Don’t you just love the feeling of returning from a summer vacation? You’re tan, you’ve read at least five pages of your book despite bringing it everywhere with you, and there’s a new public health emergency waiting for you at home!
I can’t think of a better way to return from E4P’s first ever three-week hiatus than to chat with the brilliant minds that brought you Us, Empaths: Diseases Are Bad about the fun new disease jet setting around the globe! That’s right baby: we’re talking monkeypox today!!!!
This week, Arthur Menezes and Eleni Kokolakis return to the Emily For President Crisis on Demand Corner (CDC) to course-correct inflammatory messaging about the disease, explain what it is and how scared we should be, and lend more credence to the hill I will die on, which is that our history education needs to be revamped if we actually want to survive this hellscape we call life.
Arthur is back by popular demand1 following his previous March 14 E4P appearance. Since his last visit, he has seen 8 Broadway shows, cracked his phone screen, successfully purchased tickets to Harry Styles, got COVID for a third time, and got his Master’s degree from Princeton University in Ecology and Evolutionary Biology with a focus on infectious diseases.
Eleni could simply not stay away from Emily and Arthur. While waiting for her next E4P reunion, she has graduated from NYU with a Master’s in Public Health, declared Dirty Shirlies to be the next espresso martini, has complained loudly and to all about the Supreme Court, has aggressively been watching Love Island S8, and continues to confirm that she is violently lactose intolerant despite living in denial.
Crisis on Demand Corner, at your service!!
Cutting-Edge Journalism
We’re all fast-paced hustlers and bustlers here so I knew I had to get right into things and ask Arthur and Eleni my two hardest-hitting questions:
Emily: What the fuck is monkeypox????
Arthur: Monkeypox is a disease caused by the monkeypox virus which is in the same family as the variola virus which causes smallpox. (Fun fact: smallpox is one of only two diseases which have been fully ERADICATED!2)
Monkeypox is NOT a new disease and it is NOT related to chickenpox!
It was discovered in monkeys in 1958 and the first human case was recorded in 1970. Since then it had been reported in 11 African countries with the first outbreak outside of Africa occurring in the United States in 2003. The 2003 U.S. outbreak was linked to contact with infected pet prairie dogs shipped from Ghana and led to more than 70 reported monkeypox cases.
Symptoms include fever, headache, muscle aches and backache, swollen lymph nodes, chills, and exhaustion. (Insert “She looks like every other bitch” Tik Tok audio because these symptoms apply to literally everything else.)
What makes monkeypox stand out is its signature rash which can look like “pimples or blisters that appear on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus.” Individuals with monkeypox have described it as the worst pain they have ever felt.
Monkeypox is transmitted from person to person through close contact with respiratory particles, skin lesions of an infected person, or contaminated objects. It can take anywhere from 5 to 21 days from infection to the onset of symptoms and symptoms last from 2 to 4 weeks. It’s unclear whether asymptomatic infections are occurring. Monkeypox case fatality rates range from 0 to 11% with more recent estimates between 3 and 6%.
BUT THERE IS A VACCINE!!!
The smallpox vaccine has been shown to be ~85% effective against monkeypox. A two-dose monkeypox vaccine based on a modified attenuated vaccinia virus was approved in 2019. The CDC recommends vaccination for anyone who has been exposed and anyone who is at higher risk of being exposed.
So why is monkeypox getting all of this attention now if it’s been around since 1958? Did it get a new marketing team? Did it hire COVID’s marketing team?
Monkeypox is endemic in parts of central and western Africa but this is the first time there are cases in non-endemic countries which aren’t linked to travel. There have been 16,836 confirmed cases worldwide and 2,890 cases in the United States. In short, monkeypox just has a new marketing team and it’s trying to rebrand itself by going on a world tour.
If you thought anyone was going to learn anything regarding public health after COVID, I would like to remind us that a not small amount of people drank bleach to cure COVID in 2020 because someone told them that could work.
Which led me to ask Eleni:
Emily: What have the initial and current messaging strategies about this disease done to increase public fear and uncertainty? What should the initial messaging have been?
