5 Things You Need to Know About Monkeypox

We are breaking down some basic facts about monkeypox - including what you should know as it continues to spread around the world.

  1. Monkeypox isn't novel. 

  2. Monkeypox is not an STD.

  3. Monkeypox is now a global health emergency and a national emergency in the US. 

  4. We already have vaccines!

  5. We don't know everything, and we probably aren't doing enough.

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EPISODE RESOURCES

TRANSCRIPT

Beth [00:00:00] All of that is going to mean that the disease of concern for the moment is probably going to be a thing. I don't think we're going to have a year where we don't have something that we're talking about. I don't think it will be at the scale of COVID. But I think it's going to be part of our lives. And so a new vocabulary around that and kind of new practices and new methods of communication, this seems like a moment that's ripe for it. 

Sarah [00:00:29] This is Sarah Stewart Holland.  

Beth [00:00:30]  And this is Beth Silvers. 

Sarah [00:00:32] Thank you for joining us for Pantsuit Politics. Hello, everyone. Welcome to Pantsuit Politics. We are so glad you're here. In addition to processing the news together, it really matters to us to prioritize curiosity and learning. Every so often we have an episode like today where we share five things you need to know about a topic in the news. Today, we're sharing some important facts about monkeypox that we hope will better equip you to both stay safe and have better conversations with people in your life about this virus.  

Beth [00:01:11] If you find today's episode helpful, you might want to head over to our Instagram account @Pantsuitpolitics, where we'll post shareable graphics with these five facts. We really appreciate when you share episodes with people in your lives, and we try to make it easy to communicate the information that we share in these five things episodes.  

Sarah [00:01:28] So up next, five things you need to know about monkeypox. The first thing you need to know is that monkeypox isn't novel.  We spent a lot of time talking about the novel Coronavirus. But monkeypox is, in fact, not novel. This virus was first identified in a laboratory in apes in 1958, and hence that's where we got the name, which I don't think is great, Beth.  

Beth [00:01:59] No. And we're going to talk about that. There's a lot of controversy about the name right now. We started to understand in 1970 that this is a zoonotic virus, meaning that it can be transmitted from animals to humans. Human monkeypox case was first identified in the Democratic Republic of the Congo in a nine-month-old boy.  

Sarah [00:02:17] And the first monkeypox outbreak outside of Africa was reported in the United States in 2003 and was linked to contact with infected prairie dog. So we call it monkey pox. But monkeys are not the only animal that carry this virus.  

Beth [00:02:30] Monkeys aren't even the main animal that carry it, it's mostly rodents.  

Sarah [00:02:34] Always with the rodents.  

Beth [00:02:34] And mostly rodents  that lived in rainforests in central and western Africa. But it is increasingly appearing in urban areas. There have been several outbreaks in Africa. This outbreak really seemed to start in Europe. So there's a lot of stigma kind of associated with calling it monkeypox and thinking of it as this African virus. That is no longer anything approaching an accurate understanding of how this virus operates.  

Sarah [00:03:03] And I think the name pox part is a little confusing too. So it is a part of the same family of viruses as smallpox, the virus that causes smallpox, but it is not related to chickenpox. So all poxes are not the same.  

Beth [00:03:16] I was just reading an article about the naming of this virus, and it talked about how chickenpox is not well named either because it's not in that small pox family and that it would more accurately be called chicken herpes. It's so interesting.  

Sarah [00:03:28] I don't want to call it chicken herpes.  

Beth [00:03:30] But I don't think anybody is going to. I think chicken pox is probably going to stick.  

Sarah [00:03:33] Okay, that's fine. Because I don't love that. All right. We know from history that the infections typically last from about 2 to 4 weeks and the symptoms can be flu like. You can have fever, muscle aches, headaches, back pain, low energy, chills, exhaustion, swollen lymph nodes, all those sort of traditionally flu like symptoms. But then there's the pox part, which is a rash of red raised bumps on the skin that turn to blisters before drying out and falling off. And the rash usually begins on the first to third day of the onset of a fever. It can develop all over the body. And we know that monkeypox impacts different people differently. Some people might get a widespread rash and others might not have a rash at all. The rash can be like a few regions or it can be several thousand covering your entire body.  

