Monkeypox is in the US. Here’s what you need to know.

Amid an international string of cases, a Massachusetts man has been infected with the first case of monkeypox in the United States this year. And while the virus isn’t likely to cause a pandemic like Covid-19, experts say the outbreak is still concerning.

What is monkeypox?

Monkeypox—so called because it was first identified in laboratory monkeys—is a rare viral infection that begins with flu-like symptoms and progresses to a distinctive rash on the face and body. Most infections resolve within weeks, but some cases can be fatal, according to the World Health Organization (WHO).

People can catch monkeypox through contact with infected animals or animal products. Human-to-human transmission, meanwhile, can occur via contact with bodily fluid, sores, or items contaminated by bodily fluid, but most often occurs via large respiratory droplets, which rarely travel more than a few feet.

According to WHO, “There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.”

Symptoms of monkeypox are typically mild, including headaches, muscle pain, chills, and swollen lymph nodes, The Hill reports. Patients can also develop rashes on their face and body that then turn into skin lesions that eventually fall off.

Although there are no specific treatments for monkeypox, at least one vaccine has been approved in the United States to protect against both monkeypox and smallpox.

Monkeypox cases pop up around the world

On Wednesday, the Massachusetts Department of Public Health (MDPH) reported the first confirmed case this year of monkeypox in the United States in a man who had recently traveled to Canada.

According to MDPH, “The case poses no risk to the public, and the individual is hospitalized and in good condition.”

MDPH said it’s “working closely with the CDC, relevant local boards of health, and the patient’s health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus.”

Generally, monkeypox cases are very rare in the United States, however two cases were reported in the United States last year—one in Texas and one in Maryland.

Monkeypox cases have also been popping up recently around the world. The United Kingdom has reported nine monkeypox cases, Spain has reported 23 suspected cases, Portugal has reported five and is investigating another 15, and Canadian health officials are investigating at least 15 potential cases in Montreal.

British officials noted that four of the nine cases it identified were among men who have sex with men, suggesting that the virus could be spreading through sexual contract.

What experts are saying

According to Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, the monkeypox virus isn’t likely to follow a similar path to Covid-19.

“This isn’t going to cause a nationwide epidemic like COVID did, but it’s a serious outbreak of a serious disease—and we should take it seriously,” he said.

Still, experts said they are concerned by the monkeypox outbreaks. Typically, monkeypox doesn’t spread easily between humans, but the fact that multiple cases are emerging in different countries at the same time is concerning, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.

“It’s either a lot of bad luck or something quite unusual happening here,” he said.

“The fact that it’s in the U.K. in multiple unrelated clusters, plus Spain, plus Portugal, is a surprise,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

According to Mateo Prochazka, an epidemiologist at the U.K. Health Security Agency, the fact that the virus appears to be spreading through sexual contact is especially strange.

“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” he said. “This is a novel route of transmission that will have implications for outbreak response and control.”

While experts aren’t worried about the virus being a global threat as of now, Jay Hooper, a monkeypox expert from the U.S. Army Medical Research Institute of Infectious Diseases, noted that “[e]very time there’s an outbreak—and the more people get infected—the more chances monkeypox has to adapt to people.”

“With viruses that spill over from animals, you just never know what’s going to happen,” he added.

United States is ‘out of the pandemic phase,’ Fauci says

The United States is finally “out of the pandemic phase,” the country’s top infectious disease expert said, as cases and hospitalizations are notably down and mask mandates are all but extinct.

While there are still new infections spreading throughout the country – an average of 50,000 per day as of Tuesday – the country is far from the heights of the pandemic, when daily case counts surpassed 1 million. Restrictions, too, are easing as many Americans appear to be putting the pandemic behind them. Masking requirements have been lifted across most of the country, and officials stopped enforcing a federal mask mandate in transportation settings after a judge struck down the requirement.

“We are certainly right now in this country out of the pandemic phase,” Anthony Fauci, President Joe Biden’s chief medical adviser, said Tuesday evening on PBS’s “NewsHour.”

