With anxiety, frustration, and “pandemic fatigue” remaining at high levels after two and a half years of watching COVID disrupt everything – from businesses to education to travel and much more – it is understandable that many people are worried that we are in the early stages of the next pandemic with the current monkeypox epidemic. Especially considering the regular headlines, the unusual name, and the recent World Health Organization (WHO) designation of monkeypox as a “public health emergency of international concern” (PHEIC).
It doesn’t help that former U.S. Surgeon General Dr. Jerome Adams, who presided over the nation’s initial response to the COVID pandemic, recently induced some panic when he tweeted, “I hate to tell you all this, but #covid19 is still a pandemic, and now #monkeypox is too. And both are gonna get a LOT worse before they get better… just wait till schools – including colleges – reopen in a few weeks…” before later admitting that this is not actually the case.
Given how new and unexpected the monkeypox outbreak is, we all have many questions: Is there any justification to panic over the monkeypox outbreak? Is monkeypox the next COVID? Will it lead to thousands or millions of deaths? Will there be any need to impose mandates or restrictions on most of society to control the epidemic? Who is at risk? How do we control it?
To understand the answers to these questions, it is necessary to understand what monkeypox is as well as what it is not. Monkeypox is a member of the pox family of viruses, which includes the now-eradicated smallpox as well as the vaccinia or cowpox virus, which would confer immunity to smallpox to those it infected. Since it was first discovered in humans in 1970, over 50 years ago, monkeypox has been largely confined to West Africa, where humans interact closely with non-human animal reservoirs of the virus (which, incidentally, tend to be rodents, not monkeys). The monkeypox virus is known to spread from one human to another via prolonged skin-to-skin or other intimate contact. Unlike SARS-CoV-2, the virus that causes COVID, it is not a respiratory pathogen, which means monkeypox is not thought to spread via inhalation of the same air or respiratory droplets that are released during a sneeze or cough.
After a five to 21-day incubation period, an illness typically lasting between two and five weeks may begin. Initially, monkeypox-infected individuals develop flu-like symptoms, including: muscle aches, fever, swollen lymph nodes, and fatigue. These early symptoms are then shortly followed by a rash resembling chickenpox, which typically originates in the face and eventually spreads outward to the hands and feet. While mortality has historically been low with monkeypox, at around three to six percent of cases (and with young adults and immunocompromised individuals at higher risk of severe disease), common complications can include respiratory distress and even blindness.
In 2003, a monkeypox outbreak occurred in the United States, originating from infected prairie dogs that were housed near animals imported from Ghana, that infected 47 people. During this outbreak, all cases were attributable to animal-to-human transmission from close handling, bites, scratches, and cleaning the cages of sick animals. The outbreak was contained by quickly identifying the source and administering smallpox vaccines (which have cross-reactivity with monkeypox) to at-risk individuals. No deaths occurred in that outbreak.
The 2022 monkeypox outbreak, however, has now arguably evolved into a global epidemic. At the time of this writing, there are over 25,000 global confirmed cases, and the United States has over 6,000 confirmed cases in 49 jurisdictions, with the highest case counts being in New York state and California. Thus far, among these cases, there have been no reported monkeypox-associated deaths in the United States. Brazil and India have each reported one death, with the Brazil patient being immunocompromised and having lymphoma. Spain has also reported two deaths. With a reported death rate in the current monkeypox epidemic far below the three to six percent previously reported, there is low concern for mortality, but there remains a risk for other complications of the infection.
We have also amassed a great deal of information regarding who is at risk. As of August 2, California’s Department of Public Health has reported that among its approximately 1,135 statewide cases of monkeypox, 14 have been hospitalized for the infection, with the vast majority of patients being aged between 25 and 44 years. From among the monkeypox cases with available data, 98.8% have been reported in male or transgender male individuals, with 97.2% of infected individuals identifying as gay, lesbian, or bisexual. Given this information, California’s public health website states: “While it’s good to stay alert about emerging public health outbreaks, the current risk of getting monkeypox in the general public is very low.”
The WHO and Centers for Disease Control (CDC) have taken a different approach to the monkeypox outbreak than they did with COVID, electing to adopt recommendations directed at the individuals and communities at greatest risk, rather than issuing broad restrictions that impact the entire public. The WHO, in addition to declaring monkeypox a PHEIC, recommended that men who have sex with men limit their number of sexual partners, while the CDC has chosen to issue “safer sex” recommendations that deliberately avoid singling out any groups to avoid stigmatization.
At this point in the monkeypox epidemic, when case numbers are relatively few and infections are concentrated among well-defined communities, we have a unique and narrow window of opportunity to adopt lessons we have learned from the COVID pandemic and enact focused protection of those who are at risk to both protect those individuals and halt the broader spread of the virus. Focused vaccination programs, educational campaigns regarding safe practices, and temporary limitations on specific events that are likely to lead to further spread of the monkeypox virus should all be considered. We learned from our initial response to the AIDS epidemic in the 1980s that we can do so while being respectful to impacted communities by focusing our language on medical risk reduction, rather than shaming individuals for their identities or personal practices. Any efforts to avoid focused protection of at-risk communities out of fear of stigmatization will cause public health agencies to squander this opportunity to contain the spread of monkeypox, effectively worsening its impact and potentially making it far more difficult to control in the future.
Given how skeptical the public has become after watching public health and political leaders make one harmful mistake after another in their attempt to manage the COVID pandemic, leaders must now set aside politics and political correctness and very transparently employ the clinical evidence about monkeypox to address this epidemic swiftly, before it spreads beyond its existing pockets. Time is running out.
Houman David Hemmati, M.D., Ph.D. is a board-certified ophthalmologist and biomedical research scientist in Santa Monica, California. Dr. Hemmati earned a BS in Biological Sciences from Stanford University, an MD from UCLA School of Medicine, and a PhD from Caltech, and completed an internship in Internal Medicine at Stanford Hospital, an ophthalmology residency at the Wilmer Eye Institute at Johns Hopkins Hospital, a postdoctoral research fellowship in chemical engineering at MIT, and a clinical fellowship at Harvard Medical School. He has co-founded and helps run two pharmaceutical companies developing treatments for eye diseases like macular degeneration, and has published extensively in the areas of stem cell research and blinding eye diseases. You can follow him on Twitter: @houmanhemmati
The views expressed in this piece are those of the author and do not necessarily represent those of The Daily Wire.