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Op-Ed

Monkeypox surge linked to end of COVID restrictions as virus finds new ‘niche’

An end to coronavirus lockdowns created the ideal “niche” to accelerate the global spread of monkeypox, experts have warned.

  • Over the last two years, restrictions imposed to curb COVID also disrupted the transmission of a raft of other pathogens, with the circulation of flu, adenoviruses and RSV falling drastically.
  • Now, scientists are tracking the unusual spread of a range of viruses which have rebounded as restrictions are lifted. Pathogens are circulating out of season, appearing in new regions and causing unexpected disease.

“I think we may well be seeing the infectious disease consequences of a prolonged period of isolation, followed by widespread exposure to a range of pathogens,” Prof. Will Irving, a professor of virology at the University of Nottingham, told the Telegraph.

Monkeypox is the latest unexpected disease to rear its head in the UK. Health officials have so far detected 90 cases since the virus was first detected in England in early May, while roughly 431 suspected or confirmed cases have been found in over 20 countries worldwide.

The pathogen is endemic in west and central Africa, where it causes regular outbreaks. In the Democratic Republic of Congo alone, where a more virulent variant is in circulation, monkeypox has killed 58 people and infected over 1,200 so far this year.

Monkeypox may have been circulating in UK for years

  • But the current outbreak is the first time the virus has spread widely outside Africa, causing scientists to scramble to understand what – if anything – has changed. And it looks increasingly likely that shifting behaviour has enabled a sudden explosion of infections.

“The virus could have been introduced to the UK during the last two years, but opportunities for it to spread were limited due to social distancing,” said Prof. Eleanor Riley, a professor of immunology and infectious disease at the University of Edinburgh. “Those restrictions have now gone and the virus has found a niche to circulate in.”

  • So far, the UK Health Security Agency says that the majority of cases identified across Britain have been among men who have sex with men (MSM). While monkeypox is not a “gay disease” or sexually transmitted, it thrives in close contact settings – and many cases have been linked to recent raves, sex parties and adult saunas across Europe.

“The sense of freedom and euphoria allowing people to travel more freely again – including for those in various sexual networks – may have boosted the ability of this virus to spread amongst a larger global population,” said Dr. Julian Tang, clinical virologist at the University of Leicester.

  • Other diseases have also found a foothold as immunity has fallen after two years of limited exposure to pathogens. Australia, for instance, has seen off-season RSV outbreaks in the young and elderly, while the United States has seen an uptick on flu hospitalisations in the last few weeks that is highly unusual for May.

Prof. Irving said he is concerned about “what the next influenza epidemic is going to look like” in the UK.

  • “This is a virus that pretty much the whole population gets exposed to each winter, thereby strengthening immune responses, and yet it still manages to cause significant numbers of hospital admissions and deaths,” he said. “And here we are, not having seen the virus for over two years.”
  • A mystery surge of severe hepatitis in children has also been linked to changing disease trends caused by lockdowns. On Friday, the UK Health Security Agency announced a further 20 cases – taking the total reported to 222 across the country.

Currently, the leading theory is that the cases are linked to an adenovirus – but as these common-cold viruses usually cause mild diseases, the UKHSA says other factors may be amplifying the infection.

  • One hypothesis is that COVID-19 lockdowns have weakened children’s immunity because they were less exposed to common pathogens while in isolation.

Others suspect that the virus is acting in tandem with another infection, such as Sars-Cov-2, or that there has been an “exceptionally large wave of normal adenovirus infections” – meaning very rare complications are presenting more frequently.

“For the hepatitis, influenza and RSV cases, it seems a reasonable hypothesis that some of the measures to control Sars-Cov-2… has changed the pattern of exposure to viruses,” said Prof David Robertson, head of the Glasgow Centre for Virus Research.

  • “As a result there’s been some reductions in immunity and thus some more severe cases are now arising.”

But the pattern for monkeypox is different, experts stressed. Because the virus was not previously circulating widely outside Africa, prior immunity was almost non-existent even before the pandemic.

  • The recent explosion of cases, however, demonstrates how easy it is for diseases to spread across borders in an interconnected world. The UK has also seen imported cases of two Ebola-like diseases – Crimean-Congo hemorrhagic fever (CCHF) and Lassa fever – this year.
  • “This multi-country outbreak again highlights that in our globally hyper-connected world of 2022, infectious disease agents rapidly move to all continents,” said Dr. Chris Walzer, executive director at the Wildlife Conservation Society. “Today, no spot is so remote that its pandemic potential can be ignored.”

Prof. Riley added: “If there are other ‘exotic’ viruses that have been circulating at low levels in the UK during the COVID restrictions, I would expect that they will make themselves known quite quickly now restrictions have lifted.”

Source: Sarah Newey – The Telegraph