Beth [00:04:22] The symptoms usually resolve within weeks. Monkeypox symptoms are treated with extra fluid, sometimes an additional treatment for secondary bacterial infections. You have to care for the rash. For really severe cases, an anti-viral agent has been developed and licensed in Europe. It's not widely available yet. But here's the great news about monkeypox. In addition to it not being novel, it is very rarely fatal; 99% of people infected with monkeypox survive.  

Sarah [00:04:48] Now, I have heard it can be pretty painful, though. I don't want to get it. It sounds very [Crosstalk].  

Beth [00:04:52] It sounds terrible.   

Sarah [00:04:53] And newborns and people with immune system deficiencies are at greater risk, of course, of these more severe symptoms and death. And in severe cases, monkeypox symptoms can include skin infections, pneumonia, confusion, and eye infections that can lead to vision loss.  

Beth [00:05:06] So as we've alluded to, the name is a whole thing right now. Naming diseases in general is a whole thing right now. There's talk about never using any place attached to it because I think that creates a lot of xenophobia.  

Sarah [00:05:21] Yeah, that's a good [Inaudible].  

Beth [00:05:22] Never using animal names anymore because people harm animals. In Brazil, people poisoned monkeys as monkeypox started to become well known in the news. So we have to stop attaching sickness to people places or things.  

Sarah [00:05:39] To species.  

Beth [00:05:41] That's  good. So right now there is discussion of renaming monkeypox because people see the name as racist. Some people see the name as homophobic. Again, some people are attacking the monkeys, which we don't want. The state of California has started calling it Mpox. Some scientists are abbreviating it as MPV or lowercase hmpxv. The World Health Organization has just named two variants Clade one and two, with some variants like Clade 2B. And it is holding an open convention for a new name for the virus. Sarah, the one thought that I have about this, other than I do think in general changing how we name viruses, to be more thoughtful is good.  

Sarah [00:06:23] Yeah. No people, places or things.  

Beth [00:06:24] I also feel that this is behind the curve. Like, it's maybe too late to rename monkeypox to have a material effect, but maybe I'm wrong about that.  

Sarah [00:06:34] Yeah, I mean, it's been around for a while, clearly, in a time where we were not hyper aware of the impact of language or deliberately ignorance of the language. And I think it's hard. I like clade. That doesn't apply to dang near anything. So let's just try to keep it simple. Let's call it a virus instead of poxes or whatever. Like Corona virus, that worked. Let's keep it simple, you guys. Let's not overcomplicate this.  

Beth [00:07:01] And we still did mean hateful things around coronavirus. There is a segment of the population. I mean, to me, the whole theme around monkey pox-- and this leads nicely into the second thing we want you to know-- is that we just have to stop stigmatizing having health issues of any variety.  

Sarah [00:07:19] Yeah. So the second thing we want you to know that's going to lead to this bigger point is that monkeypox is not, repeat, not an STD. Most cases in the United States right now are linked to male to male sexual contact. That is a fact. But it's not limited to sexual transmission. It just happens that when you are in a sexual contact with somebody, there's a lot of skin to skin contact. If you really take one beat and think about it, it sort of makes sense.  

Beth [00:07:49] So that is how it spreads, skin to skin contact with an infected person who has a lesion. It spreads through saliva. It can spread through contaminated bedsheets or clothing or other materials. It can spread through respiratory droplets. But again, we are not talking about COVID. That kind of transmission would take several hours of close contact with an infected person. We actually don't know if it can spread through semen or vaginal fluids. So it's gotten this kind of STD like reputation only because that's the population in which a lot of cases are being reported, that male sexual partner population is where these cases are being reported. But it it doesn't appear right now to be anything like an STD.  

Sarah [00:08:31] Now, the rash can resemble herpes and syphilis, which could be why the current outbreak is being reported among men seeking care at sexual health clinics. Again, when you have a disease and also a virus that presents with a rash, that makes sense when you think about it.  

Beth [00:08:46] So two things are true at once. Right now in the United States, you are at the highest risk if you have sex with multiple or anonymous partners. And anyone can contract monkeypox by coming into close contact with infected people or materials.  

Sarah [00:09:01] And that messaging has been terrible.  

Beth [00:09:03] It's been terrible.  

Sarah [00:09:04] Some of it was out of concern for like not naming that this population is at greater risk for fear of stigmatizing. It's like the opposite of what we were talking about with the name of monkeypox itself. This current messaging out of fear, stigmatizing, I think was a little sluggish. And that's problematic, too.  

