Monkeypox and the era of overlapping health crises

Make Me Smart August 09, 2022 transcript

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Kimberly Adams: Perfect. Let’s do it. Hello, everyone. I’m Kimberly Adams. Welcome to Make Me Smart, where none of us is as smart as all of us.

Meghan McCarty Carino: And I’m Meghan McCarty Carino, I’m filling in for Kai Ryssdal. It’s Tuesday, that means it’s deep dive day. And today’s topic is the latest public health emergency, monkey pox. We started to see a few cases pop up in mid-May. And now the CDC has confirmed more than 7500 in the United States.

Kimberly Adams: And I have just had so many questions about this. And then last week, the Biden administration declared that monkeypox was a public health emergency. And so what we want to do today is figure out how we got here, how did this become a crisis, what do we know about the disease and what we don’t. And also what it’s going to take to combat monkey pox, because we’re still in an economy and a world shaped by COVID-19. So, so many questions.

Meghan McCarty Carino: Right. So here to make us smart is Dr. Celine Gounder. She is an epidemiologist and editor at large for public health at Kaiser Health News. Hello, Dr. Gounder.

Celine Gounder: It’s great to be here.

Meghan McCarty Carino: So I guess first off, you know, just explain what is monkeypox, and how did it go from something that was largely thought to be containable to a public health emergency.

Celine Gounder: So monkeypox is a distant relative of smallpox. It is much less mortal, so less likely to cause death than smallpox. But it does cause these extremely painful lesions that can be quite disfiguring, can cause scarring. What we saw as around 2016, 2017, a change in the pattern of transmission that goes back to Nigeria, where we started to see a lot more cases among men, say, in their 20s and 30s. And as it turns out, likely that was the beginnings of transmission among men who have sex with men. And one of the main challenges in Nigeria is that gay sex is illegal. So if you are a man engaging in gay sex, and you have, let’s say, health issues resulting from that, maybe an STD, you’re not going to be as likely to present to your healthcare provider for help. And a lot of this is going to end up going under the radar.

Kimberly Adams: Well, let’s talk about that to start, because there’s been so much talk in the United States about the fact that it is predominantly this community that’s seeing a lot of the cases. But this is not a disease that is exclusive to that community. And it seems to be a really tough line for public health officials to walk and then also for people to just not be jerks about it.

Celine Gounder: Yeah, it is a really tough one. And there’s been this whole debate – is monkeypox an STD? I’ve been using the term sexually transmissible, so it can be transmitted sexually, but that’s not necessarily the only way it’s transmitted. What does seem to be true, though, is sexual transmission appears to be a more efficient, effective means of transmitting it, which is why we’re seeing it blow up the way it is right now.

Meghan McCarty Carino: How difficult is it to message what the risks are and how targeted that messaging should be, given the transmission dynamics that we’re seeing right now?

Celine Gounder: So if you look at other infectious diseases that have been sexually transmissible, like say, HIV or syphilis, you do see those diseases more frequently among men who have sex with men, but you don’t see them exclusively in those populations. And so there are particular groups that we are worried about seeing spillover as well as monkeypox becoming more entrenched in a long term way. And so who are those groups, women of color are the next highest risk group for HIV after men who have sex with men. And this is for a couple of reasons. One has to do with sexual networks. And so if you are in a sexual network where there’s just more of the disease, your chances probabilistically of coming into contact being exposed are going to be higher. These are also people who are having more difficulty accessing healthcare, whether that’s testing or treatment or prevention. In fact, NPR just had a poll come out in collaboration with Robert Wood Johnson Foundation and Harvard that looked at healthcare access among communities of color, and that remains a huge challenge. And then you also have whether gay sex is stigmatized in a particular population. And so the more stigmatized it is, the more likely those men may have other partners, because that is what’s socially acceptable. And that does create additional risk factors for women of color, because it is so stigmatized, gay sex is so stigmatized in that population of people of color.

