There was an undetected monkeypox outbreak already underway in the United States before health officials in Europe and the United States sounded the alarm about the dangerous viral disease in May. It is a problem. For every day a virus spreads unchecked and unchecked, there is a greater risk that it will find a permanent home in a country it was only visiting. In the case of smallpox — in our pets.
Earlier this month, the United States Centers for Disease Control and Prevention announced that two strains of the virus were circulating in the country, indicating that it has probably been here for much longer than initially thought. . It’s unclear when this other outbreak began, but it could have been months ago.
Monkeypox, which causes a rash and fever and is fatal in a very small percentage of cases, is not as transmissible as Covid-19. But unlike the new coronavirus, it spreads easily to and from certain animal populations – rodents in particular.
If the smallpox currently circulating in the United States spreads to rats, hamsters, or gerbils and becomes endemic in those species, there may not be an easy way to contain it. “I share the concern of other scientists about the lockdown and the virus becoming endemic in our rodent population in the United States,” said Stephanie James, head of a viral testing laboratory at Regis University in Colorado.
There is some good news. For starters, no one has yet died from either of the recent smallpox outbreaks. And authorities are better equipped than ever to contain outbreaks, thanks to large stocks of the smallpox vaccine (which also works against monkeypox) and their years of experience in contact tracing through Covid-19.
Other good news: despite some mixed messages of some health experts, smallpox is not airborne in its current form. The CDC did not respond to a request for comment, but the European Center for Disease Prevention and Control – the European version of the CDC – pointed out “there is no evidence of long-range airborne transmission.”
The confusion stems from the scientific definition of “airborne.” Covid fits the definition. Monkeypox does not. Smallpox can travel a very short distance on spit, but it does not float and linger in fine “aerosol” mists while breathing and talking like airborne Covid does.
The new coronavirus can travel across a room on aerosols or even hover in the air for hours at a time. The monkeypox in our saliva, on the other hand, quickly drops to the ground a few feet from our mouth. “Respiratory droplets may be able to spread the virus, but that’s not what’s fueling transmission,” says Amesh Adalja, public health expert at the Johns Hopkins Center for Health Security. Instead, smallpox is spread through very close contact.
The bad news is that we are catching up. And as this earlier, initially undetected outbreak indicates, we don’t even know how far behind we are. It is not enough to contain and treat smallpox in people. We must also prevent it from spreading to rats, hamsters and other animals.
Monkeypox, which made the leap from apes or rodents to humans in the Democratic Republic of Congo in 1970, breaks out regularly in Africa. But it rarely infects more than a few thousand people a year – and killed just 33 people in its most prolonged outbreak in the DRC between 1981 and 1986.
When monkeypox spreads to places where it is not already endemic outside of Africa, health officials rebound. In 2003, 47 people in the United States contracted smallpox after being exposed to a shipment of pet rodents from Ghana to Texas. A rapid response from state and federal health authorities – and a few doses of smallpox vaccine – stopped anyone from dying and temporarily eliminated the virus in the United States
The greatest of running outbreaks began in early May, apparently triggered by exposure of a British traveler to an infected person or animal in Nigeria. While hitchhiking in Europe, the virus spread rapidly through close physical contact. David Heymann, who previously headed the World Health Organization’s emergency department, said men attending raves in Spain and Belgium had ‘amplified’ the outbreak – apparently by kissing and rubbing the skin.
After that, the virus accompanied travelers on planes to distant countries. As of June 2, the WHO had counted 780 cases of smallpox in 27 countries. The number of cases has since risen to around 1,400. Health officials diagnosed the first US case on May 27.
From Friday, 49 Americans in 16 states plus Washington, DC have had smallpox. The CDC suspects that some of these cases are the result of an earlier outbreak that officials didn’t even notice until the later outbreak forced them to go back and take a closer look at the symptoms of some. patients.
Rashes are very similar to symptoms of other illnesses, including sexually transmitted infections or STIs. This earlier smallpox outbreak apparently eluded medical professionals because they didn’t necessarily know what they were looking at. “These monkeypox cases outside the endemic area have probably been smoldering for some time, misdiagnosed as traditional STIs,” says Adalja, the public health expert.
This delay in confirming smallpox cases worries experts. Each passing day in current outbreaks increases the risk of transmission to pets and pests. If smallpox becomes endemic in animal populations, we may never get rid of it. And countries like the United States that once had only a few smallpox outbreaks every 20 years or so could experience larger and more frequent outbreaks, just as countries in Africa already do.
It’s the worst case scenariobut authorities can’t contain an outbreak they don’t even know is happening. It’s a disturbing sign that in the third year of a devastating pandemic, doctors, health officials and epidemiologists ignored that earlier smallpox outbreak, giving the virus a head start in the race. endemicity in animals. “I think we are significantly undertesting, underestimating cases and underestimating risk,” says James Lawler, an infectious disease expert at the University of Nebraska Medical Center. “We apparently haven’t learned much from Covid.”