WEBVTT - Ep 100 Monkeypox: Here we go again? 0:00:02.240 --> 0:00:06.600 Hey everyone, just a content morning here. The first hand 0:00:06.640 --> 0:00:10.160 account does describe the death of an infant, and so 0:00:10.480 --> 0:00:12.840 if you would like to fast forward past that part, 0:00:13.160 --> 0:00:15.600 we recommend jumping ahead about two minutes. 0:00:18.560 --> 0:00:20.920 The patient was a nine month old boy who became 0:00:20.960 --> 0:00:24.560 ill with fever on August twenty second, nineteen seventy, and 0:00:24.600 --> 0:00:27.920 two days later developed a rash. He was admitted to 0:00:27.960 --> 0:00:33.400 Basankusu Hospital on September one. On examination, it was recorded 0:00:33.440 --> 0:00:37.280 that the lesions were hemorrhagic, although they showed a centrifugal 0:00:37.400 --> 0:00:43.040 distribution typical of smallpox. Crusts were collected for laboratory examination. 0:00:43.880 --> 0:00:48.199 The rash lasted about two weeks. During the scabbing stage, 0:00:48.320 --> 0:00:52.880 the patient developed otitis and mastoiditis, as well as enlarged, 0:00:53.040 --> 0:00:58.880 painful cervical nodes, which were subsequently incized and drained. The 0:00:58.960 --> 0:01:02.320 patient recovered and was about to be discharged, but on 0:01:02.360 --> 0:01:06.600 October twenty third, he developed measles and died six days later. 0:01:07.280 --> 0:01:59.080 The child had never been vaccinated. That's a tough one, because. 0:01:59.360 --> 0:02:02.120 Yeah, yeah, that's horrible. Yeah. 0:02:02.560 --> 0:02:07.320 So that is a case description of the first known 0:02:07.520 --> 0:02:11.400 human case of monkey pox, and it is from a 0:02:11.520 --> 0:02:16.600 paper by Ladinige at all from nineteen seventy two titled 0:02:16.639 --> 0:02:19.720 a Human Infection Caused by monkey Pox virus in Boston, 0:02:19.800 --> 0:02:22.560 KUSU Territory, Democratic Republic of the Congo. 0:02:23.680 --> 0:02:29.280 Ooh yeah, yeah, yep. Hi, I'm erin Welsh and i'm 0:02:29.440 --> 0:02:30.800 erin Allman Updike. 0:02:30.680 --> 0:02:33.799 And this is this podcast will Kill You and. 0:02:33.720 --> 0:02:36.000 Today we're covering monkey pox. 0:02:36.600 --> 0:02:39.680 Long awaited, much requested, here it is. 0:02:40.639 --> 0:02:41.440 Yeah. 0:02:41.560 --> 0:02:45.480 Yeah, monkey pox has obviously been making a lot of 0:02:45.520 --> 0:02:48.160 headlines lately, so a lot of you have asked for 0:02:48.240 --> 0:02:49.240 us to do this episode. 0:02:50.200 --> 0:02:51.720 We're very excited to. 0:02:51.720 --> 0:02:54.639 Dig in and deliver this episode to you because this 0:02:54.680 --> 0:02:58.080 is a very interesting virus and it's spreading in a 0:02:58.080 --> 0:03:01.400 way that we have really never seen before, which is 0:03:01.840 --> 0:03:04.600 fascinating and also potentially kind. 0:03:04.480 --> 0:03:08.840 Of terrifying, absolutely kind of terrifying. Yeah, and we know 0:03:09.000 --> 0:03:14.760 that during the last and ongoing pandemic COVID, many of 0:03:14.800 --> 0:03:18.320 you came to really appreciate our Anatomy of a Pandemic 0:03:18.400 --> 0:03:20.880 mini series for updates. 0:03:20.360 --> 0:03:22.119 And information about. 0:03:21.800 --> 0:03:25.919 What was going on and how the science was constantly changing. 