Researched by: Sara Varghese & Sheya Kurian 

First, the numbers

The location: As of Monday, there were more than 100 confirmed cases in 14 countries outside Africa—and dozens more are under investigation. The largest clusters of cases have been reported in Europe. The US has only one confirmed and six suspected cases as of now—and yet President Biden has warned that “everybody should be concerned.” The UK has 57 cases to date—which includes 36 cases announced just in the last 24 hours. 

Point to note: The disease is typically found in central and western African countries—with the majority of infections in the Democratic Republic of Congo. Experts say “ultimately this will be the largest outbreak of monkeypox that we’ve had outside of the endemic areas in Africa.”

An unknown source of spread: Cases outside Africa have typically been linked to overseas travel or imported animals. The WHO says this latest rash of cases is “highly unusual” because most patients have no history of travel to places where the disease is endemic. 

The ‘gay connection’: The WHO also noted that many of the cases are being reported from sexual health clinics among “men who have sex with men.” And it has identified the source of spread in Europe to two raves held in Spain and Belgium—including a recent Gay Pride event in the Canary Islands, which drew some 80,000 people.

But a WHO advisor also clarified: 

“While we're seeing some cases in men, this is not a 'gay disease' as some people and social media have labelled it. It seems clear it’s linked to close contact, whether through social contact or possibly sexual contact.”

It may well be that it is a coincidence that the initial infections originated in these communities—which is why they have more cases: “By nature, sexual activity involves intimate contact, which one would expect to increase the likelihood of transmission, whatever a person’s sexual orientation and irrespective of the mode of transmission.”

But both UK and US health authorities have cautioned gay and bisexual men to be more careful. And experts have warned that mass gatherings, festivals and parties could accelerate the spread of disease.

Past outbreaks: In 2017, Nigeria reported the largest outbreak—and has since reported 200 confirmed and 500 suspected cases. There have been sporadic outbreaks across 10 African countries—apart from one in the US in 2003. In that case, a shipment of rodents from Ghana spread the virus to prairie dogs—and on to humans. The infection count: 70.

So what is monkeypox?

Origin story: The disease was first documented in research monkeys in 1958—which also explains its name. Monkeys, in fact, have very little to do with how the virus spreads. They neither carry it nor transmit it to humans. The first human case was recorded in 1970 in the DRC. The patient was a nine-year-old boy. 

The virus: The monkeypox virus belongs to the same subset of a family of viruses called Orthopoxvirus—which also includes smallpox and cowpox. It has only been isolated twice from an animal in nature—though African rodents are suspected to be the main carriers.

The disease: is a milder form of smallpox. Once the virus enters the body, it spreads and replicates via the bloodstream. Symptoms—which appear in 7-14 days—are as follows: 

• Initial flu-like signs include fever, chills, exhaustion and muscle fatigue.
• It also causes the lymph nodes to swell—which helps differentiate it from smallpox.
• This is followed by the spread of a rash across the body—including inside the mouth and on your palms and soles of the feet. They can be extremely itchy and painful.
• These turn into painful blisters filled with pus. The lesions typically scab over in 14 to 21 days—and fall off. 

Point to note: The monkeypox virus is far less deadly than smallpox—which has a 30% fatality rate. There are two main strains of the disease. The West African version has a death rate of only 1%—while the Central African is more deadly at 10%. But in most cases, people recover within weeks.

The treatment: There is no specific drug to cure monkeypox—and most medicines are aimed at alleviating the symptoms of the disease. Antivirals used to treat smallpox can also be used for monkeypox.

The smallpox vaccine is also known to prevent the spread—and is known to be at least 85% effective in protecting against monkeypox. But most countries do not have a stockpile of these vaccines since smallpox has mostly been eradicated. The US is an exception as it maintains a store to protect against possible bioterrorism attacks.

Point to note: Administering a smallpox vaccine to prevent spread carries its own risks:

“Mass immunisation campaigns are not recommended because the older smallpox vaccine can have rare but severe side effects, such as inflammation of the heart muscle. That vaccine also may be risky for immuno-suppressed people, including those with undetected HIV infection. It can be fatal even in people with eczema.”

The good news about spread: Unlike the coronavirus, the monkeypox is not airborne. So you can’t catch it by just breathing the virus in. The spread requires close contact with an infected person, animal or a contaminated surface. In the case of humans, the virus spreads through broken skin, lesions or body fluids like saliva. The other carriers are infected animals and virus-contaminated surfaces like bedding or clothing. All of which means that it doesn’t spread as quickly as Covid—and requires “prolonged face to face contact.” 

So there isn’t much to worry about?

Well, medical experts always worry. A big cause of concern is that they don’t really understand why this outbreak is happening right now. So it may well be a new variant of the monkeypox virus that we don’t know about. Also a concern: the sexual route of transmission, as a WHO specialist explains:

“What seems to be happening now is that it has got into the population as a sexual form, as a genital form, and is being spread as are sexually transmitted infections, which has amplified its transmission around the world.”

This is new and “bizarre” according to epidemiologists: “This is a novel route of transmission that will have implications for outbreak response and control.”

The main takeaway: is that there is no great cause for alarm. More so, since there are no reported cases in India… as yet. And the government has issued a directive for airports and ports to check travellers from affected countries. So we can focus instead on keeping our face masks on to fend off our old friend Covid.

Reading list

There are lots of guides to monkeypox but the best are in Nature and Scientific American. NBC News has more on the concerns about the vulnerability of gay and bisexual men. New York Times and Quartz look at available treatments and vaccines. News18 has more on the India angle.