What to expect from monkeypox and whether the number of cases will increase again
KYIV. UkraineGate , 4 , June , 2022 | Society.
Ukrainians joke gloomily that on February 24 our country became the first in the world to win COVID-19. But as the chief infectious disease specialist of Ukraine, Honored Doctor, Professor Olga Golubovska told in an interview – the situation with code is developing naturally and should not be relaxed. We talked to her in an exclusive interview about what lies ahead, what diseases can replace the covid and whether we will wear masks again.
They started the conversation with an infection that excited the whole world – monkeypox.
– I remember when the epidemic of covid was in full swing, I kept asking when it would end. And you then gave a terrific answer: “The covid will end and there will be something else. Definitely will. For example, a smallpox … “. And here – the monkeypox. I wonder how you knew? And they knew that it was smallpox…
Let’s start with my field of activity. After all, I not only teach, but also engage in scientific activities, and this includes the search for information, its monitoring, systematization, analysis. And this is information from around the world. Having a certain baggage of knowledge, experience, as in any other field, not only in medicine, experts, of course, can predict something. Sometimes it works, sometimes it doesn’t work.
– So you predicted smallpox?
It’s not just that we talked about it … We need to understand that not everything that we discuss or analyze, including for our various services, is published in the public sphere. This is done in order not to sow panic, not to provoke unnecessary unprofessional discussions, which (as we saw in the example of Kovid) only hindered the normal and coordinated work. And this forecast did not arise on an equal footing. The fact is that in 2018 the FDA (US Food and Drug Administration – ed.) Approved a completely new antiviral drug for the treatment of smallpox – tecovirimate under the trade name TPOXX. I would like to emphasize that the drug is used to treat smallpox in the world. In January this year, the indications for the drug were supplemented by smallpox. In the United States, some categories of the military are vaccinated against smallpox, and it is thought that this vaccine can protect at least in part against monkeypox. Of course, given these facts, we have already speculated.
In addition, in March last year, NTI, an international non-profit organization funded by Bill Gates and Ted Buffitt, which deals with the prevention of possible biological threats, conducted a fictional exercise in conjunction with the Munich Security Conference. And the “legend” of the exercises was the monkeypox pandemic. It was March 2021. According to this fictional scenario, an outbreak of monkeypox occurred in the fictional country of Brinia, which was caused by a leak of biological material due to poor infection control from a neighboring country hostile to this Brin. The material was used for sabotage at the station, where there was a large crowd. There was an outbreak, which by June reached about one and a half thousand patients and was the first death (now there are data on the death of a patient in Nigeria). By January, the outbreak had affected about 70 million people and 1.3 million dead. By March 23, the pandemic had reached a size greater than COVID-19. In total, by the end of the pandemic, there were about 3.5 billion patients and 270 million dead. Data on these exercises were published in November last year on the NTI website.
So, of course, our vigilance increased. Interestingly, according to the scenario, in the beginning the international community reacted calmly to the data about this outbreak. No serious recommendations were given. And you and I know that an extraordinary meeting of the World Health Organization was held recently, which stated that there are no data of concern yet. I would not be so categorical that everything is so easy and simple. Although, based on formal knowledge about this disease today, there really should be no data for concern. After all, it is a zoonosis – a virus transmitted from animals to humans. This virus is transmitted through very close contact from animals to humans. Now the data is that from person to person, but the transmission is not very intense. That is, the index, so to speak, of the infectivity of this disease is five times less than that of covid. It is necessary to try to get sick. However, reports of sexual transmission are also alarming. What was not before. On the other hand, the pathogen has a fairly stable genome. But in nature there are several varieties, several lines. For example, the West African line and the Congo Valley line. And the second type causes the disease with 10% mortality. It’s a lot. And in the West African variety somewhere 1% mortality. After all, there are antiviral drugs that make me personally happy as an infectious disease specialist, because you know that the main thing in the treatment of infectious diseases is the timely appointment of specific therapy. By the way, according to the scenario of this study, vaccines were ineffective. Why am I so attentive to these scenarios? Because such a scenario, such training was conducted by these organizations on coronavirus infection and completely, unfortunately, was justified.
