3 asymptomatic people positive for monkeypox. Though none of the 3 transmitted it to their contacts, study authors suggest asymptomatic spread may be possible and make identification and containment more difficult. https://www.medrxiv.org/content/10.1101/2022.07.04.22277226v1

I don't think we know enough about transmission yet, but I read that sores in the mouth may contribute to respiratory spread.

The second-to-last document has the best description of how monkeypox spreads that I've seen so far in public health guidance. Includes multiple routes of transmission, with body fluids in the first sentence and sex specifically mentioned. I'd probably revise and tweak the order but at least they've included the relevant info.

I'm thinking of huge events like Lollapalooza, Burning Man, Sturgis...Burning Man will probably be the worst with more skin-to skin and sexual contact but I wouldn't be surprised if massive crowds, porta-potties etc make for super spreader events via all modes of transmission. I'd also love to see messaging on prevention from other countries, since the CDC does such an abysmal job.

Quotes below from the Katelyn Jetelina link above: there is droplet or aerosol transmission. Changing bedsheets in hospitals increases positive viral air samples, and there are documented cases of hospital workers changing sheets getting monkeypox. Anecdotal accounts of massage therapists, someone who changed sheets after guests left an Airbnb, and plenty of women who don't know how they were exposed. There's no doubt that sex is an especially effective mode of transmission, but we're playing with fire if we get complacent and think that's the only mode or that there isn't already community spread. I've read that the MSM community is often better connected with sexual health care and public health measures because of HIV, and that worldwide we actually don't have data on the sexual activity of the vast majority of monkeypox cases. So we're drawing broad conclusions from a subset of cases for whom this data is more likely to be collected. This is reminding me of the beginning of the pandemic, when Americans couldn't get tested for Covid unless they'd just returned from China. So all of our positive cases had traveled to China, or had contact with someone who did. Meanwhile Covid was already spreading in the US the way respiratory viruses always do. I don't think monkeypox is nearly as contagious via respiratory transmission as Covid, or that low exposure on intact skin is going to make someone sick, but it seems bananas to me to pretend what we've always known about potential modes of transmission of monkeypox and pox viruses in general is suddenly, magically no longer the case. "Preliminary data also shows droplet or aerosol transmission. Some MPV cases have lesions in their mouth, so this could, theoretically, be a mode of transmission if you’re closely talking to someone who has an active (e.g., painful) infection for a long duration of time. This is why people with active MPV and those caring for them are advised to wear masks. Previous case studies in Nigeria show secondary transmission among nurses caring for MPV patients without PPE. A preprint from the UK found positive air samples in hospital rooms of infected patients, specifically when nurses were changing bed sheets. But, just like surface transmission, this isn’t likely to happen by passing someone at the supermarket." "Because of the distinct transmission pattern, MPV has gained a foothold in one specific, tight-knit social network: men who have sex with men (MSM). This means this group is most at risk *right now,* and public health outreach, policy, and resources are laser focused on this community, rightfully so. MPV could spread to other social networks. We saw this happen with MRSA in 2008: It started in one network (gay men) and moved to other social networks (like wrestling teams). There is considerable chatter regarding MPV spread in colleges and schools, which isn’t too far fetched given tight-knit social and sexual networks on campuses. This doesn’t mean there should be panic, but institutions should absolutely prepare. (Here is guidance on controlling MPV in congregate settings)."

Actually, according to the National Monkeypox Public Health Response Guidelines linked below from Nigeria Centre for Disease Control, human-to-human transmission occurs primarily through respiratory droplets, or by direct or indirect contact with lesions, body fluids, or objects like linens that came in contact with lesions or fluids. Sexual contact poses particular risks because it often involves all of the above, but respiratory and fomite transmission of pox viruses has been widely understood since the Middle Ages. Smallpox was transmitted by Europeans to Native Americans through contaminated blankets, among other routes of transmission. Regarding genital or anal lesions, it is true that if transmission is by direct contact, the earliest lesions often appear at the site of exposure. But respiratory transmission is known to cause widespread lesions all over the body, including genital and anal lesions. Nigeria has kept monkeypox at bay for a long time. We need to learn from the knowledge base and public health practices they've developed, or this is going to be an absolute disaster when it reaches daycares, schools and congregate living communities including universities, nursing homes and prisons. The CDC is repeating the mistakes in early identification of HIV by targeting the LGBTQ community, but microbes don't discriminate. Anyone can get monkeypox through several possible modes of transmission. "Human-to-human (HHT) or secondary transmissions occur primarily through droplet respiratory particles requiring prolonged face-to-face contact, or by direct or indirect contact with skin lesions or body fluids of an infected person, and by contact with objects recently contaminated by patient fluids or lesion material (such as clothing or linens). There is limited evidence on the persistence of variola-related viruses on materials (that may act as fomites), under controlled environmental conditions, but there is evidence to suggest that vaccinia virus may persist from weeks to months9 underscoring the importance of environmental de contamination." https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf

