Health officials are keeping track of the monkeypox outbreak in the United States by turning to contact tracing, an infection tracking method that struggled to keep up with the rapid spread of COVID-19.
Contact tracing is a standard public health practice that consists of determining where and with whom an infected person has been and then contacting those places and people to inform them of the exposure. In some cases, quarantine is warranted while also monitoring for symptoms.
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“The reason we do contact tracing for diseases such as COVID-19 and monkeypox is to identify other people who may have been exposed to a case and, where possible, intervene to prevent or lessen their risk from infection … connect people to resources and information, and to identify possible common exposures where transmission could have occurred,” said Sharon Bogan, a spokeswoman at Seattle & King County Public Health in Washington, where one monkeypox case has been confirmed.
Health officials at the Centers for Disease Control and Prevention warned of the community spread of monkeypox in the U.S. less than a month after the first U.S. case was detected in Massachusetts. Since then, six cases have been confirmed in California, three in Colorado, four in Florida, two in Illinois, seven in New York, two in Utah, and one each in Washington, D.C., Georgia, Hawaii, Pennsylvania, Virginia, and Washington.
Contact tracing, according to various state and local health officials, will be crucial to forestall an increase in community spread. In Salt Lake County, where Utah’s sole case was confirmed, the Health Department was able to reach all of the patient’s contacts within a day, a timeline much shorter than contact tracing for COVID-19 would be given the speed at which the illness spreads.
Health departments in states with probable and confirmed cases, taking a page out of the COVID-19 pandemic playbook, are bolstering their infection detection and monitoring capabilities. The task of contacting people who may have been exposed to the virus falls to local health departments, though state departments have frequently stepped in to outfit jurisdictions with more resources.
“[California Department of Public Health] is leveraging experienced disease investigators already trained for investigating cases of infectious diseases to serve as the state’s first-line staffing surge support if needed by local health departments for the monkeypox response,” a department spokesperson said. “CDPH’s team of COVID-19 disease investigators are also being proactively trained on case/contact investigation specific to monkeypox should LHDs require additional staffing.”
Monkeypox tracing is theoretically much easier than tracing the transmission of COVID-19. Whereas the coronavirus is an airborne pathogen, monkeypox spreads primarily through direct, close contact, including skin-to-skin, with saliva, and with contaminated objects such as sheets or towels. Symptoms of COVID-19 appear after the person has become contagious, making infection harder to discern without a test, while a person with monkeypox is only contagious after symptoms appear.
Monkeypox symptoms are often noticeable. They include swollen lymph nodes, rashes, and skin lesions on different parts of the body. In most cases in the U.S., the symptoms have appeared among men who have sex with men, and they have frequently been misdiagnosed as a sexually transmitted infection. The outbreak’s resemblance to an STI could complicate tracing efforts, though, if people who believe they have been infected are uneasy about sharing details of their personal lives, including those with whom they have been physically intimate.
“We know that people who have been intimate with others don’t always want to tell public health investigators about that,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center. “In fact, they may not even know the names, addresses, and phone numbers of people with whom they’ve been intimate … you always have to build trust with the person, and you may have to go back a second and third time to gather the information.”
Monkeypox is not a sexually transmitted disease per se, but its pattern of spreading recently has resembled one. The first cases in Europe were determined to be linked to raves held in Spain and Belgium last month. This marks a considerable departure from the virus’s typical means of spreading from small animals such as rodents to people primarily in Central and West Africa.
Contact tracing for COVID-19 was particularly difficult for local and state health departments, which have been chronically underfunded. Multiple cash infusions allocated by Congress were not enough to buttress existing contact-tracing systems to keep up with the airborne disease. But health departments maintain they are well-equipped to deal with a growing monkeypox outbreak in the U.S.
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“These chains of transmission can go on for a while and may not all be captured,” Schaffner said. “But that said, it’s much easier than COVID, and people are used to doing these kinds of investigations. Every health department has professionals who know how to do these investigations with great sensitivity.”