0:03:26.600 --> 0:03:29.040 So that's kind of what we wanted to do here. 0:03:29.320 --> 0:03:34.200 But not a mini series specifically, hopefully not hopefully not 0:03:34.280 --> 0:03:37.160 hopefully not, but we did want to give you background 0:03:37.280 --> 0:03:39.880 on what we knew about this virus going into the 0:03:39.920 --> 0:03:43.320 current outbreak and where things stand with monkey pox today 0:03:43.360 --> 0:03:44.080 as far as we know. 0:03:44.440 --> 0:03:47.440 Yeah, And of course, the fact that this is an 0:03:47.480 --> 0:03:51.600 ongoing outbreak makes it trickier to pack in all of 0:03:51.640 --> 0:03:55.000 the super up to date info in a more deep 0:03:55.120 --> 0:03:59.680 dive research podcast like ours, And we learned that difficulty 0:04:00.080 --> 0:04:03.920 with this episode all too well because we actually initially 0:04:03.920 --> 0:04:08.800 recorded this episode in early June, June ninth to be precise, yep. 0:04:09.160 --> 0:04:12.400 But then in the week and a half that it 0:04:12.440 --> 0:04:16.039 took to edit and put it all together, so so 0:04:16.279 --> 0:04:20.360 much changed, and we didn't want to put that out 0:04:20.440 --> 0:04:23.719 and leave you with more questions than answers. 0:04:24.080 --> 0:04:27.440 Yeah, So we decided to give ourselves a little bit 0:04:27.480 --> 0:04:30.000 of time to get caught back up with monkey pocks 0:04:30.040 --> 0:04:33.240 and then record the current event section as close to 0:04:33.320 --> 0:04:35.800 the release date as possible so that we're giving you 0:04:35.839 --> 0:04:37.720 the most up to date information that we can. 0:04:38.080 --> 0:04:40.760 But since this is a virus that we've known about 0:04:40.800 --> 0:04:44.520 for quite some time, much of the biology and history 0:04:44.560 --> 0:04:48.479 section hasn't changed from that first recording, and those parts 0:04:48.480 --> 0:04:52.080 of the episode come directly from that first recording on 0:04:52.160 --> 0:04:55.760 June ninth, while this intro that you're listening to right 0:04:55.800 --> 0:04:59.920 now now and the current event section is from July sixth, 0:05:00.000 --> 0:05:01.000 twenty two. 0:05:01.440 --> 0:05:04.039 Well, can we tell you Aaron's editing is just magic. 0:05:04.120 --> 0:05:05.200 I'm sure you'll never know. 0:05:06.640 --> 0:05:07.599 You probably will. 0:05:08.880 --> 0:05:12.240 But ultimately the purpose of this episode is to give 0:05:12.240 --> 0:05:15.520 you a solid background on monkey pos how we have 0:05:15.640 --> 0:05:18.479 known this virus to act in the past, the history 0:05:18.520 --> 0:05:21.800 of its identification, and what past outbreaks can tell us 0:05:21.800 --> 0:05:25.039 about this current one. And finally we'll bring you up 0:05:25.080 --> 0:05:28.000 to speed on how things have progressed with this current 0:05:28.040 --> 0:05:29.599 outbreak in twenty twenty two. 0:05:30.080 --> 0:05:32.560 And speaking of this current outbreak, one more thing that 0:05:32.600 --> 0:05:34.839 we wanted to bring up before we get started on 0:05:34.880 --> 0:05:39.960 this episode, and that is the naming of this virus. So, 0:05:40.120 --> 0:05:43.000 as this outbreak and the number of headlines about it 0:05:43.040 --> 0:05:47.039 has grown over the past many weeks, this increased attention 0:05:47.160 --> 0:05:50.920 has generated a lot of discussion over the potentially problematic 0:05:51.000 --> 0:05:55.000 naming of this virus and its two clades. For one thing, 0:05:55.680 --> 0:05:59.560 as we'll talk a lot about, monkey pox is a misnomer, 0:06:00.120 --> 0:06:03.320 and it's also against World Health Organization guidelines to name 0:06:03.360 --> 0:06:08.159 diseases after animals or people or jobs, or food or places, 0:06:08.920 --> 0:06:11.880 because it can lead to discrimination and stigma. 0:06:11.800 --> 0:06:14.719 Which brings us to the second prong of the bad 0:06:14.839 --> 0:06:19.200 naming of monkey pox, as we'll get into again later. 0:06:19.720 --> 0:06:20.760 This virus can. 0:06:20.640 --> 0:06:24.599 Be classified into two clades or strains or subtypes of 0:06:24.640 --> 0:06:29.040 the virus, which are currently called and have historically been called, 0:06:29.160 --> 0:06:32.400 the West African clade and the Central African or Congo 0:06:32.440 --> 0:06:36.560 Basin clade, which is where they were first identified. And 0:06:36.640 --> 0:06:39.679 of course, if you've listened to this podcast before, you'll 0:06:39.720 --> 0:06:42.560 know that naming a disease or virus or clade a 0:06:42.640 --> 0:06:46.120 virus after a place is also not a good practice. 