Eleni: After a 2-day deliberation last month, the WHO concurred that with around 3,000 monkeypox cases in 47 countries that it would not be considered a public health emergency but will be monitored. Just this past week, the WHO announced that with a case increase to 14,000 across 71 countries, monkeypox is now considered a Public Health Emergency of International Concern (PHEIC). So that’s fun!
Right now, the CDC’s communication strategy is to describe monkeypox as a legitimate public health issue (relevant to all people), educate about the virus, and frame the disease using “inclusive, non-sensationalistic” language and images in order to minimize fear and promote action and a sense of personal agency.
Their current framing for messaging pertaining to monkeypox is two-fold: messaging that targets general audiences and messaging that targets gay and bisexual men.
For general audiences, they ask partners to help messaging by providing information on the virus, how it is spread, encourage seeking healthcare, and emphasizing that anyone can get monkeypox. To avoid fear and promote inclusivity, the CDC ask that when using images of monkeypox rashes, to avoid showing extreme cases in order to give an accurate presentation of the virus and to include pictures of people from diverse racial/ethnic backgrounds.
When reaching gay and bisexual men, use messaging that provides people with tools to protect themselves and others, and to use targeted channels and relatable stories to reach this audience. It is important to note that there is a quick emphasis near the top of the CDC’s page on avoiding marginalizing and stigmatizing groups who may be at increased risk by keeping messaging fact-based.
This framing of communication is succinct and to the point, with emphasis on supporting accurate information, stigma prevention, avoiding fear mongering, and diversity representation of cases. While this is all good and great, many are asking if this CDC messaging framework is just that—a framework with no active/regular follow up on actual messaging through media outlets to reach the general public.
Messaging is most effective when there is a partnership between science and media outlets. When looking back on the issues with COVID-19 messaging, we can pinpoint the problems to lack of consistency in messages, miscommunication between science community and general public, and abundance of misinformation combating with public health efforts. So if we take these lesson’s we learned from COVID and apply them to monkeypox messaging hopefully we can avoid the same consequences, in addition to preventing stigma of the gay community!
I did a quick personal poll3 asking people around me where they’ve been learning about monkeypox and everyone had a variation of three answers: the news (through which fear was incited), the CDC/ WHO announcements (from my public health girlies), and @thejefferytodd‘s TikToks.
Jeffery Todd is one of the first people I’ve seen documenting his experience with monkeypox in the US through TikTok. Me and a couple of friends have been watching this man be honest about his experience, provide facts about the virus, detail his treatments, and explain what testing has been like for him. I honestly don’t know what this says more: that my FYP is aggressively tailored to me or that its concerning that thousands are getting more information from TikTok than anywhere else.
But if you were wondering, my mother’s contribution to messaging is, “Monkeypox SOX… get it… like sux.”
Honestly, I’ll say what we’re all thinking: Arthur and Eleni For President.
What is interesting to me is that the truth of it all (what monkeypox is) isn’t overly terrifying—whether or not that’s because the last global health crisis was an airborne respiratory illness is anyone’s guess—but the dialogue and conversations around the disease are confusing with little to no clear information being made readily available. To boot, the information that is available is often presented with a je ne sais quoi of fearmongering around it.
I asked the two geniuses (not derogatory):
Emily: What is the appropriate amount of fear regarding monkeypox? How does that compare to the appropriate amount of fear we should have about BA.5?
Arthur: This is different from March 2020 because we know more about monkeypox and we have a vaccine! I don’t think we should be super afraid of monkeypox but we should be afraid of how long it has taken public health and government officials to ramp up vaccine delivery and testing accessibility.
Individuals at greater risk (aka people living in NYC, the epicenter of the US outbreak) have more reason to fear given limited access to vaccines. As someone who lives in New Jersey but spends most of their time in NYC, I’ve been pretty scared of monkeypox especially since my immune system is TRASH (see my three COVID infections for reference). I have not been able to get vaccinated against monkeypox yet so I’ve been praying that my smallpox antibodies from when I was vaccinated as an infant in Brazil are still hanging around my body.
