MONKEYPOX & OTHER PLAGUES | Medicine & Health Podcast

All right, welcome. Good day. This is Medicine Health. I'm Dr. Paul Anderson, Dr. A. Monkeypox, should we be worried? What's it all about? Um, what next? What else can happen? All those questions. So I got a number of contacts in the last few weeks about topic of monkeypox, its whole family of the pox virus, and other things. And just recently got some updates. These are the kind of updates your doctor gets from their— usually, well, in the US, their county health department, sometimes the state health department too, but mostly it's county by county. And I will say that my county— I have had my license in 2 different counties here in Washington. my particular county right now is much more on top of it than my previous county. Um, so, uh, clinician alert, monkeypox in Europe and North America. That's what it says here on the, uh, on the alert. Well, just for those of you who might remember, or those who want to go back and look on YouTube where we store all of these things, uh, I did a past webinar called Smallpox, Anthrax, and Other Bioterror Agents. And the reason that I did that— and I'll put that in the link on the YouTube in the description box, so I'll put that link to that show in there— the reason I did it was because simultaneously there was a scare where there's some old smallpox vials found, and they weren't sure they had anything in them or not. And right before that happened, I believe Bill Gates had made an announcement that we should be on guard for new outbreaks of things like smallpox and other things of that nature. And so I got a lot of questions at that time about, well, you know, we, we haven't seen smallpox, uh, really naturally transmitted since the '70s, uh, so a lot of doctors who are practicing now, you know, may not have even seen it in a living person, which is great because it's, uh, pretty much been eradicated. But, um, Now we may have, you know, things coming back. So that old— and it's just a few months old, it's not like it's 100 years old— that old podcast that I did about smallpox, anthrax, and other agents of bioterror and fear and all that, you can go back and look that up. So just a housekeeping bit here. When I say in the show notes, those are when we move this over to YouTube. And on YouTube, if you're on your phone or a small device, you go to the lower right-hand corner and there's a little down arrow and you click on that, it'll open a description box. Now, if you click on that and it opens up an ad, that's— sometimes they stack the arrows one above each other. Make sure you get to the one that opens the description box or you'll be taken to an ad somewhere on Google. So in the description box, I'll put links to all this stuff I'm going to talk about today, links to the data, links to the old programs, links to some of my colleagues around the world who I think do a really wonderful job talking about these things, and on and on. But, uh, monkeypox— well, so my prior, uh, YouTube that's still out there that I did a couple months ago about smallpox, poxvirus, anthrax, and other agents of terror, etc., was a little bit prophetic, although I don't think anyone didn't see this coming. So we get this, uh, you know, blast here for us doctors saying be on regard. And, you know, it's, uh, it's nice because most doctors only remember smallpox from reading about it, uh, unless they've worked in an endemic area, which we'll talk about later. And, uh, smallpox and monkeypox are pretty obvious things to, uh, see really when they, when they present, if you're looking for them. So the first thing I want to talk about really, because this is, I think, probably one of the biggest question areas that I've got is, um, what in the world is monkeypox? Now, is it related to chickenpox? No, it is related, however, to smallpox. So there is a family of, uh, pox virus called the Orthopoxvirus genus, the, the larger category. There's categories above that, but Orthopox then has species, and the species include 2 versions of smallpox, something called vaccinia, okay, and that's what we made the smallpox vaccine out of actually. Instead of smallpox, we made it out of vaccinia, which is a related pox virus. Then there's monkeypox, cowpox, horsepox, camelpox, and maybe Alaska pox. There was an outbreak in 2015 in Alaska of a pox virus-like outbreak, a small outbreak, and they named it Alaska pox. And I couldn't get to the bottom of whether they actually put it into the Orthopox genus or not, but that was, that was the last big pox that we saw here in, in the North American continent, really, for all intents and purposes. So The orthopoxvirus has a bunch of subspecies in it. You can think of them like families, but they're species. And monkeypox and smallpox and cowpox and horsepox, camelpox, and all this are all related. Now, you may, if you have studied history, remember cowpox. Cowpox, again, related to monkeypox and smallpox, etc. was the first thing used as an inoculation. And they took the pus from a cowpox sore, and then they used a lancet and inoculated a child to see if that would protect them against the smallpox that was going around. And it did. So that was a very long time ago. It's not really done like that anymore, but cowpox was used. So how come cowpox It's not smallpox. How come cowpox could be used to trigger immunity for smallpox? Well, the same reason that our friend Vaccinia, which is part of the Orthopox family, um, or genus really, uh, Vaccinia could be used to synthesize a smallpox vaccine. They're close enough, and we're going to talk about vaccines and all of that stuff coming up here in a little bit. Now, the history of monkeypox in particular goes back to 1958, and