0:06:46.640 --> 0:06:49.400 It can lead to discrimination and stigma. 0:06:49.440 --> 0:06:52.119 And today a lot of the discussion that's ongoing about 0:06:52.160 --> 0:06:55.000 the naming of monkey pox and its clades is not 0:06:55.200 --> 0:06:59.039 just like, hey, this isn't good names, but it's also like, hey, 0:06:59.160 --> 0:07:00.080 let's actually fit. 0:07:00.480 --> 0:07:02.120 And come up with some new names. 0:07:02.640 --> 0:07:07.359 So it's very likely that within the next weeks or months, 0:07:07.520 --> 0:07:10.280 I don't know, monkey pox and its clades will have 0:07:10.400 --> 0:07:14.800 completely different names than what we are using today. But 0:07:15.120 --> 0:07:18.200 that hasn't happened yet, and so to avoid confusion, in 0:07:18.240 --> 0:07:20.720 this episode, we'll be using the names that the virus 0:07:20.720 --> 0:07:23.240 and the disease have historically gone by, which is monkey 0:07:23.240 --> 0:07:27.440 pox and the historic clad names. All right, Yeah, with 0:07:27.560 --> 0:07:32.000 all that behind us, I do believe it's quarantin any time. 0:07:32.160 --> 0:07:36.920 It's quarantine anytime. What are we drinking this week? 0:07:37.280 --> 0:07:39.960 We're drinking more Pox on the Rock. 0:07:41.080 --> 0:07:47.560 So all the way back in twenty seventeen, twenty seventy unbelievable, 0:07:48.000 --> 0:07:52.680 Episode three was on smallpox and it was our very 0:07:52.720 --> 0:07:58.560 third quarantin ye, and we call very third and we 0:07:58.760 --> 0:08:02.760 called it on the Rocks, and you know what, we 0:08:02.880 --> 0:08:07.240 just figured we'll stick with that. It's a classic more 0:08:07.240 --> 0:08:10.320 pox on the rocks, even though we have done other 0:08:10.640 --> 0:08:11.840 pox viruses, but. 0:08:11.880 --> 0:08:15.080 Yeah, but not like a pox named pox virus. 0:08:15.120 --> 0:08:16.240 That's you know, that's true. 0:08:16.280 --> 0:08:17.000 Yeah. 0:08:17.080 --> 0:08:20.360 I also have to say that the smallpox episode was 0:08:20.400 --> 0:08:23.360 one of my favorites of all time, and I still 0:08:23.360 --> 0:08:25.480 to this day think that Smallpox on the Rocks is 0:08:25.520 --> 0:08:27.920 one of our best quarantining names. So I love that 0:08:27.960 --> 0:08:29.560 we get to just sort of bring it back to 0:08:29.640 --> 0:08:30.200 life here. 0:08:30.960 --> 0:08:33.920 More Pox on the Rocks, and basically more Pox on 0:08:33.960 --> 0:08:38.079 the Rocks is take your favorite liquor of choice or 0:08:38.400 --> 0:08:42.400 liquor substitute of choice there's a lot of non alcoholic spirits, 0:08:42.400 --> 0:08:46.040 which is super cool. Pour it over some rocks, maybe 0:08:46.080 --> 0:08:48.679 add a little bit of citrus or a couple dashes 0:08:48.720 --> 0:08:52.520 of your favorite bitters, and it's it's really up to 0:08:52.600 --> 0:08:53.280 you what. 0:08:53.240 --> 0:08:54.640 You want to make it. 0:08:54.320 --> 0:08:57.000 Clink it in your glass and. 0:08:57.160 --> 0:09:00.840 We will post the full recipe for more poks on 0:09:00.880 --> 0:09:05.440 the rocks, the most complicated of recipes, as well as 0:09:05.480 --> 0:09:08.760 the non alcoholic placy burrita on our website This podcast 0:09:08.840 --> 0:09:11.000 will Kill You dot Com, as well as on all 0:09:11.080 --> 0:09:12.440 of our social media channels. 0:09:12.880 --> 0:09:15.880 On our website, This podcast will Kill You dot Com, 0:09:15.920 --> 0:09:18.880 you can find everything that you'd hope to find on 0:09:19.480 --> 0:09:22.360 a podcast website. You can find merch you can find 0:09:22.400 --> 0:09:25.679 our Patreon, you can find our Goodreads list, you can 0:09:25.679 --> 0:09:29.120 find a link to our music from Bloodmobile and all 0:09:29.160 --> 0:09:31.760 of the sources from all of our episodes. You can 0:09:31.760 --> 0:09:34.440 find transcripts. There is just so much there. 