As if Covid-19 were not enough to worry about, now comes monkeypox. 

For pandemic-fatigued Filipinos, it comes across as another point of concern, especially because it causes flu-like symptoms as well as horrendous-looking rashes that can spread across the body and form large blisters filled with white pus-like fluid.

It does looks biblical, like something Moses brought down on the Egyptians. 

But experts such as Sylvie Briand, epidemic and pandemic preparedness and prevention chief of the World Health Organization (WHO), are not panicking over monkeypox. They say there’s no good reason for people to be particularly worried about the virus that has been circulating for decades in certain places such as parts of west and central Africa (including the Democratic Republic of the Congo, Nigeria and Cameroon), where outbreaks are quickly controlled and attract little attention.

Dr. Rebecca Castillo, an infectious-disease specialist at Adventist Medical Center Manila, is likewise not overly worried. “While [the Philippines] should be on the lookout, it’s not a cause for serious alarm. So far, no case of monkeypox has been reported here,” she says. 

The WHO was alerted early in May when cases of monkeypox were reported in Europe, North America, and Australia, and later in South America and the Middle East—places where, for years, the usually mild viral disease was seldom or never seen.

According to the WHO, there are now more than 600 cases of monkeypox in dozens of countries (Spain, Portugal and the United Kingdom are the most affected) where the virus is not normally found.

Bite or touch

The monkeypox virus belongs to the same family as the virus that causes smallpox, which was declared eradicated in 1980 by the World Health Assembly. But monkeypox is not the same as smallpox, and it does not have the same capacity for rapid human-to-human transmission.

One can become sick with Covid-19 through the airborne transmission of the coronavirus. On the other hand, one can catch monkeypox from a bite by an infected animal, or by touching its blood, body fluids or fur and then touching one’s eyes, nose or mouth. 

It’s thought to be spread by rodents such as rats, mice and squirrels.

Castillo says it’s very unusual to catch monkeypox from another human because it does not spread easily between people. However, it is possible to contract the disease by touching the clothing, bedding, or towels used by someone with the monkeypox rash. One can also catch it by touching an infected person’s skin blisters or scabs, or getting too close to that person’s coughs and sneezes.

Unlike the coronavirus, “the monkeypox virus mutates much more slowly,” says Castillo. “It’s possible, but purely speculative at the moment.”

Moreover, monkeypox rarely causes severe outcomes. The WHO’s studies in central Africa, where people have less access to quality health care, show that the disease kills one in 10 infected people, with the rest recovering within a few weeks. 

Symptoms

Monkeypox’s initial symptoms include a very prominent fever, body aches and pains, headache, and fatigue. However, because it always has a long incubation period—traditionally a week but can take up to 21 days—these symptoms do not immediately show up after one is infected.

As the body fights the symptoms, there will be enlarged lymph nodes. A rash may soon appear and often start on the face including the mouth area, which then progresses to the limbs and other parts of the body including the genitals. Soon the rash turns into raised bumps and then to painful pus-filled red papules.

From the appearance of the rash and up to the development of scabs and scars, the patient is regarded as contagious and therefore advised to avoid close contact with others to limit and prevent spread of the disease.

There is no specific vaccine yet for monkeypox. Castillo says those vaccinated for smallpox “have been shown to have some degree of protection” considering that the two viruses are closely related. 

“But the protection is not 100 percent,” she points out.

Unfortunately, smallpox vaccines have not been given out to the general public since 1980, when the disease was declared eradicated. Thus, any “cross-protective” immunity from smallpox vaccines would be limited to older people. 

The Philippines’ current supply of smallpox vaccines is used primarily by laboratory workers.

“Should one get infected, treatment is mainly supportive,” says Castillo. “Antiviral drugs like tecovirimat are being used in other countries in a strictly regulated manner. Vaccinia immune globulin is used in severe cases. Unfortunately, these are probably not available yet in the Philippines.”