Really appreciate this context from an agricultural epidemiologist on "how diseases hang out in the landscape & sometimes run into the people & the plants/animals we hang out with." It's an interesting read that covers pox viruses in general and how eradication/no longer vaccinating for smallpox opened a window for milder pox viruses. https://twitter.com/SarahTaber_bww/status/1551972659738673152?s=20&t=krPK1YC1-e4-kRollD2QVw Also a good reminder that historically pox viruses, aside from smallpox, have not been super contagious. That said, if/when cases go up in my area I'll do more mitigation than just the masking and hand washing she suggests. For one thing, it sounds like alcohol-based hand sanitizer is more effective than most soaps in killing the virus. But old-fashioned physical hand-washing and cleaning still have a crucial role in decreasing how much virus we're exposed to, and thus decreasing the chance of infection. My Twitter scrolling also suggests that masks are helpful in reducing exposure to monkeypox. Contact exposure via mucous membranes or broken skin is one route of transmission, but from what I'm gathering airborne transmission is significant, and an infection from something like contaminated linens could actually be by inhalation of skin particles that contain a lot of virus. Still not liking the outlook on this, but I'm feeling like masks, handwashing/sanitizing, and regular laundering and cleaning could go a long way to reduce individual exposure and interrupt chains of transmission. The big question is whether the CDC will quit obfuscating and trying to manage public sentiment rather than providing clear guidance that actually helps. And if people will take it seriously.

So You Got Monkeypox Google doc with anecdotal tips from lived experience on OTC remedies for symptoms and not wearing contacts, if infected, to avoid transmitting to eyes. Op or anyone else, lmk if my posts are off topic and I'll start a new thread. I'm just posting all things monkeypox here if anyone else is interested, and partly so I can find them later if needed. https://docs.google.com/document/d/1y_x0bARgXG-KNuJOHC4DtpWWi_5_tHSZ5DZqN9ny1oE/edit

National Monkeypox Public Health Response Guidelines from the Nigeria Centre for Disease Control: https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf Among other information, the document covers the stages of infection on p.3 and on the following page a list of the frequency of various signs and symptoms among confirmed cases in Nigeria in 2018 and 2019. Rash, fever, headache and itching most common, but there are others.

ETA: I'm reading that Oxiclean Sanitizer can fade clothing. That doesn't sound so great! I wouldn't use it regularly. Not sure if this has been posted. There's still a lot we don't know but this is the best resource I've found on laundry and monkeypox. It's focused on laundering linens and clothing when someone has monkeypox but I'm going to pick up some Oxiclean Laundry & Home Sanitizer and have started washing and drying on hot when we've been on public transport etc. https://www.verifythis.com/article/news/verify/monkeypox-verify/monkeypox-transmission-spread-through-contiminated-clothes-bed-linens-fact-check/536-3a4ea57d-bbd4-4d3b-9d35-9b264a440264

Lanolin on hands under gloves at night works much better than Vaseline. At colder temperatures it’s thick and sticky, but you can check before applying and warm it to a thinner consistency if needed.

I’m often amazed at what other adults can get my teens to do that they would never do if I suggested or encouraged it.