Fauci said the United States was no longer seeing “tens and tens and tens of thousands of hospitalizations and thousands of deaths. We are at a low level right now.”

During the pandemic’s darkest moments, many wondered when the country would officially declare itself past the nationwide disaster, which has killed nearly 1 million Americans.

Fauci’s comments are likely to fuel debate about whether this is truly the moment: New cases are on the rise in the United States, and deaths are down, though they often lag spikes in cases. The Centers for Disease Control and Prevention said Tuesday that as of the end of February, nearly 60 percent of Americans – including three out of every four children – have been infected with the coronavirus. But officials cautioned that the data did not indicate that Americans have widespread immunity against the virus because of their prior infections.

While previous infections are believed to offer some protection against serious disease for most people, health experts say the best protection against infection and serious disease or death from the coronavirus is vaccination.

The coronavirus will not be eradicated, Fauci said, but can be handled if its level of spread is kept “very low” and people are “intermittently” vaccinated, though he said he did not know how frequently. And Fauci echoed warnings from the World Health Organization and the United Nations this month that worldwide, the pandemic is far from over as vaccinations lag, particularly in developing nations.

The Biden administration, meanwhile, is appealing a ruling by a Trump-appointed federal judge that struck down the federal mask mandate on transit, including on planes, though it is unclear whether they will be successful, and likely face an American public that could be unwilling to comply again.

And in a less-than-subtle reminder that the coronavirus is still hanging around, the White House on Tuesday announced arguably the nation’s highest-profile coronavirus infection since former president Donald Trump, saying that Vice President Kamala Harris had tested positive and was asymptomatic. She was not considered in close contact to Biden, the White House said.

Feds poised to fight to preserve mask mandate for travel

The Department of Justice (DOJ) is appealing a Florida judge’s Monday decision to strike down the mask requirement for public transportation. Federal judge Kathryn Mizelle ruled the Centers for Disease Control and Prevention (CDC) exceeded its authority under the Public Health Service Act of 1944. Meanwhile, giddy passengers and flight crew have been discarding their face coverings as airlines, the Transportation Safety Administration, several local transit authorities, Uber and Lyft, all removed their mask requirements.  

The Gist: Despite DOJ’s appeal, which appears to be aimed at preserving its own authority to act during health crises, rather than reinstating the current mask requirement (which was set to expire in two weeks anyway), the tone of the Biden administration is clearly shifting. Earlier this week President Biden told reporters that the decision to wear a mask is “up to them,” meaning individual Americans. 

In the bumpy transition out of the emergency phase of the pandemic, we now have a patchwork of rules for masking. This is even true within healthcare facilities: some, including Houston Methodist and Iowa-based UnityPoint Health, are no longer requiring masks for visitors or employees who are not involved in patient care. 

With COVID cases now rising in 41 states as mask mandates fall, the next month will prove critical in determining whether “endemic” COVID remains manageable, or once again stresses the healthcare system and other critical infrastructure.  

Coronavirus has infected majority of Americans

But officials caution that people should not presume they have protection against the virus going forward.

Before omicron, one-third of Americans had been infected with the coronavirus, but by the end of February, that rate had climbed to nearly 60 percent — including about 75 percent of kids and 60 percent of people age 18 to 49according to federal health data released Tuesday.

The data from blood tests offers the first evidence that over half the U.S. population, or 189 million people have been infected at least once since the pandemic began — double the number reflected in official case counts. Officials cautioned, however, that the data, in a report from the Centers for Disease Control and Prevention, does not indicate people have protection against the virus going forward, especially against increasingly transmissible variants.

“We continue to recommend that everyone be up to date on their vaccinations, get your primary series and booster, when eligible,” CDC Director Rochelle Walensky said during a media briefing.

Kristie Clarke, the CDC official who authored the report, said by February, “evidence of previous COVID-19 infections substantially increased among every age group, likely reflecting the increase in cases we noted as omicron surged in this country.”

Clarke said the greatest increases took place in those with the lowest levels of vaccination, noting that older adults were more likely to be fully vaccinated.

