Photo illustration by Erin O’Flynn / The Daily Beast / Getty
We failed to get on top of the monkeypox outbreak and we missed our chance to prevent the disease from becoming an endemic and permanent threat in the US and Europe.
Monkeypox is spreading rapidly all over the world, especially in the United States and Europe. With cases doubling every two weeks, monkeypox is at increased risk of becoming a permanent problem in countries where, previously, outbreaks were rare and small.
In other words, smallpox is close to being endemic in many new places. If it does, it can be very difficult to eradicate. Monkeypox, which causes fever and rash and is fatal in very few cases, will become another disease that people have to worry about all the time.
For smallpox, there are two paths of endemism. If the virus infects people so rapidly that it beats authorities’ efforts to trace transmission and vaccinate at-risk individuals, it could be endemic in people. “We’re already getting closer to this,” James Lawler, an infectious disease specialist at the University of Nebraska Medical Center, told The Daily Beast.
‘Shocking’ monkeypox screw-up means we need to accept that we are now facing two pandemics
The good news with this kind of endemism is that it’s not passed to be permanent Human endemism is hard to reverse, yes—but it is possible. Amesh Adalja, a public-health expert at the Johns Hopkins Center for Health Security, told The Daily Beast, “If it’s just spreading to humans, it can be controlled — eventually — through vaccination and natural immunity. “
But monkeypox was originally a “zoonotic” animal virus. It spreads to rodent and monkey species in West and Central Africa, where outbreaks occur frequently in human populations.
If smallpox found a home in some animal species in North America or Europe – say, squirrels, rats or prairie dogs – it would be impossible to eradicate on a regional scale. “Game over,” Lawler said. Smallpox will be around us, probably forever, just waiting for opportunities to spread from animals to people. Outbreaks will be frequent and large, just as they are in West and Central Africa now.
To be clear, smallpox is not yet endemic in people or animals in the United States or Europe. But the trends are not encouraging. “I share the concern of other scientists and the concern that the virus is endemic in our US rodent population,” Stephanie James, head of a viral testing lab at Regis University in Colorado, told The Daily Beast.
After diagnosing a UK traveler returning from Nigeria in early May, officials first took note of the current outbreak, which involved a relatively mild West African strain of smallpox. Spread through close physical contact, including sex, smallpox soon joined passengers on planes bound for faraway lands. Doctors diagnosed the first US case on May 27.
But now it is clear that diagnosis Smallpox was not the first real case in Europe and America. On June 3, the US Centers for Disease Control and Prevention announced that it had found genetic evidence of cases of American pox that predate the first cases in Europe from May.
Because of the similarity between the symptoms of smallpox and those of some common sexually transmitted diseases such as herpes, doctors may not have noticed or reported these infections at first. “The virus was masquerading as a sexually transmitted infection and was spreading covertly for several months,” Adalja explained.
The virus had a great start, which helps explain why, months later, it is still ahead of intense efforts to contain it. As of Wednesday, there were 20,638 confirmed cases in 77 countries, according to the CDC. This is up from less than 10,000 cases two weeks ago. The World Health Organization counts five smallpox-related deaths in non-endemic countries.
What is frustrating for epidemiologists is that, in theory, we had all the tools we needed to rapidly stop smallpox outbreaks. Thanks to COVID, healthcare workers around the world are better than ever at contact-tracing. Vaccines and treatments that work for smallpox also work for monkeypox. There is a proven strategy: diagnose cases, isolate and treat the infected, vaccinate their family, friends and colleagues.
And educate the public—especially the highest-risk groups, including men who have sex with men.
But so far the strategy is not working. Part of the problem lies with the virus itself, Lawler said. “This disease is different from the monkeypox that we have seen in the past. I don’t think we know why- probably a combination of virus, host and environment.
Mostly, it’s our fault. Many doctors misdiagnose cases of smallpox as shingles or some other STD. Both the WHO and the CDC waited too long to designate the smallpox outbreak as a public-health emergency and to mobilize resources. The WHO declared a state of emergency on 23 July. The CDC is expected to do so in the next few days.
The monkeypox crisis is lurking in this virus hotspot
Officials are deploying more vaccines and treatments and promoting testing. Still, clinics on the front lines of public-health in America are in need of more of everything. more tests. More vaccines and treatments. More money for community outreach. The US National Coalition of STD Directors recently surveyed a hundred clinics and found that half lacked the ability to deal with monkeypox outbreaks.
“We’re still going too slowly,” Lawler warned. And, he added, “we are still ruling out the possibility of the unexpected.” Including an increased chance of smallpox spreading to squirrels or rats.
The Feds are at a loss for dealing with “reverse zoonotic” people-to-animal transmission. To prevent endemicity in animals, you’ll need to detect smallpox infection in a species, catch infected animals, and then closely monitor the rest of the population to make sure you’ve eliminated all of the virus.
But it is not clear who should take the lead in the federal health establishment. “The operational zoonotic disease response falls into this gray area,” Lawler said. The CDC maintains a website describing the symptoms of smallpox in pets and livestock and describing where to send samples for diagnosis. The Department of Agriculture’s Animal and Plant Health Inspection Service monitors animal diseases. Especially livestock.
APHIS could not or could not confirm animal testing for monkeypox. The agency referred The Daily Beast to the CDC, which did not respond to an email seeking comment. If there is a major agency for detecting smallpox in animals, that agency doesn’t seem eager to take responsibility.
The rapid spread of monkeypox among people is a preventable tragedy. but it can still get a very Worse. With hard work and a little luck, it is still possible to prevent and eventually end human outbreaks.
But if American or European rodents caught smallpox, the outbreak would be much worse. A new endemic disease. Which is impossible to erase.
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