Beth [00:09:21] And then there's kind of the flip side of it. Like, I think people wanted to keep it limited to a population without stigmatizing that population because everyone has virus fatigue. It's like we don't want to scare people. We don't want there to be a panic. We don't want it to sound like there's another pandemic coming. So how can we not stigmatize this population but also not worry anybody else about it? And it's just been a mess.  

Sarah [00:09:48] The CDC has publicly announced that they're doing some soul searching. That's just what I call them. We call it soul searching. And I wish I could just sit them down and say I love you so much, and I know you're trying hard. Stop trying to anticipate reactions and just tell the truth. Just tell the truth. Just trust people with the truth. It won't always go your way. People don't always act reasonably, we know that. But trying to anticipate and prevent those unreasonable reactions has not worked. I would like to argue it will continue not to work. So just tell the truth. Just tell the facts on the ground as you know them. If you have to change them later, that's the reality. But stop trying to anticipate how people are going to react or what you think they're going to do.  That has not lead us down a good path. Please stop doing that.  

Beth [00:10:36] It's really hard because I get that there is a social science component to public health always, and that figuring out people's behavior is part of the deal. What I would love is as part of educating the public, for the CDC to always underscore this information could change. Here's what we know today. Here are the questions that we still have. This information could change. We could learn more. The virus itself could change. I just think our foundational understanding of science in America is so poor that we really need constant reminders of the scientific method.  

Sarah [00:11:13] Yeah, but the science with regards to monkeypox and how to prevent the spread, it's pretty clear. Avoid skin to skin contact with people who have a rash that looks like monkey pox. Don't share eating utensils or cups with people who have that rash. When you are in places like clubs or parties or saunas where there can easily be skin to skin contact, be very careful. Talk with your sexual partners about whether they have symptoms or have been exposed. Wash your hands with soap and if you learn that you've been exposed, contact your doctor to test for it and isolate at home if you're actively infected.  

Beth [00:11:46] The third thing we want you to know is that monkeypox is now classified as a global health emergency and a national emergency in the United States. This handful of cases in the United Kingdom in May ballooned to more than 16,000 cases from 75 countries very quickly. And that's why it's an emergency. It is not as deadly as COVID by a long shot, but it is spreading really fast. Every state in the U.S. now has at least one confirmed case of monkeypox. Twenty three states and the District of Columbia have reported more than 100 infections.  

Sarah [00:12:19] Now kids are at very low risk in the U.S. right now. But if we don't prevent wider spread, we all know kids are not so great at skin to skin contact and precautions around it. So the risk is low right now, but that's why they're trying to prevent further spread. The risk of monkeypox is moderate globally, except in Europe, where it's pretty high and the mortality rate, again, is low. There have been five deaths reported in Africa where the strain spreading has about a 1% rate of being lethal. In other countries, though, the outbreak seems to be even less lethal, perhaps due to probably a stronger health care infrastructure.  

Beth [00:12:54] The importance of these designations public health emergency, national emergency is that it triggers funding and it triggers collaboration so that vaccines can be shared information and treatments can be shared. When you don't declare it a public health emergency, it causes us to get far behind the spread. That's another thing I think that would just be helpful to hear from officials. We have classified this as an emergency. That doesn't mean that you need to be scared of it. It doesn't mean you need to panic. It means that we're going to bring our full resources to it before it becomes something that should scare us.  

Sarah [00:13:25] Yeah. And, again, our language is not great. If you don't want to scare people, then maybe emergency is not the word we're looking for here. Increased awareness. Increased threat level. Could we do the colors like we did back in the day after 9/11? I don't know. I'm just trying to brainstorm here because it feels like they want to get people's attention, but they're worried about scaring them. Well, then emergency is not the word you want. Let's find another way to alert people to increase spread.  

Beth [00:13:50] I think that's a really important point for everyone to think about, especially since we just know that the transmission of new or previously contained viruses is only going to increase. We just travel a lot more. We're out and about. The climate is changing, weather patterns are changing. All of that is going to mean that the disease of concern for the moment is probably going to be a thing. I don't think we're going to have a year where we don't have something that we're talking about. I don't think it will be at the scale of COVID, but I think it's going to be part of our lives. And so a new vocabulary around that and kind of new practices and new methods of communication, this seems like a moment that's ripe for it.  

