Dr. Loh: Tired of fretting about COVID? Well, how about monkeypox?

Just as the world is inappropriately dropping its guard against COVID, some new infectious disease ominously named monkeypox is cropping up on the radar. All my columns on COVID have been based on fundamental understanding of biology, evolution, clinical trials, and the general principles of internal medicine. But I have to admit that monkeypox, based on the name alone, caught my attention and I thought it might be worthwhile sharing a bit of what I’ve learned.

First, this is not a newly discovered disease. It was first detected in laboratory monkeys in 1958 but the first known human case was reported in about 1970. Cases were generally found in western and central Africa, with a couple of different strains identified with different characteristics. It is related to the smallpox virus but is less transmissible and less lethal. People born before 1970 and who may have been vaccinated against smallpox may have some cross-immunity to monkeypox. Despite the name, the animals that are the reservoir for the virus are likely rodents.

Monkeypox has visited America before. In 2003, some rodents from Ghana spread the virus to prairie dogs in Illinois. These prairie dogs were sold as pets (anyone from Illinois who understands that can contact me to explain) and infected about 47 people. Nobody died, though monkeypox has a mortality of about 1%, except for the more virulent strain from the Congo that has a mortality of about 10%. And those data are from regions without widely available modern healthcare resources.

The current non-African outbreak was first reported earlier this month in the United Kingdom in a traveler who had gone to Nigeria. But cases now have been reported (alphabetically) in Australia, Belgium, Canada, France, Germany, Italy, Sweden, and here in the U.S. These cases include people who have not been to Africa, nor have they been in contact with obviously infected individuals. This usually means that there likely are undetected cases. For further paranoia, please turn to the internet and Fox News. Just kidding. Sorta.

Here’s where some interesting mass psychology may come into play. It has been pointed out that people react to a new experience based on their last similar experience. So remember when Ebola was on everyone’s mind and the country initially overreacted and quarantined nurses who had traveled to help care for Ebola patients? Well Ebola fizzled out (then). So when COVID became a thing, the official White House response was to say not to worry about it. Remember? No cases here. It will be gone when the weather warms up. The way to keep the COVID numbers down is to not test for it. The CDC was politically stifled in order to downplay COVID. For an alternate prediction of what was to occur, see my Star column from January 2020.

Well, we are in our third year of this COVID pandemic which has wreaked havoc on our economy and our collective psyche. So we are all a bit jumpy and twitchy, based on our last experience with a new virus. And we’re not sure this time if we should trust official pronouncements. So, here’s my two bits. The anti-vaxxers can stop reading here. So can those who think Anthony Fauci and Bill Gates are behind monkeypox and 5G networks will give it to you, or make your children think … well, think.

So briefly, what is monkeypox? First, it is not COVID. As I stated before, monkeypox is a known disease. COVID was a brand new disease. Different viruses, different characteristics. It is not easy to catch monkeypox. It is not airborne although prolonged contact with aerosolized particles may contribute to risk. You catch it from contaminated surfaces or prolonged close association with infected people. The R0 is less than 1. R0 is the number of people who are infected by an infected patient. COVID’s R0 was about 3.5. The incubation period ranges from 5 to 21 days. It manifests with fever and a bumpyrash on the face and upper body, and characteristically on the palms. Lymph nodes get enlarged and may be painful. The disease runs its course over two to four weeks and only supportive care is required. There is as of this time no validated specific monkeypox treatments although the internet will undoubtedly rise to the occasion.

There have not been a large number of monkeypox cases worldwide thus far, so it is difficult to know if this outbreak will behave like prior ones. After all, with the drop in smallpox vaccinations since the apparent eradication of that disease in the late 1970s, monkeypox cases have increased in Africa. And COVID has illustrated that circulating reservoirs of viruses can allow for mutations that especially focus on enhanced transmissibility.

There is an undercurrent of concern about why monkeypox is suddenly showing up. Are more people traveling to endemic regions? Or has the monkeypox virus mutated? Science again is at the barricades. Gene sequencing is well underway to determine what mutations have occurred and when and where they began. If that turns out to be case, it also happens that the U.S. has adequate supplies of an older smallpox vaccine to vaccinate our entire population, and new more effective vaccines are being developed at this time.

Unless, of course, you don’t want that vaccine, either.

Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.

This article originally appeared on Ventura County Star: Dr. Loh: Tired of fretting about COVID? Well, how about monkeypox?