Why there's no reason to panic over monkeypox

Experts say while the current monkeypox outbreaks should be taken seriously, there is no need for the public to panic.

Infectious disease specialist and professor at the University of California San Francisco, Dr Peter Chin Hong said he does not expect monkeypox to be a serious threat to public health because it is not very transmissible and people are now on alert for it.

“The reason why people are hearing about it now is that there is, for the first time in the history of monkeypox, simultaneous outbreaks in multiple countries where you would not usually see monkeypox as it is usually seen in West and Central Africa.”

The first monkeypox outbreak outside of Africa consisted of 70 cases in the US in 2003 when pet prairie dogs were infected after being housed with Gambian pouched rats and dormice that had been imported from Ghana. The humans who bought the animals got infected.

Recently, the first case was reported on May 7. Up to Thursday, there were 200 confirmed cases and more than 100 suspected cases of monkeypox in more than 20 countries including Spain, Portugal, France, Germany, Sweden, the United Kingdom, the US and Canada.

He said one school of thought is that the recent spread was related to two large raves (parties) held in Belgium and Spain.

“A lot of people attended and went back home. And because monkeypox has a long incubation period, around 12 days to three weeks, you are exposed, you have it, you don’t even know you’re sick and you could potentially transmit it.”

Chin Hong explained that monkeypox is not a disease of humans but one of rodents like squirrels and mice, and occasionally monkeys, that accidentally got into humans. A comparable disease for humans is smallpox, which the World Health Organization declared eradicated in 1980. Because both diseases are of the orthopoxvirus family, smallpox vaccines give protection against monkeypox.

Initial symptoms are flu-like and can include fever, intense headache, muscle pain and swollen lymph nodes. Then comes a rash and lesions, usually on the face and extremities but there have been recent cases of rashes around the genitals.

The disease is spread when an animal bites a human or through blood, infected fluids or lesions on the animal. From human to human, it is spread by close contact with body secretions, saliva, respiratory droplets, intimate contact, or contact with contaminated materials such as clothing and bedding.

“But you need to have a lot of contact. If it’s 15 minutes for covid, you need to have three hours or more contact with somebody at close range for monkeypox. And with the respiratory droplets, it’s not aerosol-like fine droplets which can go into the air like influenza or covid. These are big, heavy drops that fall so if you’re wearing a mask you would be protected.”

Comparing it with other diseases, from least to most transmissible are monkeypox, smallpox, influenza and colds, covid19 variants, and measles. He said monkeypox has a 23 percent attack rate while smallpox was around 70 per cent.

“The main thing is do not have intimate contact with anyone who is sick. That’s the same rule for influenza, covid, colds or anything. It goes for monkeypox too because, in the beginning, it all looks the same.

“The second thing is, after the flu-like illness, you can get a rash and this rash looks like nothing else – these fluid-filled sores that scab off and get better over time. But once people have recognised that they should contact the health authorities.”

Those more likely to get ill from the virus are pregnant women and those with compromised immune systems but most people would be fine even though the lesions look “scary.” He added that older people who received the smallpox vaccine before the disease was eradicated may be less susceptible to monkeypox.

Chin Hong said since smallpox is a potential bio-terrorist agent, the US stockpiled smallpox vaccines so they are available. There are also anti-viral and anti-body treatments which were developed for other viruses but are effective for monkeypox.

The vaccine is said to be very effective because the time between exposure and onset of symptoms is about three weeks and during that time the vaccine can intervene.

“The biggest impact will not be on people getting sick but the stigma people have if they see someone with this rash.”

Dr Christopher Oura, professor of veterinary virology at the Faculty of Medical Sciences, UWI agreed with Chin Hong that, although it is alarming to see monkeypox in so many countries outside of Africa, people should not be too scared or concerned.

“We know what we’re dealing with here. We know this virus, we know it can and has spread in the past, we know how to control it, we know it’s not very transmissible, we know that with appropriate contact tracing we can stop it spreading.

“So we have to put it into context that, although it is a significant amount, there is only a very small amount of people infected worldwide. So what we need to do is take the situation seriously, not panic because it’s not going to spread like covid19, and we will, pretty soon, get it under control.”

He said the only reason it spread as much as it did is because it is so unusual and rare outside of Africa. Because it was unexpected and the fact that it is a mild disease in most people, it went unnoticed and now doctors and scientists are “trying to catch up with it.”

“It seems that it came in a while ago and has passed under the radar so it hasn’t been diagnosed and so has been allowed to spread.”

Oura said while it is usually a mild disease, the lesions could become infected and without anti-biotic treatment, or proper health services, people, especially those with compromised immune systems, could suffer more severely or die from it.

However, he stressed that the mortality rate is very low. Most people would improve without medical intervention within a few weeks.

He said once contact tracing is done and infected people are isolated, the virus would “turn the corner,” the numbers would start reducing, and the virus would be stamped out.

He added that monkeypox can be transmitted from humans to animals such as rodents or monkeys but, as far as scientists know, it is not transmittable to domestic pets such as cats and dogs or agricultural animals.

At Wednesday’s Ministry of Health virtual media conference, Chief Medical Officer Dr Roshan Parasram said there is a moderate risk of monkeypox entering the country.

He said there would not be a population-wide vaccination strategy like covid19. Instead, if there is a suspected or confirmed case of monkeypox, that person’s immediate contacts would be vaccinated.

“If there were to be a quarantine period it would be 21 days to ensure there is no further spread. I think it is a little bit early to say what form or fashion the quarantine will take, and if we are looking at primary or secondary contacts.”

He added that the government was making efforts to acquire the Jynneos vaccine as well as an antiviral drug called tecovirimat for symptomatic treatment.

There have been no suspected or confirmed cases of monkeypox in TT or the Caribbean and there have been no reported monkeypox deaths so far.