Transcript: Monkeypox Explained For Patients

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​Liz Rohr:
So there's a lot of talk in the news about Monkeypox, and I wanted to make this video specifically to talk about how I talk about this with my patients.

So my name is Liz. I'm a family nurse practitioner and educator, and I usually make video episodes for nurse practitioners, medical education, specifically, but I felt like it would be really helpful in the context of what's going on right now to have a video where it'll hopefully answer some questions that you may have that I talk about with my patients as well.

A couple of disclaimers I want to make, though, first is that this is not medical advice. This is for educational, and enjoyment purposes only. So if you have symptom-based questions, you're worried about something, please seek out the care of a healthcare professional of your choice, nurse practitioner, physician, physician associate, et cetera, and they can best answer your questions and direct you to the right treatment or testing or support that you need.

Well, hey there, it's Liz Rohr from Real World NP, and you are watching the Real World NP YouTube channel. We make weekly episodes to help save you time, frustration, and help you take the best care of your patients.

Okay. First, I want to talk about some background about what is Monkeypox. I have a couple of questions I want to answer.

So what is monkeypox? What are the symptoms and how bad are they? Who is getting this and why? And then will I die from this? That's definitely a question that I get, and I want to talk about how it spreads. And then I want to talk about a vaccine, because there's a lot of questions about is there a vaccine? Can I get a vaccine? Why can't I get a vaccine?

So let's start... I'm looking down at my notes so I don't forget anything.

So first things first. So Monkeypox is a virus. When we get sick with a cold, with a common cold, runny nose, coughing, it's not Coronavirus, when we have a regular old cold that we've had a million times before, that's a virus. That is something that gives us an illness. Our body handles it and gets better on its own without any need for treatment. We take things like maybe Acetaminophen or Ibuprofen or some sort of pain relievers or cold medications to help us feel better, but it still goes away on its own. Those things don't make it go away. Don't cure it.

Monkeypox is also a virus that 99% of the time, people survive. 1% of the time people have died from usually related to some sort of complication. So it's a very mild, what's called self-limiting illness. Meaning same thing, you get sick. The symptoms run their course. It goes away, without any need for treatment. There's a very small portion of people that need the treatment or the vaccine. And I'll talk about that in a second, but there's a very small portion of people that need that. And the vast majority of people do not need that. Right?

So if you're feeling really stressed about it, you're feeling really worried, just take some deep breaths, because this is nothing like Coronavirus. This is not as easy to spread. It is not as widespread, not as contagious. There are so many things that are different about it, and it is way less harmful and way less deaths from it.

So just to give you some context. So since May, the World Health Organization, who talks about global health issues, said that this was an outbreak, meaning that there are more cases than they would expect for this particular virus. This virus is not new. It's been around since 1950, and it's been detected in monkeys in 1950, hence the name Monkeypox. And it can be transmitted between animals and people, usually either monkeys or small rodents that are infected.

But yeah, so it's been around since 1950, and it's been detected in people since 1970. So it's not a new virus. It's just spread more than it usually does.

So that's why it's been in the news so much. That's why it's such a concern because we need to watch out for it and we need to understand why it's been spreading. The type of virus that's going around now, though, again, 99% ... We know this virus. It's been around before; 99% of the people live just fine.

So I want to talk about the symptoms next.

So symptoms are usually what starts is that people have a headache. They feel tired. They have maybe swollen lymph nodes on their body and a fever. A lot of people have those symptoms first, and then the next step is that they start to get sores on their body. A note, though, is that sometimes people just start with sores on their body, but I want to let you know that as soon as you start having symptoms, whether it's the sores or not, you can infect other people if you got that. And other people could infect you if they had those symptoms.

So the sores, unfortunately, they can be quite painful. Some of the reasons that people have been sent to the hospital is because of pain.

So just for a couple of numbers, if you're a numbers type of person, out of 18,000 people infected over 78 countries, five people died, and 10% of those people, so about 1800 people out of the 18,000, were sent to the hospital. Some of it was for pain. Some of it was for another infection that happened on top of the sores. And some people had other medical issues that they were dealing with. And so hopefully that helps to highlight how serious or not it is. The problem with the sores is that they're quite painful. 

So what happens is that they start to look like really deep, hard pimples that are painful that turn into almost like a white-head-looking type of pimple. And from there they can be opened up and then start to get a scab on it. I know that's not the most pretty picture to talk about, but I want you to know what to expect here. And the time that a person is contagious is from the start of their symptoms all the way until their sores are gone, which leads me into how does this get spread, the scabs fall off, rather.

So how does this get spread? Three ways.

Number one, close physical skin-to-skin contact with somebody who has sores on their body. So if somebody has sores and you come into prolonged contact, unfortunately, I don't have a set number of minutes, but it's thought to be like 15 minutes or more and in close skin-to-skin contact with somebody.

The second way is actually through it's called droplets. And so when you cough or talk or sneeze in the direction of somebody else who's three feet away from you or less, that's considered a way to transmit it, but it's through close proximity to that person's breathing or coughing or sneezing and it's for a long period of time. And again, I don't have a great number for a long that we don't know this yet, but the evidence is supporting that it's a longer period of time, like 15 minutes or so.