Kimberly Adams: Right, this concept of people living on the down low, men who might have gay sex partners, but are also married or also have female partners, that they’re not disclosing that as well. You know, I remember this research that came out a little while back about COVID-19, that when people heard that it predominantly was killing people in communities of color and lower income people, that in many cases, that made some people less likely to take preventative measures. And I wonder if there’s a concern here, that by talking about the fact that this is predominantly affecting, at least right now, this community, that it’s going to decrease people’s willingness to be careful.

Celine Gounder: I think that is absolutely the case. And when I think about some of the other populations that are at risk, I’m not as concerned about monkeypox becoming entrenched in those communities, but I think they are at risk. So take college students, those are dense sexual networks, social sexual networks. Just like you see with gay men, you see college students having multiple partners, some of them at the same – you know, around the same time. And that is really the behavior that puts you at risk for monkeypox. And so you only need the introduction into a college campus a few cases for that to start to spread, if you’re not on top of it. And so I think it’s really important that we be educating colleges, universities, the students, the staff, about the risk, so that they can contain it, they can prevent that kind of spread from happening.

Meghan McCarty Carino: Right now, the government has declared a public health emergency here. I mean, what exactly does that do? What kind of resources does that open up? What kind… you know, how is this address the problem?

Celine Gounder: Well, it certainly creates more flexibility in terms of how public health funding is spent, how it can be reallocated, taken out of silos and reapplied to this. So for example, if there’s funding, you know, for COVID that hasn’t been spent, can you reallocate that for monkeypox, but it also has other implications. So for example, the FDA, the COVID vaccines, initially, were under these emergency use authorizations and then eventually fully approved. But the E-way that emergency use authorization was a function of the public health emergency that made that possible. So I think you’re going to see very shortly similar kinds of authorizations coming through, whether it’s for vaccines or tests for monkeypox.

Kimberly Adams: Are we equipped? I mean, is our public health system equipped to handle two outbreaks? Two significant outbreaks? Obviously, COVID is much more widespread than monkeypox, but are we ready for it?

Celine Gounder: Sadly, no.

Meghan McCarty Carino: That’s not the answer we were looking for.

Celine Gounder: Yeah, I mean, honestly, we’re coming out, we’re emerging from the pandemic weaker than ever. And my colleagues at Kaiser Health News in this series called Underfunded and Under Threat, have looked at what’s happened to public health departments throughout the pandemic. And they have lost a lot of staff, people who were fired, who quit, who retired and were not replaced. And so you’ve lost a lot of institutional memory expertise, just playing boots on the ground. And so you have that problem. People are also just burned out, morale is really low. And all of those weaknesses that were there before the pandemic, whether it’s, you know, having to fax your data, having laboratory systems that are still not able to scale up the way you might want them as quickly to do so. None of that has really been fixed. And so those same weaknesses are still there.

Meghan McCarty Carino: So there are a lot of weaknesses in the public health system. And are there lessons learned from COVID that are being applied that you see? Are there, you know, things that have continued to be neglected? And are there lessons that maybe were mis-learned from COVID that you see playing out?

