So have you heard of monkeypox?

Yesterday afternoon i I called UCLA epidemiologist Anne Rimoin to ask about the outbreak of monkeypox in Europe. This is a rare but potentially serious viral disease, United Kingdom, Spain, Portugal.. “Given the amount of movement between the United States and Europe, it’s not surprising to see cases here when you look at these clusters,” Limoin, who is studying the disease, told me. Ten minutes later, she stopped in the middle of her sentence and she said her colleague had just sent a text to a press release.Massachusetts public health authorities have confirmed cases of monkeypox.“

The virus behind monkeypox is a closely related species of the virus that caused smallpox, but it is not fatal, is less contagious, and causes symptoms such as fever and rash. Endemic to West Africa and Central Africa, it was named because it was first discovered in monkeys in 1958, but the virus-carrying wildlife is probably a rodent.Viruses sometimes spill on humans, such infections It has become more common in recent decades.. In rare cases, monkeypox does not reach other continents. If it does occur, the outbreak is “very small and measured in single digits,” Tomas Swinglessby, director of the Johns Hopkins Health and Security Center, told me. The Only significant American outbreaks It occurred in 2003 when a rodent in Ghana spread the virus to prairie dogs in Illinois. Prairie dogs were sold as pets and infected up to 47 people, but were not fatal. last year, Two travelers independently carried the virus from Nigeria to the United States But it didn’t infect anyone else.

Current outbreaks in Europe and the United States are different and of great concern. First case, This was confirmed in the UK on May 7th, Fits traditional patterns: The individual recently traveled to Nigeria. However, some have never been to endemic countries recently, while others have had no apparent contact with people known to be infected. This suggests that the monkeypox virus may be secretly spread from person to person and there are some undetected cases. (Although the incubation period from infection to symptoms is long, Range of 5-21 days.. “It is rare to see this number of cases at the same time in four countries,” Inglesby said. (The count can quickly reach 7: I talked yesterday, so Monkeypox has been confirmed in Sweden and Italy, While Canada is investigating suspicious cases. )

The occurrence of these monkeypoxes is also unique. Because … well … it’s happening in the third year of the pandemic., “When the public is being prepared to recognize the outbreak more sensitively,” Boghuma Kabisen Titangi, a doctor at Emory University, told me. “I don’t think it’s always a good thing.” When it comes to epidemics, people tend to fight the final war. During the 2014 Ebola outbreak in West Africa, American experts had to quell Excessive paranoid wavesThis probably contributed to the initials Disrespect coronavirus. Currently, the United States catastrophically underestimates COVID, and many Americans panic about monkeypox and reflexively distrust official statements that can be reassured. “I don’t think people should be surprised at this stage,” said Carl Bergstrom of the University of Washington. I tend to be optimistic. “

Therefore, monkeypox is a test of lessons the world has learned (or has not learned) from COVID. Is it better to pass the needle between panic and laziness, or avoid uncertainty when desperately searching for an answer that later turns out to be wrong?

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To clarify, Monkeypox is not a COVID. These are different diseases caused by different viruses with significantly different characteristics. COVID was completely unfamiliar when it first appeared, but monkeypox is a known amount and there are actually viral experts. One of them, Andrea McCollum of the CDC, told me that monkeypox does not spread easily and does not spread over long distances in the air, based on existing research. It is transmitted through contaminated surfaces or long-term proximity to other people. As a result, most outbreaks are low and people mainly transmit the disease to household members or health care workers. “This is not, as far as we know, a virus that is really prevalent in populations like COVID,” she said. “It really requires close contact for person-to-person communication.”

Of course, we’ve heard it before. Early 2020Many experts argued that COVID spreads only through contaminated surfaces or closely scattered droplets. Therefore, it is a 6-foot rule and sanitary theater.It is widely accepted that the disease is now widespread. Smaller and wider range of aerosol particles— Therefore, the importance of ventilation and masks. But that does not mean that history is repeated in monkeypox. 2012 survey It has been suggested that the virus can persist in aerosols for several days, but it is under artificial laboratory conditions and persistence is only part of the infectious process. The fact remains that past outbreaks of monkeypox are inconsistent with viruses that are as easily transmitted as coronavirus. “Monkeypox does not shout to me” in the air. ” That was the case with COVID-19, “Linsey Marr, an aerosol expert at Virginia Tech, told me.

Again, Mar is less confident about monkeypox than about COVID.And Titanji, our knowledge of monkeypox About 1,500 recorded cases, As of 2018. “I’ve seen many people writing as if everything we know about monkeypox is decisive and final, but in reality it’s still a rare zoonotic infection. I have a illness, “she said. So, “I’m careful with the team,” she said. “I can’t make a drastic statement using what happened in the previous monkeypox outbreak. If I learned anything from COVID, it would be humility.”