So the third way that people spread Monkeypox virus is through touching things that have touched the sores. So most specifically these are things like sheets, towels, clothing, other things that the sores have been in contact with for a longer period of time and that there's a lot more of the virus on there. So it's not that a person who has sores on their body touches something at the grocery store, you touch the same thing and you're going to get it. 
It's not like that. It's a lot more of the virus and then you're, again, in contact for a longer period of time.

We don't have enough studies yet to know how long it stays on a surface for and how much of the virus you need to be exposed to to get the infection. But the general, this jumping into ways to keep yourself safe is through just regular old hand washing, right? When you go out in public places, washing your hands before you eat, washing your hands before you touch your face, your mouth, your eyes, ears, things like that.

So another question of who is getting this and why?

So in the news, there's been a lot of disinformation, unfortunately. So you'll notice that I did not say sexually transmitted in the last part. So sexually transmitted infections are infections that come from when the sexual bodily fluids of one person has an infection and that is the way that it gets spread to another person through semen, vaginal secretions, and things like that.

So this is not sexually transmitted as far as we know. And again, this is how science works. This is how medicine works is we study things. We're trying to understand them further so we're doing research to see is this sexually transmitted? As far as we can tell from all the evidence we have, it is not. And so the reason and why it's being described as sexually transmitted is again because of that close physical contact over a longer period of time with somebody else's body.

And I just want to comment a bit on the men who have sex with men. So a lot of the cases in this outbreak have been identified among people who are born male and having sex with other people who are born as male. And I just want to say for the record, there is no such thing as a gay disease. This is an illness that can affect absolutely anybody, any gender, sex, age, appearance, doesn't matter.

So the way that diseases can spread and illnesses spread, is especially infectious ones, is that like Monkeypox is that you have to be in close contact with your social circles. And so that's what we're seeing here is that there are close social circles that are being traced. And that's part of the whole way that we get rid of infections like this is we have to understand how it's spread in the first place, talk to all those people so that they don't spread it to other people further, et cetera, et cetera.

So a number of the people who have had the illness identified had either multiple sexual partners or were in larger, bigger spaces with lots of people in close physical contact. And so those are really important things to keep in mind, not only to prevent your risk of getting this, but also to hopefully show that it's not an easy thing that you're going to touch a surface and then you're going to get it.

So there are some guidance on the CDC website that talks about safe sexual practices to try to keep yourself safe. Please take a look at those if you haven't seen that already.

And the last thing I want to touch on is about the vaccine and treatment.

The thing about Monkeypox is that it's been around for a number of years, and also it's been located primarily on the continent of Africa. And it's been contained into several different countries, and it's become endemic there, meaning that it's just a regular infection that happens every once in a while. 
So, and unfortunately, there hasn't been a lot of research around Monkeypox and treatments and things like that.

However, in the U.S., all I can speak to is the U.S., in the U.S. national government, we have a what's called a Strategic National Stockpile of vaccines, medications, and it has to do with preparedness for outbreak. So when we have big illnesses, things like that happen, we can be prepared for that to happen.

So there are no specific treatments or vaccines for Monkeypox.

However, smallpox is another type of virus. We used to vaccinate for smallpox in this country before 1970, but what happened is that it was declared as globally eradicated in 1980, meaning it was totally gone from the planet in 1980. So there was no reason to continue to give the vaccine to people past the year 1970ish. I don't know if that exact date, but; so the only vaccine that we have now is the some smaller amount of smallpox vaccine, which when tested in animals and tested for safety in people is FDA approved, like a government regulatory approved, to be given for smallpox. It could also be given for Monkeypox too.

And so it's emergency authorized use of the CDC in the United States is authorizing them to use those strategic national stockpile stores to treat people who need it. So that's the vaccine, as well as the antiviral treatments. These are both, again, in this strategic national stockpile of the government. And so there are very clear guidelines of when to use it and who needs it. And so if you are somebody seeking care or you are worried about it, please talk to your healthcare provider because your healthcare provider is going to talk with your department of public health of your state and connect you to the resources that you need.

This is not something that people stock in clinics. You can't get it at a pharmacy down the street. This is very specific guidelines about using it right now, and because we have a limited supply, not only actually, not only because we have a limited supply, doesn't everybody not need it, but actually, because, like I said, it is a self-limited mild illness in like 99% of cases, most people do not need the vaccine or any sort of treatment because it will go away on its own and it's not widespread enough or contagious enough or serious enough or severe enough for people to need that.

So to wrap up, just I encourage you to seek out medical care and advice if you have any questions about symptoms, about the need for testing, or if you're worried you were exposed to somebody. Most of the time, the vaccine is actually used for people who were exposed, and if you knew you were exposed, there's an actual confirmed they tested the case and they have monkeypox and you are around them, you may be eligible for the vaccine. So absolutely just talk with your healthcare provider. They're in touch with the same guidelines that I am of the CDC national guidelines in the United States. And there's also the World Health Organization guidelines, which I can link to down below if you're watching from a location outside of the U.S.

But please take good care and keep washing your hands and asking questions of your healthcare providers.