According to the World Health Organization, there are now 131 confirmed cases of monkeypox in 19 countries, with another 106 suspected cases. Experts describe the incident as “random” but “containable,” with sexual activity at recent raves in Spain and Belgium likely being the catalyst. Despite the fact that the world is still recovering from the effects of the covid pandemic, the emergence of a new disease has many people on edge.
Bobby Ghosh of Bloomberg Opinion moderated a live Twitter Space conversation with Bloomberg Intelligence senior pharmaceutical analyst Sam Fazeli to learn more about the disease and whether we should be concerned.
Bobby Ghosh: Let me begin by posing the most basic of questions: What exactly is monkeypox?
Sam Fazeli: The number of viruses that circulate in nature appears to be infinite. One of them happens to be this. It’s an orthopoxvirus, which causes diseases such as chickenpox and smallpox. In terms of mortality, monkeypox is less of a problem than smallpox. The virus that is currently circulating appears to be an endemic strain in West Africa.
For decades, we’ve known about two strains. Both are endemic in different parts of Africa – Central Africa and West Africa, respectively – and there have been a few cases outside of Africa, usually from people traveling from an affected area. This outbreak appears to be quite unusual in that cases are being reported from all over the world at the same time. What’s going on?
In 2003, there was a 71-case outbreak in the United States, which was caused by imported rodents from Ghana, not by a person traveling. These rodents infected pet prairie dogs, who then infected humans. There was a chance of local transmission back then, but it was definitely transmitted from animals to humans. From bird flu to covid, we’re dealing with this issue in many of these viral outbreaks.
In the case of today’s odd outbreak, it’s too early to say if the virus was actually seeded individually in different nations or if at least the majority of the cases were caused by a super spreader event. Sequencing the cases is the best technique to determine their relationship. Portuguese scientists presented the first genome, which revealed that the virus is quite similar to the one that was discovered in numerous countries in 2018 and 2019. That already indicates that it hasn’t altered significantly. Despite the fact that everything is subject to change, it appears that the majority of these situations are connected.
In passing, it’s worth noting that, despite its name, monkeypox does not actually come from monkeys. We only started to notice it when monkeys started to understand it. Is it still associated with Simians? What do we know about the disease’s transmission mechanism?
Monkeypox viruses, in particular, are thought to be generalists. This indicates that the virus can and does infect a wide range of animals. The most prevalent carriers of illness are rodents, followed by monkeys, and finally humans. Transmission can take place in a variety of ways, not all of which must follow a precise path. In this situation, it is thought that it is disseminated through contact with contaminated fluids from an infected individual and that this contact must be relatively close.
The majority of virus transmission is likely to occur when you’re either in close proximity to someone who has the virus and takes up their inhaled droplets, or when you’re in physical touch with them. It can also be spread through fomites, which are spread by touching a surface that has been infected.
According to some studies, it occurs mostly through intimate touches, such as being in extremely close proximity to another person or having intercourse with them.
I believe we must be extremely cautious not to misread the dialogue or the information that emerges. The fact that the majority of cases have been discovered in males who have sex with men has no bearing on sexual transmission. We’re just interested in how this particular spread occurred. It might have been any type of intimate touch, heterosexual or otherwise.
What do monkeypox symptoms look like?
It all starts with a headache and a fever, which are typical symptoms of a viral illness. Your defense system is kicking in with these signs. Because many viruses dislike warmer temperatures, the body raises its temperature. Because of all the chemicals generated to combat the infection, such as cytokines, we get a headache and muscle aches. Some persons experience a rash that develops into pustules within a week or two.
If you have pustules on your body, you run the danger of bacterial infection and, in some situations, sepsis. This is where the lethality may originate.
So far, there have been no fatalities in this cluster. The Central African strain’s 1-3 percent mortality rate or 10-13 percent mortality rate has been discussed extensively, but it’s important to remember that, like covid, it all relies on how patients are treated. A patient’s risk of death is increased if they are at home without oxygen, an ICU, or medical experts to care for them. That may be the case in rural Africa, where these figures were derived, but in countries with decent healthcare and treatments, I’m confident the fatality rate will remain below 1% – ideally 0%!
The symptoms remind me of when I had chickenpox as a child. I was bedridden for several days and recall finding it really unpleasant. Then it vanished.
Is it possible to say whether monkeypox is more unpleasant or dangerous than chickenpox?
