Illustration shows test tubes labelled "Monkeypox virus positive\
Test tubes labelled "Monkeypox virus positive" are seen in this photo taken May 22. Photo: Reuters/DADO RUVIC
health

Monkeypox emergency could last months, with window closing to stop spread, experts say

29 Comments
By Jennifer Rigby

Scientists advising the World Health Organization (WHO) on monkeypox say the window is closing to stop its spread, with cases currently doubling every two weeks, raising concerns that it will take several months for the outbreak to peak.

WHO Europe has forecast just over 27,000 monkeypox cases in 88 countries by Aug 2, up from 17,800 cases in nearly 70 countries at the latest count.

Making predictions beyond that are complex, scientists around the world told Reuters, but there is likely to be sustained transmission for several months and possibly longer, they said.

"We have to get in front of this," said Anne Rimoin, an epidemiology professor at the University of California, Los Angeles.

"It's clear the window of opportunity for doing so is closing," added Rimoin, a member of the WHO expert committee on monkeypox that met last week to determine whether the outbreak constituted a global health emergency.

A majority of committee members voted against the move and, in an unprecedented step, WHO Director-General Dr Tedros Adhanom Ghebreyesus declared an emergency anyway.

Action stemming from that declaration needs to be urgent, including increased vaccination, testing, isolation for those infected and contact tracing, global health experts said.

"Transmission is clearly unchecked," said Antoine Flahault, director of the Institute of Global Health at the University of Geneva, who chairs the WHO Europe advisory group.Jimmy Whitworth, a professor at the London School of Hygiene and Tropical Medicine, said he expected that cases would not plateau for at least the next four-to-six months, or until the those at highest risk of infection have been either vaccinated or infected. Sexual health organizations recently estimated that could be around 125,000 people in the UK.

Monkeypox has been a globally neglected public health problem in parts of Africa for decades, but cases began to be reported outside countries where it is endemic in May.

It generally causes mild to moderate symptoms, including fever, fatigue and the hallmark painful skin lesions, that resolve within a few weeks. Five people have died in the current outbreak, all of them in Africa.

Beyond Africa, monkeypox is spreading chiefly in men who have sex with men, putting sexual health clinics on alert for new cases.

"I remember clearly ... saying that 'I think I'm going to die,' because I can't eat, I can't drink. I can't even swallow my own spit," said Harun Tulunay, 35, a sexual health advocate who was hospitalized with monkeypox in London earlier this month but has since recovered.

'SUSTAINED TRANSMISSION'

While monkeypox is not causing large numbers of deaths globally, an unpleasant virus establishing itself in new populations is still bad news, scientists said.

Flahault's group has modeled three scenarios for the coming months, all of which include "sustained transmission," either between men who have sex with men; beyond these groups and possibly into more vulnerable populations, like children, or between humans and animals.

The latter scenario risks the establishment of a monkeypox reservoir in animals in new countries, as it has in parts of west and central Africa, said Flahault.

Ongoing transmission could also lead to mutations that make the virus more efficient at spreading in humans, scientists said.

German scientists have released a study ahead of peer review that found mutations in one of the 47 cases they sequenced that could help monkeypox spread in people more easily.

"The alarm bell was going off (in Africa) but we kept hitting the snooze button. Now it's time to wake up and do something about it," Rimoin said. "An infection anywhere is potentially an infection everywhere."

© Thomson Reuters 2022.

©2022 GPlusMedia Inc.

29 Comments

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Why are they trying to hype this all of a sudden? Tedros - who is not a medical expert - overruled a majority of the panel that recommended not making this issue an emergency. What could his motives be?

It could be related to the recent appointment of Susan Michie as the WHO's new nudge chief. Michie, a communist millionaire (!?), is one of the people from the UK's government's nudge unit set up to manipulate public behaviour during the COVID lockdowns. She has also advocated for permanent mask-wearing. She's not the kind of person who should be trusted with power and influence.

2 ( +10 / -8 )

said Harun Tulunay, 35, a sexual health advocate who was hospitalized with monkeypox in London earlier this month but has since recovered.

Could Mr. Tulunay, the professional "sexual health advocate" please elaborate on how he might have contracted this infection.

I think it's useful to know from a sexual health expert which behaviors may lead to increased risk of transmission.

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Yawn. Covid is losing traction to the masses so let's throw some more at the wall and see what sticks.

-2 ( +7 / -9 )

Something like 99.8% of cases are gay men and it's likely to stay that way since it's only spreading due to their behaviour.

-1 ( +8 / -9 )

Why are they trying to hype this all of a sudden? Tedros - who is not a medical expert - overruled a majority of the panel that recommended not making this issue an emergency. What could his motives be?

Complete mischaracterization, the panel did not reach a decision, so the director (that is a perfectly qualified expert in public health) opted to go in the side of caution, which clearly was the best decision taking into account the new information available.

