August 3, 2022

Good morning. Monkeypox is not Covid, but there are good reasons to take precautions.

An electron microscope image of monkeypox virions.CDC, via Associated Press

A painful illness

The viral disease monkeypox is spreading around the world. So far, there are more than 6,300 known cases in the U.S., almost entirely among gay and bisexual men. New York, California, Illinois and some cities have declared states of emergency, following the World Health Organization's own declaration of a global emergency.

The headlines are grim enough that you might be worried that monkeypox is like SARS or Covid: another virus that could disrupt or even threaten your life. The good news is monkeypox is much less contagious and much less likely to be deadly than Covid. There are also vaccines and treatments originally developed for smallpox that work on monkeypox.

Chart shows 7-day averages; data up to July 25. | Source: Centers for Disease Control and Prevention

But while monkeypox probably will not kill you, it can be excruciating enough that you want to avoid it nonetheless: It can cause pain that some patients compare to glass shards scraping against the skin. And although the virus is afflicting mostly gay and bisexual men now, that could change if it continues to spread unchecked. Nothing about the virus limits its spread to only men who have sex with men (not all of whom identify as gay or bisexual).

Today's newsletter explains what we know about monkeypox and what people can do to stay safe.

How bad is it?

Monkeypox produces symptoms that can range from unpleasant to painful, although they are rarely deadly. At least six deaths, out of 25,000 cases, have been reported in places where the virus was not known to exist before the current outbreak. The risk of death is higher for young children and people who are immunocompromised or pregnant.

The telltale symptom is sores, which can look like pimples or blisters. They can hurt, especially in sensitive areas like the genitals and anus.

"I was scared to use the bathroom," a recent monkeypox patient, Gabriel Morales, told The Times. He described the sores as feeling like "broken glass" in his body.

Other symptoms include fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. The disease typically lasts two to four weeks.

How does it spread?

Monkeypox mostly spreads through close physical contact, typically skin-to-skin touch. Most infections in the current outbreak have occurred through close contact during sex. The virus also can spread through contaminated surfaces, including clothes and bedding. Brief contact, like a handshake, is not usually enough to spread monkeypox. Unlike Covid, it does not seem to spread much through the air.

Nearly half of known U.S. cases have occurred in the first three states to declare emergencies: New York, California and Illinois.

So far, about 98 percent of cases worldwide are among men who have sex with men. Many of them have had multiple partners, sometimes strangers. Some early superspreader events were gay parties in Europe, which appeared to introduce the virus into the social networks of men who have sex with men.

Public health officials have struggled with acknowledging some of these factors, fearing that they could stigmatize gay and bisexual men. But part of a proper public health response is targeting the people most at risk and the riskiest activities, and that requires an honest assessment of what is happening.

A line for the monkeypox vaccine in San Francisco.Jim Wilson/The New York Times

What can you do?

Most people are not currently at serious risk of catching monkeypox, with the virus concentrated among gay and bisexual men for now. "Your risk depends on who you are," my colleague Apoorva Mandavilli, who has covered the current outbreak since the first U.S. case was identified, told me.

To lower their risk, gay and bisexual men can try to make sure their male sex partners do not have monkeypox, watching out for sores. They can use a condom, which can at least reduce the chances of getting sores in sensitive areas. They can temporarily reduce their number of sexual partners or avoid riskier activities, such as anonymous sex and sex parties. Practicing good hygiene, like frequent hand-washing, can help, too.

Vaccines and tests for monkeypox also exist, although they are not widely available right now because of supply shortages and strict government rules about access.

If someone is infected, the C.D.C. recommends isolating at home and staying away from others if possible. But that can be very difficult with a disease that can last four weeks — another reason to prioritize prevention and slow the spread.

What are officials doing?

Public health officials are trying to make vaccines, treatments and testing more available. President Biden yesterday named a national monkeypox response coordinator to oversee those efforts.

But progress has been slow. As monkeypox spread in May and June, 300,000 vaccine doses owned by the U.S. sat in Denmark.

Officials are also trying to raise public awareness of monkeypox, given that it is a new virus to most Americans.

Their main goal now is to avoid a wider outbreak that makes monkeypox an endemic virus that spreads regularly across the U.S., like influenza. If monkeypox keeps spreading unchecked, it could eventually spill over to a broader population than gay and bisexual men, said Dr. Céline Gounder, a senior fellow at the Kaiser Family Foundation.

"It's still containable," she added. "But it is going to require more aggressive screening, testing and vaccination."

The bottom line

Monkeypox is not typically fatal, but it still can cause painful disease and permanent scarring. The risk is not high for most people now, but that could change if the virus continues to spread. And the people who are at serious risk can take steps to stay safe and prevent the outbreak from getting worse.

Stopping the spread of monkeypox will depend on three crucial questions.
Some gay men see echoes of H.I.V./AIDS.
From Times Opinion: Monkeypox is about to become the next U.S. public health failure, writes Scott Gottlieb, the former head of the F.D.A.

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Pickle-flavored products.Zack Wittman for The New York Times

Sprinkle on some pickle

It's the summer of the pickle. Not actual pickles — although they're as popular as ever — but the flavor, which is everywhere, Christina Morales writes.

Pickle spice adds a sweet-and-sour flavor, which complements snack foods like popcorn and pizza. Frito-Lay now makes pickle-flavored Lays, Doritos and Ruffles chips. Trader Joe's said its dill pickle seasoning blend sold out soon after it hit shelves in May.

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Ryan Liebe for The New York Times

This skillet chicken recipe is inspired by ingredients used in Moroccan cuisine: orange and ground turmeric.

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Thanks for spending part of your morning with The Times. See you tomorrow. — German

Correction: Yesterday's newsletter incorrectly said that Russia began its invasion of Ukraine last year. It began in February.

P.S. Times journalists won awards from the Asian American Journalists Association.

Here's today's front page.

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Matthew Cullen, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Ashley Wu contributed to The Morning. You can reach the team at themorning@nytimes.com.