Monkey(pox) business

UNDER THE MICROSCOPE

Though, not unexpected, when DOH announced the detection of the first case of Monkeypox infection in the Philippines, it still came as a nasty piece of news on top of ever-increasing bad news.

The announcement came with some reassurances on how it is different from Covid-19 and what measures we can do to avoid contracting it. The WHO has declared it a Public Health Emergency and it behooves us to think and learn about the disease more.

I’ve written about Monkeypox earlier (A pox on our house-June 14, 2022) which states it’s spreading rapidly among men who have sex with men (MSM) but there are more disturbing developments and opinions from experts that will impact how we view and deal with Monkeypox. First is its rapid spread in the USA and Europe. It has gotten to the point where San Francisco and New York City, both considered epicenters of Monkeypox have declared their own states of medical emergency and are rushing to get vaccines to their MSM populations. Many experts opined that it can no longer be contained since even wastewater surveillance has detected the virus and will likely infect rats in the sewers in a phenomenon known as reverse zoonosis. That means these rats will now be vectors of disease for humans and the cycle goes on.

If this current outbreak escalates, it will be harder to contain due to several factors.

First is the stigmatization of the gay community which as in the early days of the AIDS pandemic resulted in much discrimination and also prevented access to testing and treatment for affected individuals. We’re seeing that now in the USA where hardly anyone is going for testing even if tests are readily available. With no testing comes no diagnosis and therefore no contact tracing. This will not augur well for surveillance and disease containment.

Second is the long period of contagiousness from three to four weeks. If you isolated for Covid and nearly lost your mind during the two-week period, think double that. We’re likely to see a lot more mental issues than with Covid patients. It is also bad economically for the patients who can’t work (unless they WFH) and for companies who depend on their workers to show up daily.

Third is that we’re still dealing with the Covid pandemic and now a dengue epidemic. Our health system barely survived the surges of the original and Delta variants and is now so strained under the pent-up demand for other medical care and dengue thus it will be harder to deal with another infectious outbreak.
What is more worrisome is our local situation. The Philippines is not the USA or Europe. We have far more congestion due to heavy population concentrations, especially in poorer communities and slums where hygiene is not routinely practiced. People live in very close contact in crowded rooms, sleeping together.

In our social interactions, we tend to be very touchy-feely. Our sense of personal space is non-existent with strangers creeping up on you in lines and in stores. Commuting also begets lots of skin-to-skin contact which is what Monkeypox needs to be spread. For people who think this is just a gay epidemic, think again. Here we go again.

I heard so many stories of friends who never ventured out of their homes and still got Covid due to their drivers or household help who they send out for errands. Could this be the same scenario for Monkeypox to creep out from the shadows of “high risk” groups and spread widely? I hope not but it’s not something we should ignore.

Already, there are now reports in New York of children getting Monkeypox.

But before we can identify Monkeypox cases, we have to be able to test for it. As of now, only the RITM and the Philippine genome Center are authorized to test for Monkeypox infection, much like the situation in early 2020. Yet we have over 300 labs capable of molecular testing and many Monkeypox test kits available commercially. We need to expand testing capability as rapidly as possible to prevent a repeat of the limited testing then for Covid-19 when test results came out weeks after patients had already recovered or died. It seems the DOH is adapting a wait-and-see attitude which will not allow for a nimble response.

Infectious disease expert Dr. Roentgene Solante warned about more Monkeypox cases locally, mentioning the need to expand testing capability and for the DOH to consider training other laboratories for rapid detection.

Our molecular labs that perform Covid testing are more than willing to do the initial validation of test kits but we will need the imprimatur of the DOH for that to happen. I have written about the need to repurpose Covid labs to become infectious disease surveillance laboratories (Lessons from the Pandemic, Philippine Journal of Pathology June 2021). Let us not repeat what happened in the early days of the Covid pandemic.