On the menu today: After the long global ordeal of the Covid-19 pandemic, lots of people are much more concerned about the spread of once-rare viruses from far-off corners of the globe. Wednesday brought news that the Massachusetts Department of Public Health had confirmed a single case of a monkeypox virus infection in an adult male. That’s something worth watching, but not cause for panic — particularly once you know the history of human cases of this strain of the virus.
Monkeypox: Facts and Fiction
Not great news to start your day:
The Massachusetts Department of Public Health confirmed a single case of monkeypox virus infection in an adult male with recent travel to Canada. Initial testing was completed late Tuesday at the State Public Health Laboratory in Jamaica Plain and confirmatory testing was completed today at the US Centers for Disease Control and Prevention. . . . Monkeypox is a rare but potentially serious viral illness that typically begins with flu-like illness and swelling of the lymph nodes and progresses to a rash on the face and body. Most infections last two to four weeks.
This comes after health authorities in the United Kingdom identified nine cases this month, noting that, “The two latest cases have no travel links to a country where monkeypox is endemic, so it is possible they acquired the infection through community transmission.”
Articles about monkeypox often feature close-up pictures of painful, pus-filled blisters, and note that past outbreaks have shown a death rate of 10 percent — although the strain detected in the United Kingdom, the “West African clade,” has a fatality rate of less than 1 percent. The Congo Basin or Central African clade has the much higher fatality rate.
If you’re thinking, “Oh, no, here we go again,” rest assured that this monkeypox outbreak is not likely to shake out like the Covid-19 pandemic.
The U.K. Health Security Agency states that, “Monkeypox does not spread easily between people” and when it does, it is through contact with “clothing or linens (such as bedding or towels) used by an infected person, direct contact with monkeypox skin lesions or scabs, coughing or sneezing of an individual with a monkeypox rash.” Also note that British health authorities say this outbreak is “predominantly in gay, bisexual or men who have sex with men.”
The World Health Organization’s guidance describes human-to-human transmission as “relatively limited. Infection can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers and household members of active cases at greater risk. The longest documented chain of transmission in a community was six successive person-to-person infections. Transmission can also occur via the placenta from mother to fetus.”
The Massachusetts Department of Public Health instructs us that:
Based on findings of the Massachusetts case and the recent cases in the U.K., clinicians should consider a diagnosis of monkeypox in people who present with an otherwise unexplained rash and 1) traveled, in the last 30 days, to a country that has recently had confirmed or suspected cases of monkeypox 2) report contact with a person or people with confirmed or suspected monkeypox, or 3) is a man who reports sexual contact with other men.
As unnerving as this week’s news is, the U.S. has seen similar travel-related monkeypox cases in recent years. In November 2021, a single case of monkeypox was diagnosed in a U.S. resident who’d recently returned from Nigeria to the United States. The Maryland Department of Health stated at the time that, “The individual presented with mild symptoms, is currently recovering in isolation and is not hospitalized. No special precautions are recommended at this time for the general public.”
A few months earlier, in July 2021, the CDC and the Texas Department of State Health Services confirmed a case of human monkeypox in a U.S. citizen who’d traveled from Nigeria to the United States on two commercial flights. The CDC identified 223 contacts of the man before medical isolation, but by September, the CDC monitoring of the man’s known contacts concluded, and “no secondary cases in the U.S. were identified, including among persons with suspected cases reported by clinicians to the CDC call center.” Sometimes, a virus just isn’t that contagious.
The biggest outbreak of monkeypox in the U.S. occurred in 2003, when health authorities found 47 confirmed and probable cases in six states — Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. “All people infected with monkeypox in this outbreak became ill after having contact with pet prairie dogs. The pets were infected after being housed near imported small mammals from Ghana. This was the first time that human monkeypox was reported outside of Africa.” During this outbreak, 28 adults and two children were given the smallpox vaccine and “no serious adverse events were reported.” Not only did this outbreak not turn into a major public-health crisis, it barely made the national news. When the New York Times wrote about it back in June 2003, the story ran on page A20.
If you’re old enough to have been vaccinated against smallpox, then you likely still have good protection against monkeypox — according to the WHO’s figures, a smallpox vaccination is about 85 percent effective in preventing monkeypox. But the U.S. stopped vaccinating citizens against smallpox back in 1972, concluding that the virus was eradicated. The only Americans who still get vaccinated against smallpox are lab workers who work with the smallpox virus or other similar viruses.
In the kind of development likely to set off a million conspiracy theories, in recent years, medical researchers have made breakthroughs in vaccines designed to protect against monkeypox. In September 2019, the FDA approved the Jynneos smallpox and monkeypox vaccine. This is the first FDA-approved vaccine for monkeypox, and the agency declared that it would be added to the Strategic National Stockpile. Dr. Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, said at the time that, “Although naturally occurring smallpox disease is no longer a global threat, the intentional release of this highly contagious virus could have a devastating effect.”
The FDA notes that:
Jynneos does not contain the viruses that cause smallpox or monkeypox. It is made from a vaccinia virus, a virus that is closely related to, but less harmful than, variola or monkeypox viruses and can protect against both diseases. Jynneos contains a modified form of the vaccinia virus called Modified Vaccinia Ankara, which does not cause disease in humans and is non-replicating, meaning it cannot reproduce in human cells.
Yesterday, the U.S. Biomedical Advanced Research and Development Authority, a part of the Department of Health and Human Services, “exercised the first options under an existing contract to supply a freeze-dried version of the Jynneos smallpox vaccine.” Before this move is interpreted as a sign that HHS is worried about a major monkeypox outbreak, note that the first doses of this vaccine order will be manufactured and invoiced in 2023 and 2024.
So how worried should you be about monkeypox? Not much, unless you’ve traveled to one of the countries where it is endemic, or you’ve had close contact with someone who has recently traveled to one of those countries. Since 1970, human cases of monkeypox have been reported in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. As noted, the most recent outbreaks in the U.K. are among men who have sex with other men — who may well have “prolonged face-to-face contact.”
(Public safety is not helped by doctors who jump onto social media and declare that, “If monkeypox spreads, I think I’m leaving medicine. I’m not exposing myself to a disease with 10% mortality because this country of selfish f**** refuses to mask or get vaccines when they’re available.” As noted earlier, this is not the strain with a 10 percent mortality rate, masking is not necessary, and only a handful of Americans are eligible to get vaccinated against smallpox.)
ADDENDA: Have you ever read a news story and, once finished, concluded that, “There’s no way events played out the way this article described them?” That’s how I felt when reading Taylor Lorenz’s insanely one-sided, self-serving account of the end of the Biden administration’s Disinformation Governance Board. As noted yesterday, if intense criticism from the Internet could get a federal agency to stop doing something, very few federal agencies would ever do anything.
And finally, our Dominic Pino has some more thoughts on oil refineries:
We need more refining capacity now, which means we needed more refinery investment five to ten years ago. The U.S. must learn from its mistakes (both public and private) and prioritize refining. If we fail to learn now, we’re only setting ourselves up for future crises that will have nothing to do with Vladimir Putin.