We missed our chance to contain quickly monkeypox. Now the dangerous virus is spreading rapidly all over the world.
Health experts agree: The outbreak could soon be classified as a pandemic, if it isn’t already. And the situation is likely to get worse before it gets better. More infections, more deaths, more chance of the smallpox mutate.
“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 counted 9,647 infections as of July 11. That is a fourfold increase from a month ago.
“It’s shocking after all we’ve learned with COVID-19, we’ve escalated another virus so far.
— Lawrence Gostin, Georgetown University
The virus, which causes skin rashes and fever and can be fatal in a very small percentage of cases, is found in 63 countries, 57 of which are mostly unaffected. each cases of monkey pox.
Cases are concentrated in West and Central Africa – where the virus is endemic – and in Europe, where the current outbreak first started in May. But the US is logging in also a startling number of cases: 865 in 39 states, according to the CDC. That’s five times what it was a month ago.
“Monkeypox is clearly a global health emergency,” Lawrence Gostin, a global health expert from 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 in virtually every region of the world and it is spreading rapidly.”
Fortunately, the death rate 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.
Three out of 9,647 — or 0.03 percent — is a much lower death rate than the West and Central African countries that had apparently suffered from their own smallpox outbreaks in recent decades. The worst African outbreaks, involving a strain of the virus endemic to the Congo River basin in Central Africa, have resulted in official death rates as high as 10 percent.
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, potentially increasing the death toll.
Monkeypox usually spreads through close physical contact, especially sexual contact. To be not a sexually transmitted disease, but. It just takes advantage of the skin-to-skin contact that comes with sex. The virus can also travel short distances with saliva, although probably not far enough to qualify as “airborne.”
Officials first noticed the current outbreak, involving a relatively mild West African strain of smallpox, following the diagnosis of a British traveler who returned from Nigeria in early May. Hitchhiking to Europe, the virus quickly spread through physical contact.
David Heymann, formerly head of WHO’s emergency department, said that men attending raves in Spain and Belgium ‘exacerbated’ the outbreak – apparently through close, sometimes sexual contact with other men.
After that, the virus accompanied travelers on planes bound for distant lands. Doctors diagnosed the first US case on May 27.
But it is now clear that the first diagnosed cases of smallpox in Europe and the US were not the real first cases. On June 3, the CDC announced it had found genetic evidence of smallpox cases in the US predating the first cases in Europe as of May.
Doctors may not have noticed or reported these previous cases at first because of the similarity between smallpox symptoms and the symptoms of some common sexually transmitted diseases such as herpes. In other words, the current outbreak started and spread without anyone noticing.
The virus had a big lead, which partly explains why it is still in favor months later. “By the time we recognized that things were going on, we were already behind,” Lawler said.
A prompt diagnosis is the key to quickly containing a dangerous virus. 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, treat the infected and protect the uninfected. (Luckily for us, commonly available smallpox vaccines work just fine against monkeypox.)
With its most likely infection vectors cut off by early intervention, the virus withers and disappears –before it can mutate into a new variant that is, for example, more contagious or even evades vaccines.
That should have happened in April or even earlier, but not done because the WHO, CDC and other health organizations didn’t even know there was a smallpox outbreak going on. The current rapid spread is the result of that initial failure.
The worst result is not hard to imagine. Ten thousand cases can quickly grow to a hundred thousand cases. Then a million. Several experts and agencies disagree on the precise definition of ‘pandemic’, but it is increasingly likely that the smallpox outbreak qualifies now – or will qualify in the coming weeks. At that point, the world will be battling concurrent pandemics.
For example, the WHO has zealously avoided using the p-word to describe the smallpox outbreak. The CDC did not immediately respond to a question
This is a mistake, Lawler said. “We certainly cannot make ‘pandemic’ statements about any disease outbreak that crosses multiple international borders without becoming the boy that the wolf howls,” he admitted.
But, he added, “I would say we should have learned some humility now in the face of emerging viruses.” If the word “pandemic” grabs people’s attention and underscores the growing risk, use it.
The silver lining is the very low death rate in the current smallpox outbreak. That could be a statistical anomaly resulting from a massive overcount of deaths from past African outbreaks. “I’m not sure we fully understand the denominator of cases actually occurring in West Africa,” Lawler noted. This means it’s possible that smallpox deaths in Africa were spread across a much wider range of infections than we realized at the time.
It’s also possible that we’re seeing a happy side effect of a smallpox outbreak that primarily affects wealthier communities. “Monkeypox is now being diagnosed in urban populations where more people have access to health care facilities,” Blossom Damania, a virologist at the University of North Carolina at Chapel Hill, told The Daily Beast.
Anyway, we shouldn’t get complacent. The smallpox like all viruses treats every infected person like a laboratory. A chance to try new things, learn and change. Each additional infection increases the chance of the emergence of new variants. As COVID has repeatedly shown, new variants mean new risks. Greater transmissibility, severity, or vaccine evasion – or a combination of all three.
There is still time to avert the worst-case scenario of millions of cases and possibly thousands of deaths. The WHO, CDC and other health agencies must redouble their efforts to educate doctors and speed up diagnoses — then act faster to isolate and treat infected people and vaccinate those around them. “If we can get enough vaccine into high-risk contacts, this will stop,” Amesh Adalja, a public health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.
COVID reminded us how bad a viral outbreak can get. Then Monkeypox came to remind us of our strong propensity for complacency, even amid an ongoing health crisis. “It’s shocking that after all we’ve learned with COVID-19, we’ve let another virus escalate into a global health emergency,” Gostin said.
To catch up with the fast-moving smallpox, we now need – more than anything else – a new sense of urgency.