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With local, state and national officials declaring emergencies over the monkeypox outbreak and a scramble for vaccines spurring long lines — and waits — in many U.S. cities, the latest updates about the rare virus can seem overwhelming and, well, confusing.

But experts say it’s important to remember that monkeypox is a known disease that is rarely deadly (unlike the coronavirus) and already has an approved vaccine and treatment.

That’s not to say there aren’t real concerns about the outbreak, including a vaccine shortage, rapidly rising infections and the fact that one community — men who have sex with men — remains most at-risk.

The first step in addressing this virus is education, experts say, so people can better understand their risks and know how the disease spreads and how to prevent transmission.

California

California’s LGBTQ community feeling ignored, angry, confused as monkeypox cases rise

Some are asking: ‘Would monkeypox have received a stronger response if it were not primarily affecting queer folks?’

Can only gay or bisexual men get monkeypox?

No. While the outbreak is spreading primarily among gay and bisexual men, as well as some transgender and nonbinary people, anyone — regardless of gender or sexual orientation — can become infected.

“No single individual or community is to blame for the spread of any virus,” said Dr. Tomás Aragón, California’s public health director. “Monkeypox can affect anyone, and it spreads by skin-to-skin contact, as well as from sharing items like clothing, bedding and towels.”

Dr. Stuart Burstin, the interim national director of infectious diseases for the AIDS Healthcare Foundation, said it was “by chance” that monkeypox first infected men who have sex with men. The virus has continued to spread in that group, as transmission can easily occur during sexual encounters.

Of the more than 400 confirmed and suspected monkeypox cases in Los Angeles County, 99% have been in men, about 90% of whom identified as LGBTQ, according to data from the Department of Public Health. Similar demographics from state and national health officials have found the same trend, and for that reason, gay and bisexual men, as well as some other queer people, remain most at risk.

“The risk to the general public is low, but there is a chance — and I would predict — this virus does make some inroads into the general public,” Burstin said. In very rare instances it already has: At least five children in the U.S. and one pregnant woman have been infected, according to health officials.

Science & Medicine

If monkeypox spreads through sexual contact, is it an STD?

For decades monkeypox was not known as a disease that spreads through sex. That has changed.

How does monkeypox spread?

Monkeypox spreads primarily through close skin-to-skin contact, but it also can be passed through infected bed sheets or towels or through “respiratory secretions,” according to the Centers for Disease Control and Prevention.

Intimate contact has to include direct, and usually prolonged, interaction with an infected sore, rash or lesion, but Burstin said such markings may not always be obvious, especially at the beginning of an infection.

“It is possible that someone can have early disease that looks like a pimple or something in the anus you can’t see,” Burstin said.

There’s no evidence that monkeypox can spread through shared airspace, like the coronavirus, experts say.

“I think it’s really important for people to recognize monkeypox is not like COVID,” Aragón said. "[Monkeypox] is very different in terms of transmission; you really have to have a close, physical contact.”

Science & Medicine

Facing criticism, U.S. officials say monkeypox can still be stopped

Top U.S. health officials say the country’s monkeypox outbreak can still be stopped despite rising case numbers and limited vaccine supplies.

What are the typical symptoms?

Dr. Leo Moore, director of clinical services for the Los Angeles County Department of Public Health, said that people with monkeypox typically develop a flu-like illness, including fever, fatigue, muscle aches and enlarged lymph nodes. Those symptoms are then followed by a rash.

“In many instances with the current outbreak, people are developing a rash with or without swollen lymph nodes that can occur in the genital region or anally as well,” Moore said. “We’re also seeing the rash occur all over the body, including in the face.”

He said people usually develop symptoms a week or two after being exposed, but it can take up to 21 days for evidence of the virus and symptoms can last up to four weeks.

“The rash doesn’t look exactly the same on every person,” L.A. County Director of Public Health Barbara Ferrer said. That’s why it’s important to check yourself and get tested if anything looks irregular, she said.

Symptoms are usually mild, although lesions can become quite painful for some patients, Moore said. No one has died of monkeypox in California, but at least 14 people have been hospitalized for the illness.

California

Column: Why are we botching the monkeypox response? Blame homophobia

Gay, bisexual and transgender communities fear a repeat of the AIDS-era indifference that left too many without care.

Who can get a vaccine or treatment?

The two-dose Jynneos vaccine series, which has been approved by the Food and Drug Administration for monkeypox, can be used preventatively and within two weeks of an exposure. But doses are currently limited, which has prompted health officials to set eligibility requirements so those at greatest risk of infection can get the first available shots.

In Los Angeles County, officials recently expanded eligibility, but the focus is still only on those who have been directly exposed or gay and bisexual men and transgender people who meet certain criteria, such as having multiple recent sex partners.

As for treatment, health experts say most patients can recover on their own, but there is one antiviral — tecovirimat, also known as Tpoxx — that can be administered to help ease symptoms. However, many health providers have had difficulty accessing Tpoxx, which is recommended only for use in severe cases or for people with certain high-risk health factors. CDC officials have said they are working to streamline the process so more people can get access to the drug.

