An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment. |
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 | | The New York Times |
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 | | A laboratory of the biotech company Bavarian Nordic, which produces a smallpox vaccine that is also effective against monkeypox.Lukas Barth/Reuters |
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Today we're taking a break from the coronavirus pandemic to explore the other viral threat that's grabbing headlines: monkeypox. |
Since May 13, when the first case in the outbreak was reported, more than a thousand people in 32 countries have been infected. At least another 1,300 cases are being investigated. As of yesterday, the U.S. had recorded 40 cases in 14 states and the District of Columbia. |
For more on the outbreak, I turned to my colleague Apoorva Mandavilli, who covers infectious diseases. |
The thing to know about monkeypox for now is that it looks like it's been circulating for quite a while, and that it will continue to do so for quite a while longer. The big question is what 'quite a while longer' means, and whether monkeypox will find a permanent home in animals in the U.S. It's endemic in about 10 countries in Africa because it's in the wild animals there. So if monkeypox becomes endemic in animals in North America or Europe, we're looking at a similar situation where we will probably have ongoing small outbreaks and cases every year — forever. |
It's a combination of multiple factors. There's really low population immunity in most places by this point to any of the orthopoxviruses — the family that includes smallpox and monkeypox — because we haven't been vaccinating for smallpox for decades. The virus has probably been circulating at a low level for a while, but then it found hooks into the broader population through these big parties that happened in Europe. |
We think that many of the cases possibly originated in these big parties, where a lot of men who have sex with men gathered and had many different partners. Monkeypox is not usually very efficient at spreading, but these gatherings may have offered intimate contact among large numbers of people and given the virus some room to jump around. |
That said, it's really important that we not make the mistakes we made with H.I.V., which is to think, "Oh, this is a gay disease and it's not going to affect anybody else." We stigmatized the gay community at the beginning of the AIDS epidemic. That slowed down our response to the virus in general because people made the wrong assumption that it wouldn't spread to the general population. |
During this latest outbreak, how deadly has monkeypox been? |
In West Africa, in the past, they've had a mortality rate of about 3 to 4 percent, and the version that has circulated in the Democratic Republic of Congo has a mortality of about 10 percent. But fortunately, during this outbreak in Europe and in all these other countries, we've not seen a single death so far. |
We're not exactly sure. The symptoms that doctors are seeing seem to be milder than monkeypox has been associated with in the past. That could be because the countries affected now have better health care. People in general may be in better health. The deaths that have happened in African countries have also been primarily in very young children or in immunocompromised people, whereas most of the cases right now have been in men between the ages of 20 and 50. Because of all those factors, we shouldn't make assumptions about whether the virus has changed in some significant way. |
What are the vaccination and treatment options? |
There are a few different vaccines and drugs available, but most of them are not great options, and most of them have only been tested in animals. The best vaccine option is a safer, gentler version of the smallpox vaccine than the one used to eradicate the disease. But in most parts of the world, people only have access to the old smallpox vaccine, which carries a lot of very harsh side effects and can even be deadly for some people. |
In terms of treatments, there are two main options. One is so toxic that it has what the F.D.A. calls a "black box warning" — the most stringent warning that the F.D.A. uses for drugs — and also doesn't seem to be all that effective. But the other one, which is called TPOXX, does seem to be fairly safe and effective. |
 | | The New York Times |
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The déjà vu I felt was less about how the virus spreads and more about the C.D.C.'s response to it. It looks like in some circumstances, monkeypox can spread through the air — not as efficiently as the coronavirus or measles or other viruses that we think of as airborne, but enough that public health authorities should be discussing it openly. They haven't really done that yet. That to me was very reminiscent of what happened in the early days of the coronavirus pandemic. |
But I want to be very clear: Monkeypox is not Covid. The coronavirus mainly spreads through the air, and it looks like with monkeypox it's the opposite — that it sometimes spreads through the air, and most of the time it's through close contact. |
What do we not know about the virus? |
Almost everything we know about monkeypox is because of smallpox, and we still know very little about smallpox. And because monkeypox has circulated mainly in African countries, there's been little to no study of it. We don't know whether people can spread the monkeypox virus without being symptomatic. We don't know exactly how much airborne transmission contributes versus tactile contact. And we don't know if it is sexually transmitted. |
How should I think about my risk? |
The number of cases is almost certainly a huge underestimate because what's clear now is that the virus has been circulating undetected for quite a while. |
However, for most people this is not something to panic about or even be alarmed about. It's something to be aware of so that if you do have symptoms, you immediately seek medical care. You should also know about it if you are around someone who might be infected with monkeypox, or if you're traveling to countries where monkeypox is known to be circulating. Overall, I'd say inform yourself and be cautious — but don't panic. |
 | | Vials of Moderna's Covid-19 vaccine.Justin Sullivan/Getty Images |
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The firm tested a booster dose combining the original vaccine with one targeted specifically against Omicron. They found that the combination produced 1.75 times the level of neutralizing antibodies against Omicron as the existing vaccine alone. |
But Omicron has been spawning subvariants for months, and some vaccine experts say what matters now is how well a new booster formulation would protect against the latest subvariants — BA.4 and BA.5, which now account for 13 percent of new cases in the U.S. — not Omicron itself. By some estimates, within a month they could outcompete the now-dominant Omicron subvariants BA.2 and BA.2.12.1. |
The problem with targeting the newest versions of the virus is that Moderna and Pfizer do not have enough time to run more human clinical trials and still manufacture shots before the fall, when the Biden administration is hoping to be able to offer an updated vaccine for a potential winter surge. That might force regulators to choose updated vaccines based on data from laboratory tests and trials involving mice or other animals. |
Your best and worst pandemic dining experiences |
Dining during 2022 is a mixed bag. While it feels less fraught compared to earlier stages in the pandemic, a meal can still be a crapshoot. |
And there are still plenty of ups and downs. The highs might include a first meal back at a restaurant or outdoors during a sunny spring afternoon. But the lows can be disheartening: sparse get-togethers after a string of surprise infections, or your favorite restaurant reopening only to close down again. |
For an upcoming newsletter on the current state of restaurants and dining out, we're asking readers for their best — or worst — dining experiences from 2022 so far. Tell us what was so special, or terrible, about this meal and we may include your story. To participate, you can fill out this form here. |
What else we're following |
We are two couples, friends and travelers for many years. We are in our 70s and know that life is short. We are vaccinated, double-boosted and planning on a third booster before we head, masked, to France in July. We'll visit Normandy — especially the invasion beaches — and Brittany. We'll stay in B & Bs, hotels and Airbnbs, eat exceedingly well, laugh as often as possible, and get negative Covid tests before we return to the U.S. We know we are fortunate and remind ourselves of that every single day. — Rosalind Andrews, Knoxville, Tenn. |
Let us know how you're dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter. |
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