A Monkeypox Primer

COVID-19 isn’t even in the rearview mirror yet, and now possibly speeding toward us: monkeypox.

With the Centers for Disease Control and Prevention reporting 15 cases in the United States as of Tuesday and hundreds more cropping up worldwide in places where the disease is not endemic, another pathogen spillover from wildlife to humans has stoked new fears.

The good news, says School of Public Health Dean Boris Lushniak, a physician and former acting U.S. surgeon general, is that monkeypox almost certainly lacks the natural potential to spread like wildfire and cause widespread illness and death like the coronavirus has.

But Lushniak, who was in West Africa and Central Africa leading the response to the Ebola outbreak of 2013-16 and has responded to other frightening health scenarios, told Maryland Today that monkeypox won’t be the last outbreak the world sees; a new way of thinking about human connections to other creatures and Earth’s environment is required to head off future pandemics.

Have you ever worked on a monkeypox outbreak before?
We actually had an outbreak in the United States in 2003 and had about 47 cases related to prairie dogs people were keeping as pets. I remember driving out to a small rural hospital in Indiana to take a skin biopsy from a patient. I scared the bejeebers out of the whole ER staff going in there in my moon suit. It turned out the person did not have monkeypox, but in the post 9/11 atmosphere, there was worry about a smallpox-type scenario spreading rapidly.

Is monkeypox at all like COVID in its ability to spread? Or is it similar to Ebola in some way?
It’s certainly not like COVID—I want to stress that coronaviruses are far more transmissible than monkeypox and spread easily from person to person via the respiratory route, even from asymptomatic people, as we’ve seen during the pandemic. If you look at the literature, monkeypox spreads through direct contact with bodily fluids or lesions, or large respiratory droplets from your nose or mouth that fall to ground quickly and don’t spread around the room like COVID.

And it’s not like Ebola, which is part of a group called the viral hemorrhagic fevers, which are very, very serious and deadly, and spread through direct contact with someone who has the disease.

Where did monkeypox come from?
It’s what we call a zoonotic disease. These mainly circulate in wildlife like rodents or sometimes primates in West Africa, but ultimately make the jump to humans, in the context of increasing human populations and closer connectivity between humans and animals. There have been monkeypox outbreaks in the last two years in the Democratic Republic of Congo and Nigeria, but they haven’t gotten much attention.

How worried to we all need to be?
We should take it seriously, but certainly not panic about it, as if smallpox (which is a related disease) were coming back. Monkeypox deaths are often attributed to inadequate health care in places where the disease is endemic. You start off with influenza-like symptoms—fevers, chills, aches—and then you start getting swollen lymph nodes. The real game changer, and how we normally diagnose it, is when you develop a chickenpox type-rash. In most people, it’s self-limited. Your body ultimately fights it off and it’s gone.

What has your work taught you about public health responses to emerging diseases?
The most impactful thing for me personally was running the U.S. Public Health Service hospital for Ebola in Monrovia, Liberia, along with a group of 80 Public Health Service officers. It was the only U.S. government entity directly providing care to Ebola patients. What I learned is that it really does take the community to stamp out a disease. You don’t do that just by treating people who have the disease, for which the mortality can be very, very high. You have to focus on the prevention front, and make sure the media and everyone else understands transmission and how to prevent it. A lot of the discussions we’ve seen about these topics during the pandemic could play out during monkeypox as well.

How should the global community approach this apparently rising threat to head off the next pandemic?
There’s a movement developing in the medical and public health fields to look at this as a “one health” model and think about it as the points of a triangle, where the concept of human health is not independent of animal health, and those two kinds of health are not independent of environmental health. They’re all intertwined. For millennia, we’ve thought of human health as the dominating feature, but now we need to understand that connectivity if we want to deal with problems like pandemics.