As of this week, the California Public Health Department said 1,144 courses of TPOXX have been delivered and are ready for use at 71 sites around the state.

Politics

Biden administration declares monkeypox a public health emergency

The move aims to fast-track potential new treatments and vaccines for the disease, which about 1.6 million Americans are at high risk of contracting.

Can monkeypox spread asymptomatically?

“It does not, at this point, look like there’s risk from asymptomatic spread,” said Dr. Jay Gladstein, the chief medical officer for APLA Health, an L.A. group focused on providing healthcare to the LGBTQ community.

While this outbreak continues to be studied, Gladstein said transmission has so far been linked only to contact with virus-filled lesions.

But people should know the virus can be spread until lesions have healed completely and are covered by a new layer of skin, which can take weeks.

World & Nation

As monkeypox cases grow, so do fears of a return of gay blame and stigma

Although the monkeypox virus can affect anyone, some gay and bisexual men are worried about being once again branded as carriers of an exotic disease.

Are massage therapists or tattoo artists are risk?

Burstin said the risk remains very low for people who work in industries that come in contact with skin, but he said it’s important to monitor for rashes or bumps.

“The safety is really very high,” Burstin said. “If you don’t see a lesion, the person is much more likely than not to not be infectious.”

He said to be extra safe, professionals should wear gloves and increase cleaning protocols, but he didn’t recommend drastically changing operations.

“The skin lesions are visible, and for the people who have them, they’re painful, so hopefully people will notice,” Gladstein said. He said there have not been any outbreaks among healthcare workers who provide care to patients with active monkeypox.

Science & Medicine

What is monkeypox and where is it spreading?

U.S. and European health officials identify a number of cases of monkeypox, an illness previously limited mostly to central and western Africa.

Should gyms, bars, swimming pools or public transportation be worrisome?

“What we’re not seeing is casual spread. It’s really got to be really close contact,” Gladstein said. “The risk is going to be vanishingly low, close to zero.”

Moore said there are certain precautions people can take in crowded spaces, such as wearing long sleeves and pants to limit skin-to-skin contact. He recommended wiping down equipment at the gym and washing your hands. But surface contact and short-term interactions are not how monkeypox is transmitted, experts say.

As for swimming pools, Burstin said he’s not worried, given the chlorine and how anything in the water would be diluted.

He said there are scenarios, such as being at a club with an event for gay men where many people could be shirtless, that he would consider more risky. But most day-to-day interactions should not concern people. He said he wouldn’t worry about brushing someone’s arm at a bar or on public transportation.

“This type of contact disease is usually not that rapidly transmitted,” Burstin said.

California

Sex, rashes and outbreaks: A rational guide to the monkeypox risk in California

Everything you need to know about monkeypox.

Can using condoms prevent the spread?

Unfortunately, condoms are not a foolproof way to prevent contracting monkeypox, but they can be protective, experts say. Researchers have noticed in this outbreak that many patients’ lesions have been concentrated on genitalia or the anus — in which case a condom could provide protection — but just as many have reported infectious lesions elsewhere on the body.

“A condom is not going to be perfectly protective,” Burstin said. “That doesn’t mean people shouldn’t wear condoms; it may give some degree of protection.”

Monkeypox is not considered a sexually transmitted disease, but researchers are still trying to determine whether it can spread through semen or vaginal fluids. Some studies have indicated that possibility, so experts also recommend using a condom for a few weeks after recovering from the virus.

World & Nation

Biden taps FEMA and CDC officials to lead monkeypox response

The appointment of a White House coordinator and deputy coordinator to deal with monkeypox mirrors the Biden administration’s response to COVID-19.

Does the smallpox vaccine provide protection?

Adults who may have received a smallpox vaccine could have some protection against monkeypox, but experts say it’s very limited.

“There’s not any significant protection as far as we know,” Gladstein said. “They may end up with a slightly more mild case of monkeypox, but it’s certainly not considered fully protective.”

As with all vaccines, he said, protection wanes over time, and with the U.S. smallpox vaccine campaign ending in the 1970s, no one should rely on that inoculation.

People who got the smallpox vaccine are eligible for the Jynneos shot.

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Mesmerizing video shows car get its first wash in 10 years so it looks like a totally different vehicle

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Lars von Trier’s ‘The Kingdom Exodus’: A Guide to the Most Wonderfully Weird Show on TV

Lars von Trier likes to tell stories in trilogies. Those who know the director—as much as one could know or understand the Danish provocateur/auteur/saboteur of good taste—know him mainly from the feature films which drove him to international success:

Breaking the Waves, The Idiots, and Dancer in the Dark, collectively known as the Golden Hearts trilogy; and later Antichrist, Melancholia, and Nymphomaniac, cheerily nicknamed the Depression trilogy.

But, before any of these, when von Trier was still attempting to break free of the Danish cinema mold (with the beginnings of his strict filmmaking manifesto Dogme 95 still brewing in his head), he wrote and directed the supernatural hospital drama The Kingdom, which, after 27 years, is finally concluding with the five-episode season The Kingdom: Exodus.

