Monkeypox may not snowball into another massive pandemic

Medical Advice

By Dr Satish K Gupta*

Can Monkeypox be the next pandemic? Barely a few months that people had some respite from Covid-19 pandemic, this other virus, Monkeypox, came knocking. The outbreak is rising gradually and attracting headlines. WHO too declared it as a global emergency.

Can Monkeypox become a massive global pandemic –like COVID-19?

This is the biggest question causing anxiety among citizens. However, it is pretty unlikely that Monkeypox will snowball into another massive pandemic because there are important differences that make monkeypox a much less serious threat than COVID-19.

10 reasons that MPX may not spread like Covid :

1. Transmission is not airborne. Monkeypox is primarily transmitted by close contact – prolonged physical contact or direct contact with body fluids or lesions. Though MPX virus may also spread through respiratory droplets this has not been the primary mode of spread during this pandemic as evidenced by a low secondary attack rate of 9% which may be partly attributed to contact with contaminated bedding or clothing or body fluids. Most importantly MPX doesn’t primarily spread through the air like COVID-19.
2. Asymptomatic people don’t spread the disease. Unlike COVID-19, MPX isn’t contagious until the infected person becomes symptomatic. Though the Indian Council of Medical Research (ICMR) website mentions the infectivity period of MPX to start 2 days prior to the onset of symptoms, most evidence worldwide comes with the infection spreading through symptomatic persons only. That makes it much easier to isolate infected individuals and prevent the spread.
3. Takes a long time to develop symptoms. A long incubation period of 5 to 21 days could be protective. Effective vaccination during this period may prevent severe disease. Though more data on vaccination is needed to prove the same.
4. We already have a vaccine. The fact that we already have an effective vaccine is another factor that sets Monkeypox apart from COVID-19, which was a novel virus that required development of a new vaccine. Though the availability of doses of vaccine can be an issue presently.
5. Population already has immunity from past Smallpox vaccination. The Smallpox vaccine or a newer smallpox/monkeypox vaccine that came out in 2019 can possibly prevent the disease in a person who has been exposed or who is at risk of being exposed, such as a caregiver or household contact.
6. We are better equipped. We know how to handle monkeypox because it’s so closely related to Smallpox. Covid has sensitized people about pandemics.
7. We already have a treatment for Monkeypox. Most people don’t require any specific monkeypox treatment. But tecovirimat – an antiviral drug that was developed for Smallpox is effective against Monkeypox. Cidofovir is another good bet.
8. Mortality from Monkeypox is currently low. Four deaths have been reported up to August 2, 2022, among more than 26800 cases detected so far. Indian Clade A.2 is even milder than European Clade B.1 Most people will have a relatively minor illness. West African strain that is spreading has a case fatality rate of less than 1 per cent in Africa. It might be even lesser in places with better backup. Some previous African studies have reported higher mortality but present health management systems are capable of delivering better results.
9. The virus is presently manifesting in the MSM population (Gay population). It is important to note that vulnerable populations (children, the elderly and immunocompromised people) have been spared from infection so far. Though some women have been infected. It is a noteworthy statement by WHO “It is important to note that the risk of monkeypox is not limited to men who have sex with men. Anyone who has close contact with someone who is infectious is at risk.”
10. MPX virus doesn’t change often. MPX virus is a large DNA virus. It does not change (mutate) as frequently as small RNA viruses like Covid-19. MPX Genome is 6 times larger than the Covid-19 virus.

Then what is cause for alarm? Should we take the viral outbreak casually?

The answer is NO.

1. Right now, the Monkeypox outbreak is primarily contained in adult men, who can fight the virus in most cases. If the virus jumps to large populations of children or seniors, the outlook could quickly change. The virus can change though chances are remote.
2. The other concern is that Monkeypox could jump to our rodent population and become endemic.
3. The monkeypox virus seems manageable, but it is *becoming a bigger deal every day.
4. More than 70 countries where Monkeypox is not endemic have already reported outbreaks of the viral disease including India.
5. People have died already -one in India, another in Brazil and 2 in Spain. COVID-19 brought to light deficiencies in our underfunded public health system* and now monkeypox reminds us that strong public health is our best defence.
6. There is another strain from Central Africa that is more severe. That strain is not involved in the current outbreak in India. But who knows?

So stay alert. Take precautions and be watchful. Early diagnosis and isolation are the keys.

*Dr. Satish K Gupta is an MD in Medicines, a Visiting Senior Consultant Physician and Internist at Max Super Speciality Hospital, and a Clinical Assistant Professor at GS Medical College, Chaudhary Charan Singh University, Meerut. He is the author of Journey of COVID in India: A Doctor’s Perspective.