Monkeypox breaks through China's defenses! How do assess its health threat and "psychological distance"?

First reported case of monkeypox in mainland China!

Monkeypox is nearer, closer ......5 a monkeypox outbreak in the UK in July, the WHO sounded the alarm in July, and monkeypox cases were reported in Taiwan and Hong Kong, China, until September 16, when one confirmed case of monkeypox was found in Chongqing.

This is also the first case of monkeypox infection in mainland China. The case is from foreign transit Chongqing inbound personnel, by the provisions of the new crown pneumonia prevention and control of inbound personnel during the centralized isolation, found rash and other symptoms, by the Chongqing CDC laboratory testing and China CDC review, the laboratory results of monkeypox virus nucleic acid positive, diagnosed as a confirmed case of monkeypox.

So far, China has accumulated 5 cases of monkeypox: 1 case in Chongqing, 1 case in Hong Kong, and 3 cases in Taiwan.

The boulder has fallen and the threat has become more tangible.

Globally, monkeypox is running rampant: as of September 5, the World Health Organization reported 52,996 cases of monkeypox and 18 deaths in 102 countries and territories worldwide. Also according to data from the Our World in Data project at Oxford University in the United Kingdom, the average daily number of confirmed cases was 492 worldwide in the last week.

But it is worth noting that this number is about one-thousandth of the daily number of new confirmed cases of the new crown. The voices of experts also tend to be optimistic: the monkeypox virus is not very lethal or infectious, has a limited mode of transmission, is only highly prevalent in the gay male population, and is currently preventable and manageable.

If the visual memory of the new coronavirus is masks, protective clothing, and cotton swabs for nucleic acid testing, monkeypox is a series of "dense phobic" visual impacts: papules and blisters on the face, hands, and legs, and pustules on the limbs and trunk.

Faced with another global epidemic since the New Guinea epidemic, how should people who are still under the pressure of epidemic preparedness and sensitivity assess the health threat of monkeypox and the "psychological distance" from it?

Can we prevent monkeypox if we can't prevent new crowns with immigration control?

On September 19, CDC Weekly described the first imported case of monkeypox in mainland China, which appeared in Chongqing, in the form of a field note.

The summary noted that the infected person visited Germany from September 2 to 8, then traveled to Spain, and returned to Chongqing on September 14. He had symptoms of a dry and itchy throat, fever, and a red rash and pustules on his right ankle.

On September 14, at the new crown pneumonia entry isolation site in Chongqing, the infected person reported himself with monkeypox-like clinical manifestations and was subsequently tested and diagnosed as the first imported case of monkeypox in mainland China, which is highly homologous to the German monkeypox virus.

There is an important detail in this summary - the monkeypox-infected person was found at the centralized isolation site for new crown pneumonia arrivals. So, in a sense, China's current measures to prevent the importation of New Crown pneumonia outside of China played an important role in the discovery of the monkeypox-infected person.

Lu Hongzhou, president of Shenzhen Third People's Hospital, told Eight Points Health News that since there was no previous monkeypox epidemic on the mainland, the key is to keeping the entrance, i.e., finding imported cases from outside the country for timely isolation and treatment.

As early as May 30, the General Administration of Customs stated that it should "continue to do a good job of 'multi-disease prevention' to prevent the overlap of epidemics". In the quarantine measures, "strict implementation of health declaration, temperature monitoring, medical inspection, sampling and testing of inbound personnel and other health and quarantine measures".

On July 24, the General Administration of Customs also issued a "Notice on the Prevention of the Introduction of Monkeypox Epidemic into China" to refine the rules of prevention and control. People from countries where the monkeypox epidemic occurs are required to take the initiative to declare to Customs upon entry if they have been in contact with monkeypox cases or have symptoms related to monkeypox, and Customs health and quarantine officers will take medical measures and conduct sampling and testing according to the prescribed procedures.

On the other hand, China is still insisting on centralized isolation and observation of incoming persons. To some extent, China's current measures to prevent the importation of monkeypox into the country are themselves still a variation of the measures to prevent the importation of New Crown Pneumonia outside China.

Several infectious disease experts have told Eight Health News that China has accumulated a great deal of practical experience in dealing with Newcastle pneumonia. For monkeypox, which is much less contagious than New Crown, the mainland's measures to prevent its importation from outside the country, in terms of immigration, are sufficient to deal with the importation of New Crown pneumonia from outside the country.

Considering the current strict border prevention and management methods for New Guan in China, it is difficult to spread to domestic urban communities when a new case like the first one is diagnosed during isolation, but still, one must not be careless.

In Taiwan and Hong Kong, a total of five cases of monkeypox infection have been detected in China so far.

On June 23, after the emergence of the first case of monkeypox infection in Taiwan, Taiwan included monkeypox in the second category of statutory infectious diseases, requiring that once a suspected case is found, it be notified within 24 hours and, if necessary, treated in isolation at a designated isolation treatment facility.