The largest increases were in children and teenagers through age 17 — about 75 percent of them had been infected by February, based on blood samples that look at antibodies developed in response to a coronavirus infection but not in response to vaccination. That’s about 58 million children.

The blood test data suggests 189 million Americans had covid-19 by end of February, well over double the 80 million cases shown by The Washington Post case tracker, which is based on state data of confirmed infections. Clarke said that’s because the blood tests captures asymptomatic cases and others that were never confirmed on coronavirus tests.

With the omicron surge, officials had expected there would be more infections. “But I didn’t expect the increase to be quite this much,” Clarke added.

Separately, CDC is about to publish another study that estimates three infections for every reported case, she said.

Omicron subvariant BA.2 now dominant strain in the US: CDC

A subvariant of omicron known as BA.2 is now the dominant strain in the United States, according to new data from the Centers for Disease Control and Prevention (CDC).  

The variant has been steadily rising in proportion because of its increased transmissibility compared to the original omicron strain, and it represented 54.9 percent of new cases for the week ending March 26, according to CDC data. That is up from about 27 percent two weeks earlier.  

The BA.2 subvariant is thought to be about 30 percent more transmissible than the original BA.1 omicron strain, which itself was already more contagious than earlier versions of the virus.

Importantly, though, experts say there is no evidence that BA.2 causes more severe disease than the original omicron strain or that it evades the protection from vaccines to a greater degree.

The subvariant may cause some increase in cases after weeks of steady declines that have led to a relative lull in the virus. But it is unclear how sharp the increase will be, and people who are vaccinated and boosted are still well-protected against severe disease.  

The Food and Drug Administration on Tuesday authorized a fourth COVID-19 vaccine shot for people 50 and older, which could further help protect the most vulnerable from the subvariant.  

“CDC says the BA.2 subvariant of Omicron is now dominant in the US,” tweeted Leana Wen, a public health professor at George Washington University. “Reminder that while this appears to be even more contagious than the original Omicron, it is not more virulent than previous strains, and existing vaccines still protect well against severe disease.” 

CDC Director Rochelle Walensky said last week that her agency was monitoring the subvariant, particularly in the Northeast, where it has been concentrated so far.  

“Over the past week, we have seen a small increase in reported COVID-19 cases in New York state and New York City, and some increases in people in the hospital with COVID-19 in New England, specifically where the BA.2 variant has been reaching levels above 50 percent,” she said. 

“This small increase in cases in the Northeast is something that we are closely watching as we look for any indication of an increase in severe disease from COVID-19 and track whether it represents any strain on our hospitals. We have not yet seen this so far.” 

How do you convince a skeptical public to get a fourth shot?

The expected green light for a second coronavirus booster shot poses a challenge to the Biden administration, which will need to work overtime to convince a public that has largely decided to move on from the COVID-19 pandemic.

Both Pfizer and Moderna have filed for emergency use authorization with the Food and Drug Administration for a fourth dose of their respective vaccines, citing evidence that protection from the third shot has decreased enough to warrant a fourth dose.

Yet the nation’s vaccination and booster rates have dropped to record lows, just as experts and officials are bracing for the possibility of another wave of infections from the BA.2 subvariant of omicron.

The BA.2 version of omicron is much more transmissible than the original variant. Combined with relaxed precautions like indoor masking and waning immunity among those who have not received a vaccine booster, cases have risen sharply in Europe in the past few weeks, and the U.S. could follow shortly. 

The omicron subvariant is responsible for about 35 percent of all cases in the country. In some regions though, like the northeast, it is responsible for the majority of infections.

Federal health officials are reportedly poised to authorize a fourth dose of coronavirus vaccine for adults age 50 and older as soon as this week. A fourth shot is already authorized for the immunocompromised.

But the issues that plagued the administration during the first booster campaign loom large, and officials are likely eager to avoid the same pitfalls. 

