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Can the monkeypox outbreak be stopped? Some experts say it's too late

MARY LOUISE KELLY, HOST:

It has been more than two months since the first case of monkeypox was detected in the U.S. At the time, many health officials thought the country had a chance to control, even eliminate, the disease. That didn't happen. On the contrary, cases have kept rising, and now there's increasing concern that the window of opportunity to contain the outbreak is closing.

Well, to talk this 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, which means the country is reporting more and more new cases each week. Now, the number of cases is still quite low. We have about 5,000 cases detected so far, but that number is doubling each week. And that shows that the outbreak isn't under control. And if this trend continues, we could reach 10,000 cases quite quickly 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 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. 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.

KELLY: All right. A sobering update there from NPR health correspondents Michaeleen Doucleff and Pien Huang. Thank you both very much for joining us.

HUANG: You're welcome.

DOUCLEFF: You're welcome. Transcript provided by NPR, Copyright NPR.

Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.
Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.