There is no need for conspiracy theories to explain a decision that is supported by experts in the field around the world, reading the article would have made this clear.

I think it's useful to know from a sexual health expert which behaviors may lead to increased risk of transmission

Why? do you believe a N=1 report has any importance against studies done on hundreds or thousands of people that already have this explanation?

Yawn. Covid is losing traction to the masses so let's throw some more at the wall and see what sticks.

So according to you the experts that recognize the risk and can prove it with epidemiological evidence are just wrong? any argument except that you like to believe in conspiracies?

Something like 99.8% of cases are gay men and it's likely to stay that way since it's only spreading due to their behaviour.

The article explicitly describes other ways for the infection for sustained transmission, and the very real possibility of mutations that would lead to the disease being more easily transmitted between humans, eliminating the need of sexual contact for efficient spreading.

-4 ( +7 / -11 )

It is important however to listen to what experts have to say.

Prof Shmuel C. Shapira MD MPH, head of Israel Biological Institute, the most senior medical-scientific position in Israel said the following on the topic of Monkeypox yesterday:

Each phenomena may not be related to "you know what", but the clustering and timing suggest differently.

-1 ( +6 / -7 )

I almost never agree with most of the above posters but in this case I do. Monkeypox has caused zero deaths so far, is not transmissible by airborne infection, and the vast majority of cases are being experienced in a cohort to which most people do not belong. It is curable by available means of medication and although unpleasant, sufferers will almost certainly recover. So what’s all the panic about? Target vulnerable populations, educate them as to the risks, treat medically when necessary and stop trying to beat this up into something it isn’t, i.e. another pandemic.

-1 ( +5 / -6 )

which clearly was the best decision taking into account the new information available.

Could you please explain why 9 out of the 15 experts ( a clear majority) on the panel disagreed his decision.

How does 1 expert overruling 9 other experts become a "consensus of global experts"?

-1 ( +7 / -8 )

How does 1 expert overruling 9 other experts become a "consensus of global experts"?

When you redefine "consensus" to be whatever the hell you want it to mean. Post-modernism applied to medicine. What could possibly go wrong?

-3 ( +5 / -8 )

 So what’s all the panic about? 

Sustained transmission that can lead to the introduction of the infection to the world in general, this frequently ends up with a big change of the characteristics of the disease that cause huge health problems (like it has happened with West Nile or Zika for example) specially on developing countries.

This is the timing where a global emergency is to be declared, when there is still time to prevent the worst consequences, waiting until things go to the drain to do something about it is obviously the worst way to do it.

Could you please explain why 9 out of the 15 experts ( a clear majority) on the panel disagreed his decision.

Because they choose to side of convenience, economy, simplicity? the evidence at the point of the meeting could justify both decisions, but this is a changing situation and the newest data clearly points out to a risk that is bigger than predicted, which is why the experts on the article justify the decision.

This may be surprising for people that systematically reject science, but in the beginning of every public health problem there is never enough information to make a 100% sure decision, so sometimes things have to be done focusing on what could be found in the future and what would have worst consequences.

How does 1 expert overruling 9 other experts become a "consensus of global experts"?

Strawman, there was no "overruling" the decision was not made by the panel, so it was done by the general director. Overruling would mean a clear decision not to enact the emergency was reached (which by this point would have been clearly wrong) this is not the case.

Now, if you could quote where this was said to be the consensus of all the experts of the world? neither the article or the comments make this claim, just that the WHO decision is justified and has been proved correct in light of the evidence at the moment

When you redefine "consensus" to be whatever the hell you want it to mean

That would apply to the comment you are quoting, not to the article, that never made this claim, it just presented the opinion of the experts being quoted while never saying this was the only one. This is the fallacy called a strawman, making up an imaginary argument to defeat because the real arguments could not be refuted.

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That would apply to the comment you are quoting, not to the article, that never made this claim, it just presented the opinion of the experts being quoted

Thank you for the clarification, it makes sense now.

When you refer to a "consensus of global experts" you actually mean a consensus of cherry picked talking heads who the media paid to spout a narrative.

The experts who disagree with the narrative aren't included in the "consensus"

-4 ( +5 / -9 )

Thank you for the clarification, it makes sense now.

It should be clear from the very beginning that making up things nobody has said is invalid and only makes it obvious you could not address the actual arguments being said.

When you refer to a "consensus of global experts" you actually mean a consensus of cherry picked talking heads who the media paid to spout a narrative.

Well, imaginary things nobody used as an argument can be as wrong as you want, after all they are made up precisely so you can disprove them, even if not real.

-1 ( +8 / -9 )

Virusrex, those are quite some impressive mental gymnastics for a Sunday morning. Have a healthy breakfast?