Chaotic and at times disparate messages from administration health officials culminated in a complicated set of recommendations about who should be getting booster shots, and why, which experts said helped depress enthusiasm. 

“I think that some of the low uptake of boosters, especially amongst people who would benefit, the high risk population, is because that message has been diluted,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

But the underlying disagreement about the goal of booster shots has not changed. While there’s widespread agreement that older Americans are much more at risk for severe outcomes, it’s still not clear if younger people will benefit from an additional dose. 

Much of the debate has centered on whether the goal is to prevent people from being hospitalized with COVID-19 or whether the goal is to prevent them from getting sick at all, even if it is milder. 

Anthony Fauci, White House chief medical advisor and the nation’s top infectious disease doctor, said regulators are trying to determine how low protection against hospitalization needs to drop before a booster is warranted.

“So the real open question that we don’t know definitively the answer to, is how long is the durability of protection against severe disease going to last even when the protection against infection diminishes substantially,” Fauci said during a Washington Post event last week. 

“For example, we know that when you get down to a rather low level 30, 40 or so percent of protection against infection, you still have, when you look at hospitalization, a high degree [of protection],” Fauci said.

President Biden last summer promised widespread boosters for all Americans by the end of September, well before the FDA and the Centers for Disease Control and Prevention (CDC) had examined the evidence. 

While officials were careful to say the booster program was contingent on the FDA and CDC giving the green light, scientists inside and outside the government argued there wasn’t enough evidence showing protection against severe illness and hospitalization dropped to levels that warranted a booster.

The CDC initially decided against recommending broad authorization, and instead recommended a booster shot for people over the age of 65, as well as anyone who was at “high risk” of exposure to the virus in the workplace. 

The agency eventually decided to make everyone eligible, but by then much of the damage had been done. Vaccinated Americans have largely shown they are not interested in getting a booster.

According to current CDC data, less than 45 percent of all adults have received a booster shot, but the number rises to about 67 percent of adults age 65 and older. 

Adalja said it makes sense to be proactive and have a plan to get additional booster shots to the older group. But he said the decisions should be left to the scientists, and the health agencies should make decisions independent of the White House. 

Keep the politicians out of it,” Adalja said. “The miscommunications occurred because they made boosters a political issue, not a scientific issue.”

But even if there is a targeted recommendation, a stalled funding request in Congress further complicates matters. The U.S government does not have enough doses on hand to vaccinate everyone who would be eligible for another booster.

The White House says it needs tens of billions of dollars in COVID response funding, which is tied up due to political disagreements. Administration officials say they don’t have enough doses on hand to cover anyone other than the immunocompromised and people aged 65 and older.

But an independent analysis from the Kaiser Family Foundation found the government only has enough vaccine supplies to cover 70 percent of the 65 and older group. 

More than 90% of the U.S. population lives in an area with a “low” or “medium” risk of COVID-19

More than 90% of the U.S. population lives in an area with a “low” or “medium” risk of COVID-19, the U.S. Centers for Disease Control and Prevention (CDC) announced yesterday. Last week, the CDC changed the way it assesses county-level COVID-19 risk, using data on hospitalizations and health care capacity in addition to case counts. The CDC now recommends universal indoor masking only for counties that are at “high” risk under this system—which means that the vast majority of Americans are not currently advised to wear masks inside.

US approaches end of ‘full-blown’ pandemic, Fauci says

Fauci: US exiting 'full-blown' pandemic phase of coronavirus crisis

The U.S. may see an end to all pandemic restrictions, including mandatory mask-wearing, in the coming months, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told the Financial Times Feb. 8. 

He said he hopes that the end to these restrictions will come soon and explained that the response to the pandemic going forward will be concentrated at a local level. 

“As we get out of the full-blown pandemic phase of COVID-19, which we are certainly heading out of, these decisions will increasingly be made on a local level rather than centrally decided or mandated. There will also be more people making their own decisions on how they want to deal with the virus,” he told the FT

The National Institute for Allergy and Infectious Diseases is preparing for the next pandemic by monitoring viruses that are known to cause severe illness.

