered to be at high risk of infection. Your level of risk increases if you have multiple sexual partners or are engaging in social activities where there is close physical or skin-to-skin contact.
How does monkeypox spread?
Dr. Rimoin explains that monkeypox can be transmitted a variety of ways, and with varying levels of risk. Enter sex, a very fun activity with a lot of close physical contact.
So is it an STI? That’s not yet known, since researchers haven’t determined if monkeypox can be passed on directly through semen or vaginal fluids. What is clear is that contact with the lesions and healing scabs poses the greatest risk of transmission. As lesions can appear anywhere on the body, contact can take place during anything from kissing to penetration. “Whether or not semen or vaginal fluids are directly implicated in transmission, sex by defention is close contact,” Rimoin says. “So of course the more close contact you have the more likely you are to become infected.”
Can it be transmitted asymptomatically? The likelihood is low, but undetermined. As of now the consensus is that monkeypox can be spread “from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed,” according to the CDC.
There are also other, less likely ways to spread the virus. “There’s probably some people picking it up because they’re caring for somebody that’s recovering from the illness,” says Dr. Stephen Hoption Cann, a clinical professor at the University of British Columbia’s School of Population and Public Health. Transmission can occur through close contact with the individual or working with items like bedding “but that’s not the majority of cases by far,” he says.
As of now there is no evidence that day to day activities like work, grocery shopping, or taking public transportation carry a significant risk of monkeypox infection. “We don’t want to confuse this with Covid,” Hoption Cann says.
So is monkeypox airborne?
No? But also, kind of? It’s a little nuanced.
Airborne transmission means that infectious viral particles can remain suspended in the air for significant periods of time. This was the most common mechanism for Covid. As of now researchers have yet to determine how likely it is that monkeypox could spread through respiratory and airborne transmission, and so far there are no reported cases of it doing so.
However, close contact with respiratory secretions — or large droplets emitted through the mouth or nose that do not remain suspended in the air — during kissing or oral sex, is a possible way to transmit the infection, particularly if the infected person has lesions in their mouth,
So do you need to wear a mask? Probably not. Hoption Cann recommends doing so if you’re infected or “If you’re caring for someone with monkeypox you and that individual should be wearing masks,” but otherwise there’s no need to mask up.
What about vaccines?
As there is currently a limited supply of smallpox vaccines, which has been shown to be effective against monkeypox, experts are focusing vaccine distribution on groups facing the highest levels of risk. If you are an MSM, a sex worker, or an individual in another identified high-risk group, experts and the Center for Disease Control reccomend getting vaccinated.
There is a caveat. Experts caution that there is still little research on how well the smallpox vaccine holds up against the intimate, sustained modes of physical contact driving the current outbreak. Still, the benefits of getting vaccinated outweigh trying to tough out an infection.
“There’s probably good evidence that a person who’s vaccinated, and has had some weeks for that immune response to develop, they’re probably going to develop a much milder disease,” Hoption Cann explains. “But is that going to fully prevent them transmitting the disease to another individual? It’s not fully clear at this stage”
The two-dose vaccines can be obtained through consultation with your doctor, local health agencies, or at pop-up clinics in various cities. It’s important to get both doses of the vaccine, Rimoin says, and “allow time for the vaccines to build immunity,” before resuming regular activity.
The vaccine can also be taken as a preventative treatment if you’re exposed to monkeypox. “It’s very difficult at the individual level to say ‘this lesion I have is monkeypox, or syphilis, or whatever,” Cann says. If a person has lesions “It’s better to go find out what it is and get treated if you can.”
Vaccinated or not, it’s a good idea to keep practicing personal hygiene such as hand washing and implement safe sex strategies. Experts advise openly discussing sexual health and history with one’s partners, and to avoid sex if any party is feeling ill or has unexplained rashes or symptoms.
I have monkeypox. Now what?
A monkeypox diagnosis is not a judgment of character; it’s just getting sick. Like any other illness there are steps you should take to help your recovery and prevent passing it on to others.
Isolation is recommended, and you probably shouldn’t have sex or close contact with other people until the infection fully clears (you arent considered fully healed until all scabs fall off and have fresh skin). You should also take protective measures when interacting with those you live with, including when doing laundry and disposing of waste. If you need to break isolation, cover up as much skin as possible, wear a mask, and avoid using public transportation.
Read CDC’s updated recommendations for people with #monkeypox. If you have monkeypox, isolate until your rash has fully healed. If you need to go out, cover your rash, wear a well-fitting mask, and avoid public transportation. Learn more: https://t.co/q2CNaAY2mx. pic.twitter.com/UFCI7gJKri
— CDC (@CDCgov) August 1, 2022
There are also smallpox treatments approved for treating monkeypox, like TPOXX and tecovirimat, which can be obtained through your doctor.
It’s also important to notify anyone you’ve had close contact with so they can properly monitor themselves and take preventative measures.
What does it all mean?
While the monkeypox outbreak is a serious medical concern, much of the fear around the virus has been built up through unnecessary stigma against the people being primarily affected by the outbreak, and very real anxieties surrounding the Covid pandemic.
Monkeypox is far more difficult to transmit than Covid, and is much less deadly, there are existing treatments and preventative strategies, as well as an existing base of knowledge researchers can pull from and expand on.
As Dr. Rimoin put it “we all live together, and this is just an issue of controlling the virus.” There are tools and knowledge and our disposal, we just need to be “thoughtful about how we deal with it.”