Did you do some strengthening exercises to tighten your grip when clutching at straws?

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Stop the spread by refraining from the activity that is responsible for the spread. You all know what that activity is by the ones that represent nearly 100% of the cases.

-4 ( +2 / -6 )

Monkey Pox, is a gay or bi-sexual transmitted disease. So a straight individual has sexual relations with a bi-sexual partner unknowingly it is going to spread even further. I am not sure now, however, many years ago I was in a gay bar and as a straight woman with my gay friends was an eye opening experience. There were many married Japanese men and I only knew this fact because of their wedding bands.

-5 ( +0 / -5 )

Japan should close the border. Every Japanese returning to Japan should be tested for Monkey Pox.

-6 ( +2 / -8 )

Virusrex, those are quite some impressive mental gymnastics for a Sunday morning. Have a healthy breakfast?

Once you give up trying to address the arguments that disprove your point and lower yourself to "attack" those that wrote it you make it clear you completely accept being proved wrong.

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It is important however to listen to what experts have to say.

Sure, but in this case we actually don't need to. There is no real value in "expert evaluation", we have been through this half a decade ago. Poxviruses are a very well known enemy, the drive to eradicate poxviruses is the oldest in human history. There have been clear plans to combat a poxvirus outbreak for decades, including this one.

This is not COVID, this is not a novel virus, unlike with COVID we actually know exactly what to do and we have the means to do it reliably. (Yes, this involves vaccines. No, not everyone has to be vaccinated.)

This means the only thing we have to do is generate awareness so the affected people know to seek out and get help.

But to that end, the monkeypox outbreak could not have come at a worse time. Most everyone is hypersensitized because of COVID, expecting every virus outbreak to be the "next Corona crisis" ...

Why are they trying to hype this all of a sudden?

... and going straight to doubt, rejection and fatigue.

Also, seriously, stigmatizing a group of people really does not help the cause. We had "zero poxvirus", we want to get back to "zero poxvirus", and driving people to hide that they are affected is pretty much the least helpful thing we can do.

4 ( +5 / -1 )

BigYen

I almost never agree with most of the above posters but in this case I do. Monkeypox has caused zero deaths so far, is not transmissible by airborne infection, and the vast majority of cases are being experienced in a cohort to which most people do not belong. It is curable by available means of medication and although unpleasant, sufferers will almost certainly recover. So what’s all the panic about? Target vulnerable populations, educate them as to the risks, treat medically when necessary and stop trying to beat this up into something it isn’t, i.e. another pandemic.

Outside of Africa (where there are countries where the virus is endemic) there have been 3 deaths so far. A 41 year old man in Brazil with underlying comorbidities who died two days ago. On the same day another man in Spain died of an encephalitis associated with a monkeypox infection. And the third one died yesterday although I don't know of more information on that one. It is quite rare, nontheless there have been 3 cases where monkeypox is believed to have played a role in their death.

Ashley Shiba

Monkey Pox, is a gay or bi-sexual transmitted disease. So a straight individual has sexual relations with a bi-sexual partner unknowingly it is going to spread even further. I am not sure now, however, many years ago I was in a gay bar and as a straight woman with my gay friends was an eye opening experience. There were many married Japanese men and I only knew this fact because of their wedding bands.

It is indeed correct that most cases were men (around 99%) of which most engaged in sex with other men (again around the same %), but monkeypox is usually not a disease that is primarily sexually transmitted.

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385

...

Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

...

5 ( +6 / -1 )

Scientists advising the World Health Organization (WHO) on monkeypox say the window is closing to stop its spread,

I hope these are the scientists who were not waffling over whether or not to call monkeypox a global emergency when the WHO agency, which a month ago decided it was not.

Thankfully Tedros overruled the committee recently.

A majority of committee members voted against the move and, in an unprecedented step, WHO Director-General Dr Tedros Adhanom Ghebreyesus declared an emergency anyway.

By overriding the committee, Tedros seems to have learned from the many mistakes the WHO has made recently, such as with the Covid crisis.

https://www.usatoday.com/story/news/health/2022/07/23/who-monkeypox-outbreak-global-emergency/10134299002/

-6 ( +1 / -7 )

Close to 100% are gay men, and 41% also tested positive for HIV.

And yet this non medical Tedros overruled the majority of the panel of actual experts.

This is not a global emergency.

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Close to 100% are gay men, and 41% also tested positive for HIV.

I believe this is crucial information no one cant fond in your long article...?

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I hope these are the scientists who were not waffling over whether or not to call monkeypox a global emergency when the WHO agency, which a month ago decided it was not.

That is the whole point of analyzing scientific evidence. When the evidence points out to one conclusion that is what is done, when the evidence changes and points to the opposite then a change is justified. Arguing that anybody should have a time machine and know the data from the future so recommendations and conclusions are not changed ever is deeply irrational.

