Next question: Is there a “new” monkeypox at all, or is it the same virus that African doctors have been managing for years, suddenly spreading to Europe for reasons that remain unclear?
Either way, the trends aren’t great.
Confirmed #monkeypox cases now in 11 countries, according to @globaldothealth case tracking. So far, 39 additional cases have been confirmed. pic.twitter.com/zGPTs9O1gJ
– Kristen Pantagani, MD, PhD (@kmpanthagani) May 20, 2022
Today’s global cases are twice as many as on Wednesday. Cases have also doubled in the UK. The virus has been detected on at least four continents in the last month, suggesting that something has changed qualitatively. But if so, it is curious that Africa is not seeing an unusually large outbreak this year. Globally, in the first (almost) five months of 2022, 1,300 cases and 58 deaths were registered. In the first eight months of 2020, the WHO tracked more than 4,500 cases and 171 deaths.
If monkeypox has mutated into some more infectious version of monkeypox, we would expect the evidence to appear first in Africa. Is not.
How, then, can we explain the strangely large number of people infected in Europe? Some scholars have a theory cited by a WHO official: “As the summer season enters the European region with mass gatherings, festivals and parties, I am concerned that the broadcast could be accelerated as the cases that open up they are currently among those who engage in sexual activity and the symptoms are unknown to many. “New monkeypox – * if * there is a new monkeypox – is it more likely to be sexually transmitted?
Dr. Jeremy Faust studied the outbreak in Europe and found that all 89 confirmed cases had something in common.
Contrary to the idea that this virus is more easily transmitted than earlier versions – say through smaller droplets or by air – it is that of the 89 cases we know of sex, all 89 are men, most of whom are young and middle-aged adults. Public health agencies have reported that the smallpox epidemic is spreading to men who have had sexual contact with other infected men (or members of a shared sexual network). However, we do not know whether this is true in some, many, most or all cases.
Yet what we know strongly suggests, at least for me, that monkeypox can still be spread mainly through sexual contact, a known major mode of transmission. It is possible that this virus has not acquired any newly discovered stability in the air or in droplets – and this would certainly be welcome news – but that it spreads more easily than usual (and therefore through more casual contact) in sexual networks due to some genetic changes in the virus.
If the virus had spread through the air through respiratory droplets, we would expect some women to have been infected by now. As such, health authorities in the United Kingdom, Spain and Portugal said a “significant proportion” of infected patients were gay or bisexual men.
Does this mean that the “new” monkey pattern is gay-specific? There is no reason to think so. It has always been known that the virus spreads through the air during prolonged close contact, which is inevitable during sex of any kind. At the moment, it may seem specific to gays, simply because it is spread through sexual contact between men who do not have sex with women. More from virologist Angela Rasmussen (“MSM” means “men who have sex with men” here):
If there is a spread within a sexual network followed by travel, this can easily explain why clusters appear in other countries within these extended networks.
Monkeypox has a fairly long incubation period. It takes a long time for people to travel before the first vesicles pop out.
– Dr. Angela Rasmussen (@angie_rasmussen) May 20, 2022
The good news is that we would have expected many more cases if the virus had made a quantum leap in airborne transmission, and we don’t see that. However, we are left with the mystery of “Why now?” If this is the same old ape pattern that scientists have known about for years, we would expect these random outbreaks on sexual networks in the United States and Europe every year. As it is, this one is unusual. Something must have changed genetically in the virus itself, as Faust suggested, right?
“I am just amazed. I wake up every day and there are more countries infected, “said Oyuele Tomori, a virologist who previously headed the Nigerian Academy of Sciences and who is a member of several World Health Organization advisory boards.
“This is not the kind of proliferation we’ve seen in West Africa, so there may be something new happening in the West,” he said.
The irony is that we are victims of our own success here to some extent. “The smallpox vaccine accidentally protected against monkeypox,” said Ed Yong. “And when new generations were born into a world without smallpox or smallpox vaccination campaigns, they grew up vulnerable to monkeypox.” I will be curious to know the age demographics of the 89 infected patients so far. Older men would have been vaccinated against smallpox as children, while younger men would not. Would a vaccine received 60 years ago still provide some protection against monkeypox today?
Even if not, Yong offers two good news. First, because of the government’s fears of a bioterrorist attack by Russia, there are enough stockpiles of smallpox vaccine to immunize nearly the entire U.S. population if necessary. If monkeypox disappears, the federal must be able to move quickly to protect people. Second, there is already a therapeutic agent that also (probably) works called TPOXX. This is also accumulated.
Bottom line: If you’re going to lie awake and worry about disease, COVID is still the one to worry about, not monkeypox. But just in case it’s too cheerful a feeling coming from me, here’s Scott Gottlieb to scare you a little.
“It’s spreading in the community now, it may be difficult to completely suppress it. “I don’t think it’s going to be a big epidemic because it’s a virus that’s hard to spread.” – I do not think it will be widespread. pic.twitter.com/bq1mgxRSMQ
– Squawk Box (@SquawkCNBC) May 20, 2022
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