Sarah [00:14:36] Well, because it's all out there, like, my son had somebody come to middle school in gloves because they were worried of monkeypox. One day he came home and said, "We have our first case in McCracken County." That was not true. He had just heard it at school. And so kids are telling other kids, well, do you have monkeypox, if they have something on them. It's out there,  that increased concern. Or even that just sort of energy is circulating. And so instead of just hoping it goes away or hoping it dies down, if we don't build trust by, again, openly and honestly describing the facts as we see them, then it's going to continue to build.  

Beth [00:15:16] And this is, I think, a moment for parents to pay attention. This happened to Jane. She has terrible bug bites all over her legs. She's just delicious. She gets bitten constantly in the summer and then she scratches them and they look awful for a while and are really painful for her. And she has already heard kids say, "Do you have monkeypox?" And I've tried to tell her, like, we don't use sickness as an insult. And that's what you need to say to people.  A.They are bug bites, as you probably know. And B.Sickness is not an insult. That's rude.  

Sarah [00:15:48] Well, I heard about a woman who had a nerve condition and people took video of her put on TikTok. Do does she have monkey pox? And, look, here's what I think some of what's happening, because I think even in our own household it's like when it's out there and you know it's it's spreading but it's not a high risk, some of the way I signal to my own kids like, yeah, it's real, but we don't need to worry about, it is to joke about it. And I shouldn't do that, you know. But I think it is a natural human tendency to like, oh, is that monkeypox? Like, to joke. Kids pick up on that too. Like, you're trying to be flippant to signal I'm not worried about this or to sort of process your own concern.  We all do that. And I think I don't know if it's never do it again or just be aware of like, oh, look what I'm doing there. Like, I'm trying to to ease my own concern or be flippant about it, to make my own self feel better, to make my kids feel better. But you're right. What we're doing is we're using health in a very, like, dismissive way. And we're teaching kids that you can you can joke about this kind of stuff.  

Beth [00:16:57] I mean, it can be true that we don't want to get it. I don't want to get it. I don't want my kids to get it. I don't want to get it. Sounds terrible. And if we get it, we'll deal with it. And if we get it, it's not because we're bad people, because we made a mistake, because our choices are not virtuous the way other people's choices are. We have to figure out how to hold those things together, that being sick is not what we wish for ourselves and it is okay and it is part of being a human.  

Sarah [00:17:27] Yeah. And the humor part can be a way to deal with that. I think there's a flavor of dark humor that helps people deal with really difficult diagnoses. And I think there's nothing wrong with that. And I think, look, health is always tied up with this sort of undercurrent of existential dread. And I think that's what we're always working out with every virus, with every health concern, with all of this. Is just this fear of, like, I don't want to die. What happens when I die? Like, that's it.That's what's always going on. We're working that out on each other. We're Working that out with our public health messaging. And so we're asking a lot of one another. All right. Up next, we'll move on to the fourth and fifth things you need to know about monkeypox.  

Beth [00:18:26] So we mentioned this is a totally different type of emergency than COVID. And one reason for that is the fourth thing we want you to know. We already have vaccines. Yeah, we have vaccines. We're not scrambling to invent a path forward.  

Sarah [00:18:38] Well, that's a complicated message, but we'll get to that.  

Beth [00:18:40] It is a complicated message. 

Sarah [00:18:42] That's a complicated yey! 

Beth [00:18:43] So let's start with just, like, the Science is yey! And the vaccines also work after you've been exposed. If you're at high risk or have already been exposed to the virus, getting vaccinated 4 to 14 days post-exposure can reduce your symptoms. That's amazing. So who's high risk right now? Again, health care workers, people who engage in sex with multiple and or anonymous partners, people in settings where there is prolonged skin to skin contact. So if you're in those categories, try to get the vaccine. It is difficult. This is the complicated part of the message.  

Sarah [00:19:16] Yeah, it was a complicated yay. So there are two vaccines available in the U.S.. One is the smallpox vaccine. And data from Africa suggests it's about 85% effective in preventing monkeypox.  

Beth [00:19:29] We also have a vaccine called JYNNEOS that has fewer serious side effects than the smallpox vaccine. We just don't have enough of it. It's made in Denmark. More shots have been ordered. This company that makes it, Bavarian Nordic, says it can produce quite a bit of it, but perhaps not as much as everybody wants right now. It has worked with a partner in the U.S. to try to increase its capacity. But this is spreading really fast. And can the manufacturing follow it? We don't know.  