Celine Gounder: Yeah, it’s funny, I’m getting this question a lot. Have we learned the lessons of COVID? What were the lessons from COVID? Are we going to do better? I think the question is, who has learned the questions from COVID? Who needed to learn them? And, honestly, public health officials, they knew what the problems were. Even before COVID, they knew what the weaknesses of the system were. Clinicians also had a pretty good awareness. But who are the people that can actually change those problems? A lot of it comes down to funding. And funding is allocated by Congress, by legislators, they’re the ones that have the power of the purse. You have regulatory powers, public health powers. Public health departments don’t claim those powers or set the rules, someone else delegates those powers to them. And again, that’s generally elected officials. And then you have the public. Is the public calling up those elected officials saying, you know what, public health is important to me? Are they calling up those, those elected officials in the same way that they might say, inflation is out of control, or schools are closed, this is a major problem for my kids? They’re not. And as long as you have elected officials, legislators, who have themselves not learn the lessons of COVID in terms of building a public health, and as long as you have a public that is not clamoring for building up public health, I don’t think the lessons have been learned, and I don’t think you’re gonna see true improvement. So then, as far as brass tacks, like, what, what now for people? Like what can we do? Like I was in the store the other day trying on a dress, and I was like, oh, wait a minute. If monkey pox is transmissible on surfaces? Is this a way that I could potentially get monkey pox trying on clothes that other people have tried on? And I remember early in COVID, like when we didn’t know how it spread, everyone was like washing their mail. And I don’t feel like – while I don’t want the panic of that moment, I just still really don’t know, what are people supposed to do at this point to help contain it? So I wouldn’t worry too much about trying on clothes at the clothing store. In general, if you have skin lesions, most people probably wouldn’t go clothes shopping and having their blisters leaking out on clothing. And in particular, the lesions that are really infectious, that are really spreading the disease right now, are these lesions in more intimate areas. So the genitalia, the anus, and that would mean you’re trying underwear or bathing suits without something on underneath. That’s not really how stores let you try on clothing. And you’re only trying these things on for a very brief period of time. I think we’re more concerned about the towel you might use on those intimate parts of the body, and something that you’re using daily, or your bedsheets that you’re spending the night in, or clothing that you’ve worn all day. Something you’ve just worn briefly is much lower risk. Let’s talk about vaccines. There’s been, you know, a lot of talk about ring vaccination, whether vaccines are available enough. Obviously, this is a different situation than COVID. We have existing vaccines that can prevent the smallpox, but where are we with the supply, with the availability, with access to them? So there are multiple vaccines that are effective in preventing monkeypox. The one we’re most focused on right now is the JYNNEOS vaccine. And that’s because it has the best safety profile including among people who are immunocompromised, people who have skin conditions like atopic dermatitis, or eczema. And so that’s the one that is currently being given to high risk persons. But we don’t have enough. And so there’s a lot of debate right now about how can we stretch the supply? Can we administer it in different ways that would allow you to use a smaller dose? Can we stretch out the interval between the first and second dose and so on? That’s all under discussion. You mentioned ring vaccination. So that’s something that dates back to the smallpox days. There’s a big difference here though, is that smallpox – basically everybody who had smallpox, you could see it, they had the lesions, everybody was symptomatic. With monkey pox, it looks like some people may not be symptomatic. And there are definitely cases going under the radar. So if you’re not able to identify every case and vaccinate around it, you’re not able to do that ring vaccination.

Kimberly Adams: Is it? I guess I’m wondering, is this the new normal, where we’re sort of dealing with more than one national health crisis so close together? Overlapping? Are we just going to be in the era of pandemics and always sort of playing Whack a Mole with one disease or another moving forward?

Celine Gounder: Well, we see a very clear trend over the last century that as you’ve seen global warming, climate change, you see the rate at which infectious diseases emerge to be speeding up. You see more and more infectious diseases emerge. And so just over the last few years, we’ve had HIV, you have SARS, you have MERS, you have Chikungunya, you have Zika, you have Ebola, you have – you know, the number of infectious diseases where you’ve had outbreaks has been increasing. And why is that? Well, I mentioned climate change, but you also have other factors. So some of this is globalization. It’s just easier to get from one part of the world to another. You have trends like deforestation, and people encroaching more on wild habitats, animal habitats. And so these kinds of forces are leading to more and more infectious diseases emerging. And so yes, I do think that’s going to be more and more the new normal.

Kimberly Adams: Okay, not a normal I love, but I guess this is where we are. Dr. Celine Gounder. Thank you so much. She’s with p–excuse me, a infectious disease epidemiologist and editor at large for public health at Kaiser Health News. Thank you so much.

Celine Gounder: My pleasure.

