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Is monkeypox a pandemic? Experts explain why it's not another COVID-19

We still have a chance to contain the outbreak, but experts fear monkeypox could become endemic in the U.S.
/ Source: TODAY

What started with a few monkeypox cases in Europe back in May is now classified as an international public health emergency, according to the World Health Organization.

With memories of the early days of COVID-19 lingering in our minds, it's natural to be anxious about where the monkeypox outbreak may go. But, while monkeypox is a serious public health concern, experts say it's not another COVID-19.

"It isn’t the next COVID for several reasons,” Matthew Hamill, Ph.D., assistant professor at the Johns Hopkins School of Medicine, told TODAY.

We know more about the virus that causes monkeypox — and we already have tools to help slow the spread. But experts are worried that even if we're able to contain monkeypox, it could be with us for a while.

Where and how is monkeypox spreading right now?

There are now about 32,000 cases of monkeypox globally and more than 10,700 in the U.S., according to the Centers for Disease Control and Prevention. Around the world, approximately 98% of monkeypox patients are men and, among those who reported their sexual orientation, 97% are men who have sex with men, the WHO said.

So it's especially important for people in that community to be aware of their risks and be given access to the tools to reduce those risks.

But experts told TODAY it's also important to recognize that monkeypox can affect anyone — and we are already seeing it spread outside of the populations that were initially affected. For instance, at least one pregnant woman and five children have had confirmed cases of monkeypox in this outbreak so far, TODAY reported previously.

“There are no biological boundaries to monkeypox,” Hamill said. And the truth is that sexual networks are not "sealed," he added, meaning that men who have sex with men may also have sex with people of other genders.

Additionally, it's important to recognize that the virus may spread through any kind of close physical contact — which can occur outside of sex. “Sex is just another form of skin-to-skin contact,” Dr. Bernard Camins, medical director for infection prevention at the Mount Sinai Health System, told TODAY. Transmission can also happen via shared towels or sheets within a household, he added.

For these reasons, it's "very problematic to see monkeypox only as a sexually transmitted infection and only as an STI that's affecting men who have sex with men," Hamill said. In fact, that kind of stigmatizing message can keep people from seeking necessary medical care, he said.

Monkeypox and COVID-19 are different in a few important ways

These two viruses are different, the experts said. And we are better poised to tackle monkeypox than we were in the early days of the COVID-19 pandemic.

Crucially, we are not starting from zero with monkeypox. “It is an old disease,” Camins said, and it's already endemic mainly in countries in Western and Central Africa. "So we’re still learning a lot, but we also know quite a bit already.”

First, there are differences in the ways the viruses spread: Unlike COVID-19, monkeypox spreads primarily through touch or close contact with someone who has lesions or rashes, Dr. Scott Roberts, associate professor and associate medical director for infection prevention at Yale School of Medicine, told TODAY. “The rash is basically chock full of virus," he said.

The fact that monkeypox typically requires that level of close contact to spread makes it harder to get that disease than COVID-19, which we now know spreads through respiratory droplets. (There are reports of monkeypox spreading via respiratory droplets but that is much less common.)

Monkeypox is also less deadly than COVID-19, Hamill explained. About 400 people are still dying in the U.S. every day due to the coronavirus, CDC data show. So far, there've been 12 deaths in the current monkeypox outbreak, five of which were in countries that haven't historically reported monkeypox.

Additionally, we already have testing protocols, vaccines and even treatments for monkeypox, Hamill said. But there have been issues with the rollout of pretty much every one of those tools, he added.

In order to get the vaccine or treatment, you have to go through the state health department, Roberts explained, which can add another roadblock for patients. "Unfortunately, you can't just go to your doctor and get this without them talking to the state." Vaccine eligibility can also vary widely depending on where in the country you are, he said.

Will monkeypox become another pandemic?

The experts agreed that monkeypox will not become a pandemic in the sense that it will drastically change everyone's daily life the way COIVD-19 has. "This will not become a pandemic and societal shutdown problem the way we saw with COVID," Roberts said.

But the emergence of monkeypox is a very concerning development — and the disease could very well keep spreading within the U.S. and around the world.

"My sense is that we are still very early on in the epidemic in the U.S.," Hamill said, adding that he anticipates the numbers will keep increasing the way they have over the last few weeks.

As public awareness, access to testing and availability of vaccines increases, Hamill hopes that "will start to slow the spread of this infection within our communities." Making it easier for people to feasibly isolate at home during the infectious period will also help, he said.

But there is still a worry that, even if we are able to significantly reduce the spread of monkeypox, the virus could become endemic in the U.S.

"The biggest concern is that we've lost our opportunity to contain this," Roberts said. For instance, there's a chance that monkeypox could continue to circulate among people in high-risk populations the way chlamydia and gonorrhea do now, he explained.

But Hamill is still optimistic: "I don't think we are at a place where we should collectively throw up our hands and say that's inevitable," he said. Hamill noted that we have the tools to prevent the disease from getting to that point, but they need to be made more accessible — especially to people who already have a disproportionately hard time getting care.

What we really need are "big, bold public health policy decisions," Hamill said, like those we saw with COVID-19, such as making testing free regardless of insurance coverage.

Still, even if we are able to eradicate monkeypox in the U.S., this should be a reminder that diseases circulating elsewhere in the world can find their way here, Camins said. To think otherwise would be a "fantasy," he said.