Why Monkeypox is not like Covid-19

On Wednesday, the CDC confirmed a case of monkeypox in a Massachusetts man who had recently traveled to Canada.

It wasn’t the first time the US has seen a case of monkeypox, a virus related to smallpox that causes flu-like symptoms and rashes, and can sometimes be fatal. Occasionally, public health authorities identify individual cases in people who have recently returned from West or Central Africa, where the disease is more common.

What’s different — and worrying — about this Massachusetts case is that it’s occurring as clusters of monkeypox infections are popping up in other countries where the virus is also rare.

Since the beginning of May, the UK Health Security Agency has 9 cases of the infection, and Portugal and Spain have reported 14 and 23 respectively suspected cases. (The numbers are changing fast; an epidemiologist from the University of Oxford) tweeted a link to a makeshift tracker where you can see the latest numbers.)

With so many cases of monkeypox popping up in several countries at the same time, the immediate questions from public health officials are whether the cases are related and whether monkeypox is spreading undetected in other communities.

“The global concern of public health authorities is trying to understand how these are related and what causes them,” said Agam Rao, an infectious disease specialist and smallpox virus expert at the CDC.

Just weeks after this outbreak, it is too early to say exactly what is going on and whether this outbreak has epidemic potential. For now, the general public need not worry, according to Rao. “The risk is still very rare,” she said, and the strain of monkeypox currently being detected is relatively mild.

Two years after a global pandemic that is divisive, news of another pathogen spreading unchecked may make some people want to launch themselves straight into the sun.

But with Monkeypox, the world is facing a very different situation than it was in the early days of Covid-19. Monkeypox, unlike SARS-CoV-2, is a known amount. We have more tools to prevent and treat it – far more than we had before Covid-19 at the start of the pandemic – and both public health and the general public have had a lot of practice taking measures to prevent infections from spreading. to spread. Still, the course of the outbreak so far is uncertain, and public health experts remain vigilant.

What is monkey pox?

Monkeypox viruses generally circulate among wild animals in Central and West Africa and usually spread to humans when they eat or have other close contact with infected animals. The virus was first identified under lab animals at the CDC in the 1950s (that’s how it got the name “monkeypox”), and for a long time afterward, human infections were sporadic, even in countries where many animals are infected.

That’s partly because monkeypox is related to the smallpox virus, and smallpox immunity is protective against monkeypox. But from 1980, smallpox has been eradicated in humans and smallpox vaccinations have become rare – and cases of monkeypox in humans are on the rise. It’s still rare: According to the CDC, Nigeria has reported 450 cases since 2017, when public health authorities started seeing more cases in humans.

Infection with the monkeypox virus usually causes a flu-like illness with fever, headache, muscle aches, swollen lymph nodes, and skin rash. Although monkeypox is not related to chickenpox, the characteristic monkey pox rash looks a lot like it, starting as red spots on the mouth and face, then spreading to the arms and legs. Over four to five days, the spots turn into small fluid-filled blisters that are often tender to the touch, eventually become donut-shaped and begin to crust over after two weeks.

Smith Collection/Gado via Getty Images

Studies have suggested that the virus’s R0 — the number of people who will hypothetically contract an infectious disease from a person infected with that disease — is relatively low, somewhere between one and two.

“It’s not as transmissible as something like smallpox, or measles, or certainly not Covid,” he said Anne Rimoinan infectious disease epidemiologist at the University of California at Los Angeles with expertise in monkeypox and other emerging diseases.

Transmission can occur through close contact with an infected person’s bodily fluids, sores, or items that have touched fluids or sores (such as bedding); the virus can also spread through respiratory drops or aerosols that hang in the air. But unlike Covid-19, where infected people can spread the disease before they get sick, Monkeypox is not considered contagious until people develop symptoms†

There are two predominant strains of monkeypox: the “West African” version and the “Congo Basin” version. Of the two, the Congo Basin version has historically spread more easily from person to person and caused more deaths. The current outbreak concerns the West African version.

the infection does not often lead to deaths in resource-rich countries like the United States because the people who live there generally have better access to the supportive care that clears up most monkeypox infections, Rimoin said. In 2003, there were at least 53 people in the Midwestern United States caught the infection from prairie dogs as pets that were infected when housed near rodents imported from Ghana; none of the infected people died.

In rural parts of Africa, where access to hospital care is lower, infection has resulted in death in about 4 percent of people infected with the virus.

Multiple treatments approved for the treatment of smallpox, may possibly be used to treat monkeypox infections if needed. However, most cases are relatively mild; it’s unclear whether any of the currently affected patients needed or received any of these medications.

What’s different about the latest cases of monkey pox?

The latest clusters of monkeypox cases differ from previous clusters in a number of ways.

For starters, the current cluster includes many infections occurring simultaneously outside the African countries where the disease circulates in wildlife. “We’ve never had a situation where so many cases have occurred simultaneously outside those countries,” Rao said.

What is also unusual about the latter cases is that many of them have so far occurred in men who have sex with men (monkeypox transmission has not previously been associated with sexual orientation or intimate contact). Many of the cases present with: clusters of pimple-like spots in the genital area – an unusual area where the monkeypox rash begins.

After clinicians made the first few diagnoses in men who came to sexual health clinics with unusual skin rashes, health officials began asking sexual health clinics to look out for cases of monkey pox. This does not mean that monkeypox only circulates among men who have sex with men, and some infections have been diagnosed in people who are not gay or bisexual men.

“We find what we look for,” Maria Van Kerkhove, the World Health Organization’s expert on emerging diseases and zoonoses, said in an interview with STAT†

Linking this monkeypox outbreak to male sexual networks doesn’t mean it’s necessarily a sexually transmitted infection; it may just be a matter of who gets close enough to an infected person to get infected themselves. Other germs spread nearby — but not specifically sexual — contact has previously caused clusters of infections among gay and bisexual men and students, such as: meningitisa disease spread by respiratory droplets in narrow environments.

How concerned should the general public be about this outbreak?

In addition to trying to understand the cause of the current outbreak and the routes of transmission, public health authorities are working to sequence the viruses isolated from individual patients to better understand whether it has been altered in some way to make it more or less transmissible. said Rao.

At this point, however, there’s no reason to believe the virus has undergone a meaningful mutation, she said.

Currently, the general public need not worry about the risk monkeypox viruses pose to themselves and their loved ones. “It doesn’t spread easily from person to person. The risk to the general public is low,” Rimoin said. And now that healthcare providers are on high alert for the infection, it’s more likely to be recognized quickly in people who become infected and quickly contained, halting the transmission chains.

“We should see a significant cluster of cases and continued transmission” before public health authorities take broad preventive action, Rimoin said.

Even a major monkeypox outbreak would likely be much easier to handle than the Covid-19 pandemic. First, the fact that the virus isn’t considered contagious before people show symptoms can make it harder for people to spread it unknowingly. And in addition to treatments, we already have excellent vaccines to protect those most at risk of infection – public health authorities in the UK are currently vaccinate close contacts of cases to prevent further spread of the infection.

This isn’t a new disease — so if monkeypox becomes a much bigger outbreak than it already is, public health agencies will be better equipped with tools to manage it.

In fact, as a result of the Covid-19 pandemic, public health is in a relatively strong position to tackle this outbreak.

“I think we’re in a good position to respond to monkeypox because most health departments have Covid staff, lab networks, and funding that can be used for emergency response,” said Jay Varma, a physician and epidemiologist in New York City. who recently served as a senior advisor to the Africa Centers for Disease Control and Prevention. “The real risk is what happens if that funding runs out in the next few years.”