Monkeypox: How the Covid pandemic shaped our response to virus outbreaks

A social distancing sign in Leeds city centre, West Yorkshire, where tougher lockdown measures may be introduced locally after a rise in coronavirus infections.
Face coverings and social distancing helped reduce cases of Covid-19. Credit: PA

Words by ITV News Multimedia Producer Suzanne Elliott

Just as the world cautiously began to believe the worst of the Covid-19 pandemic was behind us, another virus grabs the headlines.

Monkeypox, a cousin of the eradicated smallpox, is not a new disease, but before this outbreak it had rarely seen outside of West Africa and community transmissions have not been seen on this scale in the outbreaks that have previously been seen in Europe and the US.

But while this cluster is unusual, the risk to the population remains low and scientists are confident they have the tools to tackle it - many enhanced by lessons learned during the pandemic.

The monkeypox virus is very different from SARS-CoV-2, the virus that causes Covid-19. Monkeypox does not spread easily from human to human, unlike SARS-CoV-2, and because it is related to the smallpox virus there are already treatments and vaccines to reduce its spread.

But with confirmed cases in the UK rising, scientists are concerned by its seemingly new behaviour and public health bodies have ramped up their response in a bid to contain further spread.

What lessons, if any, have the UK and other countries learned from the Covid pandemic in their reaction to monkeypox?

Cutting off transmission

Contact tracing was more or less abandoned within days of the Covid arriving on UK shores in March 2020 despite outbreaks getting exponentially harder to contain once they have expanded beyond a limited area.

The most effective way to control a disease, experts agree, is to cut off its spread by limiting contact with an infected person.

NHS test and trace look a while to get going but contact tracing, either through the app or through personal connections, became a huge part of the pandemic response by the second wave.

This time, closing down monkeypox transmission chains has been swift.

UKHSA teams have been tracing contacts of people with a confirmed case and are advising those at highest risk to isolate at home for up to 21 days.

Dr Susan Hopkins, UKHSA chief medical adviser, said: “We are continuing to promptly identify further monkeypox cases in England through our extensive surveillance and contact tracing networks, our vigilant NHS services, and thanks to people coming forward with symptoms."

A nurse puts on PPE on a ward for Covid patients at King’s College Hospital, London Credit: Victoria Jones/PA

Will a 'pandemic-savvy' public help?

After two years, the public are well versed in virus and pandemic response lingo. We understand the terms "self-isolate", and "quarantine"; we know to keep our distance from people if we think we might be infected; we are familiar with contact tracing.

Personal Chair of Immunopathology, University of Edinburgh Professor Neil Mabbot adds that the public also saw how effective health measures were - we saw how lockdowns saw brought Covid cases down and we witnessed numbers rise as we began mixing again.

Reacting fast

Scientists have a head start with monkeypox in that it is not a new disease, unlike SARS-CoV-2.

"We have experienced significant outbreaks in the past and therefore have good systems in place that we can respond to when we do encounter such cases," Dr Mabbot explained.

"Whereas coronavirus was a new disease; the scientific community and the health service reacted extremely fast, and we were learning all the time about this new disease. Obviously, there were debates about the transmission routes. It took a while for these kinds of things to be established and for measures to be put in place."

The stages of Monkeypox Credit: UK Health Security Agency

How has the government's response changed?

Sir Jeremy Farrar, the director of Wellcome, praised the UK's response to monkeypox, saying the health agency “deserves great credit” for its “textbook example” response to the outbreak.

“The action is what’s happening in the UK at the moment, which is very detailed, very painstaking contact tracing, identifying people who come forward and identifying their contacts and tracking everybody to see that you can break those chains of transmission, and making sure that that’s done in a trusted way…,“ Sir Jeremy told BBC Radio 4.

Prof. Mabbot agrees: "I think the responses has been pretty good," he told ITV News.

