The next pandemic? Why monkeypox isn't the new COVID

As cases of monkeypox spread across the world, with the medical community still grappling with the cause of the spike, it may raise alarms for some and trigger memories of the early days of COVID-19.

But health experts say that monkeypox isn’t likely to have a similar impact to the coronavirus and cause a worldwide pandemic, mainly because it isn’t a new virus and doesn’t spread the same way as COVID-19.

So far there have been 26 confirmed cases of monkeypox in Canada, 25 in Quebec and one case in Ontario. 

Outbreaks of the virus have also been found in countries in Europe and Australia, along with the U.S. The Czech Republic and Slovenia recently reported their first cases, now making 18 countries to detect the virus outside of Western and Central Africa.

“As surveillance expands, we do expect that more cases will be seen. But, we need to put this into context because it’s not COVID,” said Dr. Maria Van Kerkhove, the World Health Organization’s technical lead on COVID-19, in a live online Q&A on Monday.

CTVNews.ca breaks down the origins of the monkeypox virus and how its significance will likely differ from COVID-19:

Monkeypox isn’t a new virus, and we already know how it spreads

Monkeypox was discovered in 1958; it is a rare disease caused by a virus that belongs to the same family as the one that causes smallpox.

The disease was initially discovered in monkey colonies used for research. The first human case was not discovered until 1970 in the Democratic Republic of the Congo, two years after smallpox had been eliminated in the region.

Monkeypox is "not easily spread between humans" but can be transmitted through large respiratory droplets or direct contact with skin lesions, bodily fluids or contaminated materials like clothing, family physician Dr. Rhonda Low told CTV Morning Live on Wednesday.

Large respiratory droplets generally do not travel far, and require extended close contact to transmit the disease.

COVID-19 spreads much more easily. It doesn’t require skin-to-skin contact to spread and can transmit at a “conventional distance,” according to the World Health Organization (WHO).

The virus can spread during conversations with an infected person and if an infected person shares a room with you. The virus spread fastest in poorly ventilated rooms.

A distinguishing symptom of monkeypox is a rash that usually begins on the face and then spreads to a person's limbs or other parts of the body.

"It seems that people are only infectious when they have those skin lesions," Low said. "The risk to the general public is low, but we want to know if it exists."

Experts believe the current monkeypox outbreak is being spread through close, intimate skin-on-skin contact with someone who has an active rash. That should make its spread easier to contain once infections are identified, experts said.

"It's not a situation where if you're passing someone in the grocery store, they're going to be at risk for monkeypox," said Dr. Jennifer McQuiston of the Centers for Disease Control and Prevention, in a briefing on Monday.

A vaccine that can protect from monkeypox currently exists

The Orthopox family of viruses includes monkeypox and smallpox. Smallpox, which used to kill millions of people every year, was eliminated in 1980 thanks to a successful global vaccination effort. Routine smallpox immunization for the general population ended in Canada and the United States in 1972.

The smallpox vaccine can still be used to protect against monkeypox and has a greater than 85 per cent efficacy, according to WHO.

There is also a newer vaccine that was approved for the monkeypox in 2019, but the availability is limited. The WHO also notes that an antiviral agent known as tecovirimat developed for smallpox was licensed for monkeypox in 2022 by the European Medical Association, but is not yet widely available.

Antiviral drugs for smallpox could also be used to treat monkeypox under certain circumstances, a spokesperson for the U.S. Department of Health and Human Services said in a statement.

In Canada, PHAC says it has given Quebec a small shipment of the smallpox vaccine Imvamune from Canada's National Emergency Strategic Stockpile, with other jurisdictions able to receive some supply.

In April, Public Services and Procurement Canada submitted a tender to purchase 500,000 doses of the Imvamune vaccine between 2023 and 2028.

PHAC also says that there is currently no need for mass immunizations for monkeypox.

COVID-19 is more contagious and more deadly

COVID-19 is now considered one of the most contagious viruses in the world; a major reason why it spread as quickly as did.

Medical researchers measure the contagiousness of a virus by determining its basic reproduction number, or R0. This number measures how many people are likely to be infected by one sick person.

An R0 of 1 means the average carrier can be expected to infect one other person. An R0 below 1 means the virus will die out on its own and a higher number increases the possibility of outbreaks, epidemics and pandemics.

For COVID-19’s original version in 2020, the number was between 2 and 3. That number is likely more than double for the omicron variant, recent studies show.

While the Monkeypox’s R0 has not yet been determined, it is thought to be far less than that of COVID, according to WHO.

Previously, the longest documented chain of Monkeypox infection was four generations of person-to-person transmission, Health Canada notes, suggesting that it has “limited potential for epidemic spread.”

Monkeypox is also less deadly than COVID. While there is a more serious strain of the virus, Low said most cases being reported are mild infections.

"It goes away by itself in two to four weeks without any treatment," she said.

In Africa, one to 10 per cent of those infected with monkeypox die. Death rates have been higher among children.

The WHO says that the case fatality ratio in recent times has been around three to six per cent, but the suspected cases in Montreal and other overseas cases appear be milder.

With files from Solarina Ho and Associated Press 

Do you have any questions about monkeypox?

CTVNews.ca wants to hear from Canadians with any questions.

Tell us what you'd like to know when it comes to monkeypox.

To submit your question, email us at [e-mail] with your name, location and question. Your comments may be used in a CTVNews.ca story.