there was 2 pox-like illness outbreaks, meaning that they generally— when there's a pox-like illness outbreak, it resembles smallpox or another pox that you've seen before. And it started in colonies of monkeys that were kept for research. So this is transmissible, especially if you're close to the other person, or if you're a monkey close to the other monkey. And so it started there, um, and, um, they noticed it in the primates, in the monkeys, in 1958. So they called it monkeypox. Now that became a little confusing because it doesn't really come from monkeys. It can, but most of the animal transmission is not from monkeys. We'll get to that in a little bit. But unfortunately, there was a bunch of, you know, caged-up, uh, monkeys, uh, in, in some research areas where they all could, uh, you know, spit at each other and scratch each other's sores and stuff. So they all had these outbreaks, and so it got named monkeypox, right? So one of the things with the orthopoxvirus genus is a lot of them can go between animal reservoirs and humans, and that is the case certainly with monkeypox and, uh, and probably some of the other pox that are in there. But monkeypox, what we're talking about today Then in 1970, in the Republic of Congo, they had an official outbreak among humans, and since then places in Africa have been considered endemic for monkeypox that would go to humans. So remember, in 1958 it was monkeys, got the name monkeypox. Turns out it doesn't come from monkeys for the most part. It can, but Not always, and certainly not right now so much, but we call it monkeypox. Big deal. It's sort of like camelpox, noticed in camels, you know, horsepox, cowpox, you get the idea there. These are not elaborate and mysterious sort of names. So when we're thinking about all that, then we think, okay, well, this goes back a ways. Number one, it's related to smallpox, but it's not smallpox. How similar is it? Let's consider that, because smallpox obviously was a big problem in years gone by for people, and when there would be outbreaks, that was a big issue. Another factor we want to talk about is the endemic nature of it, and it's endemic right now just in Africa. But what would happen if we start to have it be endemic in Europe and North America and Asia and other places like that? How does that change transmission potential, etc.? What does the disease look like? How transmissible is it if I were to get it? And what are the likely outcomes with the disease? So one of the things I think, and one of the links I did put in was to Dr. Vinay Prasad, Uh, who's a researcher in the University of California system. He's an oncologist, I believe, by training, but he has really, really awesome videos and he really breaks down a lot of research. But he also sometimes has a, you know, just sort of a fireside chat about things. He did a really good one about monkeypox and fear and all of that. So I put the link down there. It just says Dr. Prasad Monkeypox. Uh, He's awesome, by the way. Follow him on YouTube. He's, he's got really good information. Very, very conservative researcher, uh, very, uh, good at breaking down research on different things and takes a lot of stuff in different directions than I do. So I really, I think, really appreciate his channel and his approach. But one of the things that he brought up that I was thinking about that I thought, well, this makes a lot of sense, is if this— let's say all of us doctors get this, uh, update from our you know, local health board or state provincial health board saying, oh, monkeypox is on the move and we found it, you know, in North America. Uh, if this was pre-COVID, what would anyone think about that? Would anyone really care? Would people be talking about it? And the answer is probably a few people would, and your doctor would know to be on guard for classic signs and symptoms of pox virus, uh, someone coming into his office with a pox virus. But, um, The, the doctors would probably just look at it and say, well, you know, we get alerts like this all the time for all sorts of stuff, and most of it doesn't turn into anything, right? And the public probably would not be hearing so much about it. It'd be a lot like— I don't know if you recall, but back— and again, this will be in the, in the show notes on YouTube when we put it over there, this program, uh, and I'll have the link to, um, my smallpox, anthrax, and bioterror YouTube that I did. After that came out and after the potential for a smallpox leak, which did not happen, we don't believe, based on the reporting, um, after that all happened and I did that reporting on that and bioterror and all that, um, basically that story fell off the edge of the earth. We didn't hear about smallpox anymore, and it just sort of all went quiet. And, uh, I think that's what would have happened know, in the pre-COVID days. But COVID has made us all so sensitive to infectious disease issues, which of course, if you have an infectious disease that might kill you, you might want to know about it. But we have some real big differences between COVID and the way that that transmits and all that, and monkeypox or any other pox virus, but especially monkeypox, as long as it's transmitted in the normal ways. Okay. Now, when you are thinking about our old friend monkeypox, if you were to go to your doctor and need to be tested, they're supposed to take 2 different samples. And so one comes from the lesions of the pox virus have different stages. And so as a doctor, you're supposed to sample one dry lesion, and one wet lesion, which would actually have the pus liquid in it. And you— those go in 2 different samples, and then you have to handle them a particular way. You refrigerate them and