Author’s note: I am not an epidemiologist. I am a disabled, immunocompromised mom with a degree in history who listens to epidemiologists and disability activists about disease spread and prevention. The intended audience for this essay is the people I know and love who are reading this because they subscribed to my Substack after I chose to leave Facebook. While it is my hope that people read this and share it widely, as it is important information we will all need in the coming weeks and months, I understand not everyone will want to heed my message. That is beyond my control. All I can do is share with you, dear reader, the information I’ve learned in recent weeks, how I am choosing to protect myself and my immediate family, and hope that some of you find it helpful as well. Comments are closed except to paid subscribers because this is not a matter I wish to argue about. I am merely sharing what I see as vital information. Please move along if it does not interest you.
Hello, friends. I know. You’re tired of hearing me talk about pandemics. While I was still on Facebook, I kept going on about wearing masks and staying out of crowded places long after you’d resumed your normal habits. Most of you think I go way overboard. I’ve even joked about being just shy of wearing a tinfoil hat. And I certainly hope that I am wrong about what I see as a coming tsunami in the form of monkeypox. But if there is a chance my read of this matter is correct, it is incumbent upon me to share with you what I’ve learned about how to protect yourself and your loved ones as this next pathogen spreads.
The main points I know now, which I will list in outline form and then expand in the body of my essay with citations:
Monkeypox, like all pox viruses, is incredibly contagious.
It is not a “gay disease.”
It can be transmitted through contact with lesions, but also through respiratory droplets, airborne transmission, AND by touching anything an infected person has touched.
The first case of monkeypox outside of Africa was discovered on May 6, in the UK. Since then, over 26,000 cases have been identified, with over 6,000 of them in the US as of this writing.
There is a severe shortage of available vaccines for monkeypox, and there is currently no vaccine for children under 18.
The age group at highest risk for serious complications from monkeypox is children age 8 or younger.
Monkeypox lesions are incredibly painful—most patients who get hospitalized for monkeypox are there for pain management.
Encephalitis is a complication from monkeypox—and is the culprit in some of the deaths we have seen so far.
To date, six people have died of complications from monkeypox. This number is likely to lag considerably due to the average length of a monkeypox infection being weeks.
For most in the US, school starts in 3 weeks. If the warnings of epidemiologists and disability activists are correct, a tragedy will begin to unfold in 4-8 weeks unless drastic preventive measures are implemented—which seems unlikely.
The period of isolation for monkeypox lasts on average 11-31 days, but can go much longer. A patient remains contagious until the final scab has fallen off the final lesion and the skin underneath has healed.
A bright(ish) side: Most of the precautions for monkeypox are the same protocols we observed in spring of 2020—with some key changes, including N95 or better respirator masks instead of the homemade ones many of us wore then. Laundry protocol and disinfectants are two other changes—thankfully, the solutions are both affordable and, in the case of the disinfectant, natural and food-safe. Feel free to scroll down to #10 below if you just want the tips for prevention.
Disclaimer: As the 2022 monkeypox outbreak is so different from historic outbreaks, epidemiologists and clinicians are learning more and more about the current variant(s) by the day. The information provided here is what is known as of this writing, August 4, 2022. As warranted, I may update this essay with new information—any revisions will be clearly marked with the date and my initials. ~KSM
1: Monkeypox, like its cousin smallpox, is a highly contagious disease
Monkeypox, like smallpox and cowpox, comes from a genus of viruses known as orthopoxvirus. It is not related to chickenpox, despite the similar popular name; chickenpox and shingles are both infections of the varicella zoster virus, in the genus varicellovirus. As such, smallpox vaccines do seem to have some effect on mitigating monkeypox infections due to their shared genus; a previous varicella zoster infection or vaccine will NOT.
It is not a “gay disease.” Since all prior outbreaks of monkeypox were either among patients in certain countries in Africa or people who had traveled there (or had contact with someone who had), there was no reason to suspect monkeypox when someone presented with such a rash outside those locales. However, as gay and bisexual men tend to be more vigilant about checking out skin abnormalities—they, unlike many of the rest of us, learned the importance of prompt medical attention as a result of the HIV epidemic—it stands to reason that this outbreak was primarily discovered in the MSM (men who have sex with men) community because none of the other diseases turned up in these patients presenting with painful lesions. Correlation does not always equal causation; we must bear this in mind especially in the coming weeks and months.
Although monkeypox can be transmitted through contact with lesions, or by touching bedding or clothing an infected patient has used, the CDC notes that the main source of spread (beyond zoonotic) is in fact respiratory. Indeed, there is some research that indicates monkeypox, like COVID-19 and its many variants, is airborne.
