Monkeypox in the COVID era: Here are the key differences between the viruses

Monkeypox in the COVID era: Here are the key differences between the viruses

Washington state’s first presumptive case of a virus, spreading around the globe, found in a man with a travel history. The year is … 2022?

This time, it’s not a novel coronavirus, but a case of monkeypox. King County’s public health officer announced the finding on Monday. And for the state’s COVID-19-fatigued residents, it is certainly another point of worry.

But don’t panic, local infectious disease researchers say. Key differences exist between the two viruses.

While scientists have acknowledged some unusual trends with the current monkeypox outbreaks, the virus — discovered about 50 years ago in the Democratic Republic of the Congo — shares few similarities with coronaviruses and likely won’t end in a similar global epidemic, said Deborah Fuller, a microbiologist at UW Medicine who studies viruses and vaccines.

“Just hang tight,” Fuller recommends. “The information is going to get out there, and … once [public health] recommendations come out, it’s going to be easy to avoid for most people.”

One of the biggest differences between coronaviruses and monkeypox is how they’re transmitted, she said. While people can become sick with COVID-19 through airborne transmission of the coronavirus, monkeypox is primarily spread through large droplets or the exchange of bodily fluids.

“You could be near someone with monkeypox and not get it,” Fuller said. “It usually has to be a situation where you’re standing face-to-face with someone and they’re spitting on you [in addition to direct contact with cuts or bodily fluids].”

The death rate for the circulating strain of monkeypox is also much lower than the coronavirus. While one strain in Central Africa can kill up to 10% of infected people, estimates suggest the circulating version of the virus has a death rate of less than 1%, according to a New York Times report.

In addition, monkeypox — and all pox viruses, such as smallpox — are DNA viruses, which mutate much slower than RNA viruses (which is what coronaviruses are) because they can better correct mistakes when they start to replicate, Fuller said.

RNA viruses, meanwhile, don’t have as strong a correction ability, so mutations and new variants develop more rapidly — evident in omicron’s recent slew of subvariants.

The slower mutation process also means vaccines already proven to be effective against monkeypox will continue to provide strong protection against the virus in the coming weeks and months, Fuller said.

There are a couple of vaccines that are effective against monkeypox, she said. One was recently developed as both a smallpox and monkeypox vaccine and has been shown to be 85% effective against monkeypox.

The newer vaccine is almost “ideal,” said Fuller, who helped work on past vaccine development.

“It’s room-temperature stable, so it can be stockpiled for years without losing any potency and can be deployed very quickly,” she said.

While vaccines for now-extinct smallpox aren’t available to the general public, President Joe Biden said this week he believes the U.S. has enough vaccine stockpiled to handle the monkeypox spread.

Unlike the mass vaccination efforts of the COVID pandemic, however, Fuller said monkeypox immunization plans will likely center around a strategy known as ring vaccination, which was used to eradicate smallpox in the 20th century.

“It means that we don’t have to vaccinate the entire world, we just have to vaccinate the people surrounding the person who’s infected,” she said. “That creates a wall of immunity where it then peters out and dies out.”

Still, some aspects of the world’s current monkeypox outbreak have scientists scratching their heads.

“This particular outbreak is interesting because of what they’re finding in sexual activity,” Fuller said. “It’s kind of a new thing. We never thought about monkeypox being sexually transmitted.”

Monkeypox also has a longer incubation period than coronaviruses do, which means one person could easily transmit the virus to others before realizing they’re sick or developing symptoms.

“It’s that long incubation period that’s working against us,” she said, predicting the world would continue to see more distinct monkeypox hotspots instead of the widespread community transmission we are experiencing with COVID.

Fortunately, she said, our collective experience with the pandemic will likely help rein in potential monkeypox spread, particularly when it comes to contact tracing and genomic sequencing.

“COVID was a wakeup call, and it’s helped to get the mechanisms in place already,” she said.

Dr. Adam Geballe, an infectious-disease physician at the Fred Hutchinson Cancer Research Center who’s been studying large DNA viruses for years, also said he’s “much more worried about COVID still.”

“I think we should keep our eye on [monkeypox],” Geballe said. “… But we’re ahead of the game compared to where coronavirus started.”

The animal-borne virus is normally uncommon in the U.S., but was identified in a Massachusetts man earlier this month. On Tuesday morning, the Centers for Disease Control and Prevention identified at least nine presumptive or confirmed cases in the country. Globally, hundreds of confirmed and suspected cases — and no deaths — have been reported in Europe and Australia.

The virus usually causes mild illness, including flulike symptoms, swollen lymph nodes and rashes, though those who are immunocompromised or pregnant are more at risk, Fuller added.

The King County man with a presumptive monkeypox infection has not been hospitalized and is recovering at home, county health officer Dr. Jeff Duchin said Monday. There is no evidence monkeypox is spreading locally, Duchin added, though he said he wouldn’t be surprised if more cases emerge.

“We still do need to pay attention to [the spread],” Fuller said. “If COVID-19 taught us one thing, it’s to not underestimate a virus.”

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