Visual examples of the monkeypox rash

Monkeypox Is Spreading in King County: 5 Things to Know

by Guy Oron

(This article was originally published on Real Change and has been reprinted under an agreement.)

A new outbreak of monkeypox, the viral disease that causes skin rashes, swollen lymph nodes, and flu-like symptoms, is making headlines. The disease has spread rapidly to over 60 countries since May 2022. 

The virus (also known as MPXV), is closely related to smallpox and cowpox and has historically been limited to countries in central and western Africa. Monkeypox is zoonotic, meaning it can spread between humans and non-human animals, such as rodents and squirrels. The name monkeypox is actually misleading, because monkeys — similar to humans — are not the main hosts of the virus.

According to the Centers for Disease Control and Prevention (CDC), over 14,000 cases have been reported globally as of July 19. The U.S. makes up 15% of all cases globally, with 2,107 cases. European countries make up roughly 80% of the cases reported so far. Some have criticized the U.S. government for rolling out testing and vaccines too slowly, allowing the virus to become entrenched in the country.

According to the Washington Department of Health (DOH), 54 people in Washington have contracted monkeypox. As of July 19, 49 of the cases are in King County. On July 11, the DOH had reported 19 local cases. Given the dramatic increase in cases, Real Change talked to public health experts to learn more about the outbreak and what public health agencies and local community members can do to mitigate the spread of the disease.

Monkeypox Is Spreading Quickly and Locally

Previous outbreaks of monkeypox were limited, infecting only a handful of people at a time. However, this new outbreak has spread exponentially since May 2022, reaching thousands all over the world. According to Dr. Matthew Golden, a professor at the University of Washington and the director of the HIV/STD program at Public Health — Seattle & King County (PHSKC), this kind of outbreak is unprecedented for the monkeypox virus.

“So, there have always been periodic outbreaks, small outbreaks, for reasons which are not so clear,” Golden said. “But somebody must come into contact with one of these rodents or a squirrel. And they get it, and potentially they pass it to other people. I think what’s unusual here is the scale of this outbreak and the fact that we’re seeing an outbreak like this concentrated in gay, bisexual, and other men who have sex with men, which to my knowledge has not been observed in the past.” 

Golden also said that it is not clear if the increase in transmission is due to a mutation in the virus or just that the disease happened to reach the right “contact network of people,” giving it a lot of opportunities to spread. In a study published on June 24 in the journal Nature Medicine, researchers found significant mutations between the current monkeypox strain and a previous 2018–2019 outbreak of the virus. 

The World Health Organization (WHO) is set to convene an emergency meeting on July 21, in which it could declare monkeypox a pandemic, as well as designate a new, more accurate name. 

Historically, monkeypox has spread through close, skin-to-skin contact. This can include prolonged face-to-face contact, cuddling, kissing, and sex (including non-penetrative sex). Condom use alone is not enough to necessarily prevent transmission, as the disease can be passed via skin contact, especially if there are rashes in areas of the body that are not protected.

However, there is some debate as to whether the virus can be transmitted through the air. The CDC has said the virus cannot spread through aerosols or stay in the air for very long, though it may sometimes spread through larger droplets. Others, such as controversial epidemiologist Eric Feigl-Ding, have pushed back on this claim. Feigl-Ding wrote on Twitter that the CDC downplayed the disease’s aerosol risk.

For now, local data suggests that most transmission is through close contact, not aerosols. According to a spokesperson from PHSKC, nearly all cases in the county so far have reported sexual contact.

What to Do if You Were Exposed to the Virus or May Have Caught It

The most common monkeypox symptom is swollen lymph nodes, followed by a widespread rash featuring distinctive wart-like papules. Flu-like symptoms are also very common, including fever and soreness. Other symptoms include skin lesions and pain, especially in the genital and anal areas.

If you develop symptoms or come in close contact with someone who has been diagnosed with monkeypox, you should refrain from sex and contact a medical provider as soon as possible to get tested or evaluated. People diagnosed with the virus should self-isolate to avoid spreading the disease to others. 

For most people, symptoms remain relatively mild and can last from 2 to 4 weeks, according to the CDC. Early data suggests that treatments developed for smallpox are effective against monkeypox as well. Golden said people with more severe disease can obtain the antiviral drug tecovirimat.