0:09:34.760 --> 0:09:36.640 There's no end to what you can find. 0:09:36.880 --> 0:09:41.200 Uh huh Okay, So, with this long intro out of 0:09:41.240 --> 0:09:43.360 the way, I feel like there's no possible way that 0:09:43.400 --> 0:09:44.760 there's more business to cover. 0:09:44.920 --> 0:09:46.400 So let's get started. 0:09:46.920 --> 0:09:49.280 Let's take a quick break and then get into the 0:09:49.280 --> 0:10:21.960 biology of this virus, monkey pox and smallpox and cowpox 0:10:22.600 --> 0:10:28.480 and many other animal named pox viruses are as we 0:10:28.600 --> 0:10:30.280 learned in our smallpox episode. 0:10:30.600 --> 0:10:33.000 In fact, pox viruses. 0:10:33.120 --> 0:10:35.440 Stands to reason right well. 0:10:35.320 --> 0:10:36.640 If they aren't tall though. 0:10:37.720 --> 0:10:40.240 They belong to a family of viruses called the pox 0:10:40.360 --> 0:10:46.040 Veri dae, specifically in the orthopox virus genus. So orthopox 0:10:46.120 --> 0:10:51.120 viruses and all pox viruses in general are pretty large viruses. 0:10:51.760 --> 0:10:57.320 They're generally shaped like bricks or like big chunky oval shapes. 0:10:58.280 --> 0:11:01.040 They have an envelope that surrounds them, and they have 0:11:01.240 --> 0:11:08.280 this very large, linear, double stranded DNA genome. And we 0:11:08.559 --> 0:11:13.479 on this podcast have covered the most famous pox virus, smallpox. 0:11:14.160 --> 0:11:18.240 We have way long time ago, now, huh. 0:11:18.480 --> 0:11:23.000 That virus is known as variola virus, and thanks to 0:11:23.200 --> 0:11:26.960 vaccination campaigns as well as the fact that that was 0:11:27.000 --> 0:11:33.439 a human specific pox virus, smallpox was eradicated in was 0:11:33.480 --> 0:11:35.840 it nineteen eighty that it was declared eradicated? 0:11:36.040 --> 0:11:36.280 Yep? 0:11:36.720 --> 0:11:37.960 Yeah. 0:11:38.000 --> 0:11:41.080 And then you may also remember we covered another pox virus, 0:11:41.600 --> 0:11:45.600 mix oma virus, although that is in a different genus, 0:11:45.640 --> 0:11:49.040 the late pory pox virus genus. 0:11:49.240 --> 0:11:52.240 I got a kick out of something about maxomma. 0:11:51.920 --> 0:11:52.760 Virus tell me. 0:11:52.920 --> 0:11:54.480 So I kept stumbling. 0:11:54.120 --> 0:11:58.280 Across these papers on monkey pox where the name Frank 0:11:58.320 --> 0:12:01.760 Fenner was either an AWF or mentioned in a reference 0:12:01.880 --> 0:12:04.040 to like another paper, and I was like, that name 0:12:04.120 --> 0:12:07.360 sounds so familiar, and he was like one of the 0:12:07.400 --> 0:12:12.600 big researchers who studied mixcellovirus and wrote the book, the 0:12:12.640 --> 0:12:15.320 textbook that I read for that episode, And so I 0:12:15.440 --> 0:12:17.360 just got a really fun kick out of that. 0:12:17.600 --> 0:12:20.079 I love that when episodes intertwine. 0:12:20.320 --> 0:12:23.439 Yeah, exactly, excellent. 0:12:24.920 --> 0:12:29.200 So the majority of poxviruses, especially today, I'm really just 0:12:29.240 --> 0:12:33.240 focusing on this orthopox virus genus since we're talking about 0:12:33.559 --> 0:12:34.240 monkey pox. 0:12:35.120 --> 0:12:35.679 These are not. 0:12:35.800 --> 0:12:41.360 Human specific viruses. So, like I mentioned some of them 0:12:41.360 --> 0:12:47.640 at the top, there's smallpox, camel pox, cowpox, the vaccinia 0:12:47.760 --> 0:12:52.559 virus which is what was used to make the smallpox vaccine, 0:12:52.840 --> 0:12:57.079 which includes various strains like buffalo pox and rabbit pox, 0:12:58.240 --> 0:13:00.240 and then the one we're going to focus on today 0:13:00.360 --> 0:13:03.000 that is the subject of all the media forevor currently 0:13:03.679 --> 0:13:07.720 monkey pocks. But all of these various animal based names 0:13:07.960 --> 0:13:12.640 are slight misnomers because they might lead you to believe 0:13:12.720 --> 0:13:16.080 that they only infect that particular animal. 