Joe Biden recently said we should be concerned about Monkeypox, a virus that is spreading throughout western countries after mainly being confined to Western Africa.
There are fears we could have another pandemic on our hands. Having just about come out of the Coronavirus pandemic, the virus is still here but vaccines have helped mitigate the worst effects, are we really about to go back to the dark days of March 2020 again?
What hasn’t been reported as much as Biden’s comments about being concerned, is that he also said we shouldn't be as concerned about it as Covid.
In other words, he’s saying it’s unlikely we’ll see a widespread pandemic that kills millions as was the case with Covid. Of course, developments are at an early stage and his words could come back to haunt him in a month or two. But then he can hardly say we’re guaranteed to have another pandemic at such an early stage in the outbreak.
What I want to do in this post is take a sober and rational look at what’s going on. I should make it clear that I’m not a healthcare professional, I have no background or expertise in this field. I’m merely a writer who’s interested in finding more about monkeypox out of curiosity.
I’m going to try to avoid jumping to conclusions by making claims of impending doom about what’s going to happen, because, in truth, no one really knows. All I’m going to try is lay out the information as it stands and see what it suggests.
What is Monkeypox?
Monkeypox is a viral infection that typically manifests symptoms such as fever, rash and skin lesions a week or two after exposure. It’s thought the primary method of transmission is through body fluids, close contact with someone who’s infected or through a contaminated object.
There’s no indication monkeypox can be spread from human to human through airborne transmission, although as the outbreak is in its infancy, it can’t be ruled out yet.
Monkeypox is similar to smallpox, a disease that was eradicated in 1977, with symptoms manifesting in a similar fashion. This close similarity means that the smallpox vaccine is estimated to be 85% effective against monkeypox. Although caution should be applied here again, if the strain circulated has mutated in a significant way, then that may render the vaccine less effective.
A vaccine specific to monkeypox, Jyyneos, is already approved for use in the United States. This is a significant difference from Covid, as, during the emergence of Covid-19, there was no vaccine as it was a novel virus.
Should worst come to worst and Monkeypox start to spread more widely, the fact a vaccine is available should make the possibility of a devastating pandemic like Covid less likely as we can start vaccinating people straight away rather than waiting for a vaccine to be developed.
What’s the fatality rate from Monkeypox?
It’s hard to quantify a specific percentage in regards to the fatality rate from monkeypox. The two main strains, the West African strain and Congo strain result in 1 in 100 deaths and 1 in 10 deaths respectively.
So far, only the West African strain has been detected in the UK, the epicentre of the current outbreak, but as more information becomes available following genome sequencing that may change.
It’s also important to stress that no one has died as a result of this outbreak yet as of writing. Again, that’s likely to change as time goes on, but it’s a promising sign.
Is Monkeypox going to be another pandemic?
Again, I must state that I’m not an epidemiologist or a healthcare professional, so my views should be taken with a pinch of salt. It’s too early to say at this point whether we’re staring down the barrel of another pandemic or not. There are signs suggesting it might be and signs suggesting it won’t.
The spread of monkeypox in various countries is concerning, but it’s not clear whether the spread is the result of one person, or whether it’s due to multiple travelling back from West Africa to their respective countries. If it were the result of one person, I’d be worried. If not, then a pandemic should be avoided.
Another reason why monkeypox might not result in another pandemic is that we’ve just been through one. Given all the lessons we’ve learned from Covid, which appears to be much more virulent and transmissible than monkeypox, we should be much better at controlling the spread of monkeypox.
Of course, this depends on how quickly countries act to mitigate the spread of monkeypox and how fast we decode the genome to learn if it’s changed significantly in ways that encourage it to spread.
Thankfully, we have the tools available to do this, so we are in a much better position than we were in February 2020. As I mentioned above, we also have a vaccine for monkeypox which we didn’t have for Covid, as it was a novel virus. This is a huge bonus and provided this strain of monkeypox doesn’t evade the vaccine, should mean that any surge in cases is stopped in its tracks by an effective vaccination programme.
For all the faults around Covid in 2020, the vaccination was largely a success, although it hasn’t got to as many people as it should in developing countries. But the rollout of vaccines is something we know states around the globe can do quickly and efficiently. If worst comes to worst, then I have no doubt they’ll be able to do so again.
So how concerned should we be?
This is going to be a diplomatic answer; we should be cautious but not wracked with fear about another pandemic. So far, it appears monkeypox is spread through close contact with people, in particular sexual contact. As this paper reports, all but three cases have been in males, which is not indicative of a virus that spreads freely throughout a population.
Another key difference between Covid and monkeypox is that the latter is a DNA virus unlike the former which is an RNA virus. What’s the difference I hear you ask?
Without getting into technical terms, RNA viruses find it easier to replicate than DNA viruses and they also multiply faster than DNA viruses owing to their structure. This is why we’ve had multiple strains of Covid, such as Alpha, Delta and Omicron within the space of two years. It’s also why it’s so hard to vaccinate RNA viruses as the target is constantly moving.
With DNA viruses, such as smallpox and monkeypox, it’s easier to create vaccines as they are much more stable. One of the reasons we were able to eradicate smallpox in the seventies. Given this, it should be unlikely that the current monkeypox outbreak spreads rapidly and causes the problems we saw with Covid.
The first case of the current outbreak was recorded on 4 May and as of writing, there have been a further 388 cases with no fatalities. This is a big jump but it’s not a huge one and not representative of the jump in cases that occurred initially in the initial Covid outbreak in China. This page highlights how quickly the virus spread throughout the population in January 2020 in China. By the end of January 2020, there were 2,101 new cases of Covid a day.
Thankfully, that rate of replication isn’t being reflected in the initial data for this outbreak. Scientists are yet to determine the R number for monkeypox, which will be a vital part of understanding how much of a threat monkeypox poses. Considering the data so far, and the comparison with Covid, which isn’t a perfect one, I would be cautiously optimistic about avoiding another full-scale pandemic.
I should stress that the situation is still new and likely to change. While the situation isn’t as bad as that of January 2020, we should still be cautious. Healthcare systems across the globe are still reeling from the past two years. Covid is now endemic in most countries and still poses challenges. Long Covid is still misunderstood and will have ramifications for the health of millions for years, and potentially decades to come.
Even a small but significant outbreak of monkeypox would put healthcare systems under strain. While we are better placed to deal with such an outbreak that doesn’t mean there won’t be negative consequences.
I’m reluctant to definitely say what’s going to happen one way or another as I don't have a crystal ball nor the expertise to do so. The situation is evolving and the more evidence that becomes available the clearer the consequences of this outbreak will be.
For now, I would remain vigilant and cautious but not panicked about the prospect of entering another pandemic.
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