– We are talking about vaccines. Moderna has already started developing a smallpox vaccine. Could this mean that after testing it, we will come to the same vaccine boom as in the case of covid?
You know, it’s hard for me to comment on what might be… You know my position on this issue…
– Reasonable vaccination?
So. Unfortunately, many of COVID-19’s treatment recommendations were also erroneous internationally. This has already been recognized. Or they were too late. Although everyone was already shouting that a completely different treatment was needed. And by the way, all the treatment we talked about has now been recognized by the World Health Organization. Including remdesivir. They have already recognized that it is effective – a drug that has saved a huge number of people. But what a debate there was about this, and at the international level, when we hid a huge number of people! The mind does not understand … And now the World Health Organization has recognized that when administered in the first seven days after the onset of the disease – it is quite effective and significantly prevents mortality.
Why am I constantly talking about it, repeating it and trying to draw attention to it? Because we are on the verge of new challenges, including a pandemic scale. And we have no right to make such terrible mistakes and completely ignore the opinions of experts. I think that there were a lot of purely politicized things in the covid and a banal desire to make money. And it’s not just my opinion. There are many examples of experts trying to counter this, with protests in the UK and other countries. There have been cases where FDA experts who were part of a group that even approved vaccines have written statements of withdrawal due to disagreement with the approval of recommendations. These people simply have a conscience and a professional ethic. There are also such scientists in our country, for example, the director of the Institute of Epidemiology and Infectious Diseases, Professor Zadorozhna Victoria Ivanovna. Any recommendations must be current, scientifically sound and in accordance with the principles of “do no harm”. For example, if vaccination is 90% effective, it is one question, if it is 50% effective, it is another question, if it is 20% effective, it is a third question. In addition, both age and risk groups should be assessed. In fact, we have just begun to study the code, still ahead.
– As you said, you have already announced the sexual route of transmission.
This has not been described before. And if so, then we are dealing, perhaps, with some modification of the virus, which may later provoke quite serious trouble for us. Do you remember how the covid began? I then wrote a post on Facebook – I was interested in the situation in Wuhan, and then only 40 people fell ill with pneumonia. All. And in two or three months, what did we get? Especially after the Champions League in Italy… So let’s see how it will be in the near future.
– Your assumption that the fame of monkeypox will not beat the glory?
I repeat, based on formal knowledge, this should not be the case today. But if we are talking about a modified version of the virus, and it can only be a modified one – then let’s see. Coronaviruses, which cause mild respiratory diseases every year, we were also not very worried about the known events. We must remember that any epidemic begins with a relatively small number of cases, while the pathogen accumulates in a non-immune environment, “feels”, so to speak, the soil, gaining virulence. And then, there is the explosive, literally vertical increase in morbidity, as we saw with the code. And here I will remind you once again that the registered drug for the treatment of monkeypox…
– Then the question arises, when should a smallpox epidemic occur, if drugs are already being prepared for it?
Hypothetically, these drugs, of course, are not strictly specific. That is not only this pathogen and all. They belong to the so-called etiotropic drugs, which are effective for several pathogens from the so-called group. poxviruses, including monkeypox virus. By the way, I want to pay attention, because a lot of confusion, monkeypox has nothing to do with chickenpox, chicken pox. Absolutely! No chickenpox medications are effective for treating monkeypox. Quite different pathogens, with different properties. And so they need to be treated as completely new pathogens in the human population, which today acquire new features. Some drugs for the treatment of cytomegalovirus infection are considered effective for smallpox, such as cidofovir and brintsidofovir, but both of these drugs have been studied only in vitro and in animals. and whether a person will benefit from it is unknown. Let’s see how it will be…
– The Chief Sanitary Doctor of Ukraine said that cases of monkeypox will be registered in Ukraine, but no epidemic outbreak is expected. The virus will be able to be localized.
Based on the formal knowledge of this pathogen, the fact is that these outbreaks have always been very susceptible to anti-epidemic measures. That’s why everyone says that’s why the World Health Organization has said it doesn’t see any dangers yet.
– Confidence in the World Health Organization has decreased after Kovid.
