Monkeypox shouldn’t upend our lives like Covid has

For some, the arrival of monkeypox may have felt like the beginning of the Covid-19 pandemic.

A virus many had not heard of was here. It was detected via PCR testing, cases were isolating, and close contacts had been identified and were monitoring for symptoms.

But that is about where the similarities end. Fundamentally, the viruses are different: monkeypox is a double-stranded DNA virus, while the coronavirus SARS-CoV-2, is single-stranded RNA. The monkeypox genome is much bigger and more stable. Monkeypox is also much less contagious than Covid-19 and outbreaks are smaller. So it should not turn our lives upside down in the same way Covid-19 has.

Aotearoa has recorded two cases of monkeypox – both in people recently returned from overseas. The cases were not connected and (at the time of publication) there was no evidence of community transmission.

The SARS-CoV-2 virus that causes Covid-19 is airborne and can hang in the air a long time, meaning fleeting contact – walking past an infected person – can be enough to catch the virus. Although still infectious, the monkeypox virus does not spread as easily. It requires skin-toskin contact; intimate contact with an infected person; contact with clothing or linens used by an infected person; or direct contact with lesions or scabs. Respiratory droplets can also spread the virus. Classic monkeypox is not subtle. People have a high fever, swollen lymph nodes and are stricken with pox lesions on their face, which spread to their hands and feet, making inadvertent transmission – as can occur with Covid-19 – possible but less likely.

But monkeypox is not in the same league as Covid-19. For example, Australia recorded its first monkeypox case on May 20. Nine weeks later, it had 41 confirmed and probable cases.

In the same time, to July 19, Aotearoa New Zealand reported close to 421,900 new community cases of Covid-19.

‘‘I am not surprised there are cases, and I won’t be surprised if there are more. But we are dealing with something completely different to Covid-19,’’ infectious diseases physician Professor Kurt Krause says. That does not mean we should downplay or dismiss the virus: experts say we need to contain it as soon as possible.

While it is not spreading at the same pace as Covid-19, it is not going away either.

More than 20,638 cases of monkeypox have been reported in 74 countries this year and last week the World Health Organisation declared the outbreak a public health emergency of international concern. While most cases have been in men in their 30s and 40s, fatalities from monkeypox in endemic areas of central and west Africa tend to occur most in infants, children, pregnant women and the elderly. If cases were to spill over into more vulnerable groups, through household transmission, the risk could be greater.

This monkeypox also appears somewhat different – it has more than 50 mutations between it and the 2018 strain, where experts were expecting about five.

Another anomaly is that some people are not getting that sick or have very minor looking lesions – so they don’t know they have it and can pass it on unknowingly. However, it is also easier to get ahead of, through vaccination. Covid-19 was new and no vaccines were available. But for monkeypox, the smallpox vaccine is effective.

Reporting disclosure statement: This post was written with expert advice from University of Otago Professor of biochemistry and infectious diseases physician Kurt Krause, and infectious disease and sexual health physician Dr Massimo Giola. It was reviewed by The Whole Truth: Te Māramatanga expert panel member associate professor Dianne Sika-Paotonu.