Sustaining commitment through panic and neglect
Monkeypox containment
I have a new essay out in Nature today about something that has been troubling me: sustaining commitment to ending the monkeypox epidemic. The cycle of panic and neglect is an old story in public health, and I am wary of how it will play out for monkeypox. Attention and energy ride on parallel tracks with case counts. In the U.S., we are at (or just past) peak now, which means the next phase of the response will likely take place in the context of dwindling public attention. That should not take pressure or urgency off of efforts to break chains of transmission.
This is why I also keep raising the need for metrics and targets. The topic is not a magnet for clicks, but I think it remains a big missing piece of our response. We may curb transmission, but I doubt that we will not stop it entirely without a metrics-based plan to get there.
The value of case investigations
I read with interest a recent preprint describing fomite (contaminated surface) transmission of monkeypox virus. Two healthcare workers became infected after visiting the home of someone with monkeypox. The workers wore gloves and other personal protective equipment while collecting a specimen from the patient, but not during other, non-contact interactions. The authors conclude that the healthcare workers became infected from contact with contaminated surfaces.
This finding is not unexpected. The preprint adds to an existing body of evidence that fomite transmission of MPV is possible, but we know from other data that it is uncommon. According to data from WHO, just 11 of 7,525 transmission events are linked to contaminated surfaces. The majority of transmission events, 92%, are linked to sexual encounters.
With this in mind, what I found interesting was not the conclusion of the study but the methods. The analysis was a detailed epidemiological investigation that also drew on genomic evidence. Public health departments commonly do case and cluster investigations, but often the resulting insights are not shared. This preprint is one of relatively few I have seen with this sort of analysis. (See a recent essay by Adam Kucharski for similar themes.)
Natalie Dean and I wrote about the need for more granular data early in the covid pandemic, when stock images of crowded beaches and bars led every news story. Were beaches really to blame from that summer’s surge? We wrote:
Without careful epidemiological analyses to explore these different hypotheses, the public discussion reverts to convenient narratives rather than an evidence based assessment of where transmission is occurring. These narratives run the risk of either being wrong or only partially right, preventing us from learning important lessons about how to re-open safely. They also risk polarizing discussions by unduly blaming certain groups, at a time when we need the public on board.
Over two years later, the same could be said about the monkeypox epidemic. The more information we have about the patterns and circumstances of transmission, the more we can do to tailor response efforts to where they are truly needed, while minimizing stigma and (in the case of covid and beach closures, at least) needless restrictions.
Good news
I’ll end with three bits of good outbreak news. Ghana has reported no further cases of Marburg virus following three cases last month. In Florida, news media reports that an outbreak of meningococcal disease is slowing. Today, the U.S. FDA authorized a bivalent COVID-19 vaccine that provides better protection against circulating variants.