As for BA.5, cases, hospitalizations, and deaths in the US are on the rise and some counties are planning to reinstate mask mandates indoors. It’s challenging to estimate what the current BA.5 wave looks like in terms of cases since reported case counts are likely a severe undercount since many individuals are doing at home tests now which don’t get officially reported.
We are in a much better place than we were in early 2020 in terms of therapeutics and overall knowledge in how to best treat COVID. The BA.5 variant is more transmissible but there is no evidence that it is more severe. I’m personally more scared of developing long COVID or post COVID complications from these new variants as the risk of reinfections increases than I am of BA.5 itself.
Eleni: Monkeypox is not a new virus. The media coverage has really been focused on the message that “ANOTHER virus has emerged to take over our lives!!” and tends to lose the plot. This is not a novel virus, however it’s important to be cautious as cases have been spreading in non-endemic countries at a fast rate. If anything, I am concerned with how difficult it has been for people to get tested, let alone access to the vaccine (cue flashbacks to NYC testing lines).
That being said, we’ve been going through a pandemic so we can do it again. This means washing your hands, being vigilant, taking precautions with enough concern to avoid being at risk of monkeypox.
I would say the similar vigilance should be taken with BA.5. This subvariant is the most dominant and contagious one yet. BA.5 does not cause more severe disease outcomes than the other Omicron variants, despite rising case numbers. However, I think that long COVID is a very concerning outcome, with 1 in 5 adult COVID survivors under the age of 65 in the US experiencing at least one health condition that could be considered long COVID.
Long COVID has been linked with multiple organ system disfunction, neurological conditions, and mental health conditions, all which could lead to lifelong conditions. I think the mentality of, “Oh I’ll just get COVID and get it over and done with” is a very dangerous one and has now been proven to lead to lifelong consequences.
Emily: How does the average citizen protect themselves from both?
Arthur: For BA.5, get boosted, wear a mask indoors and in crowded settings, test often, and carry a bedazzled pocket hand sanitizer. But maybe I’m not the best person to give advice on protecting yourself from COVID since I’ve gotten it 3 times now…?
For monkeypox, know the symptoms, get vaccinated if you get exposed or if you’re at high risk of being exposed
Eleni: Test often, wash your hands, get boosted/vaxxed, keep up to date on information regarding both viruses, and consider breaking out that old mask sitting in the bottom of your bag for the last couple months.
It is troubling when both of your disease expert friends tell you their disease-based fears and it’s the exact same fear, but hey—at least it’s not monkeypox!! And it’s so great that monkeypox itself does not carry with it the emotional and societal baggage of health-based discrimination and marginalization, right?
….Right?
I Am on Ronald Regan Hate TikTok and Proud
A lie I like to tell is that I’m proud of very few things I’ve done in life, especially when it comes to things I’ve written. But jokes aside, I am actually very proud of the piece I wrote in honor of World AIDS Day 2020. I shared the experience I had had earlier in the year as I researched the early days of AIDS in the 1980s while COVID was first gaining international notoriety and the eerie similarities I noticed.
In these early days, there was so much unknown about how these two diseases were spreading and why it was only appearing in one group of individuals. As a result, medical professionals refrained from naming it, leading press organizations to do so themselves: news coverage of the disease began to refer to it as GRID, or gay-related immune deficiency. Suddenly, homophobia was spreading faster than the disease itself.
The same act of “othering” happened in the fearful first months of COVID-19’s spread. Passively, news outlets referred to the disease as the Wuhan coronavirus. Most news sources have, like the majority of citizens, referred to it solely as COVID, COVID-19, or the coronavirus in the nine months since its entry into dominance on the world news stage. But then again, most news outlets also began to refer to AIDS properly after calling it GRID for a period of time, too. (X)
Homophobes never rest because already, monkeypox is being pitched as the new “gay disease.” During the first decade of the AIDS epidemic, officials were wary of allotting any resources to help or finances to fight the spread of the disease:
Despite the outbreak beginning in 1981, President Reagan did not publicly say the word “AIDS” until 1985, following the death of his Hollywood friend, Rock Hudson. Moreover, the administration’s priority of cutting domestic spending —especially on social welfare programs— meant that very little money was made available for the country’s medical research units to combat the spread of the disease.