all this business. And then if you have a suspected monkeypox patient, of course you're supposed to take precautions as you would for any other respiratory transmitted disease like tuberculosis or influenza, et cetera. And that would be to mask them up and you're masked up, etc. Now we're going to talk about masks outside of the medical setting, and you need to keep in mind that what we might do in the clinic to mask up and use precautions is for a sick user environment, which is your medical clinic, your hospital, etc. The personal protective equipment is used very differently in the medical setting, especially with you know, a potential for transmissible disease than it is out in public. So with the exception of with COVID in certain times and areas, we usually don't make public health recommendations that you do the same stuff we would do in our office with sick people because that doesn't make any sense. Okay, uh, you're, you're not going to be preventing much of anything. So we'll talk about that. That's, that's what we would do is we would be you know, using universal precautions. And certainly if somebody had something like this going on and you're working with them or examining them, you would be masked up, etc. And that's just a normal protective thing that you would do. It'd be the same if you had a patient with active tuberculosis, you know. And I'll admit that I'm old enough to remember being around active tuberculosis patients and We weren't using universal precautions back in those days, so we didn't always do all of this stuff that we do now, but we know better now, and so we do more stuff. Now, if we get through this idea of, okay, it's an orthopoxvirus, it's in the same species, families of species as, say, smallpox, etc. Why are we worried about it here in North America? And I know you could be listening from somewhere else and you're probably getting the same news. You should worry about it where you live too. Well, there have been cases around the world, but here's how these things work. If it's endemic in portions of Africa— remember, that's where we first found it, the first human cases were there in the Congo, etc.— If it's endemic there, it means that it uh, travels between the reservoir, which is usually animals, and the people, and it goes back and forth. And so you get outbreaks that are localized. Then those people are identified, diagnosed, and isolated, which isolation is wonderful for something like a pox virus. Uh, and then you try and isolate the person who's infected, treat them, uh, and use precautions so that you're not spreading it around. And then the outbreak will burn itself out. As soon as you identify all of the sick people and isolate them and treat them, it can't go anywhere else. That's endemic. Remember, pandemic is it's all over the world, it's moving around. Is monkeypox going to become pandemic? Thinking about could monkeypox become pandemic, the chances of that are almost zero. It's very unlikely because of the way it's spread, because of the way that you can identify the disease, et cetera. It's not— if you remember our discussions earlier about why does COVID— why, why did COVID become pandemic when its cousin SARS-CoV-1, the original SARS-CoV, uh, or we just used to call it SARS, uh, was almost pandemic, right? It jumped from Asia to Toronto and, and it kind of got snuffed out in certain areas. It's because the original SARS, SARS-CoV-1, gave you very fulminant disease and symptoms, and so you could be identified, you could be isolated, and you could be treated. COVID, SARS-CoV-2, stuff we got going around the world right now, has transmission and a lead time before you know you're sick, so you could go out then infect other people. and it just mushrooms out. That's how a pandemic starts. So because of the natural history and the disease process of monkeypox, it is highly unlikely that monkeypox would just take off. Okay, now we may have endemic hotspots, okay, but the idea hopefully that public health will be grappling with is We're going to educate the physicians and the healthcare providers on what to look for. We're going to say, as soon as you start seeing this or you get these history and physical exam cues, you need to test these folks. You need to have them do precautions. And then we need to isolate those folks. Now, isolating can be at home. It's not they're going to send you away somewhere. It's just isolating. Because if you do have a highly transmissible disease and at its height, these orthopox viruses like monkeypox and smallpox and stuff can be transmitted much more easily. You're better to stay away from other people. Okay, now we'll talk a little more about treatment, but that's the idea, and that's why it is very unlikely this would be a pandemic, but we might have endemic hotspots. Now, what's going on in the U.S. as of yesterday? And I'll put the link there in the notes below. So yesterday was actually June 1st, 2022. So if you're listening in the future, the link I post might, you know, go somewhere else or it may not relate. But as of June 1st, 2022, which was yesterday, we had a total of 19 cases in the United States. Washington, California, Vermont, Colorado, so kind of west, west and east coast. Georgia, Florida, Virginia, Pennsylvania, New York, and Massachusetts. Those are the places where these 19 cases are. So it's kind of hugging both coasts and And then, well, a little bit there with Colorado, a little interior. You need to know that there's a number of cases around the world. And to date, as of June 2nd, and the data I have, we've had no deaths. Okay, so that's good. We've got cases, we've got people to treat, but we don't have any deaths. So that's good. And that