Monkeypox is now definitively more widespread than just a few cases, with the World Health Organisation calling it a Public Health Emergency of International Concern.
In the context of this spread, people are beginning to wonder if we need to worry about catching the disease in casual contexts, like when trying on clothes in a store (since the virus can reportedly be transmitted on clothing). But how easy is it, really, to catch monkeypox?
Do I need to worry about monkeypox at all if I’m not a sexually active gay or bi man?
It’s important to know that monkeypox is easily transmitted during sexual contact, but also that sex is not the only way the virus can spread. For example, if a child gets monkeypox, that doesn’t mean they have been sexually abused. In previous outbreaks where people contracted monkeypox from animals, that doesn’t mean they were having sex with animals. OK? But because the virus is spreading in LGBTQ communities, it’s important for people in these communities to be aware of the risk and to take precautions like not sharing sex toys and keeping an eye out for sores on your partner.
With any infectious disease, your risk depends on a lot of things, and one of the major factors is whether you’re likely to encounter people who are already infected. If you live in New York City or San Francisco, and you’re a man having lots of hookups with other men, your chances of encountering someone who could give you monkeypox are pretty high.
On the other hand, if you’re not in one of the few urban areas where it’s spreading, and you’re not in a high risk group, your chances are much lower. Not zero, but low enough that you probably don’t have to take any special precautions in your day-to-day life.
Can you get monkeypox from random public places?
Recently, I was using a public toilet at a highway rest stop when suddenly the thought occurred to me — I wonder if monkeypox is the kind of thing one actually could catch from a toilet seat. (I still sat on the toilet seat, but made a note to myself to look this up later.) Shortly afterward, a coworker asked if it would be possible to catch monkeypox by sitting in a movie theatre seat that a monkeypox-infected person had previously sat in. And I saw a few social media posts warning people that it’s no longer safe to try on clothes in stores, because who knows who tried that outfit on before you?
At this point, I was unsure how many of these scenarios were reasonable versus paranoid. After all, the CDC notes that the virus can survive and travel on clothing, bedding, and towels. So I called up epidemiologist Kathryn Jacobsen, a professor of health studies at the University of Richmond.
She pointed out that, first of all, that emergency declaration aside, there are just not that many people with monkeypox. This might change if the disease becomes more widespread, but right now — and especially if you live outside a big city — it’s very unlikely that someone with monkeypox would happen to shop at the same store as you, much less try on the exact pair of jeans you are now bringing into the fitting room. Even in the movie theatre, the chances of a virus making the jump to the seat and then onto your body in a way that could make you sick are minuscule.
But, ok, let’s say there’s a monkeypox outbreak in your area. What then? “What we mostly would be worried about are things that infected people have had prolonged contact with,” she says. Clothes that an infected person has worn all day, for example, or bedding that they’ve slept on night after night, where there’s plenty of time for scabs or fluid from their sores to rub against the fabric.
Similarly, studies that examine how long the virus lasts on a surface are done in places like hospitals, where people are very sick (and thus may have lots of lesions) and spend a lot of time touching the bedding and objects in their room. Those items would have a lot of virus on them, not just a little smear here or there.
What’s more, just because there is virus detectable on a surface doesn’t mean it’s able to easily infect somebody. A 2019 study found that monkeypox only spreads to people in the same household about 8% of the time.
So, no, Jacobsen isn’t worried about the examples I listed, although she points out that as an epidemiologist she is already the kind of person who avoids touching doorknobs or borrowing other people’s jackets.
Where else could monkeypox spread?
Right now, we know that the virus is primarily circulating among men who have sex with men, but we don’t have much information about where else it might be, especially since testing has been hard to access. Most positive cases are, unsurprisingly, in the same population that has been designated as high risk and offered the most testing.
(Jacobsen points out that a case of monkeypox with very few lesions might be easy to mistake for another disease, but that if people outside the MSM community were commonly showing up at doctor’s offices with classic monkeypox symptoms, those would be hard to ignore, and we would see upticks in the CDC reports of “probable” or “suspected” cases.)
If this virus becomes more widespread, it could show up in other settings. My first thought was daycares; children are constantly in close contact with one another there, and plenty of other diseases spread easily this way — just ask any parent whose kid has had hand-foot-and-mouth disease. Jacobsen notes that the standard cleaning common at daycares provides a good start at controlling any potential spread of monkeypox there — but that if the virus becomes more widespread, expect increased sanitation and new guidelines about staying home if your child has a suspected monkeypox case.
She also pointed out that MRSA (methicillin-resistant Staphylococcus aureus) is another disease transmitted via skin-to-skin contact, and it spreads easily among sports teams, both from player to player and through contaminated surfaces like wrestling mats.
Congregate settings, where many people live in close contact to each other, have also been suggested as potential monkeypox hotspots. These include places like nursing homes and prisons.
But so far, this is all speculation. There’s not enough research on monkeypox to know whether it would be able to spread as well as MRSA or hand-foot-and-mouth in these settings. They seem to have the right ingredients for the virus to spread, but only time will tell for sure.
Is monkeypox airborne?
Early in the COVID-19 pandemic, we thought that the coronavirus was spread on surfaces (hence all the hand-washing) and by respiratory droplets, the kind that only travels short distances (hence the 2-metre rule). When the virus was confirmed to be able to float in smaller droplets, it was considered to be “airborne,” and masks and ventilation became much more important.
Monkeypox, so far, is not understood to be airborne. It is understood to be transmitted by respiratory droplets. It’s hard to study transmission by droplet separately from skin-to-skin transmission because both require close contact. This happens, “if you were close enough that somebody could have their spit hit your face when they exhale, or the moisture from their breath could be directly on your face,” Jacobsen says. It’s not the kind of thing that would require you to wear a mask when you go out shopping, for example.
That said, there is a good reason to wear a mask, and that is that we’re still in the middle of a COVID-19 pandemic, with more cases than ever (although, thankfully, not as many deaths as in previous waves).
When it comes to taking precautions against monkeypox, most of us don’t have to do anything different from what we’ve already been doing — but if you suddenly feel a lot more interested in masking up, that’s understandable. If the virus spreads further, we will likely want to pay more attention to hand-washing and to sanitising surfaces. Should that happen, Jacobsen mentions that, especially for people who are immunocompromised, it wouldn’t be too paranoid to avoid crowds or even to wear long sleeves when you expect to be bumping into strangers in crowded places.