The White House has officially declared monkeypox a public health emergency. While the new title will hopefully allow the nation to provide more resources to support to individuals infected—and curb spread of the virus itself— the idea of an ‘emergency’ may scare some people. And already, there has been some pretty nerve-wracking information going around about the nature of the virus, especially in terms of how it’s spread. But, as many experts will tell you, there is no reason to panic.
Here’s a breakdown of what we know about the spread of monkeypox and what kinds of (lowkey!) precautions some individuals should be taking—and why you don’t have to worry about catching monkeypox from, say, a doorknob, or shirt at a vintage store.
How does monkeypox spread?
Monkeypox primarily spreads through skin-to-skin contact. “What’s currently driving this epidemic is skin to skin contact through intimate physical contact like oral, anal, vaginal sex and other intimate contact like rimming, hugging, kissing, biting, cuddling, and massage,” Syra Madad, an infectious disease epidemiologist at Harvard’s Belfer Center explained.
The Centers for Disease Control notes that in addition to direct contact with monkeypox rash or fluids from a person with monkeypox, you could also get the virus by touching objects and surfaces that have been used by someone with monkeypox, or through contact with “respiratory secretions.”
Wait a second—you can get it from touching objects?
Theoretically, yes. But experts note that this is not how people have contracted monkeypox in most reported cases. The vast majority of the spread is from intimate contact, among men who have sex with men.
When it comes to surfaces, “the monkeypox virus is a DNA-based virus and is a bit of a wimpy virus in that you can actually kill it with household disinfectants and UV light and the like,” Madad said (this is the case with most viruses) “Just because you have viral particles on a surface doesn’t mean [they’re] going to cause infection in another person.”
Madad emphasized that in order for infection via an object to occur, a number of things need to align: the virus needs to be live, replicating, infectious—and there needs to be enough of it transferred from the infected person to the surface, and then to your skin. “It’s not as easy as ‘I’m going to touch this doorknob and somebody with monkeypox just touched it so I’m going to get infected,’ ” she says.
But I saw a TikTok about monkeypox being able to stay on fabric for 15 days! Should I be quarantining my Target haul just in case?
The CDC does note that monkeypox can survive on surfaces for a while. According to a document from the agency, “in one study, investigators found live virus 15 days after a patient’s home was left unoccupied.”
But “that doesn’t equate with infection potential,” says Joseph Cherabie, an infectious disease physician affiliated with Washington University in St. Louis. “DNA can be remnant of non-viable virus, kind of saying ‘this was here.’’”
If a person with active monkeypox lesions were to try on a shirt, and then someone else tried it on immediately after … it is theoretically possible that they could contract the virus.
But “it’s probably highly unlikely that could be a source of infection,” agrees David Hamer, the acting director of Boston University’s Center for Emerging Infectious Diseases. He says that even if someone with monkeypox tries clothing on, and gets some virus on the clothing, the virus will probably quickly become nonviable.
The experts I spoke to—some of whom see monkeypox patients in person—also noted that there have not been any reported cases where people had been clothing shopping. The main lesson of the study that the CDC references should be that it’s a good idea to wipe down a room if someone sick has been living in it, though you probably knew that already.
What about getting in a taxi, and sitting on a seat where someone with monkeypox sat? Sorry, I’m nervous about this!
Following similar logic as before, a lot of things would have to fall into place for you to get infected just by sitting on the same spot someone else did.
“There’s a small risk there could be a little residual virus there but it’s highly unlikely it would lead to infection if that were the case,” Hamer said.
The previous person in the taxi would have had to have active lesions on the area that came in contact with the seat. And timing would also play a role in whether or not the virus is still infectious.
The CDC also mentions respiratory droplets. Could I get monkeypox if I talk to someone who has it?
Yes, in theory, but only if you’re really close to them and chatting for a while. Monkeypox “is much less infectious than a coronavirus,” Cherabie says. With the novel coronavirus, there is evidence of airborne aerosol spread where smaller size particles could float around in an area, almost like cigarette smoke. Monkeypox, on the other hand, travels via fatter droplets that immediately fall to the ground, which is why you’d really need to be up in someone’s face for the virus to spread this way.
If you are living with someone who has monkeypox, it’s not a bad idea to mask up around them. “If you know someone has monkeypox and has a lesion in their mouth and you’re not wearing a mask and they’re not wearing a mask, and you are talking close by, then that risk increases substantially,” Madad adds. “But if that person does not have a lesion in their mouth or is also wearing a mask and you’re wearing a mask, then that risk goes way down.”
Hmm, the CDC kind of flip-flopped on all this with COVID!
I mean, all we can do is go by what experts are saying. “With more community spread, maybe our messaging will change and maybe we will start looking at different precautions, because that’s what happens,” Cherabie said. He emphasized that while guidance with COVID did change at the beginning of the pandemic, it did so in accordance with new science—not arbitrary decision making.
That said: masking up in public spaces might be wise anyway right now, because of increased transmission of coronavirus.
OK so maybe I don’t need to be Amazon-ing a hazmat suit, but what about stocking up on extra Lysol?
Cherabie was adamant that you should not be doing any of those things.
Fine. What should I be doing?
Right now, if you are a man who has sex with men, you should be aware of the risk of monkeypox. The World Health Organization has recommended that men who have sex with men consider reducing the number of sexual partners they have right now. Cherabie recommends getting tested if you develop skin lesions that look concerning, and isolating if the test is positive. “I don’t want people to get the impression this is something they should be worried about as a member of the public who doesn’t have much interaction with this particular network of individuals who are affected right now,” he said.
As for other ways to stay virus-free, Hamer emphasized basic hygiene precautions.
“If you shake hands with someone or brush against something, washing your hands with alcohol-based hand wash or soap and water is sufficient to reduce your risk,” Hamer says.
Okay, but what if I’m around someone who actively has monkeypox. Then I should take a few more precautions right?
That’s correct. Madad explained that if you’re caring for someone who has monkeypox, you are in fact at increased risk of contracting and so mitigation methods are important. First off, the person who is infected should be isolated. If they have contact with other individuals in the household, everyone should be wearing a mask. The person infected should cover any lesions, disinfect common spaces after use, and avoid sharing things.
They should also be sure do their own laundry. “Using hot water and laundry detergent can kill the virus,” Madad said. And if they’re not able to do their own laundry and another household member has to do it for them, that person should be sure to wear a mask, and eye protection, use gloves, and also avoid shaking the laundry just in case any infectious particles fly out. (This is the kind of scenario in which surface transmission is more likely: someone with monkeypox has been living in clothing that you then have a bunch of contact with.)
Finally, Madad emphasized the need to be careful with their tissues and trash: “the infected person should put any waste generated into a trashcan lined with a bag,” she recommends.
This is all a relief. But maybe I should cancel my concert tickets next weekend … just to be safe?
Venues where it’s hot, and people are wearing short clothing, and you’re rubbing up against people—nightclubs, concert venues, raves—do increase one’s likelihood of acquiring monkeypox. But as Cherabie notes, that’s no reason to avoid the situation entirely. Wearing a bit more clothing and avoiding skin-to-skin contact with strangers “can decrease the likelihood of you acquiring monkeypox,” he says.
One more question: I saw that my city is offering vaccines and other resources. Should I be taking advantage of that?
Unless you have a higher likelihood of contracting the virus—you are a man who is having sex with men—probably not.
“Monkeypox is happening primarily in one group and I don’t want to take the opportunity away from individuals who are at the highest likelihood of acquiring monkeypox because a lot of the general public is worrying about a theoretical possibility of acquiring monkeypox,” Cherabie says. That is: save the resources for the people who need them.