Why is America’s Covid-19 death rate so high?

Death Rates In The U.S. During Pandemic Far Higher Than Other Countries :  Shots - Health News : NPR

Covid-19 death rates in the United States are “eye-wateringly” high compared with other wealthy nations—a problem that several health experts say underscores the shortfalls of the country’s pandemic response.

U.S. Covid-19 death rates exceed those of other wealthy nations

According to CDC data, over 880,000 Americans have died from Covid-19 since the beginning of the pandemic—a death toll greater than that of any other country. And during the current omicron wave, Covid-19 deaths are now greater than the peak number seen during the delta wave and more than two-thirds as high as record numbers seen last winter before vaccines were available, the New York Times reports.

Moreover, since Dec. 1, when omicron was first detected in the United States, the proportion of Americans who have died from Covid-19 has been at least 63% higher than other large, wealthy countries, including Britain, Canada, France, and Germany, according to a Times analysis of mortality figures.

Currently, the daily Covid-19 death rate in the United States is nearly double that of Britain and four times that of Germany. The only large European countries to surpass the United States’ Covid-19 death rates have been the Czech Republic, Greece, Poland, Russian, and Ukraine—all of which are less wealthy nations where the most effective treatments may be limited.

“Death rates are so high in the States—eye-wateringly high,” said Devi Sridhar, head of the global public health program at the University of Edinburgh. “The United States is lagging.”

Similarly, Joseph Dieleman, an associate professor at the University of Washington, said the United States “stands out” with its high Covid-19 death rate. “There’s been more loss than anyone wanted or anticipated,” he said. 

Vaccination shortfalls plague the U.S.

Lagging Covid-19 vaccination rates among Americans likely contributed to the country’s outsized death toll compared with other nations, several health experts said.

Currently, around 64% of the U.S. population has been fully vaccinated. However, several peer countries, including Australia (80%), Canada (80%), and France (77%), have achieved higher vaccination rates.

Unvaccinated people make up the majority of hospitalized Covid-19 patients, according to the Times, but lagging vaccination and booster rates among vulnerable groups, such as older Americans, has also led to increased hospitalizations.

Around 12% of Americans ages 65 and older are not fully vaccinated, and among those who are fully vaccinated, 43% still have not received a booster shot, leaving them with waning immunity against the omicron variant. In comparison, only 4% of Britons ages 65 and older are not fully vaccinated, and only 9% have not had a booster shot.

“It’s not just vaccination—it’s the recency of vaccines, it’s whether or not people have been boosted, and also whether or not people have been infected in the past,” said Lauren Ancel Meyers, director of the University of Texas at Austin’s Covid-19 modeling consortium.

Similarly, former FDA Commissioner Scott Gottlieb said that the United States‘ lagging vaccination rates compared to the U.K.’s, particularly for boosters, may be due to “protracted wrangling” that “may have sowed confusion, sapping consumer interest.”

How the U.S. could fare in future Covid-19 waves

According to some scientists, the gap between the United States and other wealthy nations may soon begin to narrow. Although U.S. vaccination rates have been slow, the delta and omicron waves have infected so many people that overall immunity against the coronavirus has increased—which could potentially help blunt the effect of future waves.

“We’ve finally started getting to a stage where most of the population has been exposed either to a vaccine or the virus multiple times by now,” said David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “I think we’re now likely to start seeing [American and European Covid-19 death rates] be more synchronized going forward.”

However, other experts noted that the United States has other disadvantages that could make future Covid-19 waves difficult. For example, many Americans have chronic health problems, such as diabetes and obesity, that increase the risk of severe Covid-19 outcomes.

Overall, health experts said the impact of future Covid-19 waves will depend on what new variants emerge, as well as what level of death people decide is tolerable.

“We’ve normalized a very high death toll in the U.S.,” said Anne Sosin, who studies health equity at Dartmouth University. “If we want to declare the end of the pandemic right now, what we’re doing is normalizing a very high rate of death.”

‘Extremely erroneous’? Some health systems say hospital vaccination data is seriously flawed.