really leads to the next topic really, which is what is this disease like, okay, and what are the treatments that we can do. So if we identify it and we isolate, what can be done or what needs to be done or does anything need to be done? Well, certainly if you look back in history, smallpox outbreaks whether they were the natural endemic smallpox that would just break out because people didn't have immunity to it, you know, in years, let's say 100+ years ago, or when smallpox has been used as a bioterror agent. It was used against Native Americans in that respect, and we'll talk about transmissibility in that way. But smallpox as a bioterror agent goes back many centuries to, uh, differing, differing sides of a war, you know, catapulting a dead body that had died of smallpox or plague or something over into the, you know, either into the water supply or into this, into the town behind the walls. So these things have been used one way or the other as bioterror agents. Nowadays, we wouldn't have to— if we want to make it into a bioterror agent, uh, we don't have to be catapulting dead bodies and other very obvious things, because you would probably know if we're doing that. So if you really want to get into the bioterror side of it and how those mechanics work, go back and listen to that smallpox, anthrax, and bioterror YouTube. And I've got the link below if you're on, if you're on YouTube. If you're not, just jump over to my YouTube channel, it'll be right there. But let's say it's not being used as a bioterror agent. It's just going to become either transient, where you've got someone traveling in and bringing it from another country. But the concern the infectious disease doctors have right now is that now we're seeing sort of endemic clusters where it may be coming from local, uh, disease pods. And here's the real problem. Now remember I said it's called monkeypox, but most of the time it doesn't come from monkeys. Most of the reservoir— because, all right, think now, some of you may live with a monkey or be near a zoo, but for the rest of us, think of how many monkeys you come in contact with. Okay, unless, unless you own a monkey as a pet or you're a researcher and work with, you know, primates, or you go to the zoo, you're not seeing a lot of monkeys. I've seen a lot of primates, non-human primates. So your chance of seeing a monkey, even if they had monkeypox, is fairly low. Here's the problem: it spreads through all types of other animals, and the more common animals that we encounter all the time as humans are rodents. That includes the squirrel family and rats and mice and all those guys. Well, the rodents, once you get a bug into the rodent population, remember, like bubonic plague, et cetera, it'll spread a lot faster. So one of the concerns is if we have these little endemic hotspots and then we've got this transmission between the animal kingdom and the people, we could have endemicity. So an endemic monkeypox problem problem here in North America where it goes out with the animals for a while, they bring it back to the people, etc. Okay, so would that still trigger a pandemic? No, probably not. That's not likely. But an endemic, uh, orthopox virus is not something we've had to deal with for a very long time in North America. You know, as I said, the the last, you know, documented case in the world was in the '70s. And, uh, so most people, like I say, hadn't had to see smallpox. And, and then of course monkeypox, you know, kind of came up after that, if you will. Um, so when we think about it, uh, what's being done about it, and is there any other news about this out there? Well, there's a couple of just side points I'd like to make, and I usually, you know, the There's a couple of disclaimers I want to make. One is I'm a doctor, but I'm not your doctor, so there's nothing in this video or audio you should take as medical advice. Okay, that's— remember, it's kind of dumb to take medical advice from people on TV or YouTube or, or the radio or something. Uh, you can get information and then do your own thing, but don't take medical advice from me or anybody else on, uh, on, on a podcast, certainly. Um, The other thing is that sometimes I will report on things that sound either, gee, you know, is he trying to push an agenda, or is this, that, or the other thing going on? And I'm really not. I, I don't, I don't have a dog in the hunt here on any side around the pox virus family or monkeypox. I'm— you go back and listen to my bioterror thing, I'm reasonably educated about that sort of thing, but I don't, uh, I don't really feel one way or the other, uh, politically about pox virus. But if you were concerned, and I'll put a link to a really wonderful PhD from Britain, uh, who's done a lot of stellar reporting on the pandemic, and he did an update about, um, monkeypox where he got into some things around, uh, how did we all of a sudden get the ability to identify monkeypox, and has anybody been experimenting with monkeypox, etc.? And so he has all of the background information. That's Dr. Campbell. But I'll just say that if you want to look at that video, it's very interesting. And so think about the 2 biggest probably best-funded groups that you've heard about all through COVID, who are in the virology space, who were working on, uh, coronavirus research before we had SARS-CoV-2 or COVID, and who have the ability and the laboratories to synthesize, uh, viral genetics and to manipulate viruses. Okay, if they were working on COVID before— and some evidence shows that there is a financial paper trail between the two— um, that, you know, maybe no harm, no foul, it was just a big accident, but maybe something got out of the lab and went somewhere. Well, those 