Earlier this year, Dr. Jake Dunning, a lifelong infectious disease researcher, was talking to a colleague about monkeypox in the Central African Republic. Then one phone call surprised him. An outbreak was confirmed in the UK.
“We had talked a lot about sexually transmitted transmission, but I didn’t expect an outbreak to occur in the UK, let alone internationally, and affect people with common characteristics,” he recalls. “Nor have I heard anyone else suggest that as a likely scenario.”
As the outbreak progressed, many patients were admitted to the infectious diseases department of the Royal Free Hospital in London, said Dunning, who is also a senior research fellow at the University of Oxford. “We all realized we had to be prepared.”
Monkeypox cases, which were only found in sub-Saharan Africa, surged in May. However, after 5 months, Room 0, where the first patient was admitted, was abandoned for a monkeypox patient. The number of global cases has fallen from 7,477 in the week to 14 August to 2,167 as of 17 October, according to the World Health Organization. The main theory of the depravity is that the vaccination campaign changed the behavior of men who have sex with men.
Concerns that the disease might migrate to other more vulnerable population categories, such as children and the elderly, have not materialized. While our experience has provided some clues as to how to manage a disease that is uncommon in the north of the world, big questions remain about the future trajectory of monkeypox.
Another change in behavior in affected communities could lead to a resurgence of cases. That could lead to low but stubborn levels of disease that would be nearly impossible to eradicate, leaving the virus where it wasn’t before 2022.
In August, LGBT+ groups from the five main political parties in the UK criticized the UK Health Security Agency’s approach to vaccine purchases, saying they risked making the disease endemic. However, in October, the government rejected advice from officials to purchase additional vaccine doses, citing cost-effectiveness.
Even poor countries, where monkeypox has been endemic for decades, continue to experience severe service deficits in diagnosis, treatment and vaccines.
No one has died from monkeypox in the UK, with 29 deaths worldwide compared to 73,000 cases. However, clinicians say the disease can be very painful and may require hospital treatment. Dunning and his colleagues have seen a “very complicated disease” affecting the eyes and throat in some cases. Some patients required strong pain relievers.
Dunning said in August that hospitalizations were down, but he wasn’t entirely sure why. I was. “There may be fewer people having high-risk sex.”
Scientists are still looking for a definitive origin for the 2022 outbreak. “Obviously we know we have a zoonotic disease [animal-to-human] Several countries in Africa have reservoirs,” says Dunning. “I was always worried about monkeypox as I was worried about the burden of sub-Saharan Africa. [of the disease] It was bigger than I thought.”
Sister Jessica Joyce, a ward manager, says staffing was her “biggest” challenge © Anna Gordon for the Financial Times
But he didn’t expect to see an outbreak happening in men who had sex with men. spread,” he says. “The fact is that gay and bisexual men who have sex with men have sex with other gay and bisexual men who have sex with men, so it’s a closed sexual network.”
One of the challenges at the hospital was treating patients before they had full evidence of monkeypox drugs, says Dunning.
Sister and ward manager Jessica Joyce said the team was responsive and staffing was the “biggest” challenge. “Patients are incredibly tolerant,” she says. “Being quarantined and being told you can’t go home yet is hard.” She says the team is trying to reassure them.
Consultant physician Antonia Scobee says one of the challenges is overcoming stigma and making it easier for patients to disclose their diagnosis. © Anna Gordon for the Financial Times
Infectious disease consultant Antonia Scobie says one of the challenges is overcoming stigma and making it easier for patients to disclose their diagnosis. In the early stages of the epidemic, patients being transferred to different wards were wrapped in sheets to prevent shedding of skin into the environment. “One patient told me that she remembered in the past that her HIV patients may have felt stigmatized by their illness,” she says.
The ward has a total of 35 hospitalized patients in the current outbreak, most of whom were admitted for medical purposes and not because they could not be safely isolated at home.
Dunning says the most important lesson is to involve affected communities in the response. “Let the representative bodies participate,” he says. “You make mistakes, you fix them.” We are currently at a low level and the epidemic curve may have a long, low tail. . . we have to embrace uncertainty. All this surprises us. ”
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