Edit 8/10/2022: When I accessed the CDC link in the above paragraph, their info on monkeypox said “After zoonotic transmission, monkeypox spread from person to person is principally respiratory; contact with infectious skin lesions or scabs is another, albeit less common, means of person-to-person spread. When I checked that link today, I noticed the section on monkeypox has changed to lessen the claims of respiratory transmission. It now reads: “After zoonotic transmission, monkeypox spreads from person to person via infectious respiratory secretions or through direct contact with infectious skin lesions (including scabs).” Below I am attaching a screenshot of the CDC’s statement on monkeypox as it appeared on August 3. ~KSM
Early symptoms infected patients might experience include fever, lymph node swelling, back pain, muscle aches, and fatigue, according to the World Health Organization. Currently, it is believed that patients are only contagious while symptomatic, but preliminary research questions that theory with some evidence of asymptomatic transmission. Further research is needed to determine this, but that is the situation as it stands now. There is also some anecdotal evidence of relapse, as found in a patient in an observational study in the UK.
Essentially, although monkeypox is not as deadly as smallpox, it is still extremely contagious, extremely painful and disfiguring, and can be fatal in anywhere from 1% to 10% of cases. The current global outbreak appears to be akin to the variant that “only” has 1% fatality, but again, none of that sounds like anything I’d want to experience. There’s a reason so many TV shows have done episodes on smallpox and other airborne pathogens. It’s scary stuff, and prevention is vital. Just because most of us have, bafflingly, decided to adopt a “learn to live with deadly and disabling airborne contagions” approach to COVID-19 doesn’t mean these are not dangerous diseases we’re allowing to spread and mutate at will. If you’re not in distress in this moment, as Dayna Lynn Nuckolls has said, you are dissociated from what is happening to you and your neighbors.
2-3: Exponential growth, and a vaccine shortage
The first case of monkeypox outside of Africa was discovered on May 6, in the UK. Since then, over 26,000 cases have been identified in 90 countries, the vast majority of which do not traditionally experience monkeypox outbreaks. What’s more, over 6000 patients have been identified in 48 of 50 states in the US as of this writing.
Ninety days. 26,000 cases and climbing.
The first confirmed COVID-19 patient became ill on December 1, 2019. It took 60 days for that total to rise to 25,000. Six weeks later, nearly the entire world shut down in an attempt to stop the spread.
Sit with that.
Absorb that.
Remember how seriously we collectively took public health just two years ago.
Then recognize that here we are, with monkeypox spread growing nearly as quickly as the original variant of COVID-19, despite relative lack of public awareness and testing for the disease. Very few continue to wear masks outside of medical settings; in fact, we’re about to send our children to school.
Even though the US faces a dire shortage of monkeypox vaccine doses that will not be eased until at least October.
Even though as of now, there is no monkeypox vaccine for children under 18, except on a case-by-case basis.
Consider what might happen a few weeks after school starts if steps are not taken to mitigate the spread. Then factor in this information when you get to point 3, after a mental health kitten.
4: Children under 8 are at high risk for serious complications from monkeypox
Although trends remain to be determined regarding this current variant of monkeypox, past monkeypox outbreaks have led to particularly severe cases in children age 8 or under. Children for whom there is currently no vaccine (although one medication, Tecovirimat, is an approved treatment in children and adolescents). Children who are already more prone to contracting all sorts of illnesses due to, well, being children—touching and sharing toys and books, exploring the world around them by engaging all their senses, including touch and taste, and so much more. I’m glad my only child is an adult. My heart truly goes out to parents of children who are about to have to make some extraordinarily difficult decisions with sacrifices and risks to be had all around, short of another shutdown—this time with robust payments to allow parents to stay home with their children.
5-7: Monkeypox complications are severe, and can be fatal—especially if you have eczema, are otherwise seriously immunocompromised, or are pregnant
Monkeypox lesions can be incredibly painful—although most monkeypox cases do not require hospitalization, most patients who do require hospitalization are there for pain management. People with atopic dermatitis (eczema), some other skin conditions, HIV or other immunological disorders, or are pregnant are at highest risk for severe complications from monkeypox. As I have psoriasis, I’ve followed this portion of the research as closely as I could; as yet, I haven’t seen anything definitive about whether psoriasis is one of the dermatologic disorders at risk for monkeypox complications. From what I’ve gleaned so far, it appears those whose psoriasis is severe enough to require immunosuppressant medication are at the most risk.
Encephalitis, or swelling of the brain, is a complication from monkeypox. So are secondary infections like sepsis, a corneal infection that can lead to blindness, and pneumonia.
To date, six people have died of complications from monkeypox. In at least two of the deaths, in men from Spain, neither was immunocompromised, nor did they have underlying conditions that are known to lead to increased mortality from monkeypox.
8-9: School starts soon. Monkeypox patients remain contagious for weeks. What is the plan?
