Just when we thought that the world is finally about to become free from the clutches of Covid-19, we’re now facing the grim prospects of monkeypox and Covid-19 surging in parts of the globe. Though SARS-CoV-2 has already ravaged the world, monkeypox is yet to reach the epidemic scale. However, we all must stay vigilant. One pandemic has been quite menacing; a twin threat could be devastating!
According to a report by CIDRAP (July 13, 2022), in just over two months, the monkeypox outbreak has logged more than 10,000 cases, with the maximum cases in Germany, Spain, the UK and the US.
What’s driving the current surge? Scientists opine that this may be due to a new clade of the monkeypox virus that emerged in Europe in early March and further transmission was likely caused by sexual contacts.
Infected persons will develop flu-like symptoms and blistery rashes; but a small percentage of these may experience severe and potentially fatal complications. According to experts, monkeypox is unlikely to reach pandemic proportions. As this virus spreads through intimate physical contacts, it’s highly improbable that it would spread globally like COVID-19. But public health authorities need to be very cautious so that monkeypox doesn’t spread in unmanageable scales. As per a CNN report (June 25, 2022), the WHO has stopped short of declaring monkeypox as a global public health emergency.
Monkeypox is a rare disease and is a milder cousin of the smallpox virus. It’s endemic to parts of west and central Africa. It’s a zoonotic disease which is contracted from a rodent or small mammal. The virus doesn’t easily spread from one person to another. However, it can spread through contact with body fluids, monkeypox sores, or contaminated clothing or bedding.
Monkeypox in India
India has reported the first monkeypox case: a 35-year-old man in Kerala. The first monkeypox case outside Africa was first detected in the UK on May 6, 2022 and it has since spread to over 63 countries. The first human case was reported in Congo in 1970 (The Hindu, July 16, 2022).
The monkeypox virus is a member of the Orthopoxvirus genus in the family Poxviridae. As the virus can enter humans through contact with wild animals, in places where monkeypox is endemic, the WHO advises that all meat must be thoroughly cooked before eating. Infected people must be self-isolated and avoid close contact with other people.
An antiviral drug developed to treat smallpox called TPOXX has been approved for monkeypox. But the medicine is in short supply. Vaccines for smallpox may provide limited protection against monkeypox. Those who have been immunized against smallpox may also be similarly protected. However, people below the age group of 40-50 are unlikely to have been vaccinated against smallpox as vaccination stopped in 1980 (HT, July 14, 2022). There is another vaccine called the Jynneos vaccine but it is not produced in large amounts yet.
COVID surge in India
After a period of relative lull for the past several months, COVID-19 is again surging in India. The daily number of cases is hovering around 20,000. No one knows for sure what’s driving the current surge. However, a likely cause could be the spread of highly transmissible and/or vaccine-escape Covid variants in the country.
What variant(s) are causing the latest surge? One can only give considered guesses. The likely culprits are Omicron sub-variants: BA.4, BA.5 and BA.2.75 etc. A sub-variant called ‘Centaurus’ is spreading across India and parts of Europe (The Financial Times, July 15, 2022). This variant may not only be highly transmissible but also resistant to immunity provided by prior infections and vaccines. The Centaurus (BA.2.75) has been detected in several countries including Germany, the UK and the US.
In large parts of the world, it seems BA.5 strain is driving the Covid surge. It can infect cells more like Delta than the previous family of Omicron variants. However, in India, BA.4 and BA.5 are not spreading the way it’s happening worldwide. These two variants possibly account for less than 10% of the cases in India. About 85% of the cases seem to be driven by BA.2 and its sub-variants such as BA.2.75.
Omicron variant BA.2.75
This sub-variant is infecting vaccinated as well as previously infected persons (IE, July 13, 2022). This strain is yet to be officially named. But some groups have called it tentatively as “Centaurus.” This variant which is surging across India has also been reported in UK and US as well. The saving grace is that the fatality due to this sub-variant seems to be quite low at present.
COVID-19 seems far from over. As our immunity fades over time, there is the likelihood of the emergence of new sub-variants. Therefore, we all must strictly follow the Covid-appropriate behavior. We also must be watchful about the possibility of the monkeypox virus spreading across the country.
We also must ensure that the adult population in India is fully vaccinated at the earliest. The possibility of vaccinating children below the age of 12 must also be looked into. And, immunocompromised people and those above 60 years of age must be given the 2nd booster doses at the earliest, if feasible.