A Guide to Monkey Pox – The New York Times

Today we are taking a breather from the coronavirus pandemic to explore another viral threat that is making headlines: monkeypox.

Since May 13, when the first case of the outbreak was reported, more than 1,000 people have been infected in 32 countries. At least 1,300 other cases are being investigated. As of yesterday, the United States had recorded 40 cases in 14 states and in the District of Columbia.

For more information on the outbreak, I turned to my colleague Apurva Mandavili, who covers infectious diseases.

What is the latest?

The thing to know about monkeypox at the moment is that it appears to have been spreading for a long time, and it will continue to do so for much longer. The big question is what the phrase “too long time” means, and whether monkeypox will find a permanent home for the animals in the United States. It is endemic to about 10 countries in Africa because it is found in the wild animals there. So if monkeypox became endemic to animals in North America or Europe, we’re looking at a similar situation where we’d likely have small outbreaks and cases going on every year — forever.

Why is it spreading now?

It is a combination of several factors. There is already 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 vaccinated against smallpox in decades. The virus may have been circulating at a low level for a while, but then found a hook in the general population through these large parties that took place in Europe.

What are the big parties?

We think several issues may have arisen at these big parties, where lots of MSM gathered and had many different partners. The monkeypox virus is not usually very effective at spreading, but these gatherings may have provided intimate contact between large numbers of people and gave the virus some space to jump.

Having said that, it’s really important that we don’t make the mistakes we did with HIV, which is to think, “Oh, this is a disease like me and it won’t affect anyone else.” We shamed the gay community at the start of the AIDS epidemic. This slowed our response to the virus in general because people mistakenly assumed that it would not spread to the general public.

During this latest outbreak, how deadly is monkeypox?

In West Africa, in the past, they had a mortality rate of about 3 to 4 percent, and the version circulated in the Democratic Republic of the Congo has a mortality rate of about 10 percent. But fortunately, during the outbreak in Europe and in all of these other countries, we haven’t seen a single death so far.

why is that?

We’re not quite sure. Symptoms seen by doctors appear to be milder than the monkeypox with which it has been linked in the past. This may be because the affected countries now have better health care. People in general may be in better health. The deaths that occurred in African countries were also primarily in very young children or immunocompromised people, whereas now most cases have been in men between the ages of 20 and 50. Because of all these factors, we should not make assumptions about whether the virus has changed in a significant way.

What are the vaccination and treatment options?

There are a few different vaccines and medications available, but most of them aren’t great options, and most have only been tested on animals. The best vaccine option is a safer and gentler version of the smallpox vaccine than the one used to eliminate the disease. But in most of the world, people only get the old smallpox vaccine, which carries a lot of very severe side effects and can be fatal for some people.

In terms of treatments, there are two main options. One is so toxic that it contains what the Food and Drug Administration calls a “black box warning” — the strictest warning the FDA uses for drugs — and it also doesn’t appear to be that effective. But the other, called TPOXX, appears to be somewhat safe and effective.

I recently wrote a story about How can monkeypox virus be airborne? And he tweeted that it was déjà vu again. What you mean?

The déjà vu I felt was less about how the virus was spreading and more about the CDC’s response to it. It appears that in some circumstances monkeypox can spread through the air – not as efficiently as coronavirus, measles or other viruses we think are airborne, but it is enough for public health authorities to discuss it openly. They haven’t really done that yet. This, 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 spreads primarily through the air, and it appears that with monkeypox it is the opposite – that it sometimes spreads through the air, most of the time it is through close contact.

What do we not know about the virus?

Almost everything we know about monkeypox is caused by smallpox, and we still know very little about smallpox. Because monkeypox has spread mainly in African countries, there have been very few studies of it. We don’t know if people can spread monkeypox without showing symptoms. We don’t know exactly how much air transportation contributes to tactile contact. We do not know if it is sexually transmitted.

How do I think about my risks?

The number of cases is almost certainly an underestimate because what is now clear is that the virus has been spreading undetected for a long time.

However, for most people, this is not something to panic or even be alarmed about. It is something to be aware of so that if you have symptoms, seek medical attention immediately. You should also know if you’ve been around someone who may have monkeypox, or if you’ve been traveling to countries where monkeypox is known to spread. All in all, I’d say inform yourself and be careful – but don’t panic.


Moderna Corporation released preliminary results today on an updated coronavirus vaccine targeting the Omicron variant, calling it our “primary candidate” to serve as a US booster dose in the fall.

The company has tested a booster dose that combines the original vaccine with one specifically directed against Omicron. They found that the group produced 1.75 times the level of neutralizing antibodies against Omicron as the vaccine alone.

But Omicron has been producing subvariants for months, and some vaccine experts say what matters now is how well a new booster formulation to protect against the latest subvariants — BA.4 and BA.5, which now account for 13 percent of new cases in the United States — is not. Omicron itself. According to some estimates, in a month it could outperform the now prevalent sub-variants Omicron BA.2 and BA.2.12.1.

The problem with targeting the latest versions of the virus is that Moderna and Pfizer don’t have time to do more human clinical trials and are still making the shots before fall, when the Biden administration hopes to be able to offer an updated vaccine for a possible winter surge. This could force regulators to choose updated vaccines based on data from lab tests and experiments involving mice or other animals.


Eating through 2022 is a mixed bag. While it appears less dangerous compared to earlier stages of the pandemic, the meal can still be sloppy.

There is still a lot of volatility. Hikes may include having the first meal in a restaurant or outdoors during a sunny spring afternoon. But the lows can be frustrating: sporadic encounters after a series of sudden infections, or the reopening of your favorite restaurant to close again.

For an upcoming newsletter on the current state of restaurants and dining out, we’re asking readers for a better – or worse – dining experience from 2022 so far. Tell us what was so special or bad about this meal and we may include your story. To participate, you can fill out this form here.



We are a couple, friends and travelers for many years. We’re in our seventies and we know life is short. We’ve been vaccinated, double our boosters, and plan a third booster dose before we head out, masked, to France in July. We will visit Normandy – especially the beaches of Conquest – and Brittany. We’ll stay in B&Bs, hotels and Airbnbs, eat very well, laugh as often as possible, and get negative Covid tests before we head back to the States. We know we are lucky and we remind ourselves of that every day.

– Rosalind Andrews, Knoxville, Tenn.

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