Updates: COVID-19, Monkeypox, Google trends

DON'T PANIC! on red push button. 3d illustration. Isolated background.

It has been a while since I posted on this blog, or indeed anywhere else. The COVID-19 pandemic is blending into the background (although not going away), monkeypox is disappearing almost entirely from the news and life (almost) as-it-used-to-be is taking over.

But this does not mean less pressure – on the contrary, things seem to be more and more hectic. I am just back from a conference and field trip to Poland, and the new 2022-23 academic year has started this week, although delayed by the Queen’s funeral on Monday.

In fact, I should really have been simultaneously in three places this week: In Glasgow, catching up with my research group. In Heidelberg, attending the European Conference in Mathematics and Theoretical Biology. In London, at the first International Plant Health Conference. At home, recovering from a nasty cold caused by a non-COVID-19 coronavirus…

COVID cases since the start of the epidemic. Note that testing is highly ineffective at the start and at the end of the data.

A quick update on where we are with the pandemic. Following the Omicron peak in winter 2021/22 and another in summer 2022, we see cases slowly climbing up again. It is difficult to compare the 2022 data with the previous years, as testing largely stopped early this year and so we capture just a tip of an iceberg.

Both the winter and the summer outbreaks, although producing a lot of cases, did not result in massive mortality, thanks to vaccination and other control measures. The worrying bit, though, is that the decline – both for the COVID-19 related deaths and the excess deaths – has not been as fast as we would like to. Indeed, the pandemic is still ongoing.

As we are now moving into a “late pandemic” phase (I do not want to use the word “post-pandemic”), the focus changes to the long-term impact of the disease. Long-COVID is one of these, with estimated numbers widely differing, probably depending on the definition.

UK reported cases since June 2022

In the UK, there is a clear concern that we might be approaching a new – Autumn – wave. The most worrying part is not necessarily the actual number of cases – or deaths – but the impact on the National Health Service. The NHS has been in crisis since at least May 2022. A combined impact of another COVID-19 wave and a possible flu epidemic might create a “perfect storm”.

There are many causes for optimism, but there are also many warnings.

We seem to have “normalised” COVID like in the past we did other diseases – most recently influenza. We treat it as a part of life – a risk about which we cannot do much – or, rather, we do not feel like wanting to do much.

Barring the emergence of a particularly nasty strain of COVID-19, we probably will continue with it for a long time. The numbers will probably still go down. People will still die of it, and many more will suffer long COVID.

It will not necessarily show a strong seasonal pattern, although, in the temperate climate zone, it might be more prominent in winter when we are all crowded in small places. And mutations will occasionally cause limited outbreaks. Welcome to the “endemic COVID-19”.

On a more positive side, the monkeypox seems to be going away. A combination of behavioural changes and vaccination seems to be working and the numbers – slowly – are going down.

Certainly, the overall public interest in both pandemics (for the Monkeypox outbreak was indeed a pandemic) seems to be going away, as seen in Google trends for COVID-19

and for Monkeypox

More on excess data and Sweden’s response to the pandemic

A very interesting paper, important for understanding the role of excess deaths data in understanding the impact of #COVID19 and the non-pharmaceutical interventions:

The most important consequence is that we must be very careful when interpreting these data. In particular, direct comparison of countries on the total number of excess deaths can be very misleading, as pointed out in the following tweet:

Thanks to @ikashnitsky

Monkeypox – a zoonotic disease

‘If we have allowed monkeypox to become an endemic virus in the U.S. … it will be among the most unfortunate public health failures in recent times.’

Declan Garvey and Esther Eaton, The Dispatch
BROOKLYN, NYC, US, October 1 2013: Street art in Brooklyn. Old paper billboard saying welcome to New York, with scary drawings of mouse, roaches and pigeon. New York, US.

As monkeypox continues to spread both within and between countries, it is worth reminding that it is a zoonotic disease.

In parts of Africa, where monkeypox outbreaks are much more frequent, the virus appears to persist in other mammal populations. Although it was first discovered in a monkey (hence the name), rodents are thought to be a more likely reservoir.

Monkeypox is not as infectious as COVID-19 and not as dangerous as smallpox. It currently spreads largely in an MSM community (men having Sex with Men), but it is properly not a Sexually Transmitted Disease (STD).

Rather, it spreads through close personal contact, mainly through skin contact. Hence, there have been cases among women and children.

It is disappointing that we did not manage to stop it early. Unlike COVID-19 virus (SARS-CoV-2), monkeypox is not a new disease, it does not spread very fast and easily, we do have relatively safe and sterilising vaccines, and we know how to use them.

Monkeypox has been spreading in a relatively limited network with only sporadic breakthroughs to the general population. Although the long incubation period makes contact tracing somewhat problematic, it would not have been difficult to implement “ring” vaccination.

Once monkeypox becomes established in the ubiquitous rodent population, it will be almost impossible to eradicate. The risk to humans might not be very high,

Is there still a chance to stop it? Yes, but (as with COVID-19) it needs a swift action built on trust with the affected community. We must make sure that we work with the MSM community and not against them.

We must not end up stigmatising the infection but rather encouraging those most at risk to take appropriate actions.