2 agencies were the National Institutes of Health and the Wuhan Institute of Virology. We've heard of those, right? But it turns out that they— both of those entities have been doing monkeypox research for quite some time now, and even synthesizing monkeypox virus from scratch, which you can do. Dr. Campbell, in the, the link that I give, goes into all that, explains it. Um, and, you know, maybe that's They're just doing it for background scientific purposes. Maybe they're working on treatments or whatever. That's usually what the virology work is about. But it is kind of interesting that in the last number of years we've had not only coronavirus research going on, some of which was weaponized one way or the other, and we've also not heard about it, but now we're hearing about the fact that we've had monkeypox research going on. So make of that what you will. Like I say, I don't have a dog in the hunt there, but it's just interesting to me. Now, another thing that's interesting to me, and I put the link in again, the YouTube notes, we had in 2019. So this is, you know, at the beginning, or really before COVID We, we all got FDA news release And it was September of 2019, so certainly late enough in 2019. FDA approves the first live non-replicating vaccine to prevent smallpox and monkeypox. Hmm. So most of us alive right now didn't— if we did have a smallpox vaccine, it was when we were very young and were older, or maybe you're old enough that you were in the military during the Korean War, certainly, and World War II, and maybe up through Vietnam, where they were still doing smallpox vaccines in the military. So you may have had one there. There's other groups of people who've had smallpox vaccines. Most of those vaccines probably aren't conferring any immunity to you anymore anyway. But it was interesting that we now have this vaccine in 2019, uh, to prevent smallpox and monkeypox. Now, before the monkeypox stuff came up here in the last little bit, I often thought, well, these orthopoxvirus are easy to use as a bioterror weapon, so you would potentially want your military forces, for example, to have some immunity to the Orthopoxvirus family. And we know there's cross-immunity from the original inoculation of cowpox to prevent smallpox. We know that we use, uh, you know, vaccinia, which is a relative but it's not smallpox, to immunize people. And then in 2019, they came up with this combo vaccine that they approved to prevent smallpox and monkeypox. And monkeypox, which we had really not heard of unless you worked in you know, Africa or something like that. So, okay, that's fine. You know, a vaccine is just what it is. Some work better than others, and some have more or less problems. Uh, this one has been tested to some degree, but not, you know, not excruciatingly well, uh, across the world. And so the fact that it included monkeypox was interesting. Now, if we go by basic virology and the way vaccines work, It's probably protective against most of the orthopox virus. It's just that monkeypox is more likely today that you'd be exposed, and the variola family, the smallpox family, would be only an exposure in a lab leak or in a bioterror action. But if you go back to my bioterror video, you know that that is one of the agents we've been on alert for as a bioterror agent for a long time. Well, now you can add monkeypox to that. Any orthopox virus really is a good bioterror agent for a lot of reasons. So we've got this, uh, you know, sort of— a lot of people say, well, it's sort of mysterious that in 2019 we got this monkeypox vaccine approved. And, you know, part of it is monkeypox, smallpox cross over. The other part is they're good bioterror agents. So, you know, it's better to develop a vaccine before you need it. I think we've learned that. Um, and, uh, it's It's just interesting timing. You can make of that what you will. Um, so what's it look like when someone gets this? Now, a lot of people, uh, if, if you've been, you know, consuming news about monkeypox, which maybe you aren't, I, I do notice a lot of people are just, you know, we're newsed out and we're, uh, you know, we're terrorized out and we're uh, you know, hyped out from everything. Uh, and so people during COVID kind of either went towards over-consuming all the news and getting worried, or just shutting it off and not, not looking at it anymore. But let's say you've heard of this. Probably one of the things that you've heard of, which sounds odd if you know the history of, you know, the orthopoxviruses, is there have been outbreaks in, uh, communities where you have men, uh, men having sex with men. Okay, and so that makes, you know, that always makes a big splash when you get that sort of thing going on. And here's the bottom line, uh, it is, it is transmissible through the shedding of the virus, right? Well, the shedding of the virus is the easiest transmitted through mucous membrane and secretions coming into contact. is if you have enough viral load in the secretion from the body, whether that's your sputum or your blood or your sweat, even if it was that high of a viral load, or your urine, your feces, semen, etc., all of those things have a potential for a viral load. We can get quite a concentrated viral load in respiratory secretions, which is why we are concerned about droplet spread. Certainly, blood, urine, maybe semen can be quite concentrated, etc. So the fact that you have an outbreak in communities with men having sex with men is more just about transmission than it is that this is, you know, some new sexually transmitted disease. If we would have had smallpox around for the last, you know, 50 years, you would have seen this with smallpox too. But we didn't have