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A New National Health Emergency

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Credit...The New York Times

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The U.S. government is ramping up its response to monkeypox.Credit...Mario Tama/Getty Images

We're taking a detour from our regular Covid coverage to keep you up to speed on the monkeypox outbreak.

The Biden administration yesterday declared the growing monkeypox outbreak a national health emergency, signaling that the virus now represents a significant risk to Americans.

The declaration sets in motion measures aimed at containing the threat. It gives federal agencies power to direct money toward developing and evaluating vaccines and drugs, obtain emergency funding and hire additional workers to help manage the outbreak.

The monkeypox vaccine, called Jynneos, is in short supply in the U.S. Because of a series of government missteps, its scarcity is expected to last for months. Jynneos is approved as a two-dose regimen, but my colleague Apoorva Mandavilli reports that federal officials are considering a so-called dose-sparing strategy, which splits a single vial into five smaller doses that are delivered between layers of the skin instead of under it.

"We are making all the same errors with monkeypox policy that we made with Covid, but we are correcting the errors more rapidly," Alex Tabarrok of the Marginal Revolution blog wrote in a post about dose stretching.

The same approach has been used when supplies of other vaccines are scarce, but giving intradermal shots requires more skill than is needed for more traditional immunizations, and the F.D.A. would need to grant Jynneos an emergency use authorization.

One shot is probably enough to forestall severe symptoms in most people, and the dose-sparing strategy may work just as well. But it's unclear whether a scaled-back regimen is enough to prevent infection and, if it is, how long that immunity may last, federal health officials said.

"We're in a data-free zone," said Dr. Emily Erbelding, an infectious diseases expert at the National Institutes of Health, who oversaw testing of Covid vaccines in special populations.

The U.S. now has one of the highest rates of monkeypox infection in the world, and the number is expected to rise as the disease spreads and surveillance and testing improve. As of Thursday, the country had recorded more than 7,100 monkeypox cases, with the highest rates per capita in Washington, D.C., New York State and Georgia.

More than 99 percent of the cases are among men who have sex with men, but federal health officials are concerned that the outbreak will spill over into other populations. At least five children have been diagnosed with the disease. Although it is rarely fatal, and symptoms are resolved within a month in most cases, some experts have warned the disease can be more serious in children and people with certain medical conditions.

The administration has been criticized for moving too slowly to expand the number of available doses. Demands for stronger action against monkeypox have intensified in recent weeks, but many experts fear containment may no longer be possible.

More on monkeypox:

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Like many other airports this summer, Heathrow in London has been troubled by long lines.Credit...Henry Nicholls/Reuters

This summer — as in the past few summers — travel looks different. Many of the virus restrictions that protected travelers in the past have been removed. Even the most closed-off destinations like New Zealand are throwing their borders open, and many countries, including the U.S., have dropped testing requirements to enter.

"What this means is that travel feels more like it used to," said my colleague Heather Murphy, who covers travel. "It also means that more of the risk and ethic calculations involved in deciding whether or not to test or wear a mask are back on the individual traveler."

I caught up with Heather for more.

What does travel look like now?

Travel has looked glorious, with many people splurging on trips that they hadn't been able to pull off earlier in the pandemic. Travel has also looked miserable, with tons of flight delays, record cancellations in some airports, infuriatingly poor communication from many airlines, ridiculous gas prices and rampant misinterpretation of working-from-pretty-place as vacation.

Staffing shortages are definitely contributing to air travel issues. But also, some airlines have been unrealistic about schedules and slow to pay attention to burned-out employees' demands for more pay and better working conditions.

What should we keep in mind?

There's a decent chance that someone you'll encounter during your travels will be contagious. So, ask yourself two questions before you depart: Who is the most vulnerable person you're likely to interact with within two weeks of returning from your trip? And what are all the scenarios where testing positive soon after you return could wreak havoc on your life? Then adjust accordingly. Maybe that means you change nothing. Maybe that means that you ask everyone staying in a beach house together to test.

What is your advice for travelers this summer?

Fly direct if you can, carry on essentials in case your bag is delayed and consider using a travel agent if you can afford it.

Beyond that, even if you're too broke or overwhelmed to plan the ideal trip, try to go somewhere you've never been before for at least two nights. Spend some time in nature even if you're not outdoorsy. Talk to a stranger even if you're not an extrovert. My observation is that a lot of people are mentally struggling right now. Years of working from home, obliterated routines and exhausting daily risk assessments have taken their toll. I love how even a short trip can help reset us and extract us from the pandemic blur.

We recently asked readers for their stories of traveling during this time of fewer virus restrictions. Thanks to everyone who wrote in.

"In May, my stepdaughter and I took a fantastic 11-day cruise ending in Venice, Italy. I tested positive for Covid at disembarkation. I had very minor cold symptoms. I was transported (along with 25 others) four hours away to Florence, where we were installed in an a disgusting, moldy hotel and fed garbage for a minimum of seven days. We were told if we left our rooms, the police would be called. I was fortunate to test negative on Day 7, but some others were not. I had to spend $1,600 on my flight home and was invoiced $1,400 for the hotel." — Victoria Haviland, Appleton, Wis.

"I flew from Orlando to Anchorage in July. In the premium lounge, I watched a father administer Covid tests to his two young sons. I heard the father discussing with someone on the phone that if the boys tested positive, they would stay in the basement — but they were definitely getting on the plane. Wow." — Gail Scott, Miami

"My nightmare is that, once again, I did not travel. This is the third year in a row that I have missed my beloved Shaw Festival in Niagara-on-the-Lake, Ontario. But what's the point of going through the travel nightmares only to sit with strangers in a dark theater days on end, sometimes twice in one day, and risk getting the Covid infection? I love theater, and the Shaw Festival is among the best. At 75, I'm not sure how many more years I can make that 1,000-mile trip." — Barbara Sloan, Conway, S.C.

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