From driving the bus to intimate contact: an assessment of the risks of contracting monkeypox

People in Michigan have had to think about the coronavirus and efforts to prevent catching and spreading the infectious virus for the better part of the past 2.5 years.

So when the first major outbreak of monkeypox cases in the United States in the past 19 years was reported this spring, it understandably left people concerned about another health emergency and/or pushed them further towards the exhaustion from illness.

Both viruses are present in Michigan. Both can spread from person to person, and both can make infected people sick and need isolation. However, beyond these similarities, the viruses are quite different, both in severity and in ease of spread.

“It’s not easy to transmit this virus,” said Dr. Liam Sullivan, infectious disease specialist for Spectrum Health in West Michigan. “COVID is much easier to spread than monkeypox.”

Related: Should we be worried about parallel outbreaks of monkeypox and COVID?

Monkeypox is a viral illness that can cause a rash that looks like pimples or blisters, among other symptoms. The majority of reported cases have involved close and prolonged contact with an infected person, usually of a sexual or intimate nature.

Although not common, infections have reportedly been reported when handling shared objects or surfaces such as towels, sheets or clothing. These cases generally involved shared living spaces.

Studies have found viruses detectable on surfaces for up to two weeks after an infected person comes into contact. However, this does not necessarily mean that a person could become infected with monkeypox by touching a surface two weeks later.

“Just because they’re detecting the genetic material of the virus doesn’t mean there’s a live (viable) virus out there; it could just be dead virus, it could be particles of the virus,” said Sullivan, who noted that more research is likely to emerge on how long a surface or object can be able to contain/spread monkeypox.

This week, MLive spoke with three doctors to assess the risk levels of various settings like schools, gyms, hotels and public restrooms, as well as activities like contact sports, dancing and sex.

Assessing the risk levels, Dr. Matthew Sims, infectious disease specialist for Beaumont Health, issued a caveat.

“Ultimately, regardless, the risk will really depend on how much (virus) is in the background here in Michigan,” he said. “If you were doing a very high risk activity but there were no cases in the background, your risk would be zero. But if you are doing a medium-risk activity but there are a lot of cases, your risk is higher.

As of Thursday, September 1, Michigan had 199 known cases spread across 15 counties. Wayne had the highest total of cases with 92, including 63 in the city of Detroit.

Below is a summary of what the three doctors said for each setting or activity regarding the risk of monkeypox.

Sexual or intimate activity

The vast majority of documented cases in the United States have involved close contact for an extended period of time, making sex or other intimate activity the most risky behavior for spreading monkeypox.

Men who have sex with men have made up the majority of cases to date. However, the virus is not a sexually transmitted infection, and although it has spread in this population, there is nothing preventing it from spreading to other populations.

“If you’re heterosexual and you’re with someone who has monkeypox, the same thing happens,” Sullivan said. “Sexual activity appears to be, in this epidemic … the biggest risk factor for infection right now.”

The lesions, where the virus is most concentrated, can be anywhere in the body, although they were most commonly found on the genital and anal areas during this outbreak. They have also been found on a person’s torso, hands, and face, and can be found anywhere on the body.

An infected person can be contagious until their rash is completely healed, which can take 14 to 28 days.

Doctors recommend checking yourself regularly and talking to your partner before having sex. Having multiple partners also increases the risk, compared to monogamous relationships where the risk is lower.

“Obviously, a person would need to have monkeypox to transfer it,” said Dr. Daniel Kaul, director of infectious disease transplantation and professor of internal medicine at the University of Michigan. “If you don’t know your partner well or if they have lesions or a lot of other partners, the risk increases.”

Contact sport

In general, contact sports pose a low risk of spreading monkeypox. In most sports, skin-to-skin contact does not occur or last very long.

Wrestling might be closer to medium risk compared to other sports, given the extended time of close contact between two individuals. According to the CDC, wrestling, football and rugby are the most common for reporting skin infections like MRSA, which also often occur in sports with a lot of physical contact.