0:13:16.440 --> 0:13:18.880 Or that they come from that particular animal. 0:13:18.720 --> 0:13:23.440 Exactly, but that's not the case. But in the case 0:13:23.440 --> 0:13:26.920 of monkey pocks, the name is a real misnomer because 0:13:26.960 --> 0:13:31.160 while it was first identified from monkeys, evidence suggests that 0:13:31.160 --> 0:13:34.680 it's rodents and not monkeys, that are the primary natural 0:13:34.720 --> 0:13:40.480 reservoir for this particular virus. And just like many of 0:13:40.480 --> 0:13:44.079 the other orthopox viruses, monkey pocks can have a relatively 0:13:44.160 --> 0:13:48.400 broad host range. And what these broad host ranges mean 0:13:48.800 --> 0:13:53.040 is that sometimes these various viruses can spill over from 0:13:53.080 --> 0:13:57.520 their animal hosts into us humans, and that is what 0:13:57.720 --> 0:14:00.400 listeners of this podcast will be very famili You're with 0:14:00.559 --> 0:14:04.079 is often called a zoonotic pathogen. These are transmitted from 0:14:04.120 --> 0:14:10.160 animals to humans via spillover events, and anyone who listened 0:14:10.200 --> 0:14:14.960 to our smallpox episode one hundred million years ago remembers 0:14:15.000 --> 0:14:16.000 that this is a thing. 0:14:15.920 --> 0:14:17.680 Because of cowpox. 0:14:18.520 --> 0:14:21.160 Cowpox is what helped serve as one of the first 0:14:21.200 --> 0:14:25.560 examples of a type of vaccination that was it. Edward 0:14:25.640 --> 0:14:28.720 Jenner Aaron, uh huh, I feel so proud that I 0:14:28.720 --> 0:14:35.160 remembered that inoculated people with cowpox to protect them against smallpox. 0:14:36.560 --> 0:14:38.760 And this example. 0:14:38.400 --> 0:14:41.480 Illustrates a couple of really key characteristics that I wanted 0:14:41.480 --> 0:14:45.040 to highlight upfront about orthopox viruses because they'll be important 0:14:45.120 --> 0:14:48.760 throughout this episode, and that is a that these pox 0:14:48.840 --> 0:14:54.080 viruses can infect a wide range of potential hosts depending 0:14:54.120 --> 0:14:58.080 on the virus, and that infection with one pox virus 0:14:58.520 --> 0:15:02.680 often confers at least some degree of cross protection against 0:15:02.760 --> 0:15:04.360 other virus species. 0:15:05.360 --> 0:15:07.960 Crucial crucial information. 0:15:07.560 --> 0:15:11.720 Very very crucial, And so when it comes to monkey 0:15:11.760 --> 0:15:14.880 pos let's focus on that for now, this is not 0:15:15.120 --> 0:15:19.720 a completely new virus. We've known since nineteen seventy that 0:15:19.800 --> 0:15:22.760 it has the potential to both be a zoonotic illness 0:15:23.120 --> 0:15:26.600 as well as occasionally cause small outbreaks that do include 0:15:26.600 --> 0:15:33.120 person to person transmission. But today, what's happening currently in 0:15:33.200 --> 0:15:38.400 twenty twenty two is by far the most person to 0:15:38.480 --> 0:15:41.360 person transmission that we've seen, and we'll get into that 0:15:41.760 --> 0:15:44.200 later on, but I just kind of wanted to set 0:15:44.240 --> 0:15:47.960 the stage that we've known about monkey pox and its 0:15:48.000 --> 0:15:53.640 ability to infect humans for quite some time and in 0:15:53.680 --> 0:15:57.840 the past, like prior to the nineteen eighties, because a 0:15:57.880 --> 0:16:03.560 lot of the human population was vaccinated against smallpox, humans 0:16:03.560 --> 0:16:08.720 possessed some degree of protection against monkey pocks, and today 0:16:09.200 --> 0:16:11.720 that's really, for the