Monkeypox, Explained: 7 Things Everyone Needs to Know About Monkeypox Right Now

Last weekend, the World Health Organization declared monkeypox a global public health emergency. Bizarrely, the immediate reaction from a segment of Twitter users was anger and scorn.

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See for yourself: the WHO’s tweet got rationed, with many people accusing the organization of homophobia, calling back to the HIV/AIDS crisis of the 1980s and 1990s. This narrative has recently come to the fore: That focusing on LGBTQ+ people more broadly, and gay men more specifically, in how we talk about monkeypox is tantamount to homophobia, and that it shows we learned nothing from the HIV/AIDS crisis.

But while the US government still has not declared the situation a public health emergency (thus allowing state health departments to withhold their data from the CDC if they so choose), a UK government report showed that 97 percent of cases were in gay, bisexual, and other men who have sex with men—”GBMSM” in public health terminology. Similarly, a recently published study in the New England Journal of Medicine showed that 98 percent of affected persons were GBMSM. So how did we end up here, where efforts to focus on the people currently most impacted by monkeypox are cast as homophobic?

As a queer Writer and a queer infectious disease doctor (who has patiently responded to every one of the writer’s questions about monkeypox), we wanted to offer some information for anyone still Confused about what’s going on—and explain why the campaign to focus on queer men in responding to monkeypox is actually the opposite side of homophobia. But first, some background.

Monkeypox isn’t new, even though it might seem like it.

First reported in humans in 1970, monkeypox has been endemic in central and west Africa for decades, with periodic outbreaks occurring within these regions and rare, limited outbreaks reported outside, mainly with direct links to travel.

With respect to the current global monkeypox outbreak, the UK first reported a cluster of 2 cases with no previous history of travel to endemic regions on May 14, 2022. Since then, it has begun popping up all across the globe. As of this week, there have been over 20,000 reported cases in 77 countries. While initial cases were at times linked to travel history to endemic areas, now most cases are not, indicating widespread community transmission.

One thing that makes monkeypox challenging to contain is that it has a relatively long incubation period—symptoms can take a couple of weeks to begin appearing—meaning it’s possible that this was circulating in communities at lower levels earlier than we knew but went undetected.

The virus is largely not deadly—but it is extremely painful and unpleasant.

Historically, monkeypox infections have had a 3-10% case fatality rate. It’s reassuring that in the current outbreak, which can be traced back to the milder of the two endemic strains, only 5 deaths have been reported as of this week.

But a low fatality rate doesn’t mean there’s no cause for concern, as monkeypox infections are characterized by a wide range of symptoms. Ninety-five percent of patients have reported skin lesions—frequently on the genitals and anus, as well as the face and torso—and nearly half have had ulcerative lesions in the mouth or rectum. Most patients have also had accompanying fever, fatigue, night sweats, and swollen lymph nodes. Although some have reported milder symptoms, for a large number of patients, lesions are extremely painful, particularly internal ones that have made swallowing, urinating, or defecating very challenging. Most patients hospitalized due to monkeypox have been seeking pain relief.


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