Kimberly Adams: Okay, well, I feel better about the trying on clothes and stores things. That was definitely like a little panic moment for me. But I don’t know, I get so concerned the way that I hear this narrative developing, like I get that it’s concentrated in the community of men having sex with men at the moment. But I just, I’m so concerned that that’s going to make people dismissive of it, you know, on a larger scale. And I just, like, I want folks to do better.

Meghan McCarty Carino: Yeah, no, it’s a really tough call. Because I also think the opposite of that, of raising the alarm to a level that – that can also make people tune out. You know, when they feel like, well, this is alarmist and Doomer scare-mongering and that kind of thing, I think can also make people tune out. And I think a big issue that public health has been grappling with over the last several years is how to message to the public in a way that gets information to the people who need it, that is, you know, that is fact based, and maybe doesn’t necessarily try to anticipate all of the different ways that people could interpret. I mean, I feel like there’s been a lot of kind of trying to anticipate, you know, if we say that you need a mask, will that caused a run-out on masks? You know, just trying to anticipate psychologically how facts are going to affect the public’s interpretation of risks and what they will do, when maybe just putting all the facts out there is kind of what we need at this point. But it is a really, it’s a really delicate and complex situation. And I certainly do not envy those that are better in that position of trying to message this.

Kimberly Adams: Yeah, of trying to get out information without underselling it and also not being an alarmist. Um, well, let us know what you think. Do you have other questions about monkeypox? I’m sure we can probably go back and ask Dr. Gounder later on, but tell us. Our number is 508-827-6278 also known as 508-U-B-SMART. Or you can send us a voice memo at makemesmart@marketplace.org. And we will be right back. Okay, it is time for the news fix. Meghan, why don’t you go first?

Meghan McCarty Carino: Okay. So, this morning, the Bureau of Labor Statistics, put out the quarterly productivity numbers. And, you know, I cover workplace culture here at marketplace, I feel like I talk a lot about productivity in sort of the more business, you know, sort of the more like, individual worker oriented way. Of like, oh, you know, are you more productive when you’re working from home or not? That’s not what we’re talking about here. We’re sort of talking about how much the economy produced per hour worked. And that figure fell – 4.6% last quarter, after it fell the quarter before, 7.4%. And those two quarters combined, marked the weakest back-to-back productivity readings in the data, since that data has been collected back to 1947, which is a little bit concerning. Of course, you know, I think a lot of people think productivity like, oh, that’s just to enrich the bosses or something. I mean, at a very macro level, this matters, because productivity, and sort of how much it costs to produce a thing, you know, the unit labor cost, that has a very big effect on inflation. And inflation is having a very big effect on everyone right now, and will have a very big effect on interest rates in the future coming.

Kimberly Adams: That might need a little bit more … in terms of productivity, having that tie in to inflation. So if productivity is lower, meaning it takes more time to produce a widget, you know, somebody is paying staff more money for those hours worked to produce the same number of widgets. And that increases scarcity, because it takes longer to produce said widgets and therefore pushing up the prices. And so that decline in productivity feeds into inflation in that way. And I’m curious about these numbers, because for years and years, everyone’s been like, saying, oh, you know, mechanization is going to just keep us on the upward trajectory of – mechanization and automation are going to keep us on the upward trajectory of productivity. And I’ll be really interested to hear how economists unpack this decline. Because, you know, we lost a chunk of the labor force to the pandemic, and a lot of people still can’t go back to work because they’re dealing with long COVID or lack of child care, or, or some other thing related to the pandemic, or people just burning out, and therefore their productivity is dropping. Like this is all really interesting.