Neuropsych eval and psychiatrist in Ireland are essential. An ADHD coach, if it seems helpful and you can find the right person, would be in addition to those practitioners. A good coach can help with identifying challenge areas in everyday life and academic work, and developing personal strategies in meeting those challenges. It would be regular virtual meetings, covering what he needs to do and how things are going. With his university so far away this could be an excellent support for executive function and just to have someone checking in with him (someone who is not a parent!). There's an element of accountability over time. I have friends for whom this has been an absolute lifesaver in launching a young adult with ADHD. Like, they could not picture their children being able to manage independently but after a year or two of coaching things look very different. Not that the challenges are no longer there, but that the young person has the awareness and tools to manage and enjoy life. The tricky part is it's probably private pay and isn't cheap, and also you need to find someone he works well with. A good coach will be very adept at identifying challenge areas and helping him find strategies that work for him. They would also be very cognizant of ADHD features like the Wall of Awful and can help with developing language and self-awareness, in addition to coming up with concrete strategies. There may be other things you want to address after the neuropsych eval so I don't want to give the impression this magically helps every person. But I really have seen it be transformative, and a huge relief to parents both to have someone else working with the young adult, and to see real, life-changing gains.

Interesting observation. I wonder if that's partly because Omicron 4/5 tend to go to the lungs more than Omicron 1/2. My understanding is Omicron 4/5 are more like the earlier variants in terms of virulence.

That's huge that you were able to have a conversation without his completely shutting down. Other posters have better insight into the whole picture, but difficulty with task initiation and hyper focus on research both can definitely be part of ADHD. Diving into a rabbit hole of research can be a way to manage or reduce anxiety and increase dopamine. As you're exploring the big picture and any med adjustments I wonder if an ADHD coach could be helpful. Or perhaps after you get a better sense of the big picture. For us ADHD meds and developing personal tools and insights to manage symptoms and find what works are both necessary in equal parts. It would need to be someone he likes well enough, and he might need to try 2 or 3 people to find a good fit. A coach who works online can be an excellent, portable support for college. It's not cheap and not a quick fix, but can be life-changing. Does he like music? Would a playlist to start the day or for hygiene/getting ready be something he might be open to?

MIL was told minimum 3 months to dissolve the clots on blood thinners. She was given the option of oxygen at home and turned it down at first. Dh and BIL talked her into it by telling her professional athletes use oxygen treatments for healing. She has definitely seen more significant gains since getting oxygen at home.

FWIW, dh rapid tested positive the morning of day 10, IIRC, and negative that evening. Only negatives after that, but we gave it another 48 hrs before setting him free from isolation and nobody else got sick. TBH I'd also probably do 48 hrs after a negative rapid, and maybe masked, for cooking. Sorry--sounds like a real hardship!

Interesting, thanks for mentioning this. I'll ask her. There's a roommate she's never met, who is coming back next week. And dd's friend is arriving tomorrow to stay for a week.

Thanks so much, Hive! All of your experience and ideas have been really helpful in figuring out how to approach this. After a couple days of not working out, taking Zyrtec and continued attention to sleep/hydration/nutrition, dd felt up to going to work yesterday afternoon for a few hours. It's a big mental adjustment for her to take heavy exercise off the table for now, and use her daily spoons for self-care, getting to work if she's up to it, and either virtual or outdoor social time. She can also bring some work home, and I think it's helpful for her to have more purpose and engagement. Her internship and supervisor have been flexible and supportive so that's great. She has an appointment with her ped when she gets home, and from this thread I've made a list of things to discuss with the doc if she's still having issues. Part of me wanted to swoop in and fly her home or rush her out for medical care, but I'm encouraged that she's seeing improvement and hoping that trend continues.

It really hasn't been that long, you're right! I might make an appointment with her ped for when she comes home, and we can cancel if she's feeling better. And get her to urgent care there if she really starts feeling worse. Adding walking pneumonia, autoimmune or liver issues to my mental list. Far down the list, in order of my personal preference!

Thanks, that's a great idea to see if the urgent cares have online check-in or wait times available. No fever. Totally agree about low sleep and stress compromising immunity and dragging out minor illness. She's sleeping 11+ hours a night and wakes up not feeling rested. If she had more in the way of cold symptoms it would make more sense to me. Intense fatigue as the major symptom just seems so weird.

