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Explained: India's Fourth Monkeypox Case, The Government Response, And Can It Become A Pandemic

Experts have said there is no need to panic as Monkeypox is not expected to become a pandemic like Covid-19 as the two diseases work differently.

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Monkeypox ward Photo: AP/Mahesh Kumar A.

The fourth case of Monkeypox infection was confirmed in India on Sunday. 

The case, in a 34-year-old man, is the first from Delhi. Earlier, three people from Kerala have been confirmed to have Monkeypox infection.

A 34-year-old man from the national capital with no history of foreign travel has tested positive for monkeypox virus, official sources said on Sunday.

Several Indian states have been on alert in the light of the discovery of Monkeypox infections in India. Following the first confirmation of Monkeypox in India two weeks back, the Delhi government had made Lok Nayak Jai Prakash Narayan (LNJP) Hospital the nodal centre for management of the disease and had started training of the doctors there.  

Here we explain the Monkeypox disease, how governments are tackling it, the spread in India, and what are the norms.

What's Monkeypox disease, spread in India

Monkeypox is a rare viral disease caused by the Monkeypox virus. It's called Monkeypox because the virus was discovered in monkeys meant for research in 1958.

Monkeypox is characterised primarily by fever and rashes. Healthline lists the following symptoms that appear within 5-21 days of contracting the virus:

  • fever, which is commonly the first symptom
  • headache
  • muscle aches
  • back ache
  • fatigue
  • chills
  • swollen lymph nodes

Healthline adds that rashes develop within one to three days after fever. 

Monkeypox spreads through direct contact with infected animals and humans through blood, bodily fluids, skin or mucous lesions, and respiratory droplets.

In India, four cases of Monkeypox have been confirmed, including the one in Delhi confirmed on Sunday.

While the first three infections were in people from Kerala with international travel history, the fourth case from Delhi has no such travel history.

Monkeypox in India has also not escalated into a Covid-like outbreak and experts across the world have said that it's not likely to become a pandemic. 

Despite such assurances, the Union government and several state governments have stepped up their measures against Monkeypox in light of infections in India and abroad. 

India's Monkeypox guidelines

India had issued guidelines for Monkeypox management even before the first infection was detected.

In May, the Union Health Ministry had directed the National Centre for Disease Control and the Indian Council of Medical Research to keep a close watch on the situation. Airport and port health officers were also asked to be vigilant.

"They have been instructed that any sick passenger with a travel history to Monkeypox-affected countries be isolated and samples sent to the BSL4 facility of the National Institute of Virology in Pune for an investigation," according to a source cited by PTI.

The Union Health Ministry has also published detailed guidelines that cover various aspects of Monkeypox management, such as collection of samples, isolation and treatment of patients, and contact-tracing. The following steps to manage Monkeypox are listed:

  • Patient isolation
  • Protection of compromised skin and mucous membranes
  • Rehydration therapy and nutritional support 
  • Symptomatic treatment 
  • Monitoring and treatment of complications

The Monkeypox management is therefore similar to Covid-19 management as you test the patient, isolate them, and then start the treatment as per symptoms.

The difference is that while several labs can confirm Covid-19 samples, only National Institute of Virology (NIV), Pune confirms Monkeypox infection. 

Moreover, it's not the symptoms or a pre-determined number of days but the resolution of rashes, lesions, and scabs that decides when isolation would end.

"Skin lesions should be covered to the best extent possible (e.g. long sleeves, long pants) to minimise risk of contact with others. Isolation to be continued until all lesions have resolved and scabs have completely fallen off," say Union Health Ministry guidelines.

Should you be worried about wider Monkeypox spread?

The World Health Organization (WHO) on Saturday declared Monkeypox as "public health emergency of international concern". 

WHO Director-General Tedros Adhanom Ghebreyesus made the declaration despite a lack of consensus among members of WHO's Emergency Committee. It was the first time the WHO chief has taken such an action.

Despite this, health experts have said that Monkeypox would not become like Covid-19 and it does not pose widespread risk like Covid-19.

One reason is that infections can now be traced to events and places. In the West, a top WHO scientist has said Monkeypox outbreak began at two sex raves in Spain and Belgium. The first three cases in India had also travelled to places known to have Monkeypox. The fourth case from Delhi had also attended a stag party recently in Manali in Himachal Pradesh. 

"If hundreds of people get sick after attending a single event – like a concert or festival, that would typically be classified as an outbreak. The situation would only become an epidemic if infections started occurring among many people who were not close contacts of event attendees," noted Prof. Kathryn H. Jacobsen of University of Richmond.

She further noted in an article in The Conversation that Monkeypox patients in May-June were men from the LGBT+ community. She further lists three reasons why Monkeypox would not take Covid-19's trajectory.

  1. Monkeypox virus is much less contagious than the circulating strains of coronavirus. 
  2. Monkeypox has very less death rate. It is one death for every 1,000 adult cases
  3. Existing vaccines will be able to help slow the spread of monkeypox in high-risk populations.

Delhi Chief Minister Arvind Kejriwal has also said there should not be any panic.

"The situation is under control. We have made a separate isolation ward at Lok Nayak Jai Prakash Narayan Hospital. Our best team is on the case to prevent the spread and protect Delhiites," said Kejriwal in a tweet.

Another reason why Monkeypox would not become a wider concern like Covid-19 is that two viral droplets are different and spread differently.

"Covid particles are very small and can be transmitted through the air, which is why it can spread so easily. The particles of poxviruses, like monkeypox, are much bigger and heavier, which means they can’t travel that far through the air," said Dr Luis Sigal, Vice Chair of Research, at Thomas Jefferson University.

Reasons for current Monkeypox outbreak

While Monkeypox has been reported in Africa through animals such as rodents for decades, it's spread outside Africa without the involvement of animals is strange. Moreover, evidence has emerged that the majority of patients are men who have sex with men (MSM), leading to theory that the current outbreak is rooted in two sex raves in Europe.

Science magazines reports, "The virus may have made its way into highly interconnected sexual networks within the MSM community, where it can spread in ways that it cannot in the general population."

Dr David Heymann, who formerly headed WHO's emergencies department, described the current outbreak to The Associated Press in an interview as "a random event". He added that the leading theory to explain the spread of the disease was sexual transmission among gay and bisexual men at two raves. 

He said, "We know monkeypox can spread when there is close contact with the lesions of someone who is infected, and it looks like sexual contact has now amplified that transmission."

Such a spread would mark a significant departure from Monkeypox's typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates and outbreaks have not spilled across borders.

(With PTI, AP inputs)

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