Unusual monkeypox outbreak: Let’s  look at the facts

BAR NONE - Atty. Ian Vincent Manticajon - The Freeman

The World Health Organization (WHO) first sounded the alarm on monkeypox on May 21, 2022. A COVID-19-weary world took the news with a measure of detachment and carried on with the more pressing demands of life.

How concerned should we be? Before we let out a collective sigh of exasperation at the prospect of another widespread global infection, let’s take a step back and look at the facts. Often without looking at the facts, we tend to get emotional. It’s not easy being confronted with the prospect of another public health crisis when we have just started to see the signs of the end of an existing one.

First, the WHO sounding the alarm on monkeypox infection is not being alarmist. It is not exaggerating the danger. The WHO is simply telling the world to be vigilant so we can prevent a bigger problem from happening. The potential impact of monkeypox on the health systems and economies around the world will depend on how we react to this new threat to public health safety.

Human monkeypox is a viral zoonotic disease that has been with us since 1970, first identified in the Democratic Republic of the Congo. Most cases of monkeypox have been confined to the remote forest regions of the Congo Basin, though through the years infections have increasingly been reported from across Central and West Africa.

If this disease has been with us since the 1970s, what made WHO raise a global concern on monkeypox in May this year? It is the atypical outbreak of the infection. Multiple cases of monkeypox have been suddenly observed in around 12 non-endemic countries, or those areas where the disease was usually not present.

Monkeypox is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding. While monkeypox is less contagious than the eradicated smallpox and is usually self-limiting with symptoms lasting from two to four weeks, severe cases can occur with a death rate of around 3% to 6% in recent times. It typically manifests clinically with fever, ugly lesions, rashes, and swollen lymph nodes, and may lead to a range of medical complications, according to the WHO.

WHO Director-General Tedros Adhanom Ghebreyesus in a July 27 press briefing said that so far, five deaths have been reported and about 10% of cases are admitted to the hospital to manage the pain caused by the monkeypox. He stressed that the monkeypox outbreak can be stopped if countries, communities and individuals inform themselves, take the risks seriously, and take the steps needed to stop transmission and protect vulnerable groups.

Cebu-based infectious diseases specialist Dr. Bryan Albert Lim presents a medical and sociological point of view of a possible monkeypox outbreak in the Philippines. Without sounding alarmist but still careful not to gloss over the threat, Dr. Lim in his August 1 public social media post identifies the potential challenges in controlling monkeypox in the Philippines. These are:

“1. Inability to recognize the early infectious stages of the disease. Monkeypox rash progresses from macule to papule to vesicle to pustule to crusting. Skin diseases are some of the most challenging to diagnose, and we have very few experts.

“2. The challenge in diagnosing monkeypox will result to multiple referrals, and multiple empiric medications which can delay diagnosis, isolation, and contact tracing. I won't be surprised that patients would be "doctor shopping."

“3. Household isolation is allowed. But the reality (is), households in many areas, (especially) the slums and squatters are incapable of doing so. Household transmission will be a problem.

“4. Isolation period is at least 21 days. DOH prohibits confirmed cases from leaving their homes, except for medical care. Who will take care of these patients, (especially) the poor? Who will provide food, medications and other necessities? Do we have the resources?

“5. Our hospitals are gearing up. Isolation rooms are being prepared. Monkeypox is largely not fatal, still its complications can include pneumonia and encephalitis. Monkeypox can also infect those who are suffering from other diseases requiring hospital care. Will health workers stay to care for monkeypox patients? Are we ready?

“Let us all do our part. Let us increase awareness, let us prepare our communities, let us prepare our health system while we still have time,” Dr. Lim said.


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