It’s crucial for individuals, healthcare systems, and policymakers to prepare for the next emerging disease - even if it isn’t monkeypox, says nurse researcher Dr. Rachel Cox.

With monkeypox cases on the rise and headlines about the disease changing every day, many people have been left wondering what exactly the “new” disease is, how it spreads, and if they should be concerned.  

Rachel Cox, DNP, FNP-BC, a board-certified Family Nurse Practitioner and Assistant Professor of Nursing at MGH Institute of Health Professions, says that the first thing to understand is that monkeypox disease isn’t new.  

“Monkeypox has been reported in several central and west African countries since 1970,” says Dr. Cox. “However recently, monkeypox cases have occurred in at least 30 countries including the United States.”  

The United States has seen monkeypox outbreaks before, too. There were two travel-associated cases in 2021 and 47 confirmed and probable cases in 2003. 

An expert in epidemiology, infectious diseases, and how climate change will accelerate the arrival of the next pandemic, Cox says monkeypox disease comes from the same family of diseases as smallpox, cowpox, and camelpox. Despite this, monkeypox is less severe than smallpox and has an available and effective treatment. “We have seen that vaccination against smallpox may protect against monkeypox,” she says. “An antiviral called Tpoxx [tecovirimat] is also approved in the US to treat smallpox, monkeypox, and cowpox. It may also have use as a preventative medication as well.”  

Close-Contact Transmission 
Monkeypox is transmitted from person to person via close contact with lesions, body fluids, respiratory droplets, and contaminated materials. “Symptoms typically begin 6 to 13 days after exposure and can include headache, fever, chills, sore throat, malaise, fatigue, and swollen lymph nodes,” explains Cox. “Patients then develop a rash often beginning on the face and spreading to the rest of the body. The rash starts with flat lesions that eventually become raised and fill with fluid and pus. The lesions scab and then fall off.” 

With much of the world still feeling the effects of the COVID-19 pandemic, reports of another illness have many people on edge. “It is reasonable to be concerned,” she says. “However, the average person absolutely does not need to panic. It is never a bad idea to wash your hands, regularly disinfect high-touch surfaces, and practice safe sexual practices.” 

Sexual contact is one of the main ways that the World Health Organization has stated that monkeypox is spreading. Cox, however, explains that it is important to know that monkeypox is not a Sexually Transmitted Infection (STI) like syphilis, gonorrhea or HIV/AIDS. “Although monkeypox has been linked to sexual contact, it does not necessarily mean that it is an STI,” she says. “Human-to-human monkeypox transmission generally requires extended contact with lesions or respiratory droplets. Sexual activity provides an avenue for prolonged close physical contact that could contribute to the transmission of disease, but sex on its own is not necessarily the only way this is being spread.”  

Cox emphasizes that it is important for health care workers, the media, and the public to separate the idea of sex and monkeypox.  “We should not necessarily only be associating cases of monkeypox with gay men, bisexual men, and other men who have sex with men,” she says. “We need to make sure that when we talk about monkeypox we are not stigmatizing already disadvantaged groups of people. We need to make sure we are designing public health initiatives that prioritize the health and safety of most vulnerable.” 

A Focus on Preparing for the Next Pandemic 
Instead, Dr. Cox argues that conversations about monkeypox should be centered on how we’re preparing our society, and especially our healthcare systems for the next pandemic. “We know that the healthcare system and supply chains have been struggling,” she says. “Lawmakers at the local, state, and national level need to remember that even if monkeypox does not become more widespread and does not put increased weight on our already depleted healthcare system, We still need to continue to prepare for the next emerging disease.”  

For Cox, preparedness looks different at each level. “Small health care clinics should be looking at their stockpiles and ensuring that they have the correct supplies and personal protective equipment (PPE) should this outbreak become more widespread,” she explains. It is important for organizations to ensure their stockpiles haven’t been depleted and to understand what type of screening policies they would need to put in place should cases become more widespread. 

Larger organizations, on the other hand, should think more broadly. “Bigger healthcare systems need to think about their role in community education,” she says, citing public trainings and info sessions, PPE webinars for staff, and information on prevention techniques as ways larger health care organizations can contribute to public education. “We’ve become sort of numb to pandemics, but it is important for healthcare facilities in general to be reinforcing this. They need to protect their workforce, because the workforce is already struggling, so they need to do whatever they can to make sure that workers are safe, policies are in place to protect them, and patients are educated.”  

At the government level, Cox urges leaders to continue developing data-driven policies. “We need to maintain some of the policies we put in place during the COVID-19 emergency phase,” she says. “If workers are sick, they need to know that they can miss work and still be compensated.” 

Cox emphasizes that leaders need to continue to work to improve supply chain issues as well as ensure nurses, and all healthcare workers are compensated fairly and protected.