What We Know About Mpox
The World Health Organization has declared mpox a public health emergency of international concern, its strongest warning. The disease has once again started spreading beyond Africa. This time, we're facing a different, mutated version of the disease that's infecting large numbers of children.
Here's a recent example showing how the virus is spreading:
“The worst case I’ve seen is that of a six-week-old baby who was just two weeks old when he contracted mpox and has now been in our care for four weeks. He got infected because hospital overcrowding meant he and his mother were forced to share a room with someone else who had the virus, which was undiagnosed at the time.
That's from an epidemiologist and mpox expert in the DRC. Roughly 70 percent of the DRC's thousands of mpox cases are happening in children under 15, and a large number of those cases are occurring in children under five.
Overlooked research has confirmed that mpox can go airborne, especially the clade I version that has mutated and triggered the WHO's emergency warning. According to a 2023 article in The Lancet, "aerosols carrying MPXV could be present in environments where patients have resided," and their research shows "that airborne transmission of MPXV can occur."
As the authors go on:
As to the stability of the virus in air, it was reported that the viability of the airborne MPXV was maintained for 90 h under artificial test conditions in a rotating chamber.
A 2013 study in the Journal of Virological Methods carried out in a BSL3 lab found that mpox indeed remains infectious in the air for up to 90 hours. Another article in a 2023 issue of The Lancet confirmed that clade I of mpox has shown airborne spread. Here, the authors review decades of research on mammals to show that mpox can infect animals without direct contact.
The authors make an especially important point. They say thoughts on viral transmission and spread have been "dichotomized." As they argue, that's not how it works. It's not either/or. Instead, viruses live on a continuum. Most of them can infect you via surfaces (fomites), droplets (coughing, sneezing, close talk), or aerosols (airborne). They might prefer one or the other. They might be better at one or the other, or they could be good at them all. They can all happen.
The authors of this study did a comprehensive review of all the available evidence on mpox transmission. Here's what they concluded:
In the absence of more definitive data, public health authorities have recommended broad respiratory transmission reduction strategies, including both source control (containing infectious particles that a person breathes, coughs, or sneezes out) and respiratory protection (filtering out infectious particles in inhaled air), as an adjunct to other protective measures focused on reducing transmission through close contact. Specifically, the UK Health Security Agency and the US Centers for Disease Control and Prevention recommend that people with mpox wear a well-fitting medical mask if close contact with others cannot be avoided, and that contacts of an individual with mpox wear a respirator or well-fitting medical mask when in proximity with infected people for longer than a brief encounter.62, 63 Furthermore, it is also recommended that health-care personnel wear a respirator with N95 or higher-level filters, in addition to a gown, gloves, and eye protection, when entering the rooms or care areas of patients with suspected or confirmed mpox.63, 64
Yet another study in The Lancet examined the prevalence of mpox in the air in Spanish nightclubs during a pride celebration. They found that "high viral loads in the air were detected in the dark room but also in bar areas, sometimes even at higher concentrations... indicating poor ventilation and high risk of airborne transmission."
To summarize, we should assume that mpox can go airborne, even if it doesn't always go airborne, depending on the clade or strain. Scientists endorse proactive strategies to reduce airborne transmission.
That includes effective masks.
Aerosol scientist Linsey Marr won a MacArthur Genius Award for overturning incorrect assumptions about viral transmission. As she has said, "How far a virus can travel is determined by the size of the droplet/aerosol carrying it, not the size and weight of the virus itself." According to her, it's important to acknowledge the possibility and potential of mpox to spread via aerosolized droplets, not dismiss it.
On top of the airborne potential, the mpox incubation period lasts for 1-2 weeks on average, and sometimes it lasts even longer. The CDC themselves insist that someone isn't contagious until their symptoms appear.
Then they contradict themselves.
Later on, the CDC admits that "Some people can spread mpox to others from 1 to 4 days before they have symptoms."
Furthermore:
A 2023 study in Emerging Infectious Diseases found that "asymptomatic monkeypox infections were likely underestimated and were comparable in magnitude to symptomatic infections, highlighting the need to improve testing accessibility...."
A 2022 study in The Lancet concluded that "asymptomatic infection can substantially contribute to the transmission chain and should be clearly addressed in public health policy to contain monkeypox virus transmission."
So, we have a virus that's likely airborne, with an incubation period of 1-2 weeks, that's absolutely capable of asymptomatic transmission.
Doctors in Africa are telling everyone to get ready.
From The Guardian:
“Everyone should get prepared. Everyone should be able to detect the disease as early as possible. But more important, everyone should support the local research and local response so that it doesn’t spread.”
The response to mpox in 2022 got everything wrong. The mistake wasn't identifying the population facing the most immediate risk. It was insisting that nobody else had anything to worry about.