The CDC is currently distributing smallpox vaccines mainly to states with larger monkeypox outbreaks. As of last week, King County had about 700 courses of the vaccine. Right now, PHSKC is doing contact tracing and immunizing people who have had high-risk exposures to known cases. The CDC has ordered millions of doses, but so far demand for the vaccine outstrips supply. 

Anyone Can Get Monkeypox, but It’s Hitting the LGBTQ+ Community Harder

Anybody can contract monkeypox — no single person or community is immune. 

However, the outbreak is disproportionally affecting the queer community and specifically queer men, trans people, and sex workers. PHSKC wrote that so far, “all cases are among men, nearly all are among men who have sex with men.” 

So far, the disease has been primarily transmitted within queer communities because queer men were the first people to get monkeypox in the U.S. However, there is nothing stopping monkeypox from spreading to other parts of the population, and straight people should not ignore the virus, because it can affect them too.

DOH Spokesperson Teresa McCallion emphasized the importance of not letting the imbalance affect the agency’s approach to the outbreak.

“We are all working diligently to avoid stigmatizing any particular group,” she wrote. “I would also like to make it clear that it’s not all [men who have sex with men who] are high-risk; just those who have sex with multiple partners and/or have anonymous sex.”

Thankfully, unlike with COVID-19, elders may be relatively safe from the disease. People who were born before 1975 likely have some immunity to monkeypox due to the smallpox vaccine they received in their youth.
PHSKC hopes to vaccinate members of higher-risk groups who have not been exposed to known cases later this summer, once it gets more vaccines. In New York City, where appointments for vaccines have been made publicly available, some have raised concerns that those who are most at risk are not the ones being inoculated.

There’s Still a Lot We Don’t Know

This monkeypox outbreak is still only a few months old. There is a lot scientifically that we don’t know.  For example, it is still not clear what has caused its sudden and rapid spread across the globe.

There is also a lot we don’t know about all the possible transmission routes the virus can take. For now, it appears sexual transmission and close contact are the primary ways the virus spreads. However, some fear mutations may make spreading the virus through surfaces or droplets more efficient.

“None of us have a crystal ball to know where is this epidemic going and who will ultimately be infected,” Golden said.

Monkeypox Is Not Like COVID-19 or HIV

After experiencing the global trauma of COVID-19, it feels scary to see another large outbreak of a viral disease. However, monkeypox is a far less serious disease. To date, three deaths have been recorded by WHO in Africa, and no deaths have been recorded in Europe or North America, the main centers of the outbreak.

Unlike early COVID-19, we already have vaccines and antiviral medications that are effective against monkeypox. Governments and public health agencies could have been more proactive in responding to the disease, according to some observers, but here in Washington, there is already a clear plan to respond to the virus. 

Some media reports have alluded to HIV with their coverage of monkeypox. While the virus can transmit sexually and has affected queer and gay men, these types of comparisons can be very damaging and inflame stigma against queer and African people. 

Monkeypox tends to last a few weeks, while HIV is a lifelong disease that can cause serious and life-threatening illnesses. Although we now have medication that can help people live a long and healthy life with HIV, it is in no way similar to monkeypox. 

Golden said people, especially those who are at higher risk, should make informed decisions about how much risk they want to take as the virus spreads. He also said people should be worried and should remain vigilant to help contain the disease, but within reason.

“You know, we don’t need to panic,” he said. “This is not Ebola, right? This is not a fatal infectious disease. It is not being transmitted through the air, through just breathing with other people. There are things you can do to protect yourself. But I think it’s a reason for concern. [It’s] not nothing, and particularly with the cases increasing seemingly pretty quickly, and the fact that I don’t think we really know the true scale of the epidemic right now — I think there are more people infected than we know.”

Guy Oron is Real Change’s staff reporter. A Seattleite, he studied at the University of Washington. Guy’s writing has been featured in The Stranger and the South Seattle Emerald. Outside of work, Guy likes to spend their time organizing for justice, rock climbing, and playing chess. Find them on Twitter @GuyOron.

📸 Featured image by NHS England High Consequence Infectious Diseases Network, courtesy of the CDC.

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