most part no longer the case 0:16:12.080 --> 0:16:15.479 because the vast majority of people are not being vaccinated 0:16:15.560 --> 0:16:22.440 against smallpox anymore since it's been eradicated. But let's get 0:16:22.440 --> 0:16:27.120 into monkey pocks, shall we. Yeah, So, the disease that 0:16:27.200 --> 0:16:30.800 monkey pox causes is actually similar in a lot of 0:16:30.840 --> 0:16:37.520 ways to smallpox, although it is substantially less virulent. So historically, 0:16:37.600 --> 0:16:41.080 the way that we've understood the transmission of monkey pox 0:16:41.160 --> 0:16:44.840 is actually very similar to the transmission of smallpox, and 0:16:44.880 --> 0:16:48.640 that is by close contact with either the rash itself, 0:16:49.200 --> 0:16:52.400 which we'll talk about in a minute, or by respiratory 0:16:52.480 --> 0:16:57.360 droplets that are full of virus, and potentially by very 0:16:57.400 --> 0:17:00.440 short range aerosols, because this is a virus that can 0:17:00.520 --> 0:17:03.440 persist in the environment for a little bit longer than 0:17:03.480 --> 0:17:06.520 other viruses. And I meant to try and find an 0:17:06.560 --> 0:17:09.240 exact number for you, Erin, because I thought you might ask. 0:17:09.960 --> 0:17:10.520 I don't have a. 0:17:10.600 --> 0:17:15.200 Number, Okay, But it's more environmentally stable, for example, than 0:17:15.280 --> 0:17:20.880 like a coronavirus. Interesting, and like smallpox, monkeypox also has 0:17:21.000 --> 0:17:22.360 a potentially rather. 0:17:22.240 --> 0:17:23.720 Long incubation period. 0:17:24.280 --> 0:17:28.040 Yeah, it's usually in the range of ten to fourteen days, 0:17:28.440 --> 0:17:30.040 but it can be as short as a week. It 0:17:30.040 --> 0:17:33.240 could be even longer than a couple of weeks. And 0:17:33.520 --> 0:17:37.000 in general, as far as we understand, people don't become 0:17:37.119 --> 0:17:40.760 infectious until the development of the rash. 0:17:41.040 --> 0:17:44.560 Oh okay, yeah, so let's talk about what the symptoms 0:17:44.560 --> 0:17:46.040 look like, shall we? Mm hmm. 0:17:46.680 --> 0:17:50.000 Most people who get infected with monkey pos will start 0:17:50.080 --> 0:17:55.640 off feeling cruddy. They'll get fever, they'll have malaise, they'll 0:17:55.640 --> 0:17:58.600 start to feel very sick for at least one or 0:17:58.640 --> 0:18:03.680 two days before the development of this rash. Also, very commonly, 0:18:03.800 --> 0:18:07.920 people might also notice swelling in the lymph nodes, maybe 0:18:08.080 --> 0:18:11.080 the lymph nodes under your chin, maybe behind your ears, 0:18:11.440 --> 0:18:16.160 maybe in your groin, maybe in your armpits. This lymphatenopathy, 0:18:16.240 --> 0:18:20.280 as it's called, could be anywhere. And then after one 0:18:20.359 --> 0:18:24.840 or two days of this generalized feeling really sick is 0:18:24.880 --> 0:18:29.399 when the rash itself typically begins. And the rash of 0:18:29.440 --> 0:18:33.520 monkey pocks looks a lot like the rash of smallpox, 0:18:33.720 --> 0:18:39.440 and it follows a very classic series. It begins as 0:18:39.520 --> 0:18:45.640 these small two to five millimeters flat to maybe mildly raised, 0:18:45.640 --> 0:18:49.920 little bumps. They're called macules and papules. 0:18:50.080 --> 0:18:52.480 That's the beginning, okay. 0:18:52.280 --> 0:18:55.399 And it tends to start in what's called as centrifugal 0:18:55.760 --> 0:18:58.320 and I'm sorry, I feel like I'm pronouncing that word wrong. 0:18:58.840 --> 0:19:02.679 Rash anyway, This means that the rash tends to start 0:19:02.920 --> 0:19:06.560 on the extremities, especially the head, and then the arms 0:19:06.560 --> 0:19:09.119 and the legs, and then it spreads inwards. 0:19:10.000 --> 0:19:10.200 Huh. 0:19:10.480 --> 0:19:13.479 This is the same way that smallpox tends to start. 