Is Monkeypox Next COVID-19? What One Physician Thinks 

Americans should be aware and vigilant about monkeypox, but shouldn’t anticipate another deadly pandemic, a former federal health official says.

“This is completely unlike COVID. Now, what we ought to be doing clearly is not ignore it,” Dr. Brenda Fitzgerald, a former director of the Centers for Disease Control and Prevention, told The Daily Signal in an interview Monday about the new disease.

“So if it occurs in this country, we ought to check out what the contacts were and make sure that this is something that’s not changing,” said Fitzgerald, who was CDC’s 17th director, serving from July 2017 to January 2018.

Symptoms of monkeypox, discovered in 1958 and predominantly seen in Africa, include fever, chills, rash, and lesions. 

“Everybody should be concerned about” monkeypox, President Joe Biden said Sunday, speaking during a visit to South Korea. 

Biden added: “We’re working on it, hard to figure out what we do.”

Fitzgerald, trained as an OB-GYN physician, was commissioner of the Georgia Department of Public Health before beginning work at the Centers for Disease Control and Prevention. 

What follows are her answers to questions from The Daily Signal, lightly edited for clarity and conciseness.

Fred Lucas: Will monkeypox become the next COVID-19? 

Dr. Brenda Fitzgerald: Nothing in medicine is ever 100%. I mean, that’s true. But I think this is enormously unlikely. Enormously unlikely. … It is extremely unlikely that [a pandemic] will happen again, because this is a known virus. 

The problem with COVID-19 is that it was a new virus and you had to make some assumptions about what it would do and then act accordingly. And we may have not done that correctly, or in my opinion, maybe not evaluated correctly to know what to do. But this is a completely different business because this is a known virus. …

So … the U.S. has already dealt with being exposed to monkeypox. I mean, [so far] there are three to four different cases. But the important thing is, if you look at it, is [that] most of them were [associated] with travel. 

There are very few doctors, I think, in the United States that have actual experience dealing with monkeypox because it’s mostly been confined to Africa. … If you look at those cases, the first three that you look at … those are all travel related.

But the important one is that 2003 outbreak, and that’s when 47 people get it. The important thing about [monkeypox] was that it was transferred in a way that we were well familiar with, in that they got it from animals. In this particular case, there were prairie dogs that are being sold for pets. 

Lucas: This was in 2003 with the prairie dogs? [These cases occurred in the Midwest, specifically Wisconsin, Illinois, Indiana, Kansas, Missouri, and Ohio.]

Fitzgerald: Yes. Here are two or three important things about it. 

One is it was transferred in a way we absolutely understand [and] is consistent with our knowledge. And the most important thing is, nobody else gave it. They didn’t transfer it to any other human being. The person-to-person transmission for this virus is that you’re exposed to the lesions or you have cold, prolonged, face-to-face contact. 

For example, if you look at some of the newspaper reports that have reported on the people so far that have been infected … if you do the tracing, and I haven’t seen the tracing, but … they were possibly exposed by prolonged intimate interaction.

So, no, this is completely unlike COVID. Now, what we ought to be clearly doing is not ignore it. So if it occurs in this country, we ought to check out what the contacts were and make sure that this is something that’s not changing.

We know that smallpox vaccine protects against it. Even after you’ve been exposed, within two or three days at least, the reports are that you can be protected if you get your smallpox vaccine. 

And we know what it looks like. People need to be aware of people that have been exposed to travelers from someplace else or have been traveling, say, someplace else. They need to be aware of it. 

But this is nothing like COVID because, again, this is a known virus. We know what caused it. We’ve seen it in the United States before. It was easily controllable, especially those 47 cases that didn’t give it to anybody. 

Lucas: Just a layman’s question: Early in the COVID-19 stages we were hearing, ‘Don’t worry, this can’t be spread from an asymptomatic person to someone else.’ We also were told not to worry about wearing masks. And all these things changed over time. 

Fitzgerald: In my opinion, those comments should never have been made with an unknown disease. Like, for example, I knew when I went from being a physician that was treating patients to being the health officer of Georgia, I felt like I went from treating one patient at a time to 10 million people at a time. But the principles are the same. 

If I have a patient that comes in and I don’t know what’s going on, what you say is, “This is a new virus. Here are some things that similar viruses have been responded to in the past.”  I mean, you give those and then you start investigating them like, for example, they did in Israel. And you say, “OK, here’s what we now know about them.”

Again, … nothing in medicine is ever 100% [certain], nothing. But in this case, I would say that [monkeypox spreading like COVID-19] is extremely unlikely because we will know a lot more about this than we knew about COVID, which is a brand new virus. 

