Dr. Darien on its symptoms, its contagion—and what we’re getting wrong about it.

BY SAMHITA MUKHOPADHYAY

It’s been a big week for the monkeypox virus. The World Health Organization has said it is a “public health emergency of international concern.” On Friday, San Francisco and New York City declared a state of emergency to stop the spread. I’ve seen the pictures of people waiting in long lines to get the vaccines. (And the images of infections are terrifying). There are 3,000 confirmed cases in the United States. How worried should we be? 

I had more questions than answers, so I reached out to my friend Dr. Darien Sutton, an emergency physician and medical contributor on ABC. 

Samhita Mukhopadhyay: OK, let’s start at the beginning. What kind of virus is monkeypox, and how does it spread?

Dr. Darien Sutton: So, monkeypox belongs to a family of viruses called the orthopoxvirus, [which also] includes something we commonly know as smallpox. Smallpox was officially eradicated within the United States by 1980, thanks to vaccines. But after that, monkeypox continued, mainly endemic to places like central and Western Africa. It presents with similar symptoms [as smallpox], albeit milder, but it’s still something to be concerned about.

The symptoms we classically know monkeypox to be associated with include this whole body rash of papules and pimples that can be quite debilitating. What’s interesting now is that [in] the cases of monkeypox that we’re seeing outside of endemic areas around the world (the United States has the most reported known cases), the rashes are mainly localized in specific regions of patients’ bodies—that can be their hands, feet, shoulders, and genitals.

Transmission happens via contact, most often from close contact—skin to skin—but it can also happen from sharing items with someone infected, such as clothing or towels. There’s also the possibility of respiratory droplets, [though] not in the same way that COVID-19 transmits where it’s aerosolized and airborne; with monkeypox, droplets are less likely to transmit from person to person. To compare, to get COVID [through] a close physical interaction with someone without touching can require 15 minutes for transmission, but monkeypox requires around three hours. 

I saw some debate about whether monkeypox is an STI or not. Is it? Does it matter what we call it?

It is not an STI, and it does matter what we call it. It’s a contact virus. So it transfers from person to person through close contact, and the umbrella of contact includes sexual or intimate contact. So yes, it can be transmitted during sexual intercourse, but [that] is not the only form of transmission. 

That’s also, I think, part of why it’s been talked about as something that’s only affecting gay men. Is that true? How is it going to impact the larger population?

So the initial conversation and communication around monkeypox was that it might have been sexually transmitted and only affected gay men. And those inaccuracies put a lot of people at risk. When a pathogen first starts [to spread], it often will transmit within a self-associating community. It [just] so happened that the first couple of cases were associated with social events that involved gay and bisexual men. 

Through self-association, that pathogen will continue to transfer until it is stopped. And that’s why it’s so important to pay attention to early calls to action, especially when we heard from queer communities, thought leaders, and epidemiologists months ago that monkeypox was known to be a problem. But obviously, those calls were not heard or met with immediate responses [and] people were left with little to no resources [with delayed access to vaccines and treatment].

So now, we will see transmission outside of this initial self-associating group into the general population. And that’s why it’s important to explain to people how this virus can be transmitted and how everyone is at risk. Using language that defines the disease [with] the location or group you first find it in will always lead to misinformation. We don’t call bacterial meningitis—which often happens in colleges— “college meningitis.” We didn’t call COVID “restaurant COVID” when we first saw outbreaks through indoor dining. 

We see pathogens all the time, and we don’t define them by location or people, except when it happens to queer people. Then we quickly define them.

You make a good point: We have a real-time example of what happened with COVID and how it spread. What do you think has kind of caused the delay in vaccine distribution, especially since we know how important vaccines were to curb COVID?

Unfortunately, when the discussion involves sexuality or gender identity in science, the ball often gets fumbled. 

Adam Serwer wrote for the Atlantic that when wealthy, white politicians realized that COVID was disproportionately killing low-income and Black people, you suddenly saw calls for banning masks and reopening the economy. Do you see a similar pattern here?

I get concerned when a pathogen is identified with a group that’s already vulnerable. And that’s what I’m already starting to see. When I look in the comment sections [of stories] regarding monkeypox, I see a lot of obvious hatred and homophobia. I’ve seen what happens with COVID-19 misinformation, and I see how easy it is for misinformation to spread. And I’m afraid that homophobia will fuel this misinformation, off-tracking the direction we need to go. 

Before we go: What are your recommendations for staying safe from monkeypox?

Number one is education. [Then] awareness of symptoms. Many people may have mild to no symptoms and may not realize they are infectious with monkeypox. [But] if you have any pustules or pimples that are in places where you don’t normally get them, and especially if they are associated with flu-like symptoms or swollen lymph nodes or fever, really pay attention and isolate yourself because you may be at risk of having a monkeypox infection. Check in with your local department of health to find access to testing. And then, if you are at risk [of infection], there may be vaccines available within your community that you can get that can protect you against a severe monkeypox infection.

The media acts surprised when a child or a pregnant person gets infected with monkeypox. It’s not a surprise. There’s an active outbreak. And I think a call to action continues for those governing this public health crisis to realize that this is a real problem. And although it may not have outcomes similar to COVID-19 in terms of hospitalizations, this can be detrimental to someone’s life.

Some tips from NPR on how to take precautions against monkeypox 

• Avoid crowds where it’s hard not to touch other people.
• Separate potentially contaminated fabrics [bedding, towels, linens used by someone who has been diagnosed] until they can be washed. 
• Wash hands regularly! 
• Disclose to potential sexual or intimate partners if you fear you may have been exposed. 
• If you think you have been exposed or are at risk of exposure, you may be eligible for the vaccine.  
• Stay up to date on monkeypox spread in your area.

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