That was irresponsible.
A 2023 article in Health Science Reports highlights the irresponsibility of the prevailing corporate media narrative. As the authors state very clearly, "Framing the mpox outbreak as exclusively or primarily occurring among MSM and spreading through sexual activity could make things worse, reminding us of what occurred in the 1980s during the HIV/AIDS epidemic." As they further state, "Anyone, regardless of sexual orientation, can spread mpox."
Driving it home, they add:
So, it is essential to understand that not just men who are MSM or only male persons or only human immunodeficiency virus‐positive persons, or only persons from a specific category are at risk for mpox.
And furthermore:
The initial subconscious positioning of mpox infections among LGBTQ and MSM communities is a big problem for most preventive measures. People other than the above communities do not care for mpox infection and are unwilling to follow most health safety guidelines. However, mpoxvirus can spread in different ways like other IDs, and everybody is at equal risk of getting this disease as LGBTQ and MSM communities.
I'm going to emphasize that last point:
Everyone is at equal risk of getting the disease.
According to epidemiologists, clade I poses a much bigger threat. It's "up to 10 times more deadly, particularly among population groups with weakened or developing immune systems such as children under the age of 5, pregnant women, and immunocompromised people."
If you've stayed on top of public health news, you know that Covid damages your immune system. We're seeing renewed comparisons between Covid and HIV, "two diseases separated by a common lymphocytopenia."
As one paper confirms, scientists who studied HIV and Covid, "observed a comparable reduction in B cells in both diseases and a more severe reduction in the total amount of T cells in Covid-19..." Compared to AIDS, Covid depletes your CD8+ cells even faster. In other words, it's worse. Your CD8+ cells play a major role in your body's initial response to pathogens. If they're depleted, then you're much more vulnerable to infections (like mpox). That paper is just one of dozens of major studies linking Covid to weakened immune systems.
Right now, everyone's vulnerable thanks to multiple Covid infections. Most people probably don't even know it.
There's an even larger context:
As Ed Yong wrote more than two years ago in The Atlantic, we're living in a different era now, one characterized by increasing spillovers of diseases from animals to humans as we continue to destroy their habits and compete for space in a world that's becoming increasingly uninhabitable. Scientists at Georgetown modeled the future, and they found "the coming decades will see roughly 300,000 first encounters between species that normally don't interact, leading to about 15,000 spillovers wherein viruses enter naive hosts." That's an optimistic take.
Here's more from the article:
“I don’t think they’re overstating the problem,” Raina Plowright, a spillover expert at Montana State University, told me. The effects of climate change are compounded by habitat loss and other destructive forces in unpredictable ways, she said, which could force species to move and mingle even more radically than Iceberg simulated.
Updated studies and simulations actually suggest that the pandemicene scientists predicted for future decades is happening now.
It arrived early.
If you don't believe we've entered the pandemicene, consider that we now face threats from Covid as well as other pandemic potential viruses like H5N1 and mpox, not to mention several other diseases that have surged anywhere from 10 to 30 times worse than usual, according to a Bloomberg report.
We should be building up public health and encouraging everyone to take precautions that include effective masks and air purifiers. Unfortunately, lobbyists and corrupt public servants have politicized masks, and bans have been proliferating around the country. As Judy Stone writes in Forbes, this is the absolute worst time for that:
Dr. Angelique Corthals is a Covid-19 expert, scientific advisor for MaskTogetherAmerica and associate professor at CUNY. She said the mask bans are “robbing us of the main tool to prevent not just this pathogen, but also novel pathogens that are coming our way thanks to climate change.” Corthals continued, “The mask bans come at the worst time. Not only are we facing a new pandemic of actually airborne virus (H5N1), but mpox was another storm waiting to happen.” Because clade 1 mpox is more infectious and more virulent than the earlier clade, we need to take non-pharmacologic interventions (NPIs) to reduce the spread.
For the record, the recent prevailing scientific evidence on disease shows that it's a mistake to assume that any virus only transmits via one method or that it only poses a risk to certain groups. Identifying populations with the most immediate risk helps coordinate resources like vaccines and treatments. It's not an excuse to discourage other people from taking precautions.
Everyone should be taking precautions against airborne disease.
These days, that's always a good idea.
Now more than ever, we need governments to take a proactive stance, not a reactive complacent one. We should be improving safety and access to Far UVC light. We should be doing everything we can to make public spaces safer. We should not be listening to minimizers who keep repeating the same tired message that we have nothing to worry about.
Nobody who recommends masks or clean air is trying to make anyone panic about any disease. We're just trying to get people to do the right thing. Instead of encouraging complacency, we're encouraging action.
Protect yourself. Protect others.
Do the right thing.