How can ransomware spread through a USB stick or external drive?

In two ways. A drive can carry the malware itself, which runs when someone opens a disguised file, and some malware copies itself onto every drive it finds so that it travels between computers and sites. And a drive that is connected when encryption starts is simply encrypted with everything else, which is why a backup on a permanently attached USB disk does not protect you from ransomware. Disable automatic running of programs from removable media, scan unknown drives on a dedicated computer, allow only company-issued devices where you can, and disconnect backup drives after each run. Spain's INCIBE has published a real case in which ransomware spread as infected devices were connected. A USB transfer does not cross the network, so a network sensor does not see it; NetSenX sees what the infected computer does next, such as scanning or calling an outside server.

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