Thanks, Jean. I feel like our healthcare system just isn't great at this sort of thing, and we'd probably have better luck with our ped when she returns, and specialists here if it persists. She did a thorough tick check when she got home from camping and didn't find anything. But tick-borne illness is certainly still possible. I know so many people with Lyme who have had to seek alternative care just to get diagnosed. I wonder if there's anything a conventional doctor could do in terms of testing or if it makes sense to throw antibiotics into her system with no evidence of a tick or rash, and the minor cold symptoms she had....

Dd19 is doing an internship 2,000 miles away and has been really fatigued for a week. She's also had some headaches, a tickle in her throat and a little nasal congestion, which is resolved. Headaches have pretty much gone away. Fatigue is definitely the most marked symptom. It's kept her from going into work and is really unusual for her. The new city has been a bit of an adjustment but she's found people she likes and neither of us think it's primarily psychological, though definitely a bummer. She's had 3 Covid tests--rapid and PCR last week and another rapid yesterday, all negative. Our amazing pediatrician is on vacation for 6 more days. Her office said Friday that with negative Covid tests it's most likely a summer cold, and if she doesn't feel better this week to see someone locally. The symptoms started a couple days after she returned from camping with friends and they got very little sleep, at least for her. 5 hours one night, after a busy week. It was a national park with lots of people around. I'm encouraging her to take it really, really easy. She had Covid in April and had returned to normal, athletic activity levels. But in the past week when she tried to do short runs a few times she's gotten really exhausted, started coughing, and felt an ache in her lungs. No more running for now! She has seen a pattern where she feels a little bit bitter, tries to do more and feels worse the next day. Her last attempt at running was the day before yesterday (APA--against parental advice) but she's finally agreed to lay off all workouts for now. So I'm looking up providers in Boise, where she is, and just super confused what to do. 3 urgent cares are covered by our insurance and I'm reading reviews and thinking, okay, do I really want to send her somewhere with an hours-long wait and crowded waiting room right now? And if she's stable, just fatigued, is urgent care even the right place to go? Do I look for another type of provider? Possibilities in my mind are Long Covid, mono, tick-borne illness, mold in her new apartment, Covid despite testing negative... Ped returns in 6 days and dd flies home in 12 days, a few days before we're supposed to leave for Ireland. How do I help my girl?? I'm at a loss. I've ordered groceries and Covid tests delivered, and encouraged her to get crazy amounts of sleep, hydrate, eat healthy food and not work out. Just some stretching and a little walking for now. And watch some fun shows and have friends over to her apartment roof for takeout. WTM aunties, what would you do?

That's right, @busymama7. I really wish public health officials and health care providers were making the distinction more clear because it's important! A PCR test detects genetic fragments of the virus that can persist in the body up to 90 days, so retesting by PCR after a positive is not recommended for 3 months afterward. It just doesn't tell you anything, because a positive might only mean you had Covid a few months ago. Rapid tests (like the home tests) are a good but not perfect indicator of infectiousness. They detect live virus in nasal secretions, and a dark line means more virus and more contagiousness. Rapid tests can be negative for the first few days of infection, however, before they turn positive, so a negative rapid test in someone who is symptomatic should be followed up with a PCR, which generally turns positive a day or two sooner than a rapid test. Or you can isolate and retest with another rapid test 24-48 hours after a negative test if symptoms persist. I'd keep testing for 4 days, personally. Because of the confusion between PCR and rapid tests, I keep hearing people dismiss positive rapid test results that indicate the person is infectious. That means contagious people are going out into the world and spreading Covid without realizing it. I seriously wonder if the messaging has not been clear partly because we're all supposed to go back to work or school on day 6, without even retesting, and the fact is most people are still positive at that point. Corporations put pressure on the Biden administration and CDC not to require a negative test to go back to work, and it's coming back to bite them because so many people are getting sick. The other day I think I saw that 30% of flights out of LaGuardia were canceled! No masks required to fly, no negative test to go back to work, and no wonder so many people in the travel industry are out sick.

I agree with Arcadia. The experience of my daughter and her college roommate was eye opening for me about testing. They developed similar symptoms at the same time, and dd tested positive quickly. Her roommate tested negative for 5 days, including a PCR, before testing positive! Roommate stayed elsewhere after dd tested positive, but they think it was Covid all along based on similar timing and symptoms.