In the last few weeks, more than 350 cases of monkeypox – a viral disease that is a much milder cousin of smallpox – have been reported in more than 20 countries around the world. This is a surprise, and an unpleasant one. Monkeypox has appeared periodically in the Congo Basin and West Africa since its discovery in the 1950s, but past outbreaks have not included cases in so many countries or this degree of apparent human-to-human spread.
However, since we know from past outbreaks that monkeypox is not usually very contagious and there is already a good vaccine, it should be possible to control even this apparently larger outbreak. That is why many public health officials emphasize in their reports on monkeypox that people should not worry or overreact.
Panic is never a good strategy for public health, but in trying to prevent public fear, I think experts are failing to learn one of the most important lessons of Covid-19: that we are too afraid of “alarmism” when epidemics strike. , and should spend less time telling people not to overreact and more time telling them what’s really going on.
The public health impulse to try to control public emotions – rather than provide the public with facts – haunts us throughout the pandemic, often making it harder to make good decisions. Assurances that people do not need masks designed to protect the supply of health workers have permanently damaged trust and the rate of disguise. The CDC’s initial decision not to monitor for sudden infections – which seems to be intended to show confidence in vaccines – makes it difficult to say how long vaccine-based immunity has lasted.
There are some solid epidemiological reasons to conclude that monkeypox does not pose the same threat to the world as Covid-19 in 2020. But instead of condemning alarmism, experts must acknowledge the many causes of this concern. The world is terribly vulnerable to the next pandemic, we know it will hit at some point and the undetected spread of monkeypox around the world until dozens of cases in non-endemic countries – despite the fact that there is usually a low rate of transmission – shows how we failed to learn the lessons from Covid-19 that we need to avoid a catastrophic recurrence.
Experts need to focus more on communicating what they know about monkeypox, pandemics and the fragility of our current system, aiming to tell people what they can do and the policies they can support in response to their justified fears – instead of preventively warn against “panic”
Monkeypox, explained
Monkeypox was first identified in research animals in the 1950s and can cause flu-like symptoms and a characteristic rash with round red blisters all over the body when it infects unprotected people. Mortality has historically ranged from zero to 11 percent, according to the World Health Organization.
Outbreaks have been rare in humans for decades, largely because the smallpox vaccine protects against monkeypox, and smallpox vaccination has been common. In recent years, however, the incidence of monkeypox has increased as smallpox vaccination, which was eliminated in 1979, began to decline. According to the CDC, Nigeria has reported 450 cases of monkeypox since 2017 – not much, but a significant increase from the percentage of cases in previous decades.
Despite this rise and the recent spread to new countries, there is reason to be optimistic that we can prevent a large-scale monkeypox pandemic. Although the variant causing the current outbreaks is not fully understood and it should not be ruled out that the virus is significantly more susceptible than we are used to, the disease in general is a certain amount. Even with pessimistic assumptions about the transmission of this new variant, it is much less transmitted than the coronavirus that causes Covid-19, which originally had an R0 of 2-3 and now has an R0 of 8-10 for people without previous immunity. Unlike Covid-19, monkeypox is thought to be only contagious, while patients are symptomatic, giving further reason for optimism about the restriction.
But optimism should not be equal to complacency.
A major international epidemic of a disease that was once thought to be very difficult to transmit from person to person is bad news, period. There are still many unknowns here, and until we understand exactly what happened and slow the growth of new cases, the chances of this variant of monkeypox being significantly more transmissible – and difficult to master – are not so small that we can confidently they claim that everything will be fine.
The lessons of Covid-19
As I wrote this article, I had an ominous sense of déjà vu. I wrote a similar one in early February 2020, when Americans were just beginning to hear about Covid-19. In this article, I gathered some views on the then very new coronavirus that were in the headlines at the time:
“Don’t worry about the coronavirus. “Don’t worry about the flu,” BuzzFeed said. The flu “poses a greater and more urgent threat,” according to the Washington Post. “Why be afraid of something that hasn’t killed people here in this country?” An epidemiologist argued in the LA Times. Other retail outlets agreed. A former White House health adviser told Americans to “stop panicking and being hysterical.”
Bad call, I argued then. We still didn’t know how much the coronavirus was transmitted. We did not know whether the early figures from China, where the first cases were recorded, were misleading. (It is now thought that they almost certainly were.) “This is too much uncertainty to assure people that they have nothing to worry about,” I wrote. “And misleading people that they have nothing to worry about can do harm.”
It is obvious that Covid-19 caused a lot of damage, more than 1 million people died in the United States alone. But we risk forgetting some of these key lessons from early 2020.
Last week, CNN quoted Jennifer McQueston of the CDC, deputy director of high-impact pathogens and pathology, as saying, “There really aren’t that many reported cases – I think maybe a dozen, a few dozen – so, the broad the public should not have to worry about being at immediate risk of monkeypox. ”
This seems true, technically. Most Americans are not at immediate risk of being exposed to monkeypox, just as they were not at immediate risk of being exposed to coronavirus in early February 2020 (there may have been only a few dozen cases in the United States at the time). But this ignores the factor of exponential growth. The scary thing about infectious diseases is that a few cases can quickly turn into more cases and eventually become many cases. Monkeypox is probably not very contagious, but until we control it, we don’t know how easy it will be to control, and the fact that there aren’t many cases yet is just not so reassuring.
“No cause for concern is bad science as well as poor risk communication,” I quoted risk communication expert Peter Sandman in this 2020 story. Telling people not to worry about an emerging infectious disease because not a significant risk here and now, is stupid. We want people to worry about measles when there are very few measles around, so they will take precautions to vaccinate their children before it is inevitably necessary. We want people to worry about their retirement when they are away from retirement, so they will start saving now. “
Still, the urge to focus on reassuring Americans that they shouldn’t panic about monkeypox is on display.
“There’s certainly no reason to panic,” Daniel Bausch, president of the American Society for Tropical Medicine and Hygiene, told CNN. Reason published an article entitled Don’t Panic About Monkeypox. “Don’t worry, at least not,” Jeffrey Smith, a vixologist at the Cambridge Poxvirus, told the Washington Post.
I agree with the more nuanced opinions that each of these experts share when they are given a little more space to express their views. It is true that monkeypox should be easier to control with contact tracking and vaccination than Covid-19.
But insisting that everyone anticipate this nuance by telling me not to worry drives me crazy, and I think it reflects a mistake in our thinking about pandemics.
Worrying about pandemics is perfectly reasonable
Fact that should not be said in 2022: Pandemics cause great human suffering and death. Even if the disease kills only one in 1,000 people who get it, if it affects a billion people worldwide, it is a million dead. Infectious diseases have killed more people than any war in history, and experts continue to warn us that a much, much worse pandemic than Covid-19 is very possible and indeed possible.
The 1918 flu was more deadly than Covid-19 and especially deadly to healthy young people. Repetition would be devastating, and the world is not very prepared. Smallpox, when it existed, had an estimated 30 percent mortality. The United States has stocks of vaccines in case a laboratory incident, terrorist attack or biological weapon ever releases it, but vaccinating the world against disease – as we saw with Covid-19 – is difficult to do as quickly as a contagious disease can. to move.
They are not just natural diseases. With the rapid advances in biological engineering, it is now quite possible to make diseases that could embarrass smallpox and influenza. Work on “Enhancing Function” to make deadly diseases more deadly continues. A small group of bad actors can unleash a virus that kills millions of people – and prevention systems are limited, under-resourced and inadequate for betting.
In this light, the whole focus on storytelling …
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