Health Workers Protest Hospital Systems' COVID-19 Vaccine Requirements |  Wisconsin Public Radio

CMS is preparing to enforce its vaccine mandate for health care workers, but the agency may not have an accurate count of how many remain unvaccinated—and five health systems are pushing back on federal hospital vaccination data, calling it “extremely erroneous,” Cheryl Clark writes for MedPage Today.


The Supreme Court earlier this month ruled that CMS could require most health care workers to be vaccinated against Covid-19—but U.S. officials currently do not know exactly how many workers remain unvaccinated, primarily due to a lack of reliable immunization data.

At the end of December, CDC reported that 77.6% of hospital workers were fully vaccinated. However, that figure was based on data from only about 40% of the nation’s hospitals. Hospitals currently send vaccination data to the agency on a voluntary basis, but beginning May 15, they will be required to send in weekly data, just like nursing homes have been.

According to Janis Orlowski, chief health care officer at the Association of American Medical Colleges (AAMC), CDC’s data is likely representative of providers nationwide, as an AAMC survey of 125 academic hospitals found similar results. More than 99% of doctors and close to 90% of nurses were vaccinated, she said, but vaccination rates dropped off to the 30% to 40% range for those in more operational roles, such as transportation and food service workers.

Is federal vaccination data for hospitals inaccurate?

Further adding to the confusion about health care workers’ vaccination rates are potential inaccuracies in a federal database that tracks Covid-19 vaccinations among workers in hospitals across the country. According to five health systems listed as having the highest numbers of unvaccinated workers, the database is “extremely erroneous,” Clark writes.

In the database, Adventist Health Orlando (AHO) is shown to have 18,576 unvaccinated workers, 637 partially vaccinated workers, and 25,253 fully vaccinated workers. However, Jeff Grainger, director of external communications for AdventHealth in Central Florida, said those numbers weren’t possible since the organization “[doesn’t] have 44,000 employees in one hospital.” He added that 96% of AHO’s team members have already complied with CMS’ mandate.

The University of Illinois Hospital (UI) was listed in the database as having 12,049 unvaccinated workers and 272 partially vaccinated workers. Jacqueline Carey, from health system’s public affairs department, disputed these numbers, saying UI had 6,530 workers as of Jan. 19, with 96% of them fully vaccinated. The remainder were either partially vaccinated or had approved exemptions.

The hospital with the third highest number of unvaccinated workers was Mount Sinai Hospital, Clark writes, but Lucia Lee, a hospital spokesperson, said the federal data was inaccurate. According to Lee, Mount Sinai Health System, of which the hospital is a part, has vaccinated 99% of its more than 43,000 employees.

A representative for Ochsner Medical Center, which is listed as having the fourth highest number of unvaccinated workers, also pushed back on the statistics in the database. Currently, 99.57% of Ochsner’s over 34,000 employees are compliant with its Covid-19 policy, with 95% of workers Ochsner Health and Ochsner LSU Health Shreveport fully vaccinated.

Finally, Kena Lewis, a spokesperson for Orlando Regional Medical Center, said that federal data showing the hospital has 44,154 workers is inaccurate. Instead, she said the hospital is one of 10 in the Orlando network, which has 23,709 total employees. Although Lewis did not give the health system’s vaccination rates, she said it “continues to review the guidelines regarding Covid-19 vaccination requirements for health care organizations and will take appropriate steps.”

Although it is not clear why there are discrepancies between the federal data and what these health systems are reporting regarding vaccination rates, there are some potential explanations, Clark writes.

According to Carey, the federal database only includes vaccination information provided by the UI health system and employee health services. This means that vaccinations workers received elsewhere, such as through a personal provider or pharmacy, are not included in the data, and they will show up as being unvaccinated.

Separately, a spokesperson for another of the five organizations told Clark on background that short-term nursing staff contracted through agencies may show up as unvaccinated in the federal database. Although the agencies assure employers the nurses are vaccinated, hospitals do not independently verify this information.