Editorial
A Plague Upon Both Your Houses Deval (Reshma) Paranjpe, MD, MBA, FACS
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n Shakespeare’s day, when both plague and pox were all too prevalent, to wish a plague (or a pox!) on someone was a curse with teeth. “How quaint!”, we said of this curse as schoolchildren studying Romeo and Juliet. “How curious!” said we who had never seen a pox. Poor Mercutio, a casualty of the war between the Montagues and Capulets, utters this immortal line when he realizes he is mortally wounded so we could imagine the gravity of this curse. My medieval history class collectively dressed up in black as the Black Death for Halloween. But plagues are no longer quaint and curious or relegated to costume parties. Today, we have both plague in the form of ever-evolving variants of Covid, and pox in the form of monkeypox. And we have a nation bitterly divided between warring political parties which is a plague and a pox in itself. America might as well be Verona, but the days of a detente a la James Carville and Mary Matalin’s marriage seem long gone. How much medical and political carnage will we see before our nation develops unity and a strong, fast, agile, apolitical and organized public health response to new threats? Plays and novels will no doubt be written about these days we are living through.
ACMS Bulletin / August 2022
Mercutio’s curse has teeth again. Famed wit Dorothy Parker was wont to answer the telephone with “What fresh hell is this?” This is not an uncommon thought for most of us while checking our smartphones for the latest news. Because variety is the spice of life, we have not one but several new plagues and poxes to face, possibilities to ponder and unmentioned implications to consider. Let us begin.
Monkeypox Let’s start with monkeypox. Poxviruses can be spectacular in their presentation and infliction of suffering (hence Mercutio’s curse) and monkeypox lives up to the family name. The name monkeypox is somewhat of a misnomer as primates including humans are secondary hosts; the natural reservoir is thought to be squirrels and other rodents. Monkeypox, like its closely related cousin smallpox, is an Orthopoxvirus from the family Poxviridae. Like smallpox, it presents with fever, lymphadenopathy and characteristic rash; severe cases and death can occur. The case fatality rate for the unvaccinated is much better for monkeypox but still 3-6%, while it is a stunning 30% with the variola major form of smallpox.
Smallpox vaccine offers protection against monkeypox. However since 1980 when smallpox was declared to be eradicated smallpox vaccination has ceased, leaving humanity vulnerable to both diseases. The US has already missed the boat on containing monkeypox (as it did with COVID-19) in terms of quarantine and contact tracing. Initially reported as a disease exclusive to the gay community and spread only by close physical or sexual contact, monkeypox is now spreading widely among the population at large, often by mysterious modes of transmission. In more and more cases patients deny any sick contacts or physical contact of any kind: they have no idea how they came in contact with the virus. The lessons of COVID-19 have not been learned. The CDC and WHO currently maintain that monkeypox is transmitted through close contact with infected individuals (via direct or droplet transmission) or contaminated materials such as bedding (fomite transmission). What implications does this have for contaminated surfaces such as hotel comforters, inadequately cleaned hotel rooms, airplane and public transportation seating, and subways? What implications does this have for Continued on Page 6
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