We missed our chance to quickly contain monkeypox. Now the dangerous virus is spreading rapidly around the world.
Health experts agree: the outbreak could soon be declared a pandemic, if it isn’t already. And the situation is likely to get worse before it gets better. More infections, more deaths, more chances for smallpox to mutate.
“We are in uncharted territory with this outbreak … and we are still at the beginning of the event,” James Lawler, an infectious disease expert and colleague of Wiley’s at the University of Nebraska Medical Center, told The Daily Beast.
The latest numbers from the US Centers for Disease Control are startling. The CDC counted 9,647 infections as of July 11. That’s a fourfold increase compared to a month ago.
“It’s shocking, after all we’ve learned with COVID-19, we’ve let another virus escalate to this point.
— Lawrence Gostin, Georgetown University
The virus, which causes a rash and fever and can be fatal in a very small percentage of cases, is common in 63 countries – 57 of which do not normally do so any cases of monkeypox.
Cases are concentrated in west and central Africa – where the virus is endemic – as well as Europe, where the current outbreak began in May. But the US is also recording a staggering number of cases: 865 in 39 states, according to the CDC. That’s five times as many as a month ago.
“Monkeypox is clearly a global health emergency,” Lawrence Gostin, a global health expert at Georgetown University, told The Daily Beast. “It’s been brewing in small pockets in central and west Africa for decades, but until now there have been no cases unrelated to travel in the rest of the world. It is now in virtually every region of the world and is spreading rapidly.”
The death rate is mercifully still low. As of July 4, the most recent date for which figures are available, the World Health Organization had recorded just three deaths in the current outbreak.
Three out of 9,647 – or 0.03 percent – is a much lower death rate than West and Central African countries, which appear to have suffered in their own smallpox outbreaks in recent decades. The worst outbreaks in Africa, involving a strain of the virus endemic to the Congo Basin in central Africa, have resulted in official death rates of up to 10 percent.
But as more viruses spread, they mutate — often in ways that make them deadlier. As long as monkeypox spreads faster than public health officials can contain it, there is a greater risk that it will spawn new, more dangerous variants and potentially increase the death toll.
Monkeypox spreads primarily through close physical contact, particularly sexual contact. It is Not however, a sexually transmitted disease. It just takes advantage of the skin-to-skin contact that comes with sex. The virus can also travel short distances using spit, although it’s probably not far enough to be considered “airborne”.
Officials noted the current outbreak, which was a relatively mild strain of West African smallpox, after diagnosing a British traveler returning from Nigeria in early May. Hitchhiking to Europe, the virus spread quickly through physical contact.
David Heymann, who used to head the WHO’s emergency department, said men attending raves in Spain and Belgium “amplified” the outbreak – apparently through close, sometimes sexual, contact with other men.
After that, the virus accompanied travelers on planes to distant and distant countries. Doctors diagnosed the first US case on May 27.
But it is now obvious that the first diagnosed Smallpox cases in Europe and the US were not the first cases. On June 3, the CDC announced it had found genetic evidence of US smallpox cases that predated the first cases in Europe in May.
Because of the similarity between smallpox symptoms and the symptoms of some common STDs, such as herpes, doctors may not have noticed or reported these previous cases at first. In other words, the current outbreak started and spread without anyone noticing at first.
The virus had a huge lead, which explains why months later it still has the edge. “By the time we realized there were cases, we were already behind,” Lawler said.
A quick diagnosis is the key to quickly containing a dangerous virus. In the early days of an outbreak, if officials know where the virus is concentrated, they can isolate infected people, conduct contact tracing to identify vulnerable populations, deploy therapies and vaccines, and treat those infected and protect those uninfected. (Fortunately, widely available smallpox vaccines work well against monkeypox.)
Having cut off its most likely vectors of infection through 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 because the WHO, CDC, and other health organizations didn’t even know a smallpox outbreak was happening. The current, rapid spread is the result of this initial failure.
The worst outcome is not hard to imagine – 10,000 cases could quickly become 100,000 cases. Then 1 million. Various experts and agencies disagree on the exact definition of “pandemic,” but if the smallpox outbreak isn’t already a possibility, it’s becoming increasingly likely in the coming weeks. At that point, the world will be grappling with simultaneous pandemics.
The WHO carefully avoided using the P-word to describe the smallpox outbreak. The CDC did not immediately respond to a request
This is a mistake, Lawler said. “We certainly cannot make ‘pandemic’ declarations in every disease outbreak that crosses multiple international borders without becoming the boy who cries wolf,” he acknowledged.
But he added: “I would argue that we should have learned some humility by 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 mortality rate in the current smallpox outbreak. That could be a statistical anomaly resulting from a vast excess of deaths in previous African outbreaks. “I’m not sure we fully understand the denominator of the cases that are actually occurring in West Africa,” Lawler said. That said, it’s possible that deaths from smallpox in Africa were spread across a much larger number of infections than we thought at the time.
It’s also possible that we might see 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 facilities,” Blossom Damania, a virologist at the University of North Carolina at Chapel Hill, told The Daily Beast.
Either way, we shouldn’t get complacent. Smallpox, like all viruses, treats anyone infected like a laboratory. A chance to try new things, learn and change. Each additional infection increases the likelihood that new variants will emerge. As COVID has shown time and time again, new variants mean new risks. Greater transmissibility, severity, or evasion—or a mix of all 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 public health agencies must redouble their efforts to educate doctors and speed diagnoses — and then move faster to isolate and treat infected people and vaccinate those around them. “If we can get enough vaccine in contact with high risk, this will stop,” Amesh Adalja, a public health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.
COVID has reminded us how bad a virus outbreak can get. Then monkeypox came to remind us of our strong tendency to be complacent, even in the midst of an ongoing health crisis. “It is shocking that after everything we have learned with COVID-19, we are allowing another virus to escalate into a global public health emergency,” Gostin said.
To catch up with the fast-paced smallpox, what we need most right now is a renewed sense of urgency.