Lucas: So it pretty much comes down to this is an old, existing condition that we know about, and COVID-19 was new. So there is not as much likelihood to have misinformation out there about it. 

Fitzgerald: Absolutely right. And again, we should keep our antennae up. Just because somebody hasn’t traveled to Africa [doesn’t mean he hasn’t contracted monkeypox]. If somebody shows up in your office and they have, you know, a scab that started on their face—because … this breaks out on your face 95% of the time—[and] then all of a sudden started developing this little bump, and then [it gets] kind of pustular and then scabbed over. 

So you don’t ignore it. But again, there’s absolutely no reason for panic. Certainly … seeing a lot of it out of Africa is new. So that means we should watch it. 

Lucas: How did monkeypox spread into the U.S. and Europe? 

Fitzgerald: Looking at some of the repressed reports, there were some events where there was a lot of close contact. And the thought is, it spread from that from a couple of those events. That’s what the working diagnosis is. But that I don’t know, because again, I have not seen the epidemiology. 

But somebody is or should be doing that. And certainly if it shows up in the United States, like this one person that just showed up recently. You trace down the contacts and you figure out where it came from. And if it came from someplace unexpected, meaning you can’t explain it—like you can’t say what this person was exposed to, the person that did come from Africa recently—then you have to look at the genetic testing. 

We have these viruses identified. See if there’s any change in the genetic sequencing. You certainly want to do that and see if there’s any change in the pattern. Is anything out of the normal? And at that point, then you become more cautious. 

Lucas: The Food and Drug Administration has approved the smallpox vaccine for use to combat monkeypox. Is this disease similar to smallpox?

Fitzgerald: It is in the same virus family as smallpox. And it looks like smallpox. … It starts out with fever and you feel bad. And you get a little bump [on your face]. And the bump fills up with fluid and then it fills up with stuff that looks like infection, like pus. And then it scabs over, and then it peels off. So it looks like it’s in the same family of viruses as smallpox. 

Lucas: Smallpox is very dangerous. Is monkeypox as dangerous?

Fitzgerald: Oh, no, it is not. And a good example … is another virus that was kind of similar, which was cowpox. And if you remember, like when the smallpox vaccine was first found, it was because milkmaids didn’t get smallpox. Well, remember that. Remember that from your history.

Lucas: Everybody knows about chickenpox and everybody’s had that. Is it somewhat similar to that or more dangerous than that?

Fitzgerald: Yes, it’s different than that. And chickenpox is much more infectious than [monkeypox]. 

Lucas: Monkeypox, it has been reported, has caused at least one fatality since this emerged. So it can be fatal? 

Fitzgerald: Like most of us physicians, I’ve never treated monkeypox. I need to say that straight away, but I certainly have heard of it. And since I got into public health, I’ve heard of it on more than one occasion. 

Like there’d be an outbreak of monkeypox, for example, in Africa; there’s an endemic population of, probably, rodents. We don’t know exactly which animal carries it, but it’s endemic, meaning that [the virus] lives in the animal population there. And human beings get exposed to it. 

Lucas: So how fatal can monkeypox be, compared to other viruses?

Fitzgerald: The numbers I’ve seen are between 3% and 6% [fatal]. I’ve seen some report from the [World Health Organization] that indicates it can be higher, maybe even 10%. And I’m sure that is an especially vulnerable population. But maybe children [as] a population [are] not quite as healthy as most Americans are.

Lucas: How does that fatality rate compare with other diseases?

Fitzgerald: COVID is one [example of a deadly disease]. Ebola is one that we have seen recently. And certainly the death rate for that was enormously high. And again, Ebola is another infection that is in the animal reservoir in Africa, and people get exposed and there’s a peak outbreak of Ebola. 

So certainly when we first saw that and we didn’t have as much supportive therapy, the [Ebola] death rate was very high. But monkeypox has never been that high. It’s never been something like that. 

Lucas: If a person has not had the smallpox vaccine as a child, should he or she go and get it now? 

Fitzgerald: No. In my opinion, no. Again, if you are in that situation where you’re going to be a health care worker who’s taking care of people, a lot of people … then yes. Obviously, there’s special circumstances. But as for the general population, no.

Lucas: Is there anything else you would like Americans to know? 

Fitzgerald: Again, I think we need to be aware and we need to be vigilant. And we need to do follow-up on any single cases and certainly know that there are. 

There’s the smallpox vaccine. The vaccine has been shown to be up to 85% effective. And there’s a newer vaccine that is specific for monkeypox.

So people should know that there’s already a vaccine and the death rate for the disease is usually mild. And you need to be aware, but certainly there’s no cause for panic.

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