Meghan McCarty Carino: Yeah, sort of, on longer timescales, this has been a bit of a mystery, that productivity, you know, before the pandemic, productivity gains were not as strong as economists had predicted they would be with all of the advances in technology that we have happening so quickly, advances in artificial intelligence and computing, which generally was thought that’s going to accelerate productivity gains, but they had not really been materializing in the way that had been suspected early in the pandemic. We had this kind of jump in productivity, because so many people got sucked out of the labor force, businesses were having to do more with less. And so that meant productivity sort of, sort of artificially went up. And so part of this may be a little bit of a rebalancing happening, but it’s definitely, you know, it’s definitely concerned, I’m sure, it’ll be concerning the Fed as they continue to try to manage inflation with raising interest rates in ways that could then bring on a recession. And, you know, because when labor costs are going up, and productivity is going up in tandem with it, then businesses don’t have to raise prices in order to cover those increases in labor costs. So what you always want to see is when labor costs are going up, productivity also going up, but this, this definitely puts more pressure on the economy, puts more pressure on the Fed to tighten monetary policy even more. So. That’s where we’re at.

Kimberly Adams: And I’m gonna do mine pretty quickly, because I want to get to the mailbag. But today, President Biden signed the bipartisan – I don’t want to say that, because it actually exists sometimes – the Chips and Science Act, which is this big bill that’s trying to improve US competitiveness against China by moving more chip production domestically. And in line with this announcement, several chipmakers announced that they are going to be investing here in the US. The White House said and I’m reading from CNBC’s coverage of this now, the White House said that multiple companies have announced more than $44 billion in new semiconductor manufacturing investments. This is another one of those, you know, wins for the White House and the Democrats at this point, after a long streak of not a lot getting done. But this has the potential to create a ton of jobs, ease some of those supply chain woes that we have. But it’s going to take a while for these computer chips to be coming out of American factory and for this production to get online. But it does mark a pretty significant shift in how the supply chains are going to work. And there’s a lot of optimism throughout industry and on both sides of the aisle on this one.

Meghan McCarty Carino: Yeah, this has been kind of a novel week of doing a legislative win… in Washington. All right, I guess that’s it for the news fix. So let’s move on to the mailbag.

Kimberly Adams: Okay, first, we have a voice memo from a listener, who’s making some big decisions in the wake of the Supreme Court decision overturning Roe vs. Wade.

Rebecca: Hi, Kai and Kimberly. This is Rebecca from Austin. My husband and I are tech workers. We met in New York City, but then moved to the suburbs of Austin after our daughter was born, because that’s where I grew up. But after Texas passed its restrictive abortion law. I no longer feel safe living here. So we’re moving to Seattle. We are so blessed that we have jobs where we can work anywhere. But I am so sad to leave behind this beautiful life that we’ve been building for our family. I’m so sad that I can no longer be proud to be from Texas.  Wow.

Kimberly Adams: That, that’s really rough. It reminds me of some of the coverage that Amy Scott did about the families that felt like they had to leave Texas because of some of the antitrust legislation. And, you know, we’ve talked for years about the pending climate migration because of climate change. But now, we’re facing this migration because of politics. And I imagine a lot of people are wrestling with decisions like that. And it’s not easy. Kids, you know, determining where they’re going to go to college, people deciding where they’re going to make their lives and raise their kids. All of it. It matters. Indiana just passed its anti abortion law. And several of the big companies there said that they’re not going to be doing any further expansion in the state.

Meghan McCarty Carino: I saw Eli Lilly.

Kimberly Adams: I think it was Eli Lilly. Yeah, they said that any future expansion was going to have to be outside of the state. There are economic consequences to it as well, as clearly as we heard emotional one.

Meghan McCarty Carino: Right, absolutely. Yeah. I mean, over the last several years, I’ve been reporting on the migration to many of these states, Texas being one of the biggest ones in terms of high skilled workers, workers, remote workers moving to more affordable places, like Texas, like many states in, you know, kind of Sunbelt, and these are many of the states that have taken hard right turns in terms of these kinds of policies. And now to hear from folks like… it’s not just about work and cost of living, that there are other things that are coming to bear here that have a really big effect. For people.

Kimberly Adams: That’ll be an interesting story to follow on, you know, for us to do, I guess, because we’re the ones covering it. But, you know, we had so many people migrating into those Sunbelt states, as you said for lower cost of living, a bigger house for less money, and a lot of people coming from the more liberal or coastal cities and communities for the cheap land and the space and the schools and whatever. And now those same people with their, you know, air quote liberal values, are probably deciding to pack up and go. Like Kimberly said, it’s a privilege.

