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Monkeypox, Langya, and COVID-19: Which One Should We Fear the Most?

Is it the summer of the monkey(pox)?

Salvador Macip, MD, PhD

Disclosures

August 24, 2022

We are in the midst of the third consecutive pandemic summer in which, to paraphrase a famous movie title, we finally learned to stop worrying and love SARS-CoV-2. COVID-19 is still very much an ongoing problem, but with most rich countries having all but stopped precautions and monitoring after most of the population got two jabs (the UK went from an average of 1.7 million tests reported daily in January 2022 to the current ~200,000), it's difficult to appraise the full impact of the last waves in real time.

With the BA.5 subvariant of omicron quickly becoming dominant all over the world, it's not really the time to sit back and sip piña coladas. COVID is probably the most contagious virus we've ever known, and despite the fact that a combination of good vaccination levels and what looks like a less aggressive makeup of the Omicron lineage is keeping the percentage of severe cases low, reinfections are putting us all at risk again.

The bleak truth is that people are still dying of COVID-19 (and suffering severe complications, and having long COVID) at rates that not so long ago we considered alarming. The latest figures show 1.2 confirmed COVID-19 deaths per million people in Europe, which is similar to what we saw last summer and three times above the average for summer 2020. In North America, the picture is no better with currently 1 death per million — the same as last July.

But we made the collective decision to keep calm and carry on (some may argue that we didn't have much choice, with the economy and mental health both in a tailspin), and now we have to live with the consequences. What we didn't expect was to have two new contenders for the prize of next global health threat jumping so quickly into the arena.

In May, we saw the start of a monkeypox outbreak in the UK, which has now spread to almost a hundred countries with around 40,000 cases (but only 114 deaths, a ratio at least a thousand times lower than COVID-19). Monkeypox, which is another zoonotic disease, seems to be jumping more readily from human to human, probably due to promiscuous sexual activity. The route of transmission is not as universal as that of SARS-CoV-2, so it's unlikely that this outbreak will be as disruptive as the COVID-19 pandemic. Nevertheless, it's urgent to reduce transmission as soon as possible to keep the number of cases low and exit the current exponential growth phase while it's still feasible.

The newest arrival is the Langya virus, a recently discovered member of the nasty family of henipaviruses (which include threats like the Nipah virus, which kills 40%-75% of those it infects) that reared its head in rural China this summer. So far, only 35 cases have been reported, with no deaths and, more importantly, no evidence of human-to-human contagion. (All cases seem to have come from direct contact with wild animals, such as shrews). It doesn't look like this one should be able to wreak much havoc globally either, but it will be important to keep a close watch in case the pattern of transmission changes or more severe cases are reported.

Out of the viruses hitting the headlines, SARS-CoV-2 is probably still the one we should worry the most about (common sense, caution, and boosters are the key to minimize its impact). However, it is worth noting that we are seeing some viruses spreading faster and further than ever before.

Is this just bad luck, a consequence of a series of unfortunate events? Or is there something else helping them reach these new limits? Does this have to do with the climate emergency and other issues of planetary health? Has COVID-19 paved the way for other microbes by laying waste to our defences?

We need more time to find answers to these questions and, in the meantime, we have to keep our eyes open. There's no reason to panic, nor to be complacent.

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About Dr Salvador Macip
Salvador Macip, MD, PhD is a doctor, researcher and writer. He obtained his MD/PhD at the University of Barcelona (Spain) in 1998, then moved to do oncological research at the Mount Sinai Hospital (New York). Since 2008, he has led the Mechanisms of Ageing and Cancer Lab at the University of Leicester (UK). Macip has published over 30 books, including Where Science and Ethics Meet (2016) and Modern Epidemics (2021). Connect with him on Twitter: @DrMacip

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