Fear factor
Monkeypox, Centaurus, and the future of the pandemic
CLINICAL MATTERS
As an infectious diseases doctor, I know the names of hundreds of pathogens that can kill you in many horrible ways. From brain-eating amoeba to a virus that liquefies your internal organs into a bloody mess, to bacteria that eat your flesh, these are the stuff of nightmares. Naegleria, Yellow Fever, and group A Streptococcus are just some of these bugs. Why don’t we scream and run around in circles like headless chickens when there are all these unseen monsters lurking around the corner to murder all of us? It is because we have carefully studied these maladies and we know how to deal with them properly. With knowledge, we gain power over the deadliest of diseases.
When the pandemic hit, we knew little about what was happening. There is nothing more terrifying than the unknown. There were indications that this could be the “big one,” the once-in-a-century plague like the 1918 Spanish flu. Initial death rates, especially among the elderly and those with comorbid conditions, were astonishingly high at 10 to 20 percent. Without a clear understanding of how it spread and no proven treatments or vaccines, our only recourse was to buy time and limit the body count. Therefore, we had to resort to community quarantines and draconian control measures at the start of the pandemic. As we learned more about the virus, we got better at treating the severely ill, effective drugs were developed, and the vaccines finally arrived.
Once we understood Covid-19 better, it became a lot less scary. We were able to cautiously open our society as more and more people were vaccinated. Our hospitals were no longer overburdened as the fatality rate dropped to that of the flu among those who were fully vaccinated and boosted. Continued use of masks kept case numbers from climbing exponentially anew. Despite near pre-pandemic activity levels, we are now coping well and Filipino society has been able to remain open.
Throughout all these, there was a lot of misinformation and disinformation. There was a lot of fake news that was being shared, and many quacks craving attention came out of the woodwork. Fake Covid-19 cures and bizarre anti-vaccine rhetoric went viral. Fearmongering, especially in social media, was rampant. Even among reputable media outlets, isolated and outdated concepts such as high positivity rates, two-week growth rates, and daily case counts continue to be bandied about to scare people, although these numbers no longer mean the same thing. The current situation is far removed from the danger of the early days of the pandemic, and DOH has shifted to more relevant metrics for a better calibrated response.
While a healthy respect for Covid-19’s ability to mutate and surprise is important, living in a constant state of fear is harmful and inappropriate. Unscrupulous groups who have profited from the attention brought about by the pandemic continue to peddle their unscientific analyses, often pre-empting official sources and sowing confusion. These people need to be held accountable for the harm they cause to society at large. In addition, the public needs to be educated to be discerning of any information and to stick to scientifically rigorous sources of news.
Meanwhile, the emergence of monkeypox has driven fear levels to new heights. Despite the current outbreaks of monkeypox being novel given its mode of spread, it has far less potential to be as destructive as Covid-19. Monkeypox is endemic to Africa and there have been sporadic outbreaks in different parts of the world. It is not a new disease. The strain of monkeypox that is going around currently has a case fatality rate of less than 0.1 percent. Transmitted a lot less efficiently than Covid-19, it is only contagious when a person has symptoms. Most cases have been contracted through direct contact, particularly sexual contact, and so exponential growth on the order of a respiratory disease such as Covid-19 is very unlikely. Finally, there are effective vaccines and treatment for monkeypox, and efforts are underway to increase the availability of these interventions. Monkeypox is not on the same level as Covid-19. It is a much more manageable threat for as long as people follow scientific advice. Current control measures against Covid-19, particularly wearing masks and physical distancing, work well against monkeypox.
On the Covid-19 front, the Omicron sublineage BA.5 is now the dominant variant in the Philippines. This is consistent with official projections and the known behavior of this particular Omicron iteration. Given its higher transmissibility and propensity to evade neutralizing antibodies, there have been many instances of infection even among fully vaccinated and boosted individuals. Fortunately, protection against severe disease remains durable. Despite a continued rise in daily cases, most infections are mild. These additional cases have translated into a manageable increase in healthcare utilization, in contrast to the early days of the pandemic where the hospitals were overwhelmed. A disproportionate number of cases being admitted to the hospitals due to severe disease are unboosted or unvaccinated patients. Vaccines continue to decrease the risk of death tenfold across the board, regardless of circulating variant.
Aside from BA.5, the Omicron sublineage BA.2.75 has recently been detected locally. BA.2.75, which has been unscientifically dubbed by the media as “Centaurus,” is the latest variant that has captured the attention of the public. While there are some indications that it may be more transmissible than the original Omicron lineages based on some spike protein mutations, there is still not enough evidence to designate it as a new variant of concern over Omicron. In fact, the name Centaurus is based on a whimsical tweet by a random guy on Twitter. The name stuck because several media outlets decided to use it without any scientific basis (https://www.gavi.org/vaccineswork/omicron-what-users-guide-covid-19-variant-names). Centaurus is a constellation with several galaxies in it. It is not in any way part of official nomenclature for naming SARS-CoV-2. This seems to be par for the course where media doesn’t do its homework, contributing to and spreading misinformation.
So, what’s next? It seems as if there is still a lot on our plate. The good news is we are no longer choking on the food and we have room to manage these emerging and continuing threats to our country. With the continued partnership of the government and its citizenry, along with good scientifically sound policies, the country should be well on its way to recovery.