Sarah [00:20:04] Well, they came out and said, well, one of the vaccines you can put in subcutaneously because it wouldn't take as big of a dose. Instead of one dose going to one person, you can split it among three people. So they're clearly trying to be innovative because, again, it's a complicated yay. Yay, we have vaccines, but we don't have enough of them. And that leads very well to the fifth thing we want you to know is which we don't know everything and we probably aren't doing enough.  

Beth [00:20:28] Scientists aren't sure why it's spreading so fast. Like we said before, we know climate change and increase in global travel have generally increased the emergence and spread of viruses. We don't have a clear link on monkeypox between reported cases and travel from endemic countries. We don't have a clear link to infected animals. We just don't know. We don't know if people can transmit it asymptomatically. We don't know why it's mutating so fast. Lots of questions here.  

Sarah [00:20:55] Now, what we do know is that it is made of DNA. We spent a lot of time with COVID talking about that it is an RNA virus, and RNA viruses mutate faster and more often. DNA viruses tend to mutate less often. So on average, the family of viruses that include monkeypox tend to mutate about once per year. Now it looks like monkeypox has mutated about 50 times in the past four years. It's probably been spreading among humans in Africa or Europe for years, and most of those mutations are small. They don't make a huge difference. But experts say that as the number of infections increase, so will the chance that the virus becomes better at infecting or transmitting among humans.  

Beth [00:21:36] The biggest issue right now in the United States is that we got behind this. We did not test early and often enough. We have not increased our testing capacity enough. It's available, it's just underused. We can process about 80,000 tests a week, but there's a lack of awareness even among physicians. There is that fear of stigmatizing patients because so much of the reporting has focused on male sexual partners in terms of transmission, which I hate that that is still something that creates some sort of stigma, but that is happening. So we could have huge underreporting of monkeypox. We could be doing more with wastewater testing at a much bigger scale to try to get our arms around that. We have a lot of tools to bring to this. We've just been slow about bringing them.  

Sarah [00:22:27] I do like what Dr. Sanjay Gupta says, which is we have a cavarly culture instead of trying to prevent things. Which I think is hard, you know, establishing reliable data systems, I do think there's a good positive movement with regards to wastewater on that. Mastering our supply chain acting early, we wait for the cavarly to come in and rescue us.  

Beth [00:22:44] So the Biden administration is working on this. This goes in the bucket of things that Sarah always points out. They're working on it. The CDC is doing this soul searching process. We have a new administration for strategic preparedness and response. When you create a new agency in Washington, there's always concern that that is going to just add to the mess of coordination and communication. But there is a focused, deliberative effort to learn what we learned from COVID, apply it to monkeypox, and better prepare ourselves for whatever comes next. We're just in the messy middle of that process right now.  

Sarah [00:23:23] Yeah. And I think with the CDC there's a sense of it's just built for something different. And can they reformat to be this crisis organization? Which I think you're right, we're going to need more and more and more. We need rapid response, not long term academic study, which I think is what they've been focused on. It's not that we don't need that. We need as much data as humanly possible, but the rapid response piece of the puzzle seems to be missing.  

Beth [00:23:52] And here's the other thing. We're asking for rapid response and the kind of thorough, meticulous, rigorous science that the CDC has done for a long time and excellent public relations skills all built on top of a health care system. That's not great. You mentioned a few minutes ago that a lot of what we do is just think, how do I not die? And I had a night two weeks ago where I went to bed thinking I wonder if I'm going to wake up because I have been having weird heart sensations. And even with it being my heart, it was difficult for me to take the step of reaching out to a physician, because I know that when you've got something going on in your body and you're not sure what it is, you are going to get shoved into a process through which it is unlikely that you're going to have quick and helpful and positive experiences. So we have this whole system built that is so specialized and so bureaucratic because of our insurance that It feels unfair to me to ask the CDC to get everything right when it comes to the most novel and complex and fast moving situations, when we don't get everything right about the very routine stuff that comes through the door and that  we're dealing with in our bodies all the time.  

