Perhaps I am being pessimistic, with a “glass half full attitude,” but please hear me out. I am optimistic, but I am also realistic, and I pay attention to trends and behaviors in people. When monkeypox was first mentioned in the Canadian media, it was seen as low risk for spread. I laughed and groaned simultaneously. I remember those exact words when public health officials first acknowledged COVID. The concerns were downplayed, and some people felt that our country’s borders were impervious to a tiny, microscopic virus, which we now know is highly contagious, transferred in the air, and mission to mutate continuously.

After all, according to virology, viruses mutate to evade extinction. And after all, they are living organisms and want to live.

The Western world, at large, is trying to “move on from COVID” and return to life before COVID. I might have an unpopular opinion — there will be no such thing as going to life before COVID.

The reality is that the world has changed and will never be the same again. COVID is here to stay. The hope is that we don’t go back to record-level deaths and long-term complications from the disease, but the current trends are not encouraging.

Frankly, I am not ready to “just live with COVID,” as it means accepting unacceptably high rates of long-term COVID; lives are cut too short, and families are torn apart. As uncomfortable as living with COVID is and taking the necessary precautions, I would continue to do my best to protect my family and those most vulnerable.

So, back to monkeypox. Some of you might be wondering what it is? This is what we know right now. Monkeypox is a rare disease caused by the monkeypox virus. The monkeypox virus is related to the smallpox virus. Monkeypox is found mainly in Africa. Monkeypox spreads from person to person through close contact with an infected person, such as through touching or being near (within 2 meters) an infected person who has monkeypox. It can also spread through contact with contaminated objects, such as bedding or clothing or through contact with infected animals, like monkeys, rodents and rabbits.

The monkeypox virus does not spread easily from person to person, and most people who get monkeypox recover entirely. However, monkeypox can be severe and even deadly in some people, especially young children and people with weak immune systems. There is no specific treatment for monkeypox, but there are ways to ease symptoms and help the body fight the infection.

Canada needs to act fast to get the monkeypox outbreak under control by scaling up testing, identifying cases quickly, and solving critical unanswered questions about the origin and ongoing spread of the virus before it takes root here and puts our most vulnerable at risk. Canada needs to learn from the mistakes made during the COVID pandemic. I fear that monkeypox will become the second big pandemic.

So, what exactly is the definition of a pandemic?

A pandemic is an epidemic of an infectious disease that has spread across a large region, for instance, multiple continents or worldwide, affecting a substantial number of individuals. A widespread endemic disease with a stable number of infected individuals is not a pandemic. Widespread endemic diseases with a stable number of infected individuals, such as recurrences of seasonal influenza, are generally excluded as they co-occur in large regions of the globe rather than being spread worldwide.

Monkeypox and public health concerns are the two most common examples of a pandemic. In the past, monkeypox was only present in Africa, but due to increased travel and trade, the disease has also been found in other parts of the world. Public health concerns have also increased due to the spread of monkeypox. So, I believe it’s fair to say that monkeypox has met the threshold for a pandemic.

The World Health Organization (WHO) recently said that more than 1,000 confirmed monkeypox cases exist in 29 non-endemic countries worldwide. Still, some researchers estimate the actual number is more than 1,500 and growing rapidly. This news has sent shockwaves through the public health community as monkeypox is a severe and potentially fatal disease. There is no specific treatment for monkeypox, and it can be challenging to control the spread of the disease due to its resemblance to other pox viruses.

The WHO works closely with affected countries to contain the outbreak and prevent the further spread of monkeypox. However, the sudden appearance of monkeypox in multiple non-endemic countries suggests that there might have been undetected transmission for some time. This is a cause for concern as it indicates that monkeypox could become established in these countries if measures are not taken to prevent its spread.

History often gives us clues about the future.

I believe it is worthwhile to discuss the smallpox pandemic, as monkeypox is similar. Smallpox is a highly contagious disease caused by the variola virus. The condition is characterized by a distinctive rash and high fever, which can be fatal in up to 30% of cases. Smallpox was responsible for an estimated 300-500 million deaths during the 20th century, making it one of the most deadly diseases in history.

Fortunately, smallpox can now be prevented through vaccination. The WHO declared smallpox globally eradicated in 1979, but the variola virus still exists in laboratory stockpiles and could potentially be used for bioterrorism. Monkeypox, a related disease that is endemic in Central and West Africa, can also cause smallpox outbreaks if vaccination levels are low. Therefore, maintaining high vaccination rates is essential for protecting public health.

By no means am I suggesting we need to have the same dramatic lockdowns as we did at the start of the COVID pandemic. However, public health leaders need to learn from past mistakes and go back to the basics of testing, tracing, contact notification, and ramping up the availability of vaccines. Also, we must ensure that sound policies and the framework are in place to quickly and effectively deal with the continuously changing global virus landscape.

I would want to believe that most of society learns from past mistakes, but I am very hesitant to conclude. I hope a year from now, when I re-read this article, I feel I was overly precautious, and my worst fears didn’t occur. Though I can’t ignore my inner voice questioning, “Did we learn anything?”

Tomi Mitchell, a family physician and founder of Dr. Tomi Mitchell Holistic Wellness Strategies, is not only a distinguished international keynote speaker but also a passionate advocate for mental health and physician’s well-being, hosting her podcast, The Mental Health & Wellness Show. With over a decade of experience in presenting, public speaking, and training, she excels in creating meaningful connections with her audience. Connect with her on Facebook, Instagram, and LinkedIn and book a discovery call.

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