As monkeypox continues to spread at an unprecedented rate in the US, researchers have been racing to work out exactly how the virus is transmitted, and if it’s different from what we previously thought.
Most (94%) of cases in the outbreak that started in May have occurred in men who have had close sexual or intimate contact, according to the US Centers for Disease Control and Prevention.
People can catch monkeypox in multiple ways. The risk of someone contracting the virus outside of a sexual context is “extremely low,” especially in areas without large outbreaks. But case reports describing other possible routes of transmission have raised questions about the level of risk.
So, Insider asked experts to estimate the risk of catching monkeypox in different settings — from the gym to a restaurant or a concert.
Dr. Jay Varma, a physician and epidemiologist who specializes in infectious diseases at Weill Cornell Medicine, told Insider via email that the best way to think about risk is: “WHO you are spending time with PLUS WHAT you are doing with that person, rather than WHERE you are.”
There are other variables, said Dr. Jake Dunning, a senior researcher at the Pandemic Sciences Institute at the University of Oxford, UK. Dirtier public spaces may be riskier than clean ones, for example. People with underlying conditions like HIV may have a higher risk of infection.
Here’s what Varma, Dunning, and five other experts had to say about your risk of catching monkeypox in different settings, based on current evidence.
RISK: Very low
While monkeypox can spread via respiratory droplets, catching monkeypox in a restaurant would be highly unusual, the experts said.
“The CDC says droplet spread is possible if you are within six feet of someone, but the timeframe is more than three hours and most meals won’t last that long,” Dr. Scott Roberts, an assistant professor of infectious diseases at the Yale School of Medicine, said.
The risk is low unless you share a drink or utensils with somebody with monkeypox, and you don’t need to worry about catching it from a waiter or people not wearing masks, said Bernard Camins, medical director for infection prevention at the Mount Sinai Health System.
RISK: Low
You’re unlikely to catch monkeypox on public transport, including from touching surfaces, the experts said.
Dr. Peter Chin-Hong, a professor of medicine and an infectious disease specialist at University of California, San Francisco, said catching the virus from the air was “very unlikely with a short transit ride.” The risk would still be low if you briefly sat next to someone with a monkeypox rash who was in skimpy clothing.
Air filtration makes airplanes “even safer” than the metro or buses, Keith Neal, emeritus professor in the epidemiology of infectious diseases at the University of Nottingham, UK, said.
RISK: Low
Gyms are generally low risk, the experts said.
Sarah Bauerle Bass, director of the Temple University Risk Communication Laboratory, said washing hands, disinfecting shared equipment, wearing long sleeves, and using clean towels reduces the risk of catching monkeypox at the gym.
Neal said single-sex saunas used by men who have sex with men might be “an area of concern,” if you were to have skin-to-skin contact.
RISK: Low to medium
There is a chance you’ll catch monkeypox at a rave or concert, particularly if you have prolonged skin-to-skin contact with an infected person, Saskia Popescu, an assistant professor in the biodefense program at George Mason University, said.
Wearing long-sleeves, not using illegal drugs and alcohol that inhibit judgement, and avoiding casual sexual encounters can help to protect you.
Rubbing up against a partially clothed person with monkeypox in a mosh pit over several hours could increase the risk of catching the virus, Chin-Hong said, but it’s unlikely the average concert attendee would have monkeypox at this time.
RISK: High for MSM
Sexual and intimate contact is high risk, particularly among men who have sex with men, Dr. Aniruddha Hazra, a professor of medicine at the University of Chicago specializing in LGBTQ health and infectious diseases, said. The head of the World Health Organization recently recommended men who have sex with men limit sexual partners amid the monkeypox outbreak.
The monkeypox virus has been isolated in semen, feces, urine, blood, and saliva, but we don’t how infectious those particles are. Condoms might help stop potential transmission in semen, but it won’t stop the virus spreading if there are contaminated bed sheets or are skin lesions on other body parts, the experts said.
“It is not that infectious, this disease, and essentially with vaccination, and small amount of behavior change, like temporarily reducing the number of partners, this disease can rapidly die out,” Neal said.
Keep reading