Four months, more than 7,000 cases and three deceased after, monkeypox subsides in Spain. When referring to this outbreak, experts avoid talking about “control” or “end” because, as the coronavirus pandemic has shown, the consequences of an unexpected virus can last for years. Still, doctors and researchers acknowledge that the worst moment of contagion monkeypox was lived in our country in the months of May, June and July and that, to this day, the number of infections continues to decrease.
This is the largest monkeypox outbreak outside Africa recorded to date, and the main questions asked by those in charge of its study have to do with when it started and its powerful contagion capacity. In Spain alone, 7,037 infections have already been registered, two deaths from associated encephalitis and a third death “with concomitant infection with monkeypox”. In the rest of the world, more than 58,000 cases have been diagnosed in a hundred countries and more than 20 deaths. From these data, experts draw two conclusions. One positive: that the virus is much less lethal than some of its African versions; And a negative: if this infection – and many others – continue to go unaddressed globally, pandemics will no longer be a strange thing.
“The number of cases was explosive in the month of July, but now we are at a much lower level. Now we are not the country with the most new cases,” confirms Vicente Estrada, an infectious disease expert at the San Carlos Clinical Hospital, who still does not dare to speak of an end to this outbreak. “I don't dare to say it yet because we continue to see cases. Between the Clinic and Sandoval, last week we have seen seven new patients, so we can say that the disease is still active. It hasn't disappeared,” he maintains.
For Dr. Javier Membrillo, spokesman for the Spanish Society of Infections and Clinical Microbiology (SEIMC) and head of the Infectious Diseases section of the Gómez Ulla Central Defense Hospital, the total disappearance of the virus in our country "is very unlikely". On the one hand, he believes that underreporting for fear of stigma will keep the disease "residually circulating in certain settings." On the other hand, "as the message is transferred to the population that the infection is controlled", a certain "relaxation" will occur, as usually happens with infectious diseases, and more infections will occur. “In the next few years, monkeypox will continue to be among us”, ditch Membrillo.
Even without concluding it, the evolution of the contagion wave is now at its lowest point since the beginning of June. According to data from the Ministry of Health, in the first week 40 infections were reported and in the worst week of July 1,174 infections were reported in seven days. In the last seven days, 153 have been counted.
“Monkeypox outbreaks, which had not occurred in this way outside of Africa, always end up controlling themselves. There comes a time when there are no more chains of transmission", explains the professor of Immunology at the University of Valladolid Alfredo Corell, who adds that the best way to extinguish an outbreak of this type is "self-confinement" so that people diagnosed stop transmitting it. "Of course, it is much easier to contain than COVID-19," he concludes. Comparisons with the pandemic are inevitable.
Corell also rules out a coronavirus-style rebound, but not that a new outbreak could occur. To prevent it, the immunologist insists on a better definition of which risk groups are before proceeding with their vaccination and criticizes the fact that in some cases the dose against monkeypox has been injected into people who did not really belong to a priority group. "There has been a pull effect and many people who were not at risk have been vaccinated," he criticizes. Corell also asks to strengthen early detection systems, to cut transmission chains as soon as possible, and deal with the matter globally.
All experts, in line with the World Health Organization (WHO), ask not to consider the outbreak over. The director of the WHO, Tedros Adhanom Ghebreyesus, admitted this week that the figures at the global level were following a downward trend, but as happened in each descent of the COVID-19 curve, he said that it was not the time "to relax or lower the guard".
"Affected countries and communities must continue to work and health professionals continue to need support in their preparation to diagnose and treat new cases, as well as to prevent infections," added Tedros. This week, the dermatologist Josep Riera-Monroig explained in an interview with this newspaper that, once the clinic has been analysed, part of the studies are now focused on knowing how to treat possible complications in the form of scars caused by smallpox. Dr. Estrada adds that the San Carlos Clinic participates in various research at a European level focused on transmission, treatments and vaccines.
The director of the WHO also asked to continue making efforts in the sequencing of the genome of this virus "to better understand how it is evolving." Sequencing the genome is important because by doing so it is possible to know how the disease is going to behave, explains Estrada. At the end of May, the The Carlos III Health Institute sequenced the complete genome of the virus monkeypox that circulated in Spain and concluded that it was the clade (the family, simplifying) of West Africa, the mildest known variant.
Unlike what has happened in the last two years with the coronavirus, in the case of monkeypox the arrival of the cold can be beneficial, says epidemiologist Mario Fontán. “In summer, mobility factors, meetings and crowds have come together that could benefit the virus. The return to the regular work season may help maintain the downward trend and reduce the number of cases, "argues the specialist, although he sees" it is difficult to predict "that a peak of contagion may or may not occur.
"A few years ago, The Lancet already published an issue in which it analyzed the increase in emerging diseases, the worrying number of zoonoses that were occurring, and focused on a series of factors that we now know well." Improving epidemiological surveillance, modifying the way in which society relates to nature and thinking globally are the key points to avoid the scourge of a new virus.