The lack of funding coupled with the tolerated discrimination created horrific situations for individuals who were already suffering: if infected gay men “were finally admitted [to hospitals], terrified orderlies would let them lie in their own excrement and urine, refusing out of fear even to enter their room. They left the patients’ food trays piled up in the hallways. When a patient with AIDS died, he’d be put in a black trash bag. Many funeral parlors were refusing to handle the dead.” (X)
Many doctors did not want to be known as “AIDS doctors,” leading 23% of resident doctors to say that “they would not care for patients with AIDS if they had a choice.” Some doctors began outright refusing to treat infected patients, often using the same line: “I don’t see that.” (X)
Bearing all of this in mind, I wanted to know:
Emily: What are your reactions to how monkeypox has come to be portrayed as AIDS was in its early GRID days? Why haven't we learned from our mistakes?
Arthur: Monkeypox has been spreading predominately among men who have sex with men which has led it to wrongfully being labeled as a gay disease. Sound familiar?! Similar to the AIDS crisis, men who have sex with men have already begun to be stigmatized.
If you take anything away from this edition of E4P it should be that MONKEYPOX IS NOT A GAY DISEASE.
It has been hypothesized that an infected individual with a lesion attended a gay rave in Europe and spread monkeypox among that social and sexual network.
Source: Matt Bernstein. Matt’s comments correcting this misinformation are in blue.
During the AIDS crisis, less resources were allocated to combating the disease and the wide stigmatization discouraged many individuals from seeking proper care. Officials need to tread with caution in order to effectively educate and assist an already stigmatized group and not imply that they are the only ones at risk.
We have a playbook to follow which outlines what not to do when a disease starts circulating among the gay community and it’s time we start following it a bit closer. All of this makes me wonder if the response to monkeypox would be different if it started to circulate in a different social circle first. What if that infected individual attended a golf tournament and it spread to those social circles first? Would the response be different? Would it be quicker? (Hint: the answer is most likely yes!)
As we also saw at the dawn of COVID, there was an enemy to blame for the disease before there was enough information available on how to protect ourselves. I asked:
Emily: Why are we so eager to first find someone to blame for public health crises before we establish proper messaging about protection and prevention, disease spread, and who’s at risk?
Eleni: My HIV/AIDS course professor told us once that when faced with fear, there is nothing easier to do than blame—it’s much easier than tackling that thing inciting the fear.
Before we get into it, I have no gripes—now or ever—with teachers. They are amazing humans who do incredible work and are not who my #1 beef is directed at. District curriculums around the country prioritize certain histories and don’t allow much wiggle room for conversations on why history happened because there are too many who/what/where/when/how’s to memorize. When you neglect to teach the why’s (along with, um, the facts), the phrase “history repeats itself” actually comes true.
History doesn’t repeat itself—we just never learn how to stop making the same mistakes.
With that, I asked:
Emily: How does what we're seeing in the public health sphere connect with issues with how we learn history in school?
Arthur: All throughout grade school, I’m sure you also heard that we had to learn history so that we didn’t repeat our mistakes. But oftentimes, history is taught as just rote memorization to pass a test (I’m looking at you APUSH) and not in a critical way which educates us on why mistakes were made and how we can work towards not making them again.
Eleni: The whole “learn” part of learn history to avoid repeating mistakes seems to be a pretty loose term these days. Human beings have survived countless public health crises throughout our history, and then always looking back on “lessons learned” for what to do and what not to do in the future. Looking back and “learning” is pretty useless when you do nothing to prevent something similar from happening again.
Critical thinking on historical events and the application of prevention frameworks to prevent them from reoccurring should be part of the learning process. Like k we did this, what are we doing to not do it again? (hint: usually not much). Kinda like COVID burn out, if you don’t think about it lightning cant strike twice right?
What do they say the definition of insanity is….
Emily: Which moments in history would you recommend everyone looks into to learn from and better understand our current moment in public health?
Arthur: The AIDS crisis and its effect on the gay community and how public health officials came together with the community to eradicate smallpox (read House on Fire: The Fight to Eradicate Smallpox by William Foege.
