What are the possible outcomes of an outbreak of monkeypox?

As news continues of an increase in monkeypox infections, questions arise about the future scenario of infections, and comparisons with the outbreak of the Corona virus appear.

What are the likely outcomes of the current outbreak of monkeypox virus?

How does it compare to COVID-19?

Will we see coexistence with him?

Can we predict its paths?

Before we begin, we note that what we will present in this report are possible hypotheses based on the currently available data, but new data may appear and changes may occur in the virus, which changes these hypotheses and their possibilities.

What are the possible outcomes of the current outbreak of monkeypox?

We all remember the beginning of the outbreak of the Corona virus, there were many recommendations, and then later they changed.

For example, at first it was not recommended to use masks, and it was requested that their use be limited to doctors and health workers, later this recommendation was changed.

 Currently, according to the data available to us, the possibilities are as follows:

First, monkeypox will not be the next global epidemic

The reason is that when the new Corona virus appeared, it had no treatments and vaccines, but it is different for monkeypox, which has known vaccines and treatments.

There are several effective vaccines available in the world against monkeypox, the most important of which are ACAM2000 and JYNNEOS. We are still at the beginning of this disease, and their distribution has already begun.

As for the vaccines in the Corona epidemic, they appeared about 10 months after the beginning of the pandemic.

There are effective treatments against monkeypox available, including tecovirimat.

Also, the basic reproduction number for monkeypox is generally estimated between 0.57 and a maximum of 1.25, according to the report of the US Department of Homeland Security.

In contrast, the basic reproduction number for the original Covid-19 strain is from about 3.0 to 3.3.

The basic reproductive number (R0) is pronounced "RNAT" or "RZERO" and indicates the average number of people to whom an infected person is expected to transmit the disease.

This means that the susceptibility to spread is lower for monkeypox than for corona.

Second: the monkeypox virus is changing and we may see an increase in infections

Although monkeypox virus is a DNA virus that mutates at a lower rate than RNA viruses such as corona, this does not eliminate the possibility of it undergoing mutations that make it change and become more transmissible. or cause him to develop other symptoms.

For example, a new study published in the journal BMJ describes the clinical characteristics of monkeypox infection during the current outbreak, and notes a difference in symptoms.

The researchers said the classic symptoms of monkeypox include fever, malaise and lymph node enlargement, often accompanied by headache and sweating.

The rash erupts within 2-4 days, begins as macules and passes through papules, vesicles, and blisters.

These lesions eventually turn crust and fall off.

Lesions occur at the same time, mostly on the face.

However, in about 75% of individuals, lesions also appear on the palms, soles and mucous membranes, and genital lesions were uncommon.

Complications occur in some individuals, some of which can include encephalitis, pneumonia, secondary bacterial skin infection and vision loss due to an eye injury.

Infants and newborns, as well as those with weakened immune systems, are more likely to get complicated monkeypox.

In the current outbreak there are differences, including:

• While children were mostly affected during previous outbreaks in endemic countries, both adult males and children were most prevalent in recent epidemics in these areas.

• The current outbreak has primarily affected men and has almost exclusively affected gay men.

• Almost all of the patients studied in the current outbreak had an average of 5 skin or mucosal lesions in different stages of recovery.

Mutations in monkeypox may mean the emergence of more ferocious strains that can cause problems and complications.

Third: The monkeypox virus will not change and we will have difficulty in dealing with it

In this possibility, monkeypox does not mutate, but we may encounter difficulties in dealing with it, most notably the lack of vaccinations.

It is true that vaccines exist, but providing large quantities of them can be a challenge.

For example, the Washington Post reported that monkeypox vaccines may not be readily available to at-risk Americans if cases continue to rise.

The newspaper reported that officials celebrated the arrival of about 800,000 doses of the monkeypox vaccine earlier this week, but indicated that these vaccines are not enough to cover people most at risk of contracting the virus, and more doses will not arrive until next October.

Even with the new doses, the United States has only enough to vaccinate a third of the 1.6 million high-risk classified, according to the newspaper.

In a related context, the American news website Axios quoted the president of the Infectious Diseases Association, Daniel McQuillan, as saying, "The United States must continue to increase vaccine supplies and must move quickly to implement a comprehensive distribution approach to dramatically increase equitable access to vaccines."

Can we predict the future of any epidemic?

The answer may be difficult, for example, on the topic of the Corona epidemic, David Daoudi, an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health, says, “Anyone who says they can predict the future of this epidemic is either overconfident or liar,” in statements to Reuters.

The Covid epidemic is the closest example, and currently, despite the great efforts and achievements that have been made in addressing it, a Reuters report reveals that with the third winter of the Corona pandemic approaching in the northern hemisphere, scientists are calling on governments and the exhausted population alike to prepare for more waves of Covid-19.

In the United States alone, the number of infections could reach one million per day this winter, Chris Murray, head of the Institute for Health Metrics and Evaluation, an independent group at the University of Washington that tracks the pandemic, told Reuters.

This would be about double the current daily toll.

Across the UK and Europe, scientists expect a series of Covid waves, as people spend more time indoors during the colder months, this time with almost no restrictions related to wearing masks or social distancing.

However, while cases may rise again in the coming months, it is unlikely that deaths and hospitalizations will rise by the same intensity, experts said.

This is helped by vaccination, booster doses, previous infection, as well as the presence of less severe mutant, and provides high-efficiency Covid therapies.

These forecasts raise new questions about when countries will emerge from the Covid emergency phase into an endemic state, as societies with high vaccination rates experience fewer outbreaks, perhaps on a seasonal basis.

The emergence of new strains hinders the transition to the stage of endemic disease

For example, many experts expected that transmission for Corona would begin in early 2022, but the emergence of the mutated Omicron from the Corona virus confused those expectations.

This brings us back to the second possibility, the emergence of new strains of monkeypox, which will make the course of the virus difficult to predict.

In conclusion, these are just possibilities, and it remains to contemplate the best, which is the decline in the outbreak of monkeypox, and the success of the world in recovering from Corona.