0:19:13.880 --> 0:19:16.879 It's more concentrated on the head, the extremities, and then 0:19:16.920 --> 0:19:20.520 it spreads to the rest of the body inwards. And 0:19:20.560 --> 0:19:24.440 that's in contrast to what are sometimes called centripetal rashes, 0:19:24.800 --> 0:19:28.280 which start primarily on the trunk and then spread outwards. 0:19:28.840 --> 0:19:31.760 A great example of this is something like chicken pox. 0:19:33.320 --> 0:19:34.520 That's so interesting. 0:19:35.600 --> 0:19:38.080 There's a lot of different ways that rashes spread. You 0:19:38.160 --> 0:19:41.000 might remember when we talked about measles and rubella. They 0:19:41.040 --> 0:19:44.359 start on the head and then spread downward. That's called 0:19:44.520 --> 0:19:50.280 cephalocadad spread. Rosola is another virus that tends to start 0:19:50.320 --> 0:19:52.560 on the neck and trunk and then spread up to 0:19:52.680 --> 0:19:55.320 the face and out to the extremities. But like not 0:19:55.440 --> 0:19:58.800 in exactly the same way as something like chicken pox would. 0:19:59.440 --> 0:20:00.800 There's a lot it's interesting. 0:20:01.200 --> 0:20:03.800 Is it just different tissue tropisms or what. 0:20:04.240 --> 0:20:05.040 That's a great question. 0:20:05.160 --> 0:20:10.960 I don't actually know, Okay, yeah, or if it's just yeah, 0:20:11.000 --> 0:20:12.720 I don't know. This is a really good question. That'll 0:20:12.800 --> 0:20:16.800 be a fun whole episode. It's just like rash distributionshes. 0:20:17.080 --> 0:20:17.880 I love that. 0:20:17.880 --> 0:20:18.440 That would be. 0:20:18.359 --> 0:20:22.520 Fun actually, So it spreads in that way. But then 0:20:23.359 --> 0:20:27.040 this rash does progress through very similar phases as the 0:20:27.040 --> 0:20:30.760 smallpox rash. So they start out as those flat or 0:20:30.800 --> 0:20:36.400 slightly raised maculo papules. Then they become even more raised 0:20:36.640 --> 0:20:40.760 and fill with fluid. These are known as vesicles. Then 0:20:40.800 --> 0:20:44.520 these vesicles will start to form into these puss filled, 0:20:45.040 --> 0:20:50.359 taut pustules, and then these pustules will crust over and 0:20:50.400 --> 0:20:53.760 then eventually slough off and often leave a scar behind. 0:20:55.400 --> 0:21:00.880 So this process from papule to vesicle to pushtule to scab, 0:21:01.480 --> 0:21:04.960 this is a long process. Just like with smallpox. It 0:21:05.080 --> 0:21:08.359 generally takes between fourteen to twenty one days, so two 0:21:08.359 --> 0:21:13.720 to three weeks. And what's interesting is that, unlike something 0:21:13.920 --> 0:21:17.200 like chicken pox, what tends to happen is that all 0:21:17.200 --> 0:21:23.080 of this rash progresses through those phases at the same time. Huh, 0:21:23.400 --> 0:21:26.280 So all of your rash is papules and then they 0:21:26.400 --> 0:21:31.040 all around the same time transformed to vesicles to pushtules, 0:21:31.080 --> 0:21:35.000 et cetera, whereas with chicken pox and other herpes viruses 0:21:35.040 --> 0:21:38.679 you often see vesicles in like different stages of healing, 0:21:38.760 --> 0:21:41.000 so you'll have some that are crusting, some that are vesicles, 0:21:41.040 --> 0:21:41.600 et cetera. 0:21:42.359 --> 0:21:46.800 Yeah, I'm really trying to resist just saying like why 0:21:46.840 --> 0:21:47.400 why how? 0:21:47.480 --> 0:21:47.880 Why? 0:21:47.880 --> 0:21:49.760 Why? Why? Yeah? 0:21:49.920 --> 0:21:54.000 Yeah, it's really good questions. I don't know, Aaron, It's 0:21:54.080 --> 0:21:58.399 really interesting, especially when it comes to the details of 0:21:58.440 --> 0:22:01.960 the virology of this virus and the path of physiology. 