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Monkeypox outbreak is a reminder that viruses won't stop surprising us

Experts weigh in on the continued need for public health tools now — and in the future.

Two years into the COVID-19 pandemic, you probably didn't expect to be talking quite so much about monkeypox — or to see that an outbreak of the virus, which normally circulates in west and central Africa, would spread to 18 people in nine U.S. states and nearly 180 cases in the U.K.

But, when it comes to disease patterns, we should probably get used to the unexpected, experts told TODAY, and we should remember the important precautions we've become familiar with during the COVID-19 pandemic.

The monkeypox outbreak both is and isn't surprising, experts said.

"We didn't expect to be talking about this, especially considering that we're still in the midst of the SARS-CoV-2 pandemic," Michael Gale, Ph.D., an immunologist at the University of Washington, told TODAY.

Experts know the virus can hide out in animal species before infecting humans, and they suspect that rodents are the natural reservoir. But they still don’t know for sure, so in a sense, "an outbreak of monkeypox will always catch people by surprise," Gale said.

"This is the first time we've really seen widespread transmission in multiple countries simultaneously that were not associated with travel to countries where monkeypox is more commonly found," Dr. Daniel Uslan, co-chief infection prevention officer for UCLA Health and clinical chief of the infectious diseases division, told TODAY.

But “it’s not completely unheard of to see cases in the U.S.,” Uslan noted. In the past, there have been small clusters of cases after people traveled to countries like Nigeria where monkeypox is endemic, as well as cases traced back to exotic animals.

"Monkeypox is an infection that we know can spread from human to human in the right conditions," Dr. David Heymann, infectious disease epidemiologist and former assistant director-general for health security at the World Health Organization, told TODAY.

"What we need to do now is make sure that we can stop it," he said. 

How severe will the monkeypox outbreak become?

When asked if monkeypox could be the next pandemic, experts at the WHO this week said, “The answer is we don’t know, but we don’t think so.” And the experts TODAY spoke to agreed that it's unlikely monkeypox will become another pandemic on the scale of COVID-19.

"Even though this is not what we normally see with monkeypox, this is not a new virus," Uslan said. "While we have a lot to learn about the current outbreak, we do know an awful lot about monkeypox," he said. "And I'm not terribly concerned that this is going to spread."

That's partly because we have more tools and knowledge about this virus (including smallpox vaccines), but it's also because the virus itself behaves differently from the coronavirus. The virus that causes monkeypox is a DNA virus, which means it's less likely to develop worrying mutations and variants than the coronavirus does, Gale explained.

But we should still take precautions and make sure people know how the monkeypox virus spreads, who is most at risk for exposure and the symptoms monkeypox causes.

Monkeypox prevention: How to stop the spread

As with COVID, it’s important to remember that we have tools that can help stop the spread of monkeypox. "The control of this is in our hands right now, and if we if we want to stop it, we should react in the right way," Heymann said.

First, assess your risk for exposure so you can take the appropriate precautions, Heymann advised. Before engaging in close physical contact with someone, think about their risk for monkeypox — especially if they’ve traveled to central or west African countries where the virus is endemic.

Be aware that, so far, the virus appears to have spread mainly among other men who have sex with men, according to WHO. So people in that population should take special care to understand their risks. But monkeypox doesn't only affect people in this group, Heymann said, “and we need to be aware that it could be present in many different populations.”

Second, know the symptoms of monkeypox — especially a new or unusual rash — so that you can get care quickly. And, if you're diagnosed with the disease, you should isolate yourself to protect those around you. If there's a good chance that you've been exposed to monkeypox, you might receive a prophylactic monkeypox or smallpox vaccine.

Outbreaks will keep happening.

The monkeypox outbreak is a reminder that, even after more than two years of COVID-19, viruses can still surprise us — and we should continue to prepare for the unexpected.

"We're seeing influenza cases in Los Angeles in late May, which is unheard of," Uslan said. Experts speculate that, because the pandemic kept us from interacting with each other, "the normal cycles and patterns of exposure and immunity have been altered," he said.

Climate change may be playing a role as well, Gale said, because changing weather patterns and human behavior may force more interactions between humans and animals, thus making the spread of diseases between species more likely. "It could lead to more Zika virus exposures, or bats that carry coronaviruses would move their habitat based on weather patterns," he explained.

"Things like this monkeypox (outbreak) are a good reminder that there are infections out there in animal populations that infect humans," Heymann agreed. "We just have to be aware that there's a whole animal kingdom out there with organisms that can come into humans."

The outbreak is also "an opportunity to show the outbreak response that we've got in place," Gale said, including the Centers for Disease Control and Prevention tracking cases, putting out alerts and facilitating quarantine for those who need it.

Although it's hard to know exactly what's in store for us in this outbreak or those that may come in the future, it pays to prepare for surprises, the experts told TODAY. "If any of us learned anything over the last few years in the field of infectious disease," Uslan said, "it's how little we knew and how humble we needed to be."