Monkeypox: ‘Don’t panic’

RFI: The World Health Organization (WHO) said this week that the number of cases has exceeded 2,000 in 42 countries outside the African continent, where the disease is spreading. I start by asking you why the virus is now spreading all over the world, because it has been circulating in Africa for several years.

Celso being: I do not think the World Health Organization has a definitive and strict answer to this question because we do not yet know the context in which the first case arose, and therefore, it is difficult for us to speculate why and whether the virus left Africa. It spreads to other areas where it is not endemic. Right now, what we’re seeing is that there are outbreaks that, in different countries, likely have different origins.

In Portugal we have a concentration in the community of men who have sex with other men and this also happens in most of the cases that have been written, outside Africa, and this can lead to the belief that the initial case originated within the community and is spreading due to some of the risky behaviors that are being carried out, At the moment, that is, people who are infected at the moment and who, being themselves not very alert to the initial symptoms, help spread the virus. I think it’s a passing issue at this point and that we’ll soon be back to a certain normality with respect to this issue.

RFI: The World Health Organization, later this month, will discuss whether monkeypox should be classified as a “public health emergency with an international dimension.” If this happened, what has changed since then?

Copy: In terms of disease, nothing changes. What changes in terms of measures that can be taken or that you can advise governments and local authorities to take. At this point, I think it’s still early days. There are about 2,000 cases worldwide. In Portugal, there are about 300 cases, and in France there are dozens of cases. At the moment, as a disease with a relatively benign clinical course, compared to normal smallpox, where mortality rates are relatively low, there is, at present, no risk of it becoming a major epidemic, as was Covid. -19. That risk still doesn’t exist, for now, because with respect to Covid-19, when the virus started, we didn’t have vaccines or any effective treatment. Here, from the start, we already have vaccines, and we already have some effective drugs to treat this disease. It is not an emergency, we call it that, as was the case with Covid-19. There is no reason to panic at this point.

RFI: Is there a risk of this virus mutating or is this factor still unclear?

Copy: This virus is a virus in which its genetic material is located in a different molecule than, for example, SARS-COV2, which causes Covid-19. Covid-19, as we know, is a molecule called RNA. In this case, this virus is found in a molecule that is DNA, similar to what we have inside our cells.

When this molecule, the DNA, replicates, mutations also occur, but these mutations are too small to correct. The rate of mutation of DNA viruses is much lower than that of RNA viruses, such as SARS-COV2, HIV or even influenza virus, for example. In this case, although the genetic material of this virus, for example, the molecule in which the genes are located, is 6 times larger than that of SARS-Cov2, which causes Covid-19, a close connection is not expected. Mutations appearing during this outbreak in the near future. It is not expected that there will be significant variation in genetic material and that variants or strains that are more infectious or cause more serious disease with higher mortality may arise. This is not expected with this virus.

RFI: The way the virus spreads suggests that the disease occurs through very close contact. What are the most common forms of transmission?

Copy: Transmission occurs through close contact between an infected person and an uninfected person. Such close contact, in principle, should be long-term, and transmission is through respiratory droplets or through contact with contaminated liquids, that is, containing viral particles from infected persons.

For example, if we touch one of those little blisters, which have viruses inside, so that the fluid appears in sick people, they can transmit the disease. This disease is transmitted by transmission of body fluids from infected people, that is, through respiratory droplets. But another difference from Covid-19 is that here, in order for someone to be infected by an infected person, close contact is necessary for a much longer and longer period.

We do not realize the danger of going, for example, to the bus, having an infected person next to us and getting sick. This is unlikely to happen. It is not an impossibility, but a very high possibility. Communication occurs, above all, between people who live together, who occupy the same spaces for a long time.

RFI: What are the main symptoms? How can the disease be recognized?

Copy: In the first three days, the symptoms are relatively nonspecific, that is, they can be confused with another viral disease, even with influenza because the symptoms are fever, muscle aches or headache and sometimes a small rash that can appear in the form a little later now, but the initial signs are not specific relatively.

What distinguishes this disease, for example, from the normal smallpox, to which we are accustomed and which has been eradicated, is that the lymph nodes here tend to appear completely swollen. This is what distinguishes, above all, this monkey from the classic smallpox. Regardless, I would say that the first symptoms are nonspecific and then a small rash begins to appear, which develops and begins as small and relatively flat spots, then small bubbles appear that turn into a transparent liquid and, at a later stage, a darker yellow liquid. Then it bursts and turns into a crust. Then when they fall, people are considered healed. This entire process, from infection to recovery, can take approximately 2 to 4 weeks.

RFI: To date, only mild forms of the disease have been recorded. Is there a risk of death associated with this virus?

Copy: There is always the risk of death, but it is very low. The risk of death in monkeypox is much lower than in traditional smallpox. In classic smallpox, we can have mortality rates, much higher than 30% and here we’re talking about about 10 times lower. These fatal cases unfortunately only occur, mainly, in countries with weak health systems because in countries where health systems are richer and stronger and where there are better conditions for treatment, the monkeypox mortality rate has approached almost zero if it is sufficient.

RFI: Cases recorded on several continents affect men more than women. Why do men have immune systems less resistant to this virus?

CC: I don’t agree with that, i.e. I agree that it affects more men, they are mostly men, but that’s because, as far as we know, nowadays, the virus is starting to spread within a community of MSM Others And it’s not exactly about the differences between men’s and women’s immune systems, but about behaviors and their transmission through behaviors.

RFI: The Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, lamented a few days ago the fact that due attention was paid to the virus only when it began to affect rich and developed countries, as the virus has spread in Africa for several days. year. What is your view on this?

Copy: That’s right, the virus has been circulating in Africa for several years. It was first identified in 1970, the first human case. We know that it is endemic to Central Africa, and that there are periodic outbreaks, but they have been very limited.

Although a few dozen or even hundreds of cases have appeared, the disease is concentrated in that area. This also relates to the fact that in these countries there are also animal reservoirs because this is a zoonotic virus, i.e. the virus can be in the animal reservoir and these animals can transmit it to humans as well.

In Western countries there are no such reservoirs in the wild, therefore, the risk of contamination, through contact with animals, did not exist, at least in the West and in Africa, and therefore there is endemicity in these areas.

What’s happening here is we’ve gone from a virus that was limited to an area and a mortality rate of about 10/15%, but that’s more related to weaker health systems, not because the severity of the disease is greater. And what is now. Now, what is happening differently is that the virus is spreading all over the world, and as a result, more attention is being paid.

RFI: Finally, speaking now of the specific case of Paris and other European cities, the number of cases has been increasing exponentially. Is this worrying, at a time when Covid-19 infections are also on the rise?

Copy: It’s concerning because it could be a burden on health systems, even though most of the monkeypox cases we’ve recorded require no hospitalization and can be treated as an outpatient, by isolating people at home and restricting contacts.

Despite everything, this disease is not expected to have a significant weight in health systems. It may have an economic burden due to abstinence from work because people will miss work and stay at home for 2 to 4 weeks. If the virus spreads a lot, there could be some economic weight, but for health systems, I don’t think there will be serious pressure like there was with Covid-19 because it won’t force hospital in large numbers. For sanitary systems, in principle, it will not be a big problem.