0:22:02.320 --> 0:22:07.159 I'll just warn you, we don't know much. We really don't, right, Yeah, 0:22:07.760 --> 0:22:10.520 But in contrast to smallpox, this is where we get 0:22:10.560 --> 0:22:13.760 to the good parts about monkey pox. We don't tend 0:22:13.760 --> 0:22:16.840 to see a lot of the more severe forms, especially 0:22:17.080 --> 0:22:21.240 if you remember listening through our smallpox episode and I 0:22:21.400 --> 0:22:25.359 read over it to remind myself how horrific smallpox is. 0:22:25.600 --> 0:22:29.280 Oh yeah, the most severe form, the heemorrhagic form that 0:22:29.320 --> 0:22:32.879 we describe in that episode, doesn't tend to happen. That 0:22:33.040 --> 0:22:35.560 hasn't really been seen to happen with monkey pox. 0:22:35.280 --> 0:22:36.160 Which is very good. 0:22:37.440 --> 0:22:41.159 But that being said, case fatality rates have been shown 0:22:41.240 --> 0:22:45.440 in some cases to still be relatively high. There are, 0:22:45.680 --> 0:22:47.399 as it turns out, and I know you'll talk a 0:22:47.400 --> 0:22:51.040 little more about aaron, two different clades of this virus, 0:22:51.800 --> 0:22:55.040 and one of them seems to be more virulent, where 0:22:55.119 --> 0:22:58.040 the case fatality rate is estimated on average to be 0:22:58.119 --> 0:23:01.240 about ten percent, actually really high. 0:23:01.560 --> 0:23:04.159 In unvaccinated individuals. 0:23:03.640 --> 0:23:08.240 Exactly in unvaccinated individuals, and then in the other clade, 0:23:08.880 --> 0:23:12.359 the fatality rate is usually estimated at about three and 0:23:12.359 --> 0:23:16.320 a half percent, which again is still really high. 0:23:16.160 --> 0:23:19.120 But is much much less than smallpox. 0:23:19.640 --> 0:23:19.880 Right. 0:23:20.119 --> 0:23:23.960 Yeah, I was surprised at how high the case fatality 0:23:24.040 --> 0:23:24.399 rates were. 0:23:24.720 --> 0:23:25.760 Much had no idea. 0:23:25.960 --> 0:23:29.280 I did not realize that either. I thought that it 0:23:29.320 --> 0:23:33.200 was much lower. And it's interesting because it really does 0:23:33.320 --> 0:23:36.800 vary depending on what outbreak you're looking at, and it 0:23:36.840 --> 0:23:40.280 probably really varies how much data was collected in all 0:23:40.320 --> 0:23:41.360 of these different cases. 0:23:41.440 --> 0:23:44.560 So we'll see when we get to what's happening today. 0:23:44.920 --> 0:23:48.119 Yeah, I think there are other factors to like the 0:23:48.200 --> 0:23:51.760 number of confirmed cases first and suspected, and then the 0:23:51.800 --> 0:23:55.800 other thing too, I think is access to healthcare, because 0:23:55.920 --> 0:23:59.639 a lot of the deaths that seemed to happen seem 0:23:59.680 --> 0:24:02.400 to be secondary causes. 0:24:02.640 --> 0:24:06.240 Right, even in our first hand account, right, this poor 0:24:06.440 --> 0:24:09.440 nine month old survived infection with monkey pox, but then 0:24:09.600 --> 0:24:12.360 was left unfortunately susceptible to another infection. 0:24:12.720 --> 0:24:15.480 So yeah, it's it's. 0:24:15.480 --> 0:24:19.840 Very especially with the way that these pustules can break open, 0:24:20.480 --> 0:24:26.280 you are very susceptible to overlying bacterial infection of this rash. Yeah, yeah, 0:24:27.200 --> 0:24:31.080 so that tends to be the symptoms of monkey pocks. 0:24:31.440 --> 0:24:35.760 Most people do recover with relatively little long term effects 0:24:35.760 --> 0:24:40.960 except for scarring, which, given how prevalent this rash can 0:24:41.000 --> 0:24:45.879 be on the face, can be pretty significant, But generally 0:24:46.000 --> 0:24:48.359 don't tend to see a lot of long term like 0:24:48.560 --> 0:24:53.919 other problems that arise from monkey pocks when people survive. Okay, 0:24:55.200 --> 0:24:56.960 And like I said, when it comes to the path 0:24:56.960 --> 0:24:59.600 of physiology, I don't have a ton of detail to 0:24:59.680 --> 0:25:04.520 give you aarin. I was trying to look into a 0:25:04.520 --> 0:25:08.160