Eight health news noted that to avoid the importation of the new crown pneumonia, Taiwan has not yet fully liberalized its entry restrictions. For people entering the country, they are required to undergo 3 days of home quarantine + 4 days of independent epidemic prevention for a total of 7 days of entry home quarantine measures.

Up to now, there have been three cases of monkeypox infection in Taiwan with a history of overseas residence, all 20-30-year-old men, with residence in Germany and the United States.

On September 6, the first monkeypox-infected person appeared in Hong Kong, a 30-year-old man, who had traveled through the United States, Canada, the Philippines, and other places. The Hong Kong Center for Health Protection pointed out that the patient did not enter the community and was an imported case, and 80 passengers on the same flight with him were being quarantined at the hotel.

On June 10, Hong Kong included monkeypox as a statutorily notifiable infectious disease and submitted the Monkeypox Preparedness and Contingency Plan. on September 2, the CHAR government indicated that it was prepared to respond to imported cases of monkeypox and possible local outbreaks. on September 6, Hong Kong activated the alert level under the aforementioned Contingency Plan after the first monkeypox-infected person emerged in Hong Kong.

However, at the same time, Hong Kong has not yet lifted the control measures for people entering from overseas, and they need to undergo 3 days of mandatory quarantine at quarantine hotels and 4 days of medical surveillance, and 3 days of self-monitoring thereafter.

In other words, in addition to the three cases of monkey-pox infection in Taiwan is currently unclear at what stage was found, Hong Kong and the mainland monkey-pox infection are found during the entry centralized isolation and quarantine, and have not yet appeared community transmission.

Will the small probability event that is playing out in every country inevitably happen in China?

Human concern about infectious diseases has reached a new peak in the years since the New Crown epidemic.

It was once thought that China would be able to stand aside amid a global crisis of multiple monkeypox outbreaks, but the emergence of infected people in Chongqing has shattered that illusion, and the ancient virus from Africa has finally knocked on the door of the country, as almost all epidemiologists expected.

The question that immediately followed was, would monkey pox break out in China?

The consensus of the medical and even scientific community is that - this is highly unlikely.

Virologist Shandong Chang analyzed to Eight Points Health News that the R-value for monkeypox in the real world is difficult to obtain because, half of the population has been vaccinated against smallpox, and the protection from smallpox vaccine is lifelong so that there is an immune barrier to monkeypox. In regions outside the epidemic's source in Africa, the R-value in the gay population may have exceeded 1, but the R-value in the rest of the population in these regions remains below 1.

"In general, infectious diseases with an R around 1 are difficult to spread, so for the general population, monkeypox does not pose an infectious disease threat right now." Chang Rongshan said.

The predominantly contact-transmitted nature of monkeypox directly determines that it may be far less contagious than the new coronavirus, which is transmitted through the respiratory tract.

According to the CDC, intimate contact is one of the routes of transmission, which includes not only direct contact with body fluids and respiratory secretions of an infected person but touching objects, fabrics (clothing, bedding, or towels), and surfaces used by people with monkeypox can also lead to infection.

The CDC believes that a person with monkeypox can spread it to others from the time symptoms begin until the rash has completely healed and a new layer of skin has formed. This process usually lasts 2-4 weeks.

In addition, mother-to-child transmission and animal-to-human transmission are also possible routes of transmission.

Currently, it appears that the vast majority of infections are in men who have had male-to-male contact - WHO states that 98% of people infected with monkeypox are men, 95% of whom have had male-to-male contact, and the median age is 36 years.

In the "Science and Technology Parlor" section of the Oriental Network, Wen Yuma, an academician of the Chinese Academy of Engineering and a renowned microbiologist, and H Biggie, director of the Department of Infectious Diseases at Tangshan Hospital of Sudan University, both agreed that the monkeypox virus would probably have a very different R-value if it had appeared in China, taking into account factors such as the country's sexual culture ethics and cultural habits.

Even in the United States, which already has more than 20,000 monkeypox infections, monkeypox is much less infectious compared to the new crown.

According to the CDC, 23,893 people have been diagnosed with monkeypox in the US so far, including one death. Since May 17 (i.e., the start of the U.S. response to the current monkeypox epidemic), confirmed cases have been increasing day by day, peaking on August 22, and have since begun to recede.

Lu Hangzhou, director of the Shenzhen Third People's Hospital, told Eight Health News that Europe and the United States have begun a "ring vaccination" program, in which people who are known to have been exposed to the virus through close contact with an infected person are vaccinated against monkeypox. However, there is no such vaccination strategy in China yet, but "we can have the ability to do it when we need to".

The key is prevention.

Because of cross-immunity between pox viruses, people who have been vaccinated against smallpox are theoretically immune to the monkey-pox virus.

The theory is a theory, but the key still needs scientific evidence. When Yuma pointed out that, similar to China, the United States has stopped vaccinating against smallpox for many years, and with the increase in the number of cases, there may be retrospective studies by researchers to compare the difference in interactivity between people who have been vaccinated against smallpox and those who have not been vaccinated against smallpox in the face of the monkey-pox virus, which can help policymakers be more confident to promote the use of smallpox vaccine against monkeypox virus.