"There's obviously been a lot of coverage about monkeypox, and there's been a lot of input from scientists and health professionals explaining the situation, explaining the background and similarly, explaining the risks and what people should do if they think they are infected or have been in close contact. And that's all very important for managing this outbreak."

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Getting the right message out

There are (as of June 16) at least 574 confirmed cases in the UK. People with unusual rashes or lesions, particularly if they have had a new sexual partner, have been urged to limit their contact with others and contact NHS 111 or their local sexual health clinic. Gay, bisexual and men who have sex with men are being urged in particular to be aware of symptoms, especially if they have recently had a new sexual partner.

Dr Mabbot says while health messaging should not overly alarm the public, it is important people are informed.

"The monkeypox virus doesn't spread very easily to humans; it requires very close contact. Sexual activity has been linked, I think in this outbreak is perhaps one of the main drivers. It is not a sexually transmitted disease, but of course, sexual activities are very close activities."

He continued: "My understanding from at least what we know so far about this virus is that there doesn't appear to be any further onward transmission to close contacts that were not sexual. Partners have already been identified. So the messaging, the reaction, etc appears to be working. And I think that doesn't mean we're not going to see some more cases as we go through the next few weeks. But they should start to decline."

It is important for people to understand symptoms and not to stigmatise or alienate people as it is vital cases are identified. Epidemics can really take off if people do not come forward.

Monkeypox virus. Credit: Science photo library

Cutting off transmission chains with vaccines

Vaccines play a huge role in reducing the spread and severity of a virus. The UK government got ahead with the Covid vaccines, securing several million doses early on in the pandemic.

And again, vaccines are at the forefront of the UK's response.

Smallpox, monkeypox's virus cousin, wound down in the 1970s when the disease was eliminated. But with each passing year, our immunity has weakened.

The government has stocks of the smallpox vaccine which is being offered to healthcare staff looking after patients with confirmed monkeypox, and being offered to those exposed to confirmed cases - this is a strategy of control known as ring vaccination.

Data and communication has improved

"I think the coronavirus pandemic illustrated how effective the immediate release of data can be," said Prof. Mabbot.

Previously, scientific data was a fairly slow and cumbersome beast where research would be sent to a scientific journal and read largely by experts who would provide input and suggest any recommendations for change before eventually being published.

The data was rarely available in the public domain, Prof Mabbot explained, and the process could take weeks or months. But the pandemic changed that lengthy process and many studies were instead submitted to websites before they were reviewed.

"People could see how the science was developing at the time," Prof Mabbot said, citing dexamethasone as an example, when the findings of a study were so positive in improving the outcome of Covid patients, the data was released immediately without having to go through the usual process.

Medical staff and volunteers prepare shots of the Moderna Covid-19 vaccine at a vaccination centre in Ramsgate, Kent Credit: Leon Neal/PA

Covid vaccines, too, were developed through shared data.

"The coronavirus vaccine was again deposited in a database that scientists around the world could themselves go into and scrutinise," Prof Mabbot said.

"That allowed those working on the coronavirus vaccines to log into this website look at the coronavirus, RNA sequences, genetic information, and design their vaccines around that.

"You'll have heard that the telephone professors or Dame Professor Sarah Gilbert, who essentially designed the (Oxford/AstraZeneca) vaccine over a weekend on a laptop in the kitchen basically because she could log into this website, look at the virus sequence which had been deposited in this database and say, 'Okay, I need that parts of the genome to put into my virus vector' and there we have our coronavirus vaccine'.

"I've simplified it, but it shows how quickly these things can happen and something similar is now starting to appear for the monkeypox. Sequences have now to be deposited into similar databases for the genetic material of this strain of the virus which we think is circulating in the UK.

"This will be really important because we can compare the sequence in the cases which are circulating now with historic cases and see if there's any link with those. Likewise, we can compare the genetic sequences of cases from different parts of the UK and the world to see if they're also related as well and that again can help with control."