smallpox around, so this is, you know, seemingly new information. So, um, okay, and that's sort of a— all right, well, let's say it's not men having sex with men transmission. How do we transmit it? Well, it's considered to be not as discrete. So tuberculosis is one of those things that pretty much you got to get a respiratory droplet and breathe it in, right? Now you can get tuberculosis other ways. But you pretty much have to do something, you know, surgical or violent to get those. TB is pretty much just droplet. The orthopox virus, whether it's smallpox, monkeypox, cowpox, etc., can go in respiratory droplets. But here's the difference. We hear about this with COVID With COVID it can be in smaller respiratory drops. With monkeypox, It has to be in a very concentrated, very large droplet, and so it's not going to spread for long, long distances like you might with, say, influenza or COVID or something like that. So you generally have to be in fairly close proximity. You generally have to have poor air turnover, and that's when your exposure chance is the highest. Well, it's also possible if you are just in very close proximity, you know, that you would just have more chance of transmission. Now, yes, if you're looking at sexual transmission and you have the potential for concentration in semen, and then you have mucous membranes, and the semen and the mucous membranes come together, that's one way. But most of it is going to be airborne in short distances and high concentration, big droplets, okay? Not small droplets like influenza or other stuff like that. Now, when we think about that, then we hear stories of— well, I told you about, you know, catapulting bodies, dead bodies hopefully, that were full of, you know, pox or whatever into, into the enemy camp to kill them. But also we remember from, you know, North American history, uh, the use of smallpox blankets, right? So they would give blankets to natives, didn't know they were dosed with smallpox, and that would spread smallpox. Well, one of the things that I was curious about with this transmission business, because that really does go to a lot of how worried should I be about about monkeypox and all of that. And so, by the way, in the future, if we have a smallpox outbreak for any reason, all of this goes for smallpox as well. Okay, it's all the same stuff. So I actually put a link in, it says actual transmission data. This is a published article about smallpox, not monkeypox, but it's the same basic transmission. And it looks at the the data over time, like the veracity, the truthfulness of the data about transmission. And so it debunks a lot of stuff that we used to just believe about smallpox transmission because we didn't know any better, right? And so if you really want to get into that and look at, you know, how hard is it to spit monkeypox or smallpox on someone, have them get it, versus how hard is it, uh, to put it on you know, clothing or your table or something like that. And the bottom line that this article brings up as they go through and they look at the data and they break it down and say this data was pretty good, this data wasn't so good, is you're unlikely to, for example, you know, bring, uh, your monkeypox, uh, home on your clothing and have it be very transmissible for very long at all. Okay, now this goes to that difference between the healthcare environment versus the rest of the world. When we are doing things with patients and we're taking universal precautions, and then if we have somebody we know with an identified disease and, you know, we're making sure that, you know, they're protected, we're protected, everything else, one of the things that's not going on is you're not wearing the same clothes that that you're going to be taking outside of the hospital or outside of your clinic. You know, you're going to have things that can be cleaned like scrubs and, uh, and, and outer garbing things. Uh, so that's a little bit different. You know, if you're a doctor, nurse, healthcare provider, or whatever, you're going to be taking, you know, clothing precautions along with your universal precautions. But out in the world, you know, let's say there's, you know, monkeypox and some Bit coming across, it's going to be really hard for that to actually infect you in a well-ventilated area. It's it's on your coat. You know, it's not going to go anywhere really. So if you really want to get into that, you can read that particular research paper that I have in there. So it starts out though, just to kind of break down like what does this thing look like? It really starts out looking like you might have, you know, the flu or cold, then everything started that way. But the bottom line is, and this is actually done really well by our friends in the county health department, so I will just use the county health here to give you the straight dope. Usually the beginning symptoms include fever, chills, headache, weakness, lymph node swelling. So, you know, you get like swollen nodes in your body. They can be all over, and then the rash comes after that. So normally you're, you're fairly sick. Now, in, in monkeypox, we pretty much have one major presentation. In smallpox, there are 2 presentations they call minor and major, and they basically just go to how sick do you get, right? So So what you're supposed to be on the lookout for is if you get, you know, fever, chills, headache, whatever, most of the time that's a cold or the flu, right? Lymph node swelling, that can happen with mono, Epstein-Barr virus, that can happen with cytomegalovirus, that can happen with strep throat, that can happen with Haemophilus infection. It can happen with all sorts of stuff. Okay. stuff, right? The bottom