Is monkeypox officially a pandemic? Here’s what the experts say

This week, California and Illinois joined New York State in declaring a public health emergency in light of the growing number of monkeypox cases. Just weeks ago the World Health Organization declared a ‘global health emergency’ for the virus, which is linked to smallpox, and causes pustules to emerge on the body along with other symptoms fever.

The tri-state decision comes as 48 U.S. states record 5,811 cases of monkeypox, as of August 1, 2022; the three aforementioned states that have declared states of emergency have the highest number of cases in the country, accounting for nearly 47% of the total cases. But nearly two months ago, there were just 19 confirmed cases in 10 states. (The first case appeared in May.) In 2003, when a mini-epidemic occurred in the United States, 47 people in six states had confirmed or probable cases of monkeypox, but it was quickly contained.

The rapid increase in the number of cases is eerily reminiscent of the early days of the COVID-19 pandemic, when the number of cases soared from single digits to four digits within months. Now, as monkeypox cases continue to rise, some are wondering: is the country on the brink of a new pandemic?

“For me, a pandemic is going to be something that is an infectious disease that becomes very prevalent and causes societal disruption,” Adalja said. “And that’s something that permeates the whole population.”

It depends on how you define the pandemic, experts say at Salon; but overall the increase in cases will likely make it harder to contain at this point. Actions taken by public health officials in the days and weeks to come will influence the extent of the spread. However, there are some key differences between monkeypox and SARS-CoV-2 that will cause these two public health events to play out differently.

A dictionary of epidemiology defines a pandemic as a step above an epidemic; more specifically, a pandemic is “an epidemic which occurs throughout the world, or over a very large area, crossing international borders and generally affecting a large number of people”. But as Dr. Amesh Adalja, a principal investigator at the Johns Hopkins Center who co-authored a paper on the characteristics of pandemic pathogens, explained to Salon, there are no official markers to definitively tell when a pandemic is in progress. Classes.

“There’s no one snapping their fingers and saying ‘this is a pandemic’ – but for me a pandemic is going to be something that is an infectious disease that becomes very prevalent and causes societal disruption,” Adalja said. . “And that’s something that permeates the whole population.”

Dr. Stephen Morse, a professor of epidemiology at Columbia University’s Mailman School of Public Health, agreed.

“In the sense of [monkeypox] being the next pandemic like SARS-CoV-2, I don’t think that’s likely,” Morse said. “In the technical sense, it is already a pandemic because it is already present in many countries of the world, mainly in certain countries. communities and it spread widely, and we obviously didn’t expect that.”

Adalja and Morse agree that due to the way monkeypox is transmitted, it will not spread with the same speed as the spread of COVID-19 around the world; therefore, there is still a possibility of containing it.

The monkeypox virus originates from wild animals in the jungles of West and Central Africa; on occasion, he has made the leap to humans. The first known human case of monkeypox was discovered in 1970 in a 9-year-old boy in a remote region of Congo. However, it was first identified by scientists in 1958, when there were two outbreaks of smallpox-like illnesses in monkeys used in research laboratories.

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According to the CDC, monkeypox can cause symptoms such as painful rashes that can appear all over a person’s body. Other flu-like symptoms include swollen lymph nodes, muscle pain, back pain, headache, fever, fatigue, and chills. Eventually the lesions form and progress through a number of stages before falling off. Descriptions of pustules are uncomfortable.

“The lesions in my sensitive areas and my underwear area became very painful to the point that I couldn’t sleep,” Matt Ford, 30, told Self magazine. “I would describe the sensation as a dull, chronic ache that became twitches of intense pain if I moved the wrong way; I’m not sure I’ve experienced anything similar.”

Current data from this strain suggests a mortality rate of 3.6%, according to the European Center for Disease Prevention and Control. Notably, that’s higher than COVID-19, which now has a global death rate of 1.1%. Most victims of monkeypox recover within two to four weeks after developing symptoms. Unlike COVID-19, which is arguably the most contagious virus ever discovered, transmission of monkeypox is more difficult. Gay and bisexual men are currently most at risk of infection, according to public health officials.

Adalja said respiratory transmission is a cause for concern and could be a hallmark of a pathogen that can cause a COVID-19-like pandemic. According to Adalja, two other characteristics of a pandemic-like pathogen are the incubation period and population immunity.

“As far as transmission mechanisms go, it really has to be respiratory” in order to look like a pandemic-like pathogen, Adalja said.

According to the CDC, monkeypox is spread through direct contact with bodily fluids or wounds on the body of a person with monkeypox. It can also spread through materials that have touched bodily fluids or wounds that have come into contact with an infected person, such as clothing or bedding. It can also spread through respiratory droplets when people have close face-to-face contact. However, the latter is not its main mode of transmission, Adalja said, commenting on the increase in misinformation about monkeypox.

“I don’t think we missed our chance to contain monkeypox in the United States. What we do over the next few weeks will be very important.”

“The first thing to recognize is that just because something has the ability to spread through a pathway doesn’t mean that’s what drives transmission,” Adalja said. “Monkey pox can be transmitted biologically through respiratory droplets, but is that what’s causing the spread? Or is it a minor mode of transmission or is it a major mode of transmission?”

When a virus is transmitted by airborne droplets, Adalja said, the household attack rate – that is, secondary infections that occur after a person is initially infected – is 100%. The household attack rate for monkeypox appears to vary from 10% to 50% in one study. Unlike COVID-19, there are also readily available monkeypox vaccines. As Salon previously reported, the United States released the Jynneos monkeypox vaccine from the National Strategic Stockpile. Meanwhile, those who received the smallpox vaccine before it was discontinued in the 1970s will likely be protected against monkeypox.

Yet what happens next — and how states and the federal government respond to the threat — will affect the extent to which monkeypox spreads.

“I don’t think we’ve missed our chance to contain monkeypox in the United States,” said Melanie Chitwood, a doctoral student in microbial disease epidemiology who recently co-authored a modeling study that has yet to be announced. been peer reviewed. “What we do over the next few weeks will be very important.”

By email, Chitwood said the most critical response right now is to vaccinate those at high risk as soon as possible. It would also help slow the spread if it were easier to get tested and quarantine when a test is positive.

“We need to provide financial and social support to help infected people recover in isolation,” Chitwood said. “Our analysis suggests that contact tracing is also an important part of the response, but contact tracing can be difficult to implement; people don’t always remember who they’ve been in contact with or how to get in touch. with their contacts.

To date, Chitwood said what had been done so far “was not enough”.

“We’ve given the virus a pretty good head start, and the sooner we strengthen the public health response, the better,” Chitwood said.

“My concern is that if we fail to contain monkeypox now, we will be dealing with outbreaks for years to come,” Chitwood said. “Monkey pox can spread in congregational settings, so I’m particularly concerned about the return of students to college campuses in the coming weeks.”

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