Emerging on the heels of the COVID pandemic, mpox was beaten back just to reemerge with a more virulent, deadly variant. Diagnostic testing is critical in fighting the disease.
By Chris Wolski
Summary: Despite the dramatic portrayal of rapid global disease spread in films and television, real diseases, including COVID-19 and mpox, often spread slower and reemerge after being seemingly contained.
Takeaways:
- Real Disease Spread: Unlike apocalyptic media depictions, real diseases, such as the bubonic plague and the Spanish flu, spread more gradually and take months to reach a crisis point.
- Mpox Outbreaks: The mpox outbreaks, including a recent deadlier variant, highlight the importance of diagnostic testing and public health responses to manage and contain the disease.
- Continued Vigilance: Effective diagnostic testing, treatment, and education are crucial in combating diseases like mpox, which may not disappear quickly and can resurge in new forms.
Unlike apocalyptic movies and TV shows that depict outbreaks, zombie and non-zombie alike, no human disease has spread around the world at lightning speed. Sure, that makes for a lot of drama—but it’s just not how diseases work. But more dramatically, what can and often happens is a disease is stopped in its tracks just to reemerge again a year or even a decade or decades later.
This isn’t to say that outbreaks can’t be fast acting. We saw that with COVID-19. A few cases were reported around the globe, and then we reached a crisis point. This has always been the case with pandemics throughout the ages. The bubonic plague spread slowly to Europe along the trade routes until it reached a tipping point, spreading like wildfire. The Spanish flu, likewise, was first seen in a small group of soldiers, who then infected their comrades, allowing it to reach wider and wider populations—but this took months—not hours.
And more chillingly, many of these infections—COVID among them—are often spread before symptoms either appear or seem significant.
Mpox as an Example
Mpox is a perfect example of what I’m talking about. On the heels of COVID-19, the novel, sexually transmitted disease emerged in Africa in 2022. Originally called monkeypox, the initial outbreak of mpox, which spread quickly to countries around the world, would ultimately account for 95,000 cases of the clade II variant of the disease. The outbreak was seemingly extinguished thanks in large part to aggressive diagnostic testing.
But the reality has been more complex and variable. The emergence of a new variant in recent months, which is deadlier and has been spreading more quickly to a wider population through close non-sexual contact, has experts, including Syra Madad, DHSc, MSc, MCP, who told me recently she’s casting a worried eye at governmental and health care responses—or lack thereof.
Further Reading: Dissecting Limitations and Challenges of Mpox Testing
Echoes of HIV?
While mpox both in 2022 and currently has some parallels with the emergence of HIV in the 1980s, with many of those initially infected being men who have sex with men, there are also significant differences.
There are effective diagnostic tests and treatments for mpox. And, more to the point, because of both the experience of HIV and COVID, there are existing testing infrastructures that can cope with an expanding outbreak.
Diagnostic Testing Access
However, with the emergence of mpox clade I in the Democratic Republic of Congo (DRC), clinicians have seen increases in mortality, particularly among children. And while sexual contact remains the common way the infection is being passed, Madad notes that non-sexual partners, such as family members, are being exposed to the infection through close contact, including infected bedding and other household items. The first case outside the DRC was detected in Sweden in August 2024.
For its part, the Biden administration provided health aid to the DRC to help contain mpox, particularly clade II.
While these steps and the WHO’s declaration of it as a public health emergency of international concern are laudable and critical, Madad, who is chief bioprepardness officer at NYC Health + Hospitals, does have concerns that it’s just a “matter of time” before we’ll see clade I in the U.S.
Education, Diagnostic Testing, Treatment
Madad says that educating clinicians about what mpox is, taking thorough travel and potential exposure histories, collaboration with local health officials, followed by diagnostic testing, and treatment will help stop the infection.
While it’s likely mpox won’t go away overnight—if ever—what is clear is that diagnostic testing is a critical frontline tool in fighting this disease.
Chris Wolski is the chief editor of CLP.
Updated on October 14, 2024