line though is that if you have a garden variety reason for fever, chills, headache, and lymphadenopathy, you might need something like a strep throat test and antibiotics or some treatment for your mono or whatever, but it's not going to progress then to a skin lesion setup. And so all of that viremia or bacteremia that you have that causes the fever, chills, headache, and everything goes up, you isolate or get treatment or whatever, and it usually goes back down. There's no rash on the back end. With the orthopoxvirus, it's— now most, most of you have seen chickenpox, right? Chickenpox is not the same kind of virus as the orthopoxvirus which monkeypox is in. Chickenpox are very superficial lesions that look more pimple-like and they are smaller. Orthopoxvirus, whether it's smallpox, monkeypox, cowpox, etc., but monkeypox are going to be larger lesions that typically start on the upper part of the body and work their way around, and they are deeper. They call them dermal lesions. This is why if you see pictures of people who've had smallpox or monkeypox, a lot of times they'll have pitting scars That's because they're dermal lesions that go down through the outer layers of the skin and they're bigger. And then these pox lesions get full of a liquid. So remember we said in testing you have a dry part, so they start out flat and red and then they raise up. And then so they go from flat to raised and they go from raised to raised and full of pus, and then they go into a resolution phase where they're drying up. You are contagious through that whole time. And here's the thing, the lesions and the fluid from the lesions is much more full of virus than your lungs and your respiratory secretions are going to be. So the best advice, especially if you're in an area where you've, you know, Got a monkeypox endemic outbreak. Right now it's only between one and four people in each state, so there's no outbreaks really. But let's say you were you know potentially around people. If you get these global symptoms of the viremia, where you have fever, headache, fatigue, lymph node swelling, all that stuff, you would be good to speak to your healthcare provider. and isolate. And the minute that you see lesions developing, uh, you need to— generally you're going to be advised to go into the healthcare provider to be tested. Now, if your healthcare provider is like me and they got this update from their health department, they will, um, you know, this is just to be kind to your healthcare provider, uh, I would recommend if, if you truly think that you've gone through the viremia and now you've you've got pox lesions going on your skin, call your healthcare provider's office first because they may not be set up to do this specific testing. And they may say you have to go to some place associated with the health department. That might be a hospital, it may be a county health clinic or something. So do know that this isn't a regular sort of a test. But if you go from, you know, I've got cold and flu symptoms, but now, gee, I'm developing you know, flat red lesions, and then they're starting to swell up, and now they're getting fluid in them. There's not a lot of other things that look like that. Now, if it's chickenpox, like I said, they're going to be lower lesions and smaller and, and all of that. And most of you have either had chickenpox or had the vaccine, so it'd be unlikely that you would be getting chickenpox. So, um, It goes through that, and you want to remember that it can be anywhere. The pox lesions can be anywhere. They can be on the palms of the hand and the soles of the feet, which is sort of unique. It's not unique only to this. And so that's what you would look like if you were sick. So what happens if you're sick? Well, mostly they're going to tell you to isolate. Uh, they're probably going to give you, uh, precautions. And if you're— if you, if you live alone, it might be different, but they give you some, you know, uh, N95 masks and things to wear around other people to keep your secretions from going out. But your big thing is, if you've got the skin lesions, you very much don't want, you know, your bedding in contact with someone who doesn't have the disease, or your clothing, or whatever. So it's going to be neat. need to be washing and cleaning of all that. So all of that will become important. Is your doctor likely— or whoever doctor encounters you, it may not be your doctor— are they likely to give you a lot of treatment? Probably not. If you do develop something like monkeypox, you can isolate, you do the normal things such as hydration, Rest, all that business, and then they will tell you, you know, to watch your symptoms. Now, if you're already very sick, if you are immune compromised, either from medications you take that are immune compromising—a lot of people, so a lot of people with you know autoimmunity are on immune compromising medications. So maybe if you're on immune compromised medication. We have an immune compromised disease, or people with primary immune deficiencies. Those folks may watch a lot more closely because they don't have an intact immune system. But if you have an intact immune system, you'll probably be told to isolate, you'll be told to hydrate, all the same stuff that you're told for influenza or, you know, early COVID, etc. These type of viruses usually kill people if they go on and the person is unsupported meaning they're unable to get adequate hydration, isolation, and symptomatic treatment. And then the viral load builds up, and if it builds up enough, it can create problems in the brain, can create problems for your eyes, many other organ places. So prior to, you know, in the modern era, case fatality, uh, rates for