If you have full-blown pustules on your skin, it’s a much more uncomfortable infection, but it varies. I’ve heard of an instance where a person who had previously been vaccinated against smallpox became infected. They only had one or two lesions, which is insignificant. That’s what you assume and hope will happen to most people who have already been vaccinated. The issue revolves around those who have not been immunized. How horrible is it for them?
In the 1970s and 1980s, I grew up in India and was inoculated against smallpox as a child. After smallpox was eradicated, immunizations were no longer offered in many countries.
Is this going to make us more susceptible to monkeypox?
Yes, I believe it does, and that is most likely what is going on here. There was even speculation that the covid lockdowns made humans more susceptible to sickness. That might be said of the flu and the coronavirus, both respiratory viruses. In this case, I believe it is purely coincidental. In Central and West Africa, we have an endemic virus that has been given the opportunity to spread among a population that has never witnessed an infection or received a vaccine to protect them from the virus.
Unlike covid, the vaccination is already available, which is good news. We have vaccines that function both before and after a disease has been contracted.
So they’re both preventative and curative?
Correct, the vaccine appears to still work a few days after an illness has been diagnosed. It’s worth noting that both vaccines are currently manufactured. In instances like this, stocks may not be as high as one would like, but several countries had already been hoarding it, not for monkeypox, but for a bio-terrorism strike by smallpox.
Because the disease is less contagious than covid, vaccination is not required. It can be used to both treat and vaccinate those who have been diagnosed. This procedure is known as ring vaccination, and it has previously proven effective in controlling smallpox.
There was a lot of debate regarding whether or not poor countries could purchase covid vaccines. Is this a problem with monkeypox vaccines?
Pfizer’s covid vaccination costs between $15 and $20 per shot. Given the protection it provides, that is not expensive for most of us who reside in England, Sweden, or the United States. I believe that the COVAX equivalency will help nations that cannot afford vaccine control and effectively manage the global spread of this illness. At the same time, the cost is clearly influenced by volume. If we just need one million doses rather than 400 million, corporations will most likely have to charge a little more because margins will be lower at those numbers. I don’t anticipate this vaccination being particularly costly.
That’s comforting. How have leaders reacted to the monkeypox outbreak? During his tour to South Korea, President Biden felt forced to respond to a question about it. Have we learned any policy lessons from our fight against covid that will be particularly effective in dealing with monkeypox?
The good news is that, as we’ve already stated, this is not an illness with which we’ve never dealt before, even though it may not be fresh in many people’s minds. Smallpox immunization programs were only discontinued about 50 years ago. Bavarian Nordic, one of the smallpox vaccine makers, held meetings with health officials from numerous nations just a few days ago, which had been scheduled six months ago. This demonstrates that countries were already thinking about it, regardless of whether they were thinking of smallpox or monkeypox.
Is there any evidence that monkeypox is a seasonal disease?
Most diseases, especially respiratory infections, should be on the decline at this time of year when individuals spend more time outside than indoors. This is passed on by physical contact. As a result, I don’t believe it can be classified as seasonal.
What about variations, which have long been a source of contention with Covid? Is there any evidence that the monkeypox virus is evolving into new forms that are resistant to current treatments?
It’s far too soon to tell. Nigeria collects a lot of epidemiological data, but the number of monkeypox cases is nowhere near SARS-CoV-2 levels. Because SARS-CoV-2 is also an RNA virus, it has a higher chance of mutating.
The preliminary evidence from Portuguese experts suggests that the virus’s genome is similar to what it was in 2018 and 2019, which is comforting. When viruses replicate at a high rate, mutations are unavoidable. So we’ll have to keep an eye on that.
What can we do to avoid contracting monkeypox?
This has happened before with Covid. We can all make decisions in our life based on our unique circumstances, such as whether or not to wear a mask. You can take safeguards if you’re afraid or feel threatened. Most scientists, I believe, believe that this will eventually self-limit, especially when awareness is so high because it is difficult to convey.
Is there already more research being done on this outbreak now that it’s been a couple of weeks since the story broke and instances have been documented in several countries?
I’m aware that the genomics team is working around the clock to sequence the virus’s genomes in order to better understand its epidemiology. When you only have 200 cases to work with, this is the best way to figure out how these incidents are related. At least two medications and two vaccinations are already available to treat the infection. So I don’t believe we need to conduct much research. What we need to do now is put in place the appropriate healthcare public health policy to manage it and decide where we should go next. Do we go back and vaccinate everyone who hasn’t been vaccinated, or do we just use ring vaccination to control it?