What’s really at risk with monkeypox?
Is monkeypox a diversion from the persistent pressures of COVID or is it real? The answer is both.
Unfortunately, the media lens is very wide right now, meaning that we hear about an emerging infectious disease and jump quickly to the worst-case scenario. But unlike COVID-19, monkeypox is neither new nor is it widespread. It is also not a single-stranded RNA virus, which makes it less prone to rapid mutations like flu or SARS-CoV-2.
This particular strain of monkeypox that is capturing the media’s negative imagination traces to an outbreak in Nigeria in 2017-18. It is less virulent or deadly than another kind of monkeypox, which is itself much less virulent or deadly than smallpox. Yet it is smallpox that we think about when we talk about monkeypox, it is smallpox that we have stockpiled hundreds of millions of doses of a vaccine against, smallpox which killed more than 300 million people worldwide in the 20th century alone before the powerful vaccine eradicated it in 1977. Monkeypox is a poor cousin by contrast, though you can still get pretty sick from it with fever, fatigue, body aches and lymph node swelling, followed by a characteristic pustular rash.
But the traditional live virus smallpox vaccines are readily available — in fact, a Department of Health and Human Services spokesperson stated to me we have enough vaccine for all Americans. But actually giving it would be a huge overreaction at this point, with only sporadic cases and limited outbreaks in Europe, the U.S., and the U.K., many of which are still linked to travel or tracing to two big raves among gay and bisexual men in Spain and Belgium. Monkeypox can apparently be spread by sexual contact as well as by close contact with secretions.
It is hardly another COVID, and shouldn’t be thought of the same way, as COVID, by contrast, is approaching the easy airborne transmissibility of measles, with each subvariant being about 30 percent more transmissible than the last.
By contrast, with all the attention it is receiving, monkeypox still has 257 total cases in 23 countries worldwide and only a handful of cases here in the U.S.
Don’t get me wrong, the real case number is clearly higher when you factor in community spread with milder cases that may be mistaken for flu or another virus, but still, this is not and likely never will be another pandemic. Since its main source of spread is among symptomatic patients it is much easier to follow a standard effective public health protocol than with COVID. Namely, identify, isolate, treat (there are effective anti-virals – TPOXX and TEMBEXA, as well as potentially cidofovir) and ring vaccination of all close contacts.
The Centers for Disease Control and Prevention is closely monitoring the situation here in the U.S., and there is an abundant and growing availability of PCR testing for monkeypox. This is crucial because if we don’t know who has it, we won’t be able to contain and control it.
Back in early 2020, when I traveled to Dulles airport and the University of Nebraska Medical Center where the first U.S. COVID patients from the Diamond Princess cruise ship were being quarantined, I was among the first to warn that SARS-CoV-2 was a dangerous virus already spreading widely throughout our communities that we had no vaccine or treatment for. What followed defied even the most draconian predictions. But there is no reason to automatically apply the model of what happened and what went wrong in trying to contain COVID to all emerging infectious diseases.
Monkeypox is a problem, but it is no COVID, and it can be managed by applying the tried and true science and public health we have at our disposal. Hysteria magnifies the problem and helps no one.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”