Zhang Guofeng, chair of the Department of Epidemiology at the University of California, pointed out in a Phoenix op-ed that China only stopped universal vaccination against cowpox in 1982, and that currently people over 40 years of age (close to 50% of the Chinese population) have been vaccinated against cowpox/smallpox (85% protection), and given that the initial transmission index of the virus is quite small, the likelihood of a large outbreak is not very high.

In addition, considering that China already has a very good stockpile of smallpox vaccines based on the "Titan strain", it may be half the battle to develop a vaccine specifically for monkey pox. Considering that China has very rich experience in the development of pox vaccines, it would not be difficult to get started even if we want to do it.

Although it seems that an outbreak of monkey-pox in China is only a small probability event, infectious disease experts continue to emphasize the need for vigilance. Zhang Guofeng pointed out that once an outbreak is detected, emergency vaccination against monkey-pox should be administered to high-risk groups under the age of 40, mainly gay men and lesbians.

What's scarier than the virus?

Epidemics are consistently a hotbed of identity politics. In a new crown pandemic, it is not uncommon to see stories of an ordinary person, or even a person in a certain place, being treated differently and treated as different and poisoned overnight.

Japan, executive director of the Public Health Project, an independent think tank, tends to attribute much of this behavior to the "relocation of anger. People get angry, look for scapegoats, and blame the person or group that "brought" the epidemic here: "How could we be like this if you (they) hadn't been running around?"

According to Si Bayou, a professor at Rennin University of China Law School, the impact of the highly infectious and widespread virus, "the conflict between epidemic prevention and control and the privacy of infected people has become different from that of previous infectious diseases."

And as another infectious disease given the highest level of alert by the WHO after New Guam, people automatically subbed the monkey-pox virus into a tense epidemic prevention and control framework, placing infected people and even susceptible groups into opposing camps.

As the new pox entered its third year, and as the epidemic lingered on and prevention and control measures increased, people became more skilled at holding a magnifying glass to the official public or gossip leaked information about the flow, looking for violations by infected people, and more interested in standing on moral high ground to criticize.

Unlike the full-blown onslaught of the new crown, monkeypox makes the gay male community a high-risk group because of its specific transmission route. An analysis of an international series of cases from April-June in the New England Journal of Medicine, and a study by the CDC in May-July, showed that more than 90% of monkey-pox infections were among men who have sex with men.

"The monkey-pox virus has found a pathway to expand its (transmission and interactivity) by entering a particularly vulnerable group." Jim Ping analyzed that a big reason why the gay male community is more likely to spread comes from the relatively complex and free sexual relationships of some people in this group, "This network of sexual behavior is often difficult to establish in the general population because of the constraints of customs, social attitudes, and issues such as sexual convenience."

And it is for this reason that monkey-pox and sexual orientation, sexual behavior, and other discussions wrapped in one place, more voyeuristic and moral judgment.

In an environment where talk of sexuality, especially homosexuality, is the norm, the discussion of the monkey-pox epidemic has become very torn: on the one hand, in the mainstream narrative, the fact that the first case had engaged in male-to-male sex in Germany has been brushed aside and kept under wraps; but on major social media platforms, these brief words are still screens hotted and highlighted by citizens as a moral condemnation of the gay male community "incriminating evidence".

Throughout the history of infectious diseases, from AIDS and Hepatitis B to SARS, New Crown, and this time Monkey-pox, all have been accompanied by disease stigmatization.

When HIV was first discovered, it was seen as a "symbol of moral decay" and a "punishment for the sexual liberation movement", and in China, it was once a symbol of a "bourgeois liberal dandy with bad manners". In China, it was once a symbol of a "playboy with bad style and bourgeois liberal habits", and was entangled with terms such as sexual promiscuity and drug addiction. Under this stigma, some experts point out that not only are AIDS patients not effectively treated, but those infected choose to hide under pressure, which could lead to a larger-scale infection.

In this regard, Jim Ping believes that living in the age of the Internet and globalization, neither "not talking about it" nor "closing the door" can stop the spread of the epidemic. This is evidenced by the history of AIDS in China, "Just 'don't talk about it and 'keep the enemy out' may play a role in stopping the spread of the disease in the early stage, but as long as the community epidemic case emerge, the effectiveness of this strategy is called into question."

As a still dangerous condition, both infected and susceptible people with monkeypox need effective social interventions. Vagueness or the omission of important facts is not only "a violation of the spirit of science" but also a "vulgarized anti-discrimination" that may be underpinned by deeper, institutionalized discrimination.

The spread of monkeypox has a group preference, but low-risk people are not without the possibility of infection, which means that a small probability event may also happen to ordinary people.

Jim Ping advocates a more direct and unavoidable outreach than "don't say" to protect, "to help susceptible people, we are helping ourselves."