But so far we do not really see any formal signs. We must base our forecasts on scientific data, not on fantastic ones. You can only fantasize about a scenario, such as a global one, to see how someone will react. By the way, as a result of this voiced scenario, the conclusions were made that the response systems in many countries are very poorly prepared. Insufficient funding, particularly at the regional level. Infection control systems in biolabs that study various viruses work very poorly. And there is very little oversight of this research in the world. This is a summary, but we still understand that today everything here leaves much to be desired. It is quite difficult to fight the invisible world of microbes with obvious methods. Sometimes these methods cause rejection in people, I mean anti-epidemic measures,
– We actually went to the lockdown.
This is a very difficult question. I have said and say that, unfortunately, our anti-infection protection system has not been restored. We have formal people who are called chief health doctors, but there is no system. There was no vertical, and there is no legislation, there was no legislation. And Bill 4142 (Draft Law on the Public Health System – ed.), Which is still being pushed through the Verkhovna Rada (I very much hope that this will not happen), will completely bury and destroy our biosafety. There are negative reviews from many experts, but who needs it?
– To close the issue of smallpox… Microsoft founder Bill Gates has announced the possibility of a new pandemic in the next 20 years with a probability of 50%. He used to be more categorical. Besides, it won’t be monkeypox. The billionaire noted that the human population is growing and we are invading new ecosystems. “You have to pay for everything.” Gates has a lot of “informational” diseases that involve the production of vaccines and their introduction to the masses. Doesn’t that seem strange to you?
I’m not very committed to conspiracy theories. I think that there is a banal making of money. We have seen on the example of Kovid, which was, in the opinion of experts, a lot of completely unfounded recommendations. It’s just business. We can just discuss and everyone will have their own opinion, which we will not be able to confirm or refute. But according to formal signs and knowledge about monkeypox, it should not be catastrophic today. But we have a “keep in mind” scenario.
“So she won’t surpass the sad fame of Kovid?”
So. But there will be new pandemics, the WHO has repeatedly stated. By the way, a few years before the covid, the WHO also announced that we are facing a pandemic caused by a new virus. And it was emphasized that it will be mandatory, only a matter of time.
– Wait, let the exhale from the covid – a hard strip.
Yes, and any state must understand and not intimidate people. But we live in such a world, we can’t get away from it and we can’t influence it… But this debate…. Our world is now so open that everyone, sitting on the couch, has the right to their opinion and can argue with anyone.
– You can argue with a professor, an academician …
So. Not even realizing what they are saying. Such a world. We are not going anywhere from him. We can talk about anything, but the main thing is that the state has a response system that can protect against any threats, protect as much as possible, and provide treatment to clinicians…
There was a recent meeting of the National Security and Defense Council. By the way, they listen to doctors and specialists, we cooperate very well and closely. Fruitful. Unfortunately, the recommendations of the National Security and Defense Council are optional. And we have such “statesmen” who may not follow the recommendations of the structure responsible for our national security. For me, at least, it’s strange. But this is the situation. And we must be ready for everything.
Any epidemiological surveillance of any disease begins with a competent doctor who will be the first to diagnose. Do you understand? How many such examples were there, even those variants of the virus, remember when we first discovered dangerous variants of kovid? It is very important to identify the first patient. The sooner you detect it, the better your chances of locating any outbreak, no matter how severe. This requires training, and we are teaching, but the most important thing is to retain specialists. And we have not done this in recent years, on the contrary.
– With smallpox clarified. Let’s go back to the covid. Where did he go? On February 23, we were still wearing masks, and then the war won the covid? Did a new, more formidable collective enemy simply appear to minimize fears of the code?
We said that all subsequent variants of coronavirus will not be so difficult. There are several options that are of concern. This is the British version of the Delta version. Omicron is less virulent, less aggressive. But he compensated for the less aggressiveness with a facilitated transmission mechanism and the involvement of children in the epidemic process. It eludes immunity, both natural and artificial, and therefore it causes a huge number of patients, the number of hospitalizations was large, although very serious patients were still less than in the “British” and the Delta. In addition, we have already learned to treat. Many people have taken antiviral drugs on an outpatient basis. We have developed a regulatory framework that allows hospitalization of patients for intravenous antiviral drugs in the first days of illness.