monkeypox is somewhere between 3% and 6% from African data. We really don't have— remember, as of right now, with what's going on around the world, no one's died. Um, and I will just relate the fatality potential to something that I was told when I was being trained about the potential for smallpox to be used as a bioterror agent. And if you want more on that story, you can go back to the, uh, Smallpox, Anthrax, and Bioterror YouTube that I linked below in the— on the YouTube description. So I won't belabor why I was being taught that, but what the infectious disease doctors who were transmitting information about smallpox being potentially used at that time as a bioterror agent, uh, because there was a big event going on and it happened to be in the U.S. and all this business. So, um, Basically what they said, because our question was, well, A, most of us, you know, never even seen smallpox, or if we have, it was once. Um, and we're not really used to treating smallpox in the United States. And we heard, you know, from all the stuff we had to memorize for our board exams, that smallpox had a pretty high case fatality rate. And what the infectious disease specialist said was, well, that's very true, Smallpox, wild variola major, you know, spread to more of the body, all this business, and, you know, people, people frequently died. But all of that data predates most modern medical interventions, and I don't mean by that a lot of medicines and stuff, but what I mean by that is, if you get in a critical critical shape and you're very inflamed or you're very dehydrated, you're very what, we can treat you in a way to take care of that and get you through the viremia without a problem. Now, there are also, let's say you are immune compromised or, you know, maybe you just got done with chemo and radiation and your immune system is not doing very well or something else, or you're just having maybe some of the worst symptoms. And we're concerned about that. There are other things that can be done for you. There are immune proteins that can be given to you that will bind up the monkeypox. There are some experimental antiviral drugs that we use for other stuff that can be tried, and then there's a lot of supportive care that can be done. So all of that is still available to everybody. Now, some people have asked me this week, well, it says that you can get a smallpox vaccine and that would be helpful. Well, not preventively. So the only reason they're talking about smallpox vaccine is in a post-exposure prophylaxis. So let's say you've been in close proximity because you live with or whatever someone who turns up to have monkeypox and you've had enough close proximity that you were in the same room breathing the same air with no protection, or sleeping in the same bed or sharing, you know, clothes or whatever that might be a problem, you're probably going to be recommended for post-exposure prophylaxis. So what our county health folks say is get over and get a smallpox vaccine, and it's got about an 80% efficacy. That's going to be a pretty rare experience, but it will happen with certain people. So there are some treatments. Um, it's generally not that deadly with modern medicine, and I'm gonna guess the case fatality rate's gonna be much lower than 3 to 6%, uh, in, in most parts of the world. Uh, now we're running out of, uh, time here, I see, so we're gonna just close up with a few final thoughts. The first thing is, what can you do aside from medicine? Okay, it was a very interesting video by some infectious disease folks about heat and bringing up your interferon levels. Interferon is natural in your body, helps you fight viruses. And, uh, in early in COVID, I did a, uh, an interview, an international interview. One treatment that was brought up was heat. Yeah. Hyperthermia for the body. And I had so many comments of people saying, did you have your license taken away, you quack, and all this stuff. Well, this particular very, very conservative medical source goes into hyperthermia, and I, I put in the show notes the link and when you should start listening when they talk about hyperthermia. And you can achieve that level of hyperthermia with a sauna, anything to heat your core level The global things that help, we've talked about a million times before: vitamin D levels, vitamin C every day, all that stuff. I've got links to all these lists of stuff. Will it prevent monkeypox? Nobody knows. There's, there's no data on any of that. But will it make you a smaller target? Yes. Okay. And the better prepared you are when you get the infection, the more likely you are to live through it. And right now with modern medicine, you're very likely, if you do get monkeypox, to be treated appropriately and survive. So in summary, monkeypox is a thing. We're really hoping that no one weaponizes any of the orthopoxvirus family— smallpox, monkeypox, cowpox, camelpox, any of those pox— and we hope it's just little endemic flares. Our biggest concern is endemicity. in North America, in Asia, in places it hasn't been before, uh, because of transmission through rodents. Okay, that story we won't know for a while. When it comes out, we'll talk about it. But I'm Dr. Paul Anderson for Medicine Health with Dr. Paul Anderson. If you're listening on any of our pod burners, or if you're watching on YouTube or anything, please like, share, and subscribe. Uh, all of the show notes, all the links are always on the YouTube channel. And if you can't find me on YouTube, It's just DRA Online, Dr. A Online. You can always go to my hub website, dranow.com, and dranow.com has all the links to everything you could ever want. All right, thank you everyone, and I will see you next week on the radio.