How Might Monkeypox Affect Travel?

New York City just sent out an urgent alert about monkeypox (HT: Ken A.). Scott Gottlieb says the window for containing the virus ‘has probably closed’.

There is an outbreak of Monkeypox in NYC. Learn how you can protect yourself and others: nyc.gov/monkeypox.


Credit: CDC

We blew the response and are likely to be dealing with the virus for some time. What effect will this have on air travel?

  • First, we don’t actually know yet, because the model for how monkeypox spreads we’re using is likely outdated. Given the spread we’ve seen it’s highly likely that the virus has become more infectious than it’s been over the past 50 years though still far less infectious than many other viruses.

  • However we know that monkeypox spreads through close contact. That’s likely why it’s been concentrated among men who have sex with men, though it’s not likely to stay there since even if it were inherently sexually transmitted there would still be crossover events, and transmission isn’t limited to sexual contact.

  • Moreover what made Covid-19 so scary – aerosolized transmission including by pre-symptomatic and asymptomatic individuals – gave air travel a relative advantage. HEPA air filtration, downward air flown, and rapid refresh with outside air are protective against spread via aerosols but not as helpful for spread via close contact.

Despite pledges to broadly distribute vaccines to vulnerable groups only tens of thousands of shots actually made it into arms because we had over a million doses stored in a pharmaceutical facility in Denmark that had been inspected by the European Medical Agency but that the FDA took months to visit and the U.S. wouldn’t allow the doses to be used until they got off of their collective arses.

Meanwhile thanks to our same bureaucracy doctors must complete dozens of pages of paperwork to be permitted to treat a single case of monkeypox. So we’e completely blowing the response to monkeypox after completely blowing the response to Covid-19. And there are few signs we won’t completely blow the response to the next threat either. Whether monkeypox or something else becomes a threat broadly, including in travel, may be despite otherwise-controllable circumstances.

So far the view is that spread is primarily through skin-to-skin contact (including sexual contact) as well as via respiratory droplets and by sharing infected items like bedding or clothing. The medical establishment used to believe, though, that all cases of monkeypox were symptomatic cases however with this new outbreak we’re finding asymptomatic infections.

The numbers of known cases almost certainly are massively understating the number of actual cases at this point, even asymptomatic infection possibilities aside. Nonetheless the number of infections in absolute terms is almost certainly very small, so most people are very unlikely to come into close physical contact with someone that’s infected.

Nonetheless even before the coronavirus pandemic I didn’t love coming into close physical contact with strangers, let alone for prolonged periods, and let alone on airplanes (in the summer, in middle seats, with passengers in shorts and t-shirts and fighting over arm rests). And I don’t love underinvestment in hotel housekeeping where I might wind up sharing a comforter with the previous guest.

I do not consider myself at risk at this time and I am not taking precautions, although I regularly update my priors based on new information. As the facts change, I can change my mind. However the precautions taken earlier in the pandemic, such as extensive housekeeping, not only appeal to my previously-held preferences they seem better-suited to monkeypox and numerous other pathogens than to Covid-19.

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