tl;dr - It's going to require very strong action on a global scale, to be able to do excellent surveillance, case identification, case investigation, contact tracing, excellent genomic epidemiology, and to make sure that we get in front of it.

Haha.

Once again I am watching researchers scramble to understand a virus spreading and am getting a sinking feeling in my stomach as I watch new information come in…

So a #monkeypox thread on worries and whys

First, to be clear:

This is not #SARSCoV2. This is not about a pandemic with millions of deaths waiting to happen.

Cases in non-endemic countries have been mild so far. And monkeypox spreads slowly.

But let's not let a terrible pandemic blind us to the toll of other diseases

So what am I worried about?

That this is not contained and monkeypox virus establishes itself much more widely.

That would mean more disease and death, more fear and stigma and more opportunities for the virus to evolve and become even more of a headache.

What could that look like?

1. It could be that the virus continues to spread amongst MSM and establishes itself in these sexual networks in a way that it will be hard to get rid off.

2. It could spread in other groups and in other countries less well equipped than say the UK or Portugal to handle yet another difficult outbreak, with less surveillance or fewer resources in the health system.

3. It could spill back into animals through contact with pets or wild animals and establish itself in an animal reservoir in places where it did not exist before with continuous risk of new spillovers into humans.

Of course it could also do all three things...

So why am I worried?

It's all in the papers I have tweeted the last few days.

1. Many cases seem to have no connection to other cases and disease often appears atypical, so many cases were probably missed/are being missed and there might have been a lot of spread already.

2. Contact tracing has been difficult given the nature of many close contacts (i.e. anonymous sexual contacts). That makes public health interventions very difficult.

And there will be a lot of large events this Pride month that could lead to more spread.

3. This disease has a long incubation period. As @Boghuma told me today: "What we are detecting now is not the new transmissions that are happening, new transmissions are happening that we don't know anything about. And that really worries me."

All of this can be solved, but it does require fast, and globally coordinated action. @arimoin told us for our @pandemiapodcast last week that she thought this could be contained.

But "it's going to require very strong action on a global scale, to be able to do excellent surveillance, case identification, case investigation, contact tracing, excellent genomic epidemiology, and to make sure that we get in front of it."

And it's gonna take a public health response that is open, empathetic, and approaches people without judgement. The polarised climate is not going to make that easier.

Yes, we have therapeutics and vaccines but they mean nothing if the people who need them don't trust you.

And let's just remember once again that this virus has been sickening and killing people in endemic countries for decades and there was some interest in researching it, but not a lot.

As @arimoin told us: "This might be the the big lesson that nobody wants to learn is that an infection anywhere is potentially an infection everywhere."

Last week I spoke to Tony Fauci as well and he told me: "I think that the world needs to realise that when you have an outbreak, you can't ignore it. You've got to look at it for what it is, not panic the world, but be prepared to do whatever it is you can do to mitigate it."

For those who speak German, @pandemiapodcast episode is here:...

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