Meghan McCarty Carino: Absolutely. Yeah. Alright, so we talked recently about the helium shortage and Leslie in South Carolina sent us this.

Leslie: Hi Make Me Smart team. A while back, my family stopped using mylar and latex balloons, which are for all practical purposes, not recyclable, and they hang around in landfills for years, if not forever. And we switched to reusable Japanese paper balls and paper lanterns, we suspend the lanterns for that really cool, big floating Balloon effect. And use painted dowels to hold up the smaller paper balls. And when the party’s over, everything folds flat and goes into a box until the next birthday or graduation or whatever. So it seems like a win-win-win. Low waste, less inflation spending for Kai, and the helium can go where it’s actually needed.

Meghan McCarty Carino: I gotta see a photo.

Kimberly Adams: I love it. Actually, I have some of those lanterns that I – the round paper ball that I put up for my cherry blossom party. They fold down and they go in the storage unit. And then I pop them back out every year. And I have some stars like that that I put up around Christmas.

Meghan McCarty Carino: Right? I got some from Ikea, the little cardboard floating stars. I put those up for Christmas. Yeah, it is a great idea. And I mean, I just love that it’s reusable. So just. For sure. Bringing it out for every holiday.

Kimberly Adams: All right, before we go, we’re going to leave you with this week’s answer to the make me smart question, which is what is something you thought you knew, but later found out you were wrong about?

Chloe: This is Chloe calling from London, England. The thing that I thought I knew that I later found out that I was wrong about was when you had to buy your airline tickets for your vacation. My family always booked their airline tickets as soon as they went on sale, so about a year in advance. And I just assumed that if you didn’t buy your tickets immediately, you would not be able to get tickets at all to go anywhere, they would sell out. But as I got older, and I moved overseas, and I started booking my own vacations, it turns out that I could book an airline ticket to go anywhere tomorrow. It might be a little bit more expensive, but it also might be cheaper. So it’s something that has definitely changed how I booked my holidays, and how soon in advance I planned them. Either way, I want to say hi to both my parents who are in Wisconsin, and I told my mom to call in but we will see if she actually does. Thanks. Bye.

Meghan McCarty Carino: I mean, if you’re Chloe’s mum, or even if you’re not…

Kimberly Adams: I don’t know if that actually counts as being wrong about, because like it could be that when Chloe was younger, there were fewer airline routes and they would sell out and you know, there may not have been as much…

Meghan McCarty Carino: I feel like the wisdom of when to buy your airline ticket is constantly changing and always incorrect.

Kimberly Adams: Yeah absolutely.

Meghan McCarty Carino: So I don’t know. remember there was like oh, you should always get it on a Tuesday or whatever.

Kimberly Adams: Oh yeah, I’ve heard that.

Meghan McCarty Carino: I don’t know. Yeah, I feel like it’s never right. Well, Chloe’s mom, please do give us a call. Or anyone else, you can send us your answers to the make me smart question via voice memo to our email at makemesmart@marketplace.org Or you can leave us an actual phone message at 508-827-6278, also known as 508-U-B-SMART.

Kimberly Adams: Make Me Smart is directed and produced by Marissa Cabrera. Our intern is Olivia Zhao. Ellen Rolfes writes our newsletter. Today’s program was engineered by Charlton Thorp, with mixing by Bekah Wineman. Ben Tolliday and Daniel Ramirez composed our lovely theme music.

Meghan McCarty Carino: The Senior Producer is Bridget Bodnar. Donna Tam is the Director of On Demand. And Francesca Levy – welcome! – is the Executive Director of Digital. And Marketplace’s Vice President and General Manager is Neil Scarborough.

Kimberly Adams: I just want to get more decorations.

Meghan McCarty Carino: I want to get plane tickets. That’s what I want.