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The day to day of those who fight against monkeypox
The disease continues to spread. How do doctors deal with this situation? Report in Geneva.
At HUG, Alex Kodiyan screens patients suspected of having monkeypox daily. He must wear protective gear for this.
VALENTINE FLAURAUD
Until recently, the term was unknown. A first case of monkeypox, or monkey pox, was confirmed on May 21 in Switzerland. Since then, the virus has spread throughout the world and the WHO yesterday declared the organization’s highest level of alert. All this puts specialists under pressure. How do they act?
biosecurity concept
To accommodate these patients, a biosafety concept has been implemented. FFP2 mask, passage through the secondary corridor, consultation in a separate box, disinfection… A professional protected from head to toe takes the samples (swab of the lesions or throat) necessary for the diagnosis.
A partner steps aside, takes notes, and touches the equipment that will leave the room. Thus, the tube containing the sample, which has been handled by the first caretaker, slides into a larger container held by his colleague. Similar precautions are taken in the laboratory. As for the patient, he must return home on foot, with his car or his bicycle. But not by bus.
After the sample required for diagnosis, the tube containing the sample is slipped into an overtube stretched by a caregiver who has not touched the patient.
VALENTINE FLAURAUD
If infection is confirmed, isolation continues until symptoms resolve, which can last up to 20 days. The Cantonal Medical Service provides contact tracing. In case of hospitalization (there were four in the HUG, but none in intensive care), we used an aerosol-protected room.
“Most of the time things go well. What is to be feared are complications such as secondary infections of the lesions, which can be treated with antibiotics.
Is all this reminiscent of Covid? Alex Kodiyan notices a difference: “With the monkey pox, transmissions are primarily related to close contact with skin or mucous membranes. Questions arise about the possible role of sperm in contagiousness.
Among patients, many wonder: is it serious? “Most of the time things go well, says the doctor. What is to be feared are complications such as secondary infections of the lesions, which can be treated with antibiotics. In most cases, the symptoms are mild. In general, the illness begins with flu-like symptoms, followed by a rash. The blisters can be tender and large. In short: it can hurt.
These pustules are likely to appear all over the body, although they are seen more on the genitals. “So far it seems that the usual injuries leave a small scar that heals well. But hindsight is missing,” says Alex Kodiyan.
Since the beginning of May, more than 15,000 cases have been confirmed worldwide, according to the site. Our world in data. So far, these infections mainly affect men who have sex with men. In Swiss, there were about 80 cases at the end of June. This week, this number exceeds 220. According to the WHO, the disease affects more than 70 countries. It has caused five deaths this year, all in Africa, while mortality was estimated at around 1% in African regions where this virus was already circulating.
Aren’t we doing too much? Pauline Vetter, a referral clinician at the Center for Emerging Viral Diseases, disagrees: “When a new virus appears, people need to be informed, know what the modes of transmission are and what the symptoms are.”
“When a new virus appears, people need to be informed, to know what the modes of transmission are and what the symptoms are.”
Above all, it is necessary to educate the people most likely to be infected so that, if necessary, they can be tested. “Otherwise, we cannot try to prevent the spread to those who are most at risk (immunosuppressed people, pregnant women and children)”, concludes Pauline Vetter.
If the precautionary principle is applied, it is also because there are still many uncertainties. Although the disease already existed in Africa, very little has been studied. And about fifty mutations have been observed in the virus that is spreading in the West, without the effects being known.
international study
To learn more, a observational study takes place in several European countries. Ultimately, at least 500 people must be followed for six months. In Switzerland, the HUG coordinates this project. And it was in Geneva that the first five patients were enrolled.
“During the symptomatic period, the viral load of patients (note: who are all volunteers) it is measured three times,” explains Yvan Gosmain, who is organizing the observational study in Geneva.
VALENTINE FLAURAUD
By joining forces internationally, doctors want to get answers quickly. They are particularly interested in an oral antiviral specifically designed for monkeypox, tecovirimat. This is not yet available in Switzerland, which is the subject of criticism. The hospital hopes to make it available as part of the European study.
For the record, there is a third-generation vaccine against classical smallpox, which provides immunity against monkey pox. France, in particular, offers it to the most exposed people. Concerned about an increase in cases of “almost 50%” in a week, the European Commission announced on Monday the purchase of some 54,000 additional doses.
“In Switzerland, we still don’t have these vaccines that would allow us to carry out such a campaign,” specifies Alexandra Calmy, head of the HIV-AIDS Unit. But things are moving and the professor also follows with interest the clinical trials that are being launched. “They will allow treatments to be better positioned, as soon as the first signs appear or only in the most severely affected or most fragile patients.”
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