Thankfully Tedros overruled the committee recently

No such thing happened, there was no decision done, so the head of the organization took one based on justified precautions, the committee was never overruled.

By overriding the committee, Tedros seems to have learned from the many mistakes the WHO has made recently, such as with the Covid crisis.

No mistakes, once again only taking decisions based on the available evidence, not on future evidence that you think they should take into account even when it was not there at the time.

>

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And yet this non medical Tedros overruled the majority of the panel of actual experts.

No overrule was made, and being an expert on public health is a much better background that being a medical doctor in order to make decisions about public health, that is the whole point of the preparation.

You're not interested in facts and evidence anyway, demonstrated by your constant appeal to a thoroughly corrupt manufactured consensus. 

You have presented no data, no evidence, just misrepresented information that has been very easily disproved. Pretending you are right because the whole scientific and medical community in the world is in a supposed conspiracy that would damage their own health, and their family's and friends is simply not believable.

It also completely fails to justify your personal attacks, that are not only invalid and against the rules, they are also worthless to defend your point. thus revealing you already understand you are mistaken and have no argument to defend what you believed.

-1 ( +4 / -5 )

No overrule was made, and being an expert on public health is a much better background that being a medical doctor in order to make decisions about public health, that is the whole point of the preparation.

He certainly “overruled” the panel under the definition of the word “to exercise control or influence over.”---which is exactly what he did, You misunderstand the meaning of the word.

Because they choose to side of convenience, economy, simplicity? the evidence at the point of the meeting could justify both decisions, but this is a changing situation and the newest data clearly points out to a risk that is bigger than predicted, which is why the experts on the article justify the decision. 

Fallacious reasoning—just because you claim the evidence could justify both decisions it does not mean both decisions would be right according. And, another mistake you made is claiming there is evidence to justify both decisions. Just because someone makes a decisions does not mean there was actual evidence upon which to base it.

-3 ( +3 / -6 )

No mistakes, once again only taking decisions based on the available evidence, not on future evidence that you think they should take into account even when it was not there at the time.

Oh, you are arguing with your earlier statement here!!

Let's take a look:

so sometimes things have to be done focusing on what could be found in the future and what would have worst consequences.

Meaning they can’t see what is 100% correct in the present, but they have a crystal ball and can see what will be 100% correct information in the future?

-3 ( +3 / -6 )

He certainly “overruled” the panel under the definition of the word

No he did not, if the panel decided not to make the declaration of emergency then it would have been overruled, in reality no decision was made, so he took one. That is not overruling in any sense.

Fallacious reasoning—just because you claim the evidence could justify both decisions it does not mean both decisions would be right according

That is not the argument, the argument is that for something to be considered a mistake then the available evidence that contradicts it must be present at the time of the decision, you keep bringing examples where the future evidence is presented, even when that evidence was reflected in different conclusions.

Oh, you are arguing with your earlier statement here!!

No, I am arguing with the argument that becomes necessary for your position to make any sense, qualifying as "mistakes" things that depend on future data to be known to actually be characterized as such.

Meaning they can’t see what is 100% correct in the present, but they have a crystal ball and can see what will be 100% correct information in the future?

That is your argument. for people with common sense this is obviously irrational, since they can't see the future then decisions have to be made according to available evidence at the moment, not in the future.

Can you even find experts calling the WHO decision mistaken? all this comes only from your own idea about how future evidence should be considered, that is not a rational argument.

0 ( +5 / -5 )

No he did not, if the panel decided not to make the declaration of emergency then it would have been overruled, in reality no decision was made, so he took one. That is not overruling in any sense.

Yes he did “overrule” the panel under the definition of the word “to exercise control or influence over.”---which is exactly what he did, You misunderstand the meaning of the word.

No, I am arguing with the argument that becomes necessary for your position to make any sense, qualifying as "mistakes" things that depend on future data to be known to actually be characterized as such.

Ok, you just forgot what you wrote earlier.

That is your argument. for people with common sense this is obviously irrational, since they can't see the future then decisions have to be made according to available evidence at the moment, not in the future.

It is my showing you your two contrasting arguments; arguing with yourself.

-3 ( +3 / -6 )

The latest WHO announcement came after the second meeting of the International Health Regulations Emergency Committee (EC), which was unable to reach a consensus about the severity of the outbreak. Dr. Tedros Adhanom Ghebreyesus, the WHO’s director general, overruled the committee by declaring monkeypox a “public health emergency of international concern.”

https://www.medicalnewstoday.com/articles/monkeypox-outbreak-spreading-who-declares-global-health-emergency

Regardless of whether "overruled" is the correct term, the fact remains that the decision was made by Tedros, who is not a medical expert and he ignored the majority opinion of the expert panel.

-4 ( +1 / -5 )

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