But our situation is such that you cannot prepare the regulatory framework so that it is approved immediately. Disputes begin on the part of people who do not understand anything in this, opposition. There is no “you have no right to your opinion” in the WHO protocols. And we have a leapfrog. That is why I always say that in addition to a large information campaign in the narrow environment of medical workers, which we constantly conduct, we also need to educate the population. Journalists are very helpful in this. So you know, I’ve always been happy to give different interviews. By the way, we were already working on monkeypox among medical workers.
And back to remdesevir. I wrote a post stating that the WHO approved it as an effective drug. I read the comments, and the woman writes that she lost her husband, begging to give him this drug at an early stage of the disease, but the doctors refused because …
– Because they didn’t want to take responsibility.
Because the WHO did not recognize. And in our standards he was. In the end, the woman lost her husband because the drug was introduced too late. And the temporal factor in infectious pathology is the most important.
– Olga Anatoliyivna, will we meet the covid in the fall?
So. Kovid is now there too. He did not disappear.
– More than a thousand people were hospitalized in Ukraine.
Yes, there are still many and I think this is not the end. Currently, the increase in hospitalization is observed in the United States, France and many countries. As always, he will come to us a little later. But the other thing is that it will not be as catastrophic as it was with those new versions of the virus. Yes, tactics have already been worked out. In the fall or mid-summer there may be some growth and an increase in hospitalizations. In the United States, in May, the number of hospitalized people literally doubled in a week, and they hospitalize very difficult people. According to our regulations, there are many more eligible patients. Because we are hospitalized with a course of moderate severity, but from risk groups for the introduction of timely antiviral drugs, if tablet forms are not available. At least we’re trying to do that.
– On February 24, we faced a new reality, and for us, smallpox and heartburn receded into the background. So it’s an infection, so it’s a pandemic, but there is a full-scale war. What are infectious diseases of war and how does infection live in war conditions?
Infectious diseases are always accompanied by crises, cataclysms and even without war – social upheavals in society, natural disasters … Ukraine has led and is leading in outbreaks of many infectious diseases. We are the leader in the spread of HIV in Europe, we are in the lead in tuberculosis, including multidrug-resistant tuberculosis. Measles outbreak – we are among the top three world leaders in this disease after Madagascar and the Philippines… But there are various specific diseases in the war. The southern region is a matter of concern – we very much hope that there will be no outbreak of cholera. And these are intestinal infections.
– Hepatitis A…
Again, it belongs to intestinal infections. These are infectious diseases that are spread by rodents, hantavirus infections, such as trench fever, and so on. Wars and famines go hand in hand, difficult times await us, food crises, stresses weaken the immune system, and we become vulnerable to those infectious diseases that are usually very difficult for immunocompetent people to catch. And even if we get infected, we get sick easily and do not pay attention to it. And in a special environment, the pathogen feels great, in the human body there is no rebuff. Among low-immune and immunodeficient people, it is gaining aggression, what we call virulence. Then causes outbreaks. They will be with us. Everything is ahead. We have not escaped epidemics since the 1990s, starting with diphtheria.
– There is a special first aid kit of a soldier, we know that there are pills for water disinfection. Maybe you should put some antivirals from specific diseases there or is it already in the process?
Antibiotics, of course, are available. And of the anti-virus… in the military sphere – many things are classified. And we have too. I am often asked to show a link to something. And I answer that not everything in the world has a link. And you will never see some things – they are classified as secret. Even the Soviet Union used powerful drugs for the military, who performed certain tasks.
– This is not paracetamol, which can bring down the heat. That is, it is better to raise the immune system?
There are antiviral drugs, some of which are even strictly specific, for example for the treatment of influenza, they, in my opinion, must be in the basic set. We generally live in an era of viral infections, they are difficult to fight, and timely antiviral treatment of some diseases is a real salvation for humans.
– We talked about the state of stress, which at this time weakens the immune system…
Chronic stress.
