As if a pandemic wasn’t enough, a dangerous new virus is spreading across the globe. Beginning about two weeks ago, monkeypox, a pathogen that originated in West and Central Africa and causes flu-like symptoms and a rash, appeared in places where it is not normally found.
Portugal, Spain and the UK have reported a few dozen cases between them. And now the United States. Authorities in Massachusetts detected the infection late Tuesday and the US Centers for Disease Control and Prevention quickly confirmed it.
But don’t panic. The world has contained outbreaks of monkeypox before. And we are even better prepared for the virus now that we have had three years of practice with the novel coronavirus.
“I’m not worried about anything resembling an outbreak,” Irwin Redlener, founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast. He was using the epidemiological definition of an outbreak, which is the sudden spread of an unusual disease, but in a small geographic area rather than globally.
The handful of monkeypox cases in a handful of countries still don’t qualify as an outbreak, by the standards of many scientists. Could the virus spread to more people in more countries? Yes. But don’t expect it to be anything like the spread of COVID. “SARS-CoV is much more contagious than other infections,” Stephanie James, director of a viral testing laboratory at Regis University in Colorado, told The Daily Beast.
Slower spread means authorities have more time to confirm cases, isolate infected people and trace their recent contact with others. There is no specific vaccine against monkeypox, but the virus is similar to smallpox, so smallpox vaccines should be reasonably effective and a useful tool in blocking smallpox transmission once contact tracers have identified the people who are at risk.
That’s what happened in 2003, the last time monkeypox had a significant foothold in the United States, that time through pet rodents shipped to Texas from Ghana in West Africa. Forty-seven people got sick, but a quick response from state and federal health officials, and a few doses of smallpox vaccine, prevented anyone from dying and quickly, albeit temporarily, eliminated the virus in the US.
Monkeypox, which first spread from monkeys or rodents to people in the Democratic Republic of the Congo in Central Africa in 1970, breaks out here and there from time to time, usually in Africa. But it rarely infects more than a couple thousand people a year, killing just 33 people during its longest outbreak in the Democratic Republic of the Congo between 1981 and 1986.
There are good reasons why monkeypox is not as contagious as COVID. While COVID spreads through very fine droplets of saliva, the kind we all sling for yards in all directions every time we breathe, talk, laugh or cough, monkeypox prefers larger droplets that don’t travel far away. It can also spread through direct contact between the pathogen and an open wound, but that route of transmission is even less likely than those large, fast-falling droplets.
The key to containing monkeypox is identifying it quickly so that isolation, contact tracing, and treatment can begin before the virus spreads too far. We were pretty good at it a generation ago. Now we’re even better at it, thanks in no small part to COVID. “Most of the world is much better prepared for monkeypox than it was two and a half years ago,” Paul Anantharajah Tambyah, president of the Asia Pacific Society for Clinical Microbiology and Infections in Singapore, told The Daily Beast.
“We have to find out what’s going on, quickly.”
Testing is more sophisticated, not just for SARS-CoV-2 infections, but for a host of other viral diseases. “I’d like to think we’ve learned how to do mass testing more efficiently,” James said. “PCR testing is really easy as long as we have the right reagents. We can also test for several viruses at the same time.”
We’re also better at contact tracing. Investigate people’s movements and relationships to determine who they have been in close contact with and when it was a niche practice three years ago. Today, many tens of thousands of health workers around the world are experienced in contact tracing.
The general public is also more alert. Sure, COVID-related restrictions on schools, businesses, and travel irritate a lot of people. Nobody likes to wear a mask. Small but stubborn minorities in some countries are even refusing to take the free, safe and effective vaccines that offer strong protection against the worst outcomes of a COVID infection.
But that stubbornness belies the keen awareness most people now have when it comes to viral illnesses. People will likely notice if a friend, neighbor, or family member gets smallpox, and will likely take it seriously. “The COVID-19 pandemic has shined a light on the critical importance of staying ahead of infectious disease threats rather than constantly chasing them,” Anne Rimoin, a professor of epidemiology at the Fielding School of Public Health, told The Daily Beast. from UCLA. “The world is now familiar with the terms ‘case investigation’, ‘contact tracing’ and ‘genomic sequencing’.”
Perhaps most reassuringly, we already have a vaccine. With COVID, we had to shut down and wait a year before the first punctures were ready. But since the smallpox vaccine works on monkeypox, there’s no waiting.
If there’s cause for concern in the recent wave of monkeypox cases, it’s that we still don’t know exactly where and how it started. Identifying the origins of a viral spread obviously helps contain it. “We need to find out what’s going on, quickly,” James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast.
“That said, in general, we think monkeypox is much less lethal than smallpox, easier to control in terms of transmission, and amenable to vaccines and antivirals,” Lawler added.
All this is to say, don’t worry. Unless a contact tracer knocks on the door (an unlikely proposition) or you notice strange blisters on your neighbor or yourself (even more unlikely), you don’t need to do anything different. “The risk to the general public is very low,” Rimoin said.
Monkeypox is making one of his regular comebacks. But this is a virus that we are very good at containing.