Monkeypox: no need for panic

So. Monkeypox.

First of all this is not this season’s covid, there is no need to panic (thank you irresponsible Daily Mail headlines).

At the time of writing there have been seven confirmed cases in the UK, as well as several cases in Lisbon and Madrid. It seems that the original case was brought to the UK from Nigeria*. Although some of the UK cases had been in contact with one another and two were housemates, there are no known connections between some other cases suggesting that there is an unidentified line of transmission somewhere out there in the community. This really does underscore the importance of a robust and properly resourced contact tracing and public health surveillance infrastructure, and wouldn’t it be nice if our government believed that. The majority of the cases do seem to be part of the same community though, of which more later, which suggests it’s not as widespread as some alarmist headlines would suggest but probably spreading among people who are more likely to encounter one another.

Monkeypox produces the typical suite of flu-like symptoms, aches, fevers and chills, along with unsightly skin pustules that you can google for images of if that’s your idea of a good time. The monkeypox circulating in Europe appears to be of the West African type, which is less deadly than the Central African type – be wary of alarmist clickbait conflating the two. The West African clade is thought to have a case fatality rate of around 1%, ie if 100 people get it one will die, which is significantly lower than covid in unvaccinated people. HOWEVER it’s also worth bearing in mind that these numbers come from a low-resource setting, where patients may have underlying nutritional deficiencies or other infections or parasites, and where even simple care like hydration support may be unavailable. As we’ve seen with ebola, diseases can turn out to be less deadly than we thought with access to proper treatment.

Another significant difference from the early stages of the pandemic is that we already have a vaccine that probably offers partial protection against monkeypox, the smallpox vaccine. We stopped routinely vaccinating for smallpox once it was eradicated but we still have the technology to make the vaccines. They were deployed a couple of years ago in the US in response to a cluster of monkeypox that arose from an exotic pet importer**.

Monkeypox is transmitted through contact with infectious bodily fluids – like covid through respiratory droplets, but unlike covid where we found surface transmission was much less of an issue than we feared it was going to be it does seem to be more capable of persisting on hard surfaces as well as soft items like bed linen. And we already know what to do about both of these, and to be honest should probably keep doing them regardless – wear masks and keep spaces well ventilated for airborne transmission, and wash your hands and use hand sanitiser for surface transmission.

Monkeypox can also be transmitted through more intimate contact, and here we get on to the demographics of the current European population of patients, the majority of whom appear to be gay and bisexual men. There was an interesting phenomenon at the beginning of the pandemic where a lot of superspreader events were choirs – people propelled lots of infectious respiratory droplets at one another by singing, then met up with other people who shared an interest in singing and swapped respiratory droplets with them too. Queer men comprise a community with shared experiences and are likely to associate with one another. Maybe some of these men had sex with each other, maybe they did karaoke together or drank a smoothie out of the same cup, if they did spread it through sex this is 2022 and we should really have got used to the idea that as long as everyone’s consenting there should be no moral judgement attached to any sexual encounter. We’ve already had one pandemic in which gay people were demonised and HIV was judged a consequence of promiscuity and immorality.  It would be nice to say let’s not let that happen this time, but I’m sure the people just looking for another excuse for their hatred of LGBT+ people have already started. So let’s push back against that. And just like with wearing masks and washing your hands, the best response to this is to carry on doing what you should already be doing, using protection when having sexual contact with a new person’s bodily fluids. And get tested regularly too, although that’s less relevant in this scenario as your basic STI panel doesn’t include monkeypox.

*and I’m just guessing here, but the most likely way for someone to have come into contact with monkey bodily fluids in Nigeria would have been bushmeat. This really reiterates the lessons of covid, that probably the best way of protecting ourselves from future pandemics is to stop encroaching on natural habitats and messing with the animals we find there. And also that the cost of making sure people can afford to feed themselves and their families without resorting to poaching endangered animals is a hell of a lot lower than the cost of dealing with the consequences.

**See above

***Yes this picture probably isn’t a West African monkey, I don’t really do primates