For decades, some scientists have expressed concern that the monkeypox virus may be better at infecting people. Ironically, it eradicated its relative smallpox in the late 1970s. The smallpox vaccine was accidentally protected from monkeypox. And when a new generation was born in a world without smallpox or smallpox vaccination campaigns, they grew vulnerable to monkeypox.In the Democratic Republic of the Congo, this weakened immunity meant monkeypox Infectious diseases increased 20-fold As Limoin showed in 2010, 30 years after the disappearance of smallpox. This increases the likelihood that the virus will evolve into a more contagious pathogen in humans. To date, its R0 (the average number of illnesses from one infected person) has been less than one. This means that the outbreak occurs naturally. However, it can eventually evolve beyond that threshold and cause a longer epidemic. As simulated by Bergstrom in 2003.. “We saw monkeypox as a time bomb,” he told me.

This possibility casts a cloud of uncertainty on the current anomalous outbreak that everyone I have spoken to is worried about. Are they the work of a new, more contagious strain of monkeypox? Or is it the result of more people traveling after the global COVID restrictions were lifted? Or could it be entirely due to something else? So far, there are more cases than normal monkeypox outbreaks, but not enough to suggest a radically different virus, Ingressby told me. But he also doesn’t have a clear explanation for the unusual pattern of outbreaks-no one else.

However, the answer should come soon. Scientists need to sequence the virus from its current outbreak within a few days. This tells you if there are any latent mutations that may have changed the properties of the virus. Within a few weeks, European epidemiologists should have a clearer idea of ​​how existing cases began and whether there is a connection between them. As for the United States, “currently there are no additional suspicious cases,” McCallum told me, other than individuals in Massachusetts. But given the numbers in Europe, she’s waiting for more.

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The United States Of course, monkeypox is in a better position than COVID.The people Did not plan a coronavirus pandemicI’ve been thinking for decades how to deal with smallpox bioterrorism. Two cases of monkeypox in 2021 provided a convenient test run for these plans and are now on track. For example, a Massachusetts case was identified when a patient’s doctor who reviewed a report from the United Kingdom called the state’s public health department on Tuesday. Within 12 hours, the department collected and tested patient samples. The next day, more samples arrived at the CDC and monkeypox was confirmed. “It all worked really well,” McCollum said. “We are a fairly oiled machine.”

Also, I already have a vaccine. 1 smallpox vaccine It is 85% effective in preventing monkeypox and has already been approved for use against viruses. As another measure against bioterrorism, the stockpile of three smallpox vaccines is “basically enough to vaccinate everyone in the United States,” Inglesby said. And monkeypox patients usually receive just supportive care, but possible treatments exist and are stockpiled: Tecovirimat, or TPOXXDeveloped to treat smallpox, but may also work with monkeypox.

Monkeypox may also be less deadly than it is often claimed. The commonly quoted mortality rate of about 10% applies to strains that infect people in the Congo Basin. The mortality rate of West African strains associated with some of the current cases is close to 1%, which is found in the poor rural population. “There were no deaths of people who developed monkeypox in a high resource environment,” said Limoin.

Still, as COVID shows, even if the illness does not kill you, it is rarely considered “mild”. Monkeypox may not take off like COVID, but for those who get it, it remains a “substantial illness,” McCallum said. “If an individual is ill, they often get sick for two to four weeks. There is an urgent need to identify people early, receive treatment, and identify contacts.” One of the common symptoms is It turns out to be an obvious rash that looks like an extreme version of chickenpox. However, unlike chickenpox, the monkeypox rash is usually preceded by fever, the lesions are initially more painful than itching, and the lymph nodes are often inflamed. “The constructive thing is to make sure that the general public knows what monkeypox looks like,” Titanji said.

So it’s important not to stigmatize the infected, she added. Many of the current cases are found in men who are identified as gay, bisexual, or men having sex with men. This is a rare pattern not seen in previous monkeypox outbreaks.It raised questions about new transmission routes, but sex clearly involves long-term close contact, which is how the virus is. Normally spread. As COVID showed An early story about illness It can quickly and prematurely settle on accepted folklore. And if those stories turn into stigma, they can stop people from advancing their symptoms.

As with COVID, communication can be one of the most difficult challenges for monkeypox. “We know,” this is what we know. This is what we don’t know. I see. And we’ll be back tomorrow, “Ingressby said. However, some leaders have lost credibility in recent pandemics, while others are drowned in armchair specialists who have gained a lot of support. “Suddenly everyone became a monkeypox expert,” Titanji said.