Monkeypox Isn't the Next Covid, But Danger Still Looms. NewsWire

NewsWire: 9/19/22

• The monkeypox outbreak is slowing in the U.S. and Europe. Multiple factors have kept the virus from turning into a full-blown epidemic—but questions remain about how much further it could spread. (Centers for Disease Control and Prevention)
  
• NH: On August 4, the Biden administration declared the growing monkeypox outbreak a federal health emergency. Just a month later, the tide has turned. The number of new U.S. cases fell by 40% by the end of August. Europe also saw consistent declines in new cases. In a Senate panel last week, CDC director Rochelle Walensky testified that the pace of new cases nationally and globally has continued to slow.

• The deceleration in case growth has largely been attributed to vaccination and behavioral changes among those most at-risk. But given the nature of the virus, it was highly unlikely that monkeypox would ever become the next Covid-19. Still, health leaders warn that serious challenges remain--among them, an unusually high mutation rate that leaves open the possibility monkeypox could transform into a bigger threat.
• Since beginning in May, the global monkeypox outbreak has spread to 103 countries--96 of which had never reported monkeypox cases before. The U.S. has reported the highest number of cases (around 23K), followed by Spain (7K) and Brazil (6K). The mortality rate is low: Out of around 60K total confirmed cases, only 19 people are reported to have died. But those who get sick suffer from painful symptoms, including pus-filled lesions, rashes, fever, and exhaustion.
• As cases surged during the summer, public health officials warned that, while gay and bisexual men were at the highest risk, anyone could catch monkeypox through close face-to-face interactions or by touching items used by an infected person. In a survey conducted at the end of July, 19% of Americans said that they were concerned about getting it--not that much lower than the 30% who were worried about getting Covid-19.
• Health officials erred too far in alarming the general public. In reality, nearly all cases of monkeypox have occurred among men who have sex with men, and nearly always through sex. In one study of cases that occurred from April to June, researchers found that 98% of them were among men who have sex with men. Fully 95% had most likely caught the virus through sexual contact. This is in line with new data from the World Health Organization, which found that about 90% of those they studied caught monkeypox through sex. Only 0.2% caught it from a contaminated surface.
• What’s more, most cases have occurred among those who have sex with multiple partners. British epidemiologists found that many people who tested positive had recently attended venues like sex clubs and nightclubs. About a third reported having 10 or more partners in the last three months. The CDC, meanwhile, found that although one-night stands account for only 16% of the sex between men on a given day, they account for around 50% of daily monkeypox transmission. The overlap in risk factors may explain why an unusually high share (38%) of monkeypox cases have occurred in people who are HIV-positive.

• The highly specific means through which almost all monkeypox transmits explains why it was never likely to see sustained spread in the general population. Monkeypox’s R₀--the average number of people an infected person is expected to later infect--is estimated to be between 1.0 and 2.0, compared to around 3.0 for the original strain of Covid-19.
• Monkeypox’s relatively narrow reach has also made it easier to reduce transmission. Experts attribute much of the recent decline in cases to at-risk men changing their behavior and avoiding risky hookups. According to a recent CDC survey of gay and bisexual men, about half have reduced their overall number of sex partners, one-time sexual encounters, and use of dating apps because of the outbreak.
• The rollout of vaccines has also helped drive the decline. Since monkeypox is closely related to the virus that causes smallpox, the smallpox vaccine is about 85% effective against monkeypox. The United States and Europe are primarily relying on a smallpox vaccine called Jynneos that was approved by the FDA in 2019.
• The downturn in cases does not mean that the outbreak is over. Although the growth of monkeypox cases has slowed, the number of cases is still rising--particularly in cities and countries with limited access to treatments or vaccines. Brazil, which has about 10% of the world’s cases, has neither. Average case growth there remains around what it was in early August. 
• The biggest reason experts remain worried is that the virus might become more widely transmissible. The current strain is mutating much faster than expected. Monkeypox is a DNA virus, which mutates more slowly than RNA viruses like Covid-19. Poxviruses typically mutate only once a year. But the current strain of monkeypox has mutated about 50 times in just four years. While mutations don’t necessarily make a virus more transmissible, health officials suspect that at least some of them have helped drive the outbreak.
• Last week, the FDA warned that the present-day strain is just “one mutation away” from becoming resistant to TPOXX, a key antiviral drug that is being used to treat patients. Further mutations would undoubtedly also hurt the effectiveness of Jynneos, which some already argue isn’t that effective because the current strain causes different symptoms from the strain that has been endemic in Africa for decades. Monkeypox patients have reported serious complications like myocarditis, severe eye infections, and encephalitis. Perhaps most alarmingly, some have been asymptomatic, which spurred the CDC to change its stance that the virus cannot be transmitted asymptomatically. It’s now “uncertain.”
• Let's not forget this fundamental fact: Monkeypox is a very close relative of smallpox, the biggest scourge of the 20th century and one of the deadliest viruses in history. Routine vaccination for smallpox in the United States stopped after 1972. The longer monkeypox circulates, the more likely it becomes that the virus will mutate in ways that make it more dangerous.