However, cases of monkeypox among young people remain low, reducing the risk of spread in youth sports. As of August 31, the United States has reported six cases in children ages 0-5, seven cases in children ages 6-10, and four cases ages 11-15.

“Especially in school-aged kids, it’s not really in this community at all,” Sims said. “There are occasional cases, but it’s quite rare.”

Schools and colleges

Similar to youth sports, the risk of monkeypox infection is low in classrooms or the playground as there are not many cases in this age group and skin-to-skin contact prolonged is minimal.

Concerned parents should remind their children to wash their hands regularly, which would “virtually eliminate the risk,” Sullivan said.

The risk of transmission could increase in college when it comes to dorms or parties where people are crammed into small spaces like dance floors. To limit the risks in tight spaces, avoid sharing towels or clothing with people who may be infected.

“You can imagine a circumstance where in a dorm with multiple roommates and you could potentially get it from sheets or things like that, but today there haven’t been a lot of outbreaks in that setting” , Kaul said.

Hotels, motels or Airbnb

As long as bedding and towels are cleaned appropriately, these settings should be low risk and safe from transmission. If you’re concerned about an upcoming stay, Sims said you can inquire about cleaning policies when booking.

Dr Kaul said immunocompromised patients had asked about hotel stays and he told them not to avoid it but to do their best to make sure everything was clean.

Try on clothes

Trying on clothes in a store before deciding on a purchase is likely to pose a low risk, doctors agreed. None of the three could think of any known cases being spread this way, or any reason to avoid it.

“You hope someone with obvious lesions wouldn’t go into a store and try on clothes,” Sims said. “But you can wash the clothes if you’re worried about it.”

Dancing

Dancing in general is low risk, but it can become medium risk if it’s in a tight space where there’s a lot of skin-to-skin contact. The risk is also higher if the weather is hot and people don’t wear a lot of clothing to cover potential injuries, and if the dancing is intimate for long periods of time.

“If people are running together in a high traffic group, I would call that higher risk,” Kaul said. “But if it’s more of a nightclub with people fully clothed and the population isn’t known to be circulating it at a high level, I’d say it’s medium to low risk. “

Gym

Gyms are generally low risk, especially if precautions are taken such as regular sanitizing of equipment after use. It is always a good idea to prevent the spread of other types of viruses or bacteria.

Lesions on exposed skin could theoretically penetrate onto shared equipment, but the use of disinfectants should eliminate this risk.

Public toilet

Dr Sullivan said a public bathroom would likely pose a low risk, although this may be an area that needs further research.

A toilet seat can be a place where the virus is excreted by an infected person, but the virus is more likely to spread on a more porous item like towels and sheets. Every doctor recommended laying down a toilet seat cover or toilet paper, and of course washing your hands before leaving the bathroom.

Men represent the majority of cases in the United States to date, which means the risk is likely lower in a woman’s bathroom than in a man’s. Similarly, more men use urinals, which pose no real risk of transmission.

“Generally it’s a low risk but it’s not a zero,” Sullivan said. “If you exercise a little caution, you’ll probably be fine.”

Public transport or carpooling

Sharing a seat, whether in transit or in a restaurant or cinema, is an unlikely way to transmit monkeypox, doctors agreed.

A fomite is any object or material that can carry an infection. If the virus spread more easily through fomites, Sullivan said the outbreak would be much more widespread.

“I don’t think anyone dressed in a taxi, who had monkey pox and got in that taxi, I don’t think that’s something we should be spending a lot of time worrying about” , Kaul said.

As time passes and more data becomes available, public health guidelines may evolve. But until then, Sims said people shouldn’t worry about potential daily transmission unless they are involved in intimate contact with others.

“Reduce your amount of skin-to-skin contact and you’ll reduce your chances, and just be aware.”

Learn more about MLive:

Michigan monkeypox cases climb another 26% – surpassing national rate

Michigan expects to have targeted omicron COVID booster shots next week

CDC recommends masks in 18 counties, including most of central Michigan

Universities, after years of COVID-19 precautions, prepare for possible cases of monkeypox