Eleni: As we look at the stigmatization of monkeypox right now, but also in general, everyone should know the history of the AIDS crisis and its current impact on communities. Not much of a reader? Don’t worry there’s a movie! And the Band PlayedOn is a great intro to the crisis itself. My personal favorite is How to Survive a Plague which talks about about the stigma of the crisis and the ACT UP movement.
Also look into how vaccines played an important role in the eradication of smallpox and polio viruses. House on Fire is great as Arthur mentioned. I also loved Chasing Polio in Pakistan by Svea Closser which talks about the fight on the final polio frontier in Pakistan as a war-torn country.
It’s Hard Out Here For a Bitch!!! I’m Tired!!!!
Two big troubling turns of phrases going around are: “The pandemic is over” and “I can’t handle another health crisis so I don’t care about monkeypox.” Certainly, number three is, “Andrew and Tasha are a stable couple and I’m rooting for them” but not everyone is caught up on Love Island yet.
We obviously have to care about monkeypox!!! We have to care about BA.5 and whatever stupid letter variant is next!!! It’s exhausting and it sucks—I know. I live on this planet, too. But we have to live to slay another day. (Full honesty: we have to live to see the finale of this season of Love Island, genuinely if nothing else. Like, who the hell is going to win??)
I asked Arthur and Eleni:
Emily: What were the expectations about public health tracking and messaging in a post-COVID world, and what is our current reality?
Eleni: I think I can speak for everyone when I say that there was hope that our next ~pandemic~ would be handled with an elite tracking system, access to testing for everyone and their mothers, and vaccines basically being pumped into the water system. A girl can dream. It’s still early days (thats a Love Island reference), but right now it’s looking like tracking has been inconsistent and access to testing not as widespread. However, there are efforts to include monkeypox testing at all COVID testing sites.
Emily: Why haven't we applied some of the lessons we learned just two years ago? What effect is that going to have in the short term?
Arthur: I think there is a lot of “COVID burnout” which has bled into the monkeypox outbreak especially since the public health and medical sector have been stretched so thin over the past two years. All of this in addition to lack of funding, resources and personnel is likely one of the reasons why monkeypox testing availability and vaccine access has been lacking.
This will likely lead to continued monkeypox spread to new regions and new social circles making its elimination much more difficult!
Emily: In the long term, are public health crises going to be our new reality?
Arthur: I think public health crises have been a reality for a really long time! So many crises have large public health impacts like climate change, government instability, natural disasters and wars. It’s hard to imagine a crisis that doesn’t have a public health consequence.
Due to the growing interconnectedness of the world and the increasing encroachment of humans into animal habitats, infectious disease related public health crises will become more frequent in the long list of public health crises as more spillover events occur and diseases are able to quickly transmit.
Eleni: Humanity has lived through many public health crises, and we will live through many more. But like Arthur said, we are at a point where we are at great risk for spillover events and the spread of diseases. When we just look at the effects of climate change, it is going continue to increase morbidity and mortality due to heat-related illnesses, poor air quality, undernutrition from reduced food quality and security, and increase in vector-borne diseases.
If we are just talking disease, it increases cross-species viral transition between animals and humans (aka zoonotic spillover). I think Emily is going to have to have Arthur and I back on E4P for more than just COVID and monkeypox. Give us our corner!
So no, it’s not great. There is not really a fun ending to this installment, and I’m a little too shell-shocked to make another Love Island joke about how the next pandemic is probably going to come from some fit bird with great craic and banter (nailed it).
If you’re reading this, some part of you has survived at least one global health crisis (yay you!!). Humans, like cockroaches, will keep surviving. Living our silly little lives on this virus-infested rock is our type on paper (ITV—call me).
Thank you to Arthur and Eleni for their time and brilliance, and for always testing positive for being hot and great friends!!! If you don’t watch the show, please google Love Island because I promise you these jokes are funny.
I recommend reading House on Fire: The Fight to Eradicate Smallpox by William Foege if you’re interested in learning about how they achieved this public health miracle!