Sarah [00:25:40] When it comes to the way the health care system handles health, I guess, it's just two manifestations of the same problem, which is that cavarly problem. Individually where the same way.I think the health care system is built on saving the day when something terrible happens instead of preventing something terrible from happening. I think that's hard for a lot of reasons. I think you don't get credit when you prevent terrible things from happening. It's hard to quantify the prevention. I think we've gotten better at it. I think we've gotten more awareness around it. But we're turning a big ship when you're talking about our health care system and these viruses and our public health is just a part of that. It's the section of the ship, but it's all a piece of the whole. And that whole, I think with increasing awareness, we all understand is really messed up. And whether it's acute illnesses like a virus, whether it's chronic disease, whether it's cancer, whether it's just aging and death, we need a lot more awareness and conversation. Again, sort of like what I was saying before. We just need to be honest. We just need to describe the situation and not try to wrap it up with a bow and make ourselves feel better. Again, the undercurrent is like, well, it'll be okay. But look, the truth is, when it comes to our health, it might not be okay. And we're just really uncomfortable with that reality as human beings. And I don't say with any judgment, I say that with enormous grace and compassion. I think that that is a normal human reaction to sort of want to look away from the difficult reality of our own mortality and the difficult reality that we don't control a lot. With the health care system that's built massive infrastructure and spends lots and lots of money to really tell us that we can't control it, that we can take the right pill or we can have the right surgery, and we can control these things that are often uncontrollable.  

Beth [00:27:49] And let me say, our cavalry is amazing and I'm grateful for it. When something catastrophic happens, there's nowhere in the world I'd rather be than here. Like, we have some fantastic minds and systems and places and abilities to meet those extraordinary edge of catastrophe challenges. I wish we could lean in to our strengths and think about what is it that makes the cavalry so effective when you're in that situation? Well, it is that in an ICU all the experts are there together, cooperating. We have good stuff to build on. And we have professionals who have been educated well and are very dedicated to their work. And we can do this. It just I feel bad for the CDC. I just feel like we're asking the CDC to be out in front of the systemic changes when they are already out in front of the science. And that just feels like a big ask.  

Sarah [00:28:50] I don't feel bad for them because I think that these problems have been diagnosed for a while and they've been ignoring them before COVID even. So I don't necessarily feel bad for them. I think they are in need of really good leadership to say we know some of these problems. Well, I'm sure some people are going to attack them no matter what. And it will never be enough for some people and it won't be fast enough for some people. But I think they have some ground to make up and I think they're capable of doing that. So I look forward to the soul searching and I think luckily some of this that has been revealed with monkey pox and a less than robust response was with a virus that has a vaccine that has treatment that's not deadly. I know the ship is hard to turn, but let's do our best.  

Beth [00:29:39] Unless to our best to not be a place where we stigmatize an illness because of the people it's presenting in or because of how it's presenting or because of where it came from or what animal we associate with the name.  

Sarah [00:29:51]  Or because you are just afraid.  

Beth [00:29:52] Or just because you're afraid of dying. I mean, we just have to say, like, this is a part of being a person and it will be for the rest of my life.  

Sarah [00:30:03] Well, thank you for joining us for five things you need to know about monkeypox. Before we leave, we did want to give a shout out to Vicki, who wrote the most lovely review of our book. Now What for the Houston Mom collective. Thank you so much, Vicki, for such a lovely piece. We'll put a link to it in the show notes if you guys want to check it out. We, of course, will be back in your ears on Tuesday. And until then, keep it nuanced y'all.  

Beth [00:30:32] Pantsuit Politics is produced by Studio D Podcast Production. Allise Napp is our managing director.  

Sarah [00:30:37] Maggie Penton is our community engagement manager. Dante Lima is the composer and performer of our theme music.  

Beth [00:30:43] Our show is listener-supported. Special thanks to our executive producers.  

Executive Producers (Read their own  names) [00:30:47] Martha Bronitskty. Linda Daniel. Ali Edwards. Janice Elliot. Sarah Greenup. Julie Haller. Helen Handley. Tiffany Hasler. Emily Holladay. Katie Johnson. Katina Zugenalis Kasling. Barry Kaufman. Molly Kohrs.  

[00:31:06] The Kriebs. Lilly McClure. Emily Neesley. The Pentons. Tawni Peterson. Tracey Puthoff. Sarah Ralph. Jeremy Sequoia. Katie Stiggers. Karin True. Onica Ulveling. Nick and Alysa Valleli. Katherine Vollmer. Amy Whited.  

Beth [00:31:24] Jeff Davis. Melinda Johnston. Ashley Thompson. Michelle Wood. Joshua Allen. Morgan McHugh. Nicole Berklas. Paula Bremer and Tim Miller.  

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