Will monkeypox become another COVID? The answer is no.
Though monkeypox has been reported in over 20,000 people in more than 75 countries, and the World Health Organization has called it a global health emergency – they delayed far longer with COVID – nevertheless, there are definite reasons to believe it doesn’t have nearly the same potential as COVID.
For one thing, monkeypox doesn’t spread nearly as easily and it may be identified by a characteristic pustular or vesicular rash, which generally occurs three days after the onset of flu-like symptoms. Isolation of affected individuals and tracing their contacts is imperative, and far easier to accomplish than with COVID, which often spreads asymptomatically and has become more transmissible with each emerging omicron sub variant.
Will monkeypox become another HIV? The answer is again a resounding no.
Though monkeypox is spreading through the male gay and bisexual communities, with more than 99% of those who have acquired it so far being men who have had relations with other men, according to the CDC, and though the numbers are clearly being underestimated, much as they were for HIV and AIDS in the 1980s and 1990s, with the risk of spread into the larger community in both cases, there are essential differences.
For one thing, we already have an effective vaccine for monkeypox, and we still don’t have one for HIV. For another, for everyone who is more than 50 years old and received the old smallpox vaccine prior to 1972, there likely is at least partial protection against monkeypox. No such protection exists for HIV.
And we have an effective monkeypox treatment available, tecoviramat (TPOXX), while it took more than a decade for truly effective treatments to be developed for HIV. Granted, TPOXX, though we have over 1.7 million doses in the national stockpile, was approved for use in smallpox based largely on animal data, but it likely works against monkeypox as well.
What monkeypox does share with HIV is the danger of stigmatization of the group spreading it the most. Stigma always gets in the way of education and public health interventions. It doesn’t matter what name we call the disease or whether we call it a national emergency or not, what matters is that we get out the Jynneos vaccine, TPOXX, and proper testing to all who need it.
We are far behind where we should be, as federal, state and local health departments underestimated the risk at least initially. The CDC now has its Emergency Operations Center going for monkeypox and Health and Human Services has purchased over 7 million doses of the vaccine. Over 300,000 doses have been shipped so far and another 700,000 doses are on the way, though it is clear that the vaccine will remain in short supply for months.
In New York City, several hospitals have still not received their initial allotments. We can all recall the frustrations over limited supplies of the COVID vaccine early in 2021, and we are facing the same problem now with monkeypox.
In fact, it seems we have learned some of the wrong basic lessons from COVID, and are applying them to monkeypox. Fear and political posturing again predominate, and take the place of tools and supply. Instead, the medical community needs to rise up and treat and protect those who are sick and those who are most at risk.
Bottom line, we need enough vaccine immediately for all gay and bisexual men, and we need to quickly accumulate enough human data for TPOXX use so that the FDA can grant it an Emergency Use Authorization for monkeypox. With five companies expanding production of monkeypox tests, 70,000 per week, as the CDC promises, is still not enough to properly trace and control the outbreak.
I have dealt with outbreaks, epidemics and pandemics throughout my medical career. From HIV to swine flu to COVID, I have tried to provide for my patients, differentiating only based on need. Doctors aren’t the problem. The issue is overpromising the tools we need for our patients while too much political posturing goes on to camouflage shortages.
A virus doesn’t know from political correctness, it will infect anyone it can get to. If we have learned one thing from COVID and the uneven public health response, it is that fear of a virus is not an efficient motivation or tool to prevent spread. Punishment-driven closures or mandates fueled by fear did not ultimately prevent COVID spread and many more public health concerns occurred as a result of these interventions.
As opposed to HIV and COVID, monkeypox doesn’t appear to generally be deadly or to make its victims very sick. But the rash can be painful, which is why I am pushing hard for more availability of the treatment.
Fear of the awful looking monkeypox rash makes the public believe the disease is more life threatening than it really is. Still, it is spreading rapidly here in the U.S., with over 5,000 reported cases now as compared with 300 a month ago. And the real numbers are far greater.
We have the tools we need to beat it. We just need to get them into the right hands in time.