In 1992, after establishing himself and his art in his home country, von Trier and his producing partner Peter Aalbæk Jensen founded the production company Zentropa, named after the fictional railway line in von Trier's 1991 psychological drama Europa. To make some money for the newly minted company, von Trier opted to create and direct a television miniseries, The Kingdom, which was broadcast in 1994 on Danish channel DR. A follow-up season, The Kingdom II, debuted in 1997.

The show is set in the Danish national hospital Rigshospitalet, colloquially known as Riget ("realm" or "kingdom"), a hospital for specialized medicine and unusual medical conditions, whose staff are as peculiar as the diseases they treat. Each episode of the show begins with a prologue describing how the hospital was built over a site known as the "bleaching ponds" which contain within them some supernatural evil threatening to bubble up to the surface.

The first two seasons follow Stig Helmer (Ernst-Hugo Järegård), a crabby Swedish neurosurgeon obsessed with proving the intellectual supremacy of Sweden over the dullard Danes he's forced to work with. He’s preoccupied with fleeing the legal repercussions of a botched surgery that left a young girl, Mona, in a barely conscious state. Meanwhile, Sigrid Drusse (Kirsten Rolffes), a hypochondriac medium who keeps showing up at the hospital claiming she can hear voices in the elevator, hounds Helmer and the staff while searching for the source of the voices, unraveling a horrifying mystery from the hospital's past.

Elsewhere in the hospital, a medical student becomes obsessed with an older nurse in charge of Riget's sleep studies, a ghost ambulance haunts the highways around the campus at night, another doctor collects extra expired medication in a lab in his basement, and another resident is impregnated by a ghost—and gives birth to a rapidly growing and horrifyingly deformed child. (Both the ghost and the child are played by Udo Kier.) Every beat of the action is watched and commented upon by a Greek chorus of dishwashers with Down syndrome, whose poetic and prophetic dialogue connect the happenings above with the battle of good vs. evil down below.

    Each episode ends on a horror-tinged cliffhanger, and the finale of the second season ends on the biggest one of all: Drusse discovers a cult of tumor-obsessed doctors who reside in the hospital and falls 50-plus floors deep into the ground. Meanwhile, Helmer attempts to banish Mona to some sort of netherworld. Von Trier had plans for a third season, which never came to fruition after both Järegård and Rolffes, his main stars, died in 1998 and 2000, respectively.

    While the series is not as well-known overseas as his films, shades of The Kingdom popped up on American television not once, but twice. In 2001, UPN broadcast the short-lived hospital anthology/procedural All Souls, which took inspiration from The Kingdom in its main premise: a haunted teaching hospital with a dark past (in this case, the American Civil War) becomes the unwitting battleground of near-Biblical forces. In a fun coincidence, one of the producers of All Souls was Mark Frost, co-creator of Twin Peaks, which von Trier was heavily influenced by for The Kingdom.

    The other, perhaps slightly more well-known, is Kingdom Hospital, a 2004 miniseries directly adapted from The Kingdom by none other than Stephen King. The show hews closely to many aspects of von Trier's show: a cruel brain surgeon fleeing his greatest mistake, an elderly lady who can see ghosts, a young medical resident with a crush on an older female sleep nurse, a secret society, and a hospital built upon the site of some grave sin.

    King makes a few additions here and there: the hospital dog from The Kingdom becomes a spectral anteater with sharp teeth, who ushers spirits from the world of the living to a sort of basement purgatory. An additional character, a comatose painter hospitalized after being hit by a car, can communicate with the hospital's ghosts on the astral plane. Neither of these shows had a large viewership, and both were canceled after a single season. (Kingdom Hospital, though, is well worth a watch.)

    Lars von Trier's creation lives on in a final conclusive season, broadcast on DR and on Mubi in America as The Kingdom: Exodus. The director didn't spend too much time revisiting the earlier episodes, preferring to focus on the new story he wanted to tell, and Exodus is indeed something of a departure from the first two seasons—with a more metatextual take on the ideas of the show before diving back into all the weird stuff.

    The Drusse character arrives in the form of Karen Svensson (​​Bodil Jørgensen) an elderly sleepwalker who believes the events of a Lars von Trier TV show from the '90s to be real (ha-ha), and the absence of the original Dr. Helmer is remedied by the arrival of his son, Helmer Jr. (Mikael Persbrandt), whose fear of politically incorrect improprieties swiftly lands him in hot water. Both of the omniscient dishwashers have been replaced by new actors, one of which is a talking robot.

      Unlike the first two seasons of the show, von Trier's end credits monologues in Exodus are delivered from behind a curtain. The director was unknowingly suffering from the beginnings of Parkinson's disease, a diagnosis he announced this year, while he was filming the show, and told reporters at the Venice Film Festival that he had “a rotten time.” Instead, during his monologues the camera focuses on an Advent wreath hanging in front of the ever present red curtain, at the bottom of which you can see, presumably, the toes of von Trier's shoes.

      After each episode, another of the four candles on the wreath is lit, signifying in no uncertain terms the Biblical nature of the story von Trier is attempting to tell, substituting hospital orderlies and sickened inmates for gods and monsters, reminding us, as always, the importance of taking the good with the evil.

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