– Is the three months of the war in Ukraine already chronic stress? Can infectious diseases become more active?
This is already chronic stress. They are definitely activated. But let’s look at the world of microbes – there is a struggle between them for dominance. For example, when there was a covid, in the first season of covid there was no flu at all. This was the weakest season of influenza during the whole observation period.
– The flu came out of the chat.
This has never happened in my life. So! It really was practically non-existent. This is international data. It was in a small number of cases and did not cause mortality. Therefore, everything will depend on global processes, not just local ones.
But remember how many epidemics we have had since the 1990s? Diphtheria. And then there was no war, but there was an epidemic of diphtheria in the post-Soviet space, which is described on the WHO website. And there was no such thing in the world – so many patients among adults. This is a disease of children. And it is also impossible to explain this only by reducing the level of vaccination. Because sick adults who were normally vaccinated at the time were sick. They were sick and dying. My PhD thesis was on diphtheria. When I compared those cases in adults, the damage to the respiratory system was terrible, I found similar in only one professor in a dissertation dated 1914, but it was about a child. Here and without war it was enough. Social stresses endlessly provoke various infectious diseases. Social stresses and a weak system of epidemiological surveillance.
And measles? It would be strange if he and I did not enter the top three. What happened to us? People had a fever at home for five days, and it was difficult to bring down the temperature. The person is already tense, and then there is a rash. You can’t call a doctor, an ambulance doesn’t come – the number of calls is outrageous. And what does the patient do? Goes to the clinic. In the most contagious period of the disease – in the period of rashes. He sits there in line and infects everyone around. Patients used to ride the subway in Kyiv. And our hospital (Alexander Hospital – ed.) Was completely destroyed.
– Because two subway cars have already become infected …
Not two cars, but the whole station, the whole branch. And that’s why we inflated this epidemic artificially. I said that then and I say it now. The measles epidemic coincided with the collapse of the Sanitary and Epidemiological Service and the reform of the health care system. We do not have a resource for counteraction today, everything is unbalanced. Many of the things that were realized in the covid were done only on the enthusiasm of the people. All were taken out by professionals in epidemiology, who quickly began to return, and professional doctors who treated patients properly, rather than following false recommendations.
– Can we expect outbreaks of the same measles in the near future, especially where the concentration of people has increased, in the centers of migrants, for example?
I think we will do without measles for several years. And then let’s see, anything can happen.
– Wearing masks. At the time, it seemed to me that this dispute would be eternal. We recall the WHO recommendations: first it should be worn by those who are ill, then – healthy, then – all. We got used to it in two years. They have expired since the end of February. And in principle, nothing terrible or bad happens. But won’t we return to the mask mode?
If there is a new pathogen, we may return.
But I remember that argument. And I was horrified when such elementary things are discussed at the international level, spending money on some research, zombie training… because during the period of infection growth, already in the center all people are regarded as potentially infected… Now I do not know whether I am infected or not, but I will know only when I get sick. Therefore it is necessary to dress on all in the period of intensive growth. And this does not prevent the disease, but a person can get a lower dose of the pathogen. Therefore it is not necessary to wear masks in parks, in woods, on the street. The other day I saw the only man walking down the street in a mask. Which means the power of habit seems to say it’s better to forget to wear shoes than a mask… (Laughs)We must breathe, be with nature, our lungs must be well ventilated. But indoors, in stores, for example, where there is no special ventilation – there is a concentration of the pathogen and the likelihood of infection increases. And here people went everywhere, especially young people, not paying attention to the common cold – and this was the initial, most contagious period. Five days after the onset of the disease, the infectivity decreases sharply, and in hospitals, surprisingly, patients are much less contagious than in stores, especially with mild forms of the disease, such people are more dangerous to spread the infection. Everything must be approached wisely.
– Can I not wear a mask today?
It is possible. And do not wear. Currently, the incidence rate is at a minimum. But there is still growth. But if we have an outbreak of something else related to hostilities, it could also have an impact. Let’s see. The main thing is that infections are, have been and will be. That’s for sure. You should . afraid of them. They need to be understood.
SOURCE: Ukrgate
