Monkeypox failure means we now face two pandemics

We missed our chance to quickly contain the monkeypox. Now the dangerous virus is rapidly spreading all over the world.

Health experts agree: the outbreak could soon be called a pandemic, if it hasn’t already. And the situation is likely to get worse before it gets better. More infections, more deaths, more chance of smallpox mutating.

“We’re in uncharted territory with this outbreak…and still early in the event,” James Lawler, an infectious disease expert and a colleague of Wiley’s at the University of Nebraska Medical Center, told The Daily Beast.

The latest figures from the US Centers for Disease Control are startling. The CDC has tallied 9,647 infections as of July 11. That’s a fourfold increase from just a month ago.

It’s shocking after everything we’ve learned with COVID-19, we’ve let another virus escalate to this point.

Lawrence Gostin, Georgetown University

The virus, which causes a rash and fever and can be fatal in a very small percentage of cases, is present in 63 countries, 57 of which usually do not have any case of monkeypox.

Cases are concentrated in West and Central Africa, where the virus is endemic, as well as in Europe, where the current outbreak began in May. But the United States is also seeing a surprising number of cases: 865 in 39 states, according to the CDC. This is five times more than a month ago.

“Monkeypox is clearly a global health emergency,” Lawrence Gostin, a global health expert at Georgetown University, told The Daily Beast. “It has been simmering in small pockets in Central and West Africa for decades, but so far there have been no cases unrelated to travel in the rest of the world. Now it is present in virtually all regions of the world and is spreading rapidly.

The death rate, fortunately, is still low. As of July 4, the most recent date for which figures are available, the World Health Organization had recorded only three deaths in the current outbreak.

Health workers examine passengers arriving from overseas for symptoms of Monkeypox at the terminal of Anna International Airport in Chennai on June 03, 2022.

Arun Sankar/AFP via Getty Images

Three out of 9,647, or 0.03%, is a far lower death rate than countries in West and Central Africa have apparently suffered during their own smallpox epidemics in recent decades. Africa’s worst outbreaks, involving a strain of the virus endemic to the Congo River Basin in central Africa, have resulted in official death rates of up to 10%.

But the more viruses spread, the more they mutate, often in ways that make them more deadly. As long as monkeypox is spreading faster than health authorities can contain it, the greater the risk that it will spawn new, more dangerous variants, which could drive up the death toll.

Monkeypox is mainly spread through close physical contact, especially through sexual contact. This is not a sexually transmitted disease, however. He’s just enjoying the skin-to-skin contact that comes with sex. The virus can also travel short distances with spit, but probably not far enough to qualify as “airborne.”

Officials first noticed the current outbreak, involving a relatively mild West African strain of smallpox, after diagnosing a British traveler returning from Nigeria in early May. While hitchhiking in Europe, the virus spread rapidly through physical contact.

David Heymann, who previously headed the WHO’s emergency department, said men who frequented raves in Spain and Belgium had ‘amplified’ the outbreak, apparently through close contact, sometimes sexual, with other people. men.

After that, the virus accompanied travelers on planes to distant countries. Doctors diagnosed the first US case on May 27.

But it is obvious now that the first diagnostic the smallpox cases in Europe and the United States were not the first true cases. On June 3, the CDC announced that it had found genetic evidence of smallpox cases in the United States that preceded the first cases in Europe from May.

Doctors may not have noticed or reported these earlier cases, at first, due to the similarity between the symptoms of smallpox and the symptoms of some common sexually transmitted diseases such as herpes. In other words, the current outbreak started and spread, unnoticed at first.

The virus had a big head start, which helps explain why, months later, it still has the edge. “By the time we recognized cases were happening, we were already behind schedule,” Lawler said.

Rapid diagnosis is the key to containing a dangerous virus quickly. If officials know where the virus is concentrated in the early days of an outbreak, they can isolate infected people, conduct contact tracing to identify vulnerable populations and deploy therapies and vaccines and to treat infected people and protect uninfected people. (Fortunately for us, the widely available smallpox vaccines work very well against monkeypox.)

With its most likely vectors of infection cut off by early intervention, the virus withers away and disappears…before it can mutate into a new variant that could, for example, be more contagious or even escape vaccines.

This should have happened in April or even before, but doesn’t because the WHO, CDC and other health organizations didn’t even know a smallpox outbreak was happening. The current rapid spread is the consequence of this initial failure.

Toronto Public Health signs offer resources and information about monkeypox during the annual Dyke Walk in downtown Toronto.

Steve Russell/Toronto Star via Getty Images

The worst outcome is not hard to imagine – 10,000 cases could quickly become 100,000 cases. Then 1 million. Various experts and agencies disagree on the precise definition of “pandemic”, but if the smallpox epidemic is not already qualified, it is increasingly likely that it will be in the coming weeks. . At this point, the world will face simultaneous pandemics.

The WHO for its part has carefully avoided using the P-word to describe the smallpox epidemic. The CDC did not immediately respond to a query

It’s a mistake, Lawler said. “We certainly can’t make ‘pandemic’ statements about every outbreak that crosses multiple international borders without becoming the boy who cries wolf,” he conceded.

But, he added, “I would say we should have learned some humility in the face of emerging viruses by now.” If the word “pandemic” catches people’s attention and underscores the growing risk, use it.

The silver lining is the very low death rate in the current smallpox epidemic. This could be a statistical anomaly resulting from a huge overcount of deaths in earlier African epidemics. “I’m not sure we have a full understanding of the denominator of the cases that are actually happening in West Africa,” Lawler pointed out. This means that it is possible that smallpox deaths in Africa were spread over a much larger number of infections than we thought at the time.

It is also possible that we are witnessing a happy side effect of a smallpox epidemic mainly affecting wealthier communities. “Monkey pox is now being diagnosed in urban populations where more people have access to healthcare facilities,” Blossom Damania, a virologist at the University of North Carolina at Chapel Hill, told The Daily Beast.

Either way, we shouldn’t be complacent. Smallpox, like all viruses, treats every infected person like a lab. A chance to try new things, learn and change. Each additional infection increases the likelihood of new variants emerging. As COVID has repeatedly demonstrated, new variants mean new risks. Greater transmissibility, severity or vaccine escape – or a mixture of the three.

There is still time to avoid the worst case scenario of millions of cases and potentially thousands of deaths. The WHO, CDC and other health agencies need to do more to educate doctors and speed up diagnoses, then move faster to isolate and treat infected people and vaccinate those around them. “If we can get enough vaccines for high-risk contacts, it will stop,” Amesh Adalja, a public health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.

COVID has reminded us how serious a viral outbreak can be. Then the monkeypox came to remind us of our strong tendency towards complacency, even in the midst of an ongoing health crisis. “It’s shocking that after everything we’ve learned with COVID-19, we’ve let another virus escalate to the point of becoming a global health emergency,” Gostin said.

To catch up with fast-moving smallpox, what we need now, more than anything, is a new sense of urgency.

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