We missed our chance to quickly contain monkeypox. Now the dangerous virus is spreading rapidly all over the world.
Health experts agree: the outbreak may soon qualify as a pandemic, if it hasn’t already. And the situation is likely to get worse before it gets better. More infections, more deaths, more chance of smallpox mutating.
“We’re in uncharted territory with this epidemic … and still early in the event,” James Lawler, an infectious disease expert and Wiley colleague at the University of Nebraska Medical Center, told The Daily Beast.
The latest data from the US Centers for Disease Control is startling. The CDC reported 9,647 infections as of July 11. This is a fourfold increase compared to just a month ago.
“It’s shocking, after everything we’ve learned with COVID-19, we’ve allowed another virus to escalate to this point. “
— Lawrence Guest, Georgetown University
The virus, which causes a rash and fever and can be fatal in a very small percentage of cases, is present in 63 countries – 57 of which usually have no cases of monkeypox.
Cases are concentrated in West and Central Africa, where the virus is endemic, and in Europe, where the current outbreak first began in May. But the U.S. also has a staggering number of cases: 865 in 39 states, according to the CDC. This is five times more than a month ago.
“Monkeypox is clearly a global health emergency,” Lawrence Gostin, a global health expert at 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.” It is now in almost every region of the world and is spreading rapidly.
The death rate, fortunately, is still low. As of July 4, the latest date for which data is available, the World Health Organization has recorded only three deaths in the current outbreak.
Health workers check passengers arriving from abroad for symptoms of monkeypox at the Anna International Airport terminal in Chennai on June 03, 2022.
Arun Sankar/AFP via Getty Images
Three in 9,647 – or 0.03 percent – is a much lower death rate than countries in West and Central Africa, which have apparently suffered from their own smallpox epidemics in recent decades. The worst outbreaks in Africa, involving a strain of the virus that is endemic to the Congo River basin in central Africa, have resulted in an official death rate of up to 10 percent.
But the more viruses spread, the more they mutate — often in ways that make them more deadly. As monkeypox spreads 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 is mostly spread through close physical contact, especially sexual contact. However, it is not a sexually transmitted disease. He simply benefits from the skin-to-skin contact that accompanies sex. The virus can also travel short distances in saliva, though probably not enough to qualify as “airborne.”
Officials first became aware of the current outbreak, involving a relatively mild West African strain of smallpox, after a UK traveler returning from Nigeria was diagnosed in early May. Hitchhiking to Europe, the virus spreads rapidly through physical contact.
David Heyman, who previously headed the WHO’s emergencies department, said men attending raves in Spain and Belgium had “amplified” the outbreak – apparently through close, sometimes sexual, contact with other men.
The virus then accompanied passengers on planes traveling to countries far and wide. Doctors diagnosed the first case in the US on May 27.
But it is now clear that the first diagnosed cases of smallpox in Europe and the US were not the true first cases. On June 3, the CDC announced that it had found genetic evidence of smallpox cases in the U.S. predating the first cases in Europe since May.
Doctors may not have noticed or reported these earlier cases at first because of the similarity between the symptoms of smallpox and the symptoms of some common sexually transmitted diseases, such as herpes. In other words, the current outbreak started and grew without anyone noticing at first.
The virus had a big lead, which helps explain why, months later, it still has the upper hand. “By the time we realized cases were happening, we were already behind,” Lawler said.
Rapid diagnosis is the key to quickly controlling 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, and treat the infected and protect the uninfected. (Luckily for us, widely available smallpox vaccines work well against monkeypox.)
With the most likely vectors of infection cut off by early intervention, the virus withers and disappears—before it can mutate into some new variant that might, say, be more infectious or even avoid vaccines.
This is what should have happened back in April or even earlier, but it didn’t because WHO, CDC and other health organizations didn’t even know there was a smallpox outbreak. The current, rapid spread is a consequence of this initial failure.
Signs from Toronto Public Health offer resources and information about Monkey Pox at the annual Dyke March in downtown Toronto.
Steve Russell/Toronto Star via Getty Images
The worst outcome is not hard to imagine. Ten thousand cases can quickly grow into a hundred thousand cases. Then a million. Different experts and agencies disagree on the exact definition of a “pandemic,” but it’s increasingly likely that a smallpox outbreak qualifies now or will in the coming weeks. At this point, the world will struggle with simultaneous pandemics.
For example, the WHO stubbornly avoids using the p-word to describe the smallpox epidemic. The CDC did not immediately respond to an inquiry
That’s a mistake, Lawler said. “We certainly can’t make ‘pandemic’ declarations for every outbreak of disease that crosses multiple international borders without becoming the boy who cried wolf,” he admitted.
But, he added, “I would say that by now we should have learned a little humility in the face of emerging viruses.” If the word “pandemic” gets people’s attention and emphasizes the growing risk, use it.
The silver lining is the very low death rate in the current smallpox epidemic. This may be a statistical anomaly resulting from the large number of deaths in earlier epidemics in Africa. “I’m not sure we have a full picture of the denominator of the cases that are actually happening in West Africa,” Lawler pointed out. This means that smallpox deaths in Africa may have been spread among a much larger number of infections than we realized at the time.
We may also be seeing a happy side effect of a smallpox epidemic affecting mostly wealthier communities. “Monkeypox is now being diagnosed in urban populations where more people have access to health care,” Blossom Damania, a virologist at the University of North Carolina at Chapel Hill, told The Daily Beast.
Either way, we shouldn’t be complacent. Smallpox, like all viruses, treats everyone infected as a laboratory. A chance to try new things, learn and change. Each additional infection increases the likelihood of new variants emerging. As COVID has repeatedly demonstrated, new options mean new risks. Greater transmissibility, severity, or vaccine evasion—or a combination of the three.
There is still time to prevent the worst-case scenario of millions of cases and potentially thousands of deaths. The WHO, CDC and other health authorities must redouble their efforts to educate doctors and speed up diagnosis — and then move more quickly to isolate and treat infected people and vaccinate those around them. “If we can get enough vaccines into high-risk contacts, it will stop,” Amesh Adala, a public health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.
COVID has reminded us how bad a viral outbreak can be. Then came monkeypox to remind us of our strong tendency to complacency, even amid an ongoing health crisis. “It’s shocking that after everything we’ve learned with COVID-19, we’ve allowed another virus to escalate to the point of becoming a global health emergency,” Gostin said.
To catch up with the rapidly developing pattern, what we need now—more than anything—is a fresh sense of urgency.
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