For most in the US, school starts sometime this month, or early September. If the warnings of epidemiologists and disability activists are correct, a tragedy will begin to unfold in 4-8 weeks unless drastic preventive measures are implemented—which at this point seems unlikely.
There are glimmers of hope that world and state leaders might take action on this approaching crisis. On July 23, the World Health Organization declared monkeypox a “global health emergency.” On July 29, the state of New York declared monkeypox a “state disaster emergency;” on August 2, California and Illinois similarly declared states of emergency over the spread of monkeypox.
The period of isolation for monkeypox lasts on average 11-31 days, but can go much longer. A patient remains contagious until the final scab has fallen off the final lesion and healthy skin has grown in—or until “all signs and symptoms of monkeypox illness have been resolved,” according to the Centers for Disease Control.
In the US, paid leave is no longer guaranteed for those who test positive for COVID-19 (insofar as it ever was), and the necessary isolation time is a matter of days, not weeks like it is for monkeypox. If monkeypox continues to spread exponentially like it has so far, and the schools become massive super-spreader venues for countless elementary school children, what is the plan? How will we be able to defend inaction?
Do you have a local mutual aid network who can help if you find yourselves faced with weeks of isolation? Make some plans and procure some supplies now; if this does not come to pass, you won’t be hoarding or getting anything that isn’t a good idea to have anyway. And if it does come to pass…well, you’ll at least be more logistically and perhaps emotionally prepared for what comes.
10: What can you do to minimize risk?
A bright(ish) side: Most of the precautions for monkeypox are the same protocols we observed in spring of 2020—with some key changes, including N95 or better respirator masks instead of the homemade ones many of us wore then. (If you do not have N95 masks, I highly recommend 3M’s Aura 9205.) Also, many of these recommendations involve products that are currently widely available—some of them can even be found in clearance sales for now. Go stock up while the selection is good and prices are reasonable.
Did you buy a bunch of disinfectant wipes when they became widely available again in 2021? Good! You’ll need those. If you didn’t, go get some now. Remember the grocery-washing we all did when COVID-19 started and no one really knew whether surface transmission was a primary driver of cases? You’re going to want to start doing that now. Monkeypox can live on surfaces for a long time, and surface transmission is far more prevalent than it is with COVID-19.
Edit August 5: Thanks to an eagle-eyed reader, I’m adding a recommendation I mistakenly forgot to include when I first published. Gloves and hand sanitizer! Hand sanitizer is still widely available for now and likely will be, but if you didn’t stock up before, I would now. As for gloves, nitrile gloves like these from Harbor Freight are good; you want to go for the thickest ones you can because they’ll be less prone to break. The gloves I linked to are 9 mil, and they are safe for those with latex allergies. ~KSM
IMPORTANT NOTE: Most ordinary laundry detergent does NOT kill monkeypox. If you are caring for someone with an active monkeypox infection, you will want to wash their laundry separate from everyone else’s. Fortunately, Oxi-Clean and generic alternatives do work to kill monkeypox; their website includes instructions on how to sanitize and disinfect laundry.
For much more on disinfection tips, please check out this helpful thread from Twitter user Violet Eglantine. But if you do not have access to Twitter and/or the thread cuts off, the best tip I found there pertains to hypochlorous acid, or HOCL. It is an EPA-approved disinfectant for monkeypox, it’s a compound that occurs naturally in the human body so it is safe to consume, and as a result you can use it to clean surfaces as well as food like fruits and vegetables. While you can buy it in a spray bottle, it’s also easy and more cost-effective in the long run to make your own at home, as HOCL is a solution of electrolyzed salt water. Morton’s makes a travel-size bottle that is USB rechargeable for around $70; larger models are also available starting at around $110.
You may want to consider a UV cleaner for your cell phones, wallets, keys, and other devices that are hubs for surface transfer. We were able to find one in the clearance section of a local home supply store for around $6.
Once you have these cleaning products, you’re set. Then it’s a matter of staying out of crowds, wearing a mask everywhere you cannot avoid contact with people, and limiting travel. Simple, but I understand this might not come easily to everyone, particularly those who found the 2020 lockdown constraining.
My main goal in writing this was to make all the information I’ve found regarding monkeypox in recent weeks available in one place for those who don’t use Twitter. Everyone, of course, is free to do as they see fit for themselves. But I could not watch the spread of monkeypox without sharing prevention tips with the people I know and love. I do not say any of this to create panic; on the contrary, I’ve found that being prepared for what this fall and winter might bring has been a comfort. I hope you find this helpful as well.
Edit August 5: Thanks to an eagle-eyed reader, I added a recommendation I mistakenly forgot to include when I first published. Gloves and hand sanitizer! I was able to get a bunch of hand sanitizer when stores were literally giving away bottles, but check out the edit in item #10 (the action items section) for links to hand sanitizer and recommended gloves.