Monkeypox may be not as bad as Covid-19 but let us still take care

The news of a new virus spreading across the globe hot on the heels of a devastating pandemic is a cause for concern. However, the viral illness caused by the monkeypox virus is not like the novel coronavirus that causes Covid-19 and it’s unlikely to cause a major outbreak for six reasons: Less contagiousness, close-contact transmission mode, lack of asymptomatic spread, low fatality rate, well-known preventive measures and vaccine availability.

First, monkeypox is an old, primarily zoonotic disease—transmitted from animals to humans when people come into close contact with infected animals through an animal bite, scratch, bodily fluids, faeces or by consuming meat that isn’t cooked enough—and human-to-human transmission is very rare, unless there’s close physical contact (skin-to-skin). The primary reservoir (main disease carrier) of monkeypox virus is still unknown although African rodents are suspected to play a role in its transmission.

Secondly, although it can also spread through fomites (contaminated clothing and bedding) and respiratory droplets produced by coughing and sneezing like the novel coronavirus, monkeypox is not an airborne pathogen. The virus is made up of double-stranded DNA (which makes it larger and heavier) while the novel coronavirus is a tiny, single-stranded RNA virus, which makes it easier to float in the air and spread faster.

For the novel coronavirus, airborne transmission through tiny aerosols is a far greater risk than from large respiratory droplets (contaminated surfaces)—meaning that in a crowded, poorly-ventilated indoor space, a single infected person can release enough aerosolised virus over time to infect many people and seeding a super spreader event.

Because monkeypox virus is spread through respiratory droplets (which requires prolonged face-to-face contact because the droplets cannot travel more than a few feet), to infect a group of 30 through the droplets at one sitting, a single infected person has to be within a few feet of all the people when coughing or sneezing, or to have contaminated an object that all the 30 touched.

Other routes of monkeypox transmission include from mother-to-foetus via the placenta or close contact after birth. However, contrary to social media accounts, it’s not a sexually transmitted disease and contact with infected lesions containing the virus during sex—as opposed to semen and vaginal fluids exchanged during sexual activity—may explain why most of the identified cases are in men who have sex with other men.

Thirdly, unlike the novel coronavirus, which can be spread by an asymptomatic person, monkeypox is contagious only when an infected person shows symptoms such as lesions and blisters that can be spotted easily and victims isolated. On average, symptoms appear within six to 13 days after infection and a person experiences fever, headache, backache and muscle aches, swollen lymph nodes and general exhaustion. It then enters the body of an exposed person through broken skin, the respiratory tract or the mucous membranes (eyes, nose and mouth). Monkeypox also creates a rash, which can start on the face, hands, feet or inside the mouth or genitals and progress to the rest of the body.

Fourth, the case fatality rate for monkeypox is slightly higher than for Covid-19 but the odds of getting infected is lower than with the latter. Risk of death is a function of probability of event occurring (contagiousness) and its impact (fatality rate). For example, although the rare brain-eating amoebas can cause 100 per cent fatality rate, the risk of getting infected is extremely rare and only 310 cases have been documented globally so far. Moreover, viruses need to mutate to become more infectious but, compared to a RNA virus, DNA viruses like monkeypox are generally very stable and evolve much slower.

Fifth, the vaccine for smallpox—vaccinia virus WR—provides lifetime immunity and neutralising immune responses against all human infectious poxviruses, including Variola major and Variola minor, the strains that cause smallpox and monkeypox, respectively. When infected, older adults who were vaccinated against smallpox decades ago are likely to get mild symptoms as they maintain a high level of antibodies to keep the virus at bay.

Lastly, the same measures used to protect oneself against the novel coronavirus—social distancing, wearing a mask in public, handwashing and surface disinfections—will reduce your risk of getting monkeypox.

Dr Obwogo is a medical doctor, public health medicine specialist, health policy and systems strengthening consultant and author. [email protected]