Monkeypox Virus: There was a monkeypox outbreak of 71 cases in the US in 2003. (File)
The World Health Organization has revealed that there are now 131 confirmed cases of monkeypox, and a further 106 suspected cases, in 19 countries. Experts describe the event as “random” but “containable” and was likely sparked initially by sexual activity at recent raves in Spain and Belgium.
Nevertheless, with the world still reeling from the effects of the covid pandemic, the rise of a different disease is putting many people on edge.
Bloomberg Opinion’s Bobby Ghosh hosted a live Twitter Space discussion with Bloomberg Intelligence senior pharmaceutical analyst Sam Fazeli to get the lowdown on the disease and find out whether we should be worried.
Bobby Ghosh: Let me start by asking the most basic question possible: What is monkeypox?
Sam Fazeli: There are, seemingly, an endless number of viruses that circulate in nature. This happens to be one of them. It’s an orthopoxvirus, like other well-known diseases like chickenpox and smallpox. Monkeypox is less problematic than smallpox was in terms of the mortality rate. The virus which is currently circulating seems to be the strain that is endemic in West Africa.
We’ve known about two strains for a few decades. Both are endemic in different parts of Africa – Central Africa and West Africa, respectively – and there have been occasional cases reported outside of the African continent, usually from someone traveling from an affected area. This outbreak seems quite unusual in that cases are being reported in so many different parts of the world all at the same time. What’s happening?
There was actually an outbreak of 71 cases in the US in 2003, not because of a person traveling but because of imported rodents from Ghana. Those rodents then infected pet prairie dogs, who then infected people. There was a possibility of some local transmission back then, but it certainly was passed on from animals to humans. That’s a problem we’re dealing with in many of these viral outbreaks, from bird flu to covid.
In terms of today’s unusual outbreak, we have to be aware that it’s too early to be able to be sure whether the virus has genuinely been separately seeded in different countries or whether at least most of the cases came from a super spreader event. The best way to know how related the cases are is to sequence them. The first genome was published by Portuguese scientists and they found that the virus seems to be quite close to the virus which was found in several countries in 2018 and 2019. That already tells you that it hasn’t necessarily changed a lot. Although all of this is up for revision, it suggests that hopefully we’ll find that the majority of these cases are actually related.
In passing, it’s worth just unpacking that, although it is called monkeypox, it doesn’t really come from monkeys. We only began to pay attention to it when monkeys began to get it. Does it originate with simians now? What do we know about how the disease is transmitted?
Orthopox viruses, especially monkeypox, are viewed as generalists. That means this virus can and does infect a variety of species. Rodents are the most common vehicles for infection, then it jumped to monkeys and now humans. The transmission can happen relatively easily, not necessarily through a specific route. In this case, the view is that it’s spread through contact with contaminated fluids from an infected person and it needs to be relatively close contact.
The likelihood is that the majority of transmission will be when you’re either in very close proximity to somebody who’s got the virus, so you’re picking up their exhaled droplets, or you’re in physical contact with them. It could also be passed on via fomites – touching a surface that someone infected has touched.
There have been some reports suggesting that it happens mostly through intimate contact, including really close proximity or having sex with a person.
I think we have to be very careful not to misinterpret the conversation and the information that’s coming out. Just because the majority of cases have been found in men who have sex with men doesn’t mean anything with regards to sexual transmission. We are only looking at the way this particular spread happened. It could have easily been any other kind of intimate contact, heterosexual or whatever.
What are the symptoms of monkeypox?
It starts with a headache and fever, the usual things that you deal with when you get a viral infection. These symptoms are basically your defense system kicking in. A lot of viruses don’t like higher temperatures, which is why the body raises its temperature. We get a headache and muscle aches because of all the chemicals – such as cytokines – which get released to fight the infection. Then, within a week or two, some people get a rash which develops into pustules.
If you’re covered in these pustules, then you’d have the risk of bacterial infection and, in some cases, sepsis. That’s where the lethality can come from.
There have been zero deaths so far in this particular cluster. The 1-3 percent mortality rate or the 10-13 percent mortality rate for the Central African strain has been mentioned a lot, but you have to remember that, just like covid, it depends on how patients are looked after. If a patient is at home with no oxygen available, no ICU, no medical professionals looking after them, their risk of death is higher. That may be the situation in rural Africa where these numbers have been calculated, but in countries with good healthcare and drugs, I’m sure the fatality rate will remain below 1 percent – 0 percent, hopefully!
The symptoms remind me of my childhood when I got chickenpox. I was bedridden for several days and I remember it being very uncomfortable. Then it went away.
Do we have a sense of whether monkeypox is more painful, or more threatening than chickenpox?
It’s a much more uncomfortable infection if you get the full-blown pustules on your skin, but it varies. I’ve heard of a case where somebody was infected who had previously been vaccinated against smallpox. They had just one or two lesions, which is nothing. That’s what you assume and hope is going to be the case with most people who have been vaccinated already. The question is around folks who aren’t vaccinated. How bad do they get it?
I grew up in India in the 1970s and 80s and I was vaccinated for smallpox as a child. Then smallpox was eradicated and in many countries, vaccines were no longer given.
Does that make us more vulnerable to monkeypox?
Yes, I think it does, which is what’s likely going on here. There was the suggestion that maybe the covid lockdowns increased our susceptibility to disease. You might say that for flu and the coronavirus, both of which are respiratory viruses. Really in this case, I think it’s just a coincidence. We have an endemic virus in Central and West Africa which has then been given an opportunity to spread among a population of people who have never seen an infection or a vaccine that gives them protection against the virus.
It’s good news that the vaccine already exists, unlike with covid. We have vaccines that work both prophylactically as well as after one has got the disease.
So they can be preventative as well as a cure?
Correct, a few days after a diagnosis of infection, the vaccine seems to still do the job. The interesting thing is that both vaccines are manufacturable today. Stocks may not be as high as one would like in situations like this, but many countries had already been stockpiling it, not in fear of monkeypox, but in fear of a bio-terrorism attack by smallpox.
The disease is less transmissible than covid, you don’t need everybody to get vaccinated. You can use it to treat people who get diagnosed and vaccinate the people around them. This method is called ring vaccination, and it’s proven successful in controlling smallpox before.
There was a great deal of discussion about whether poor countries would be able to afford covid vaccines. Is that an issue for monkeypox vaccines?
The covid vaccine from Pfizer was between $15 and $20 a shot. For most of us who live in England, Sweden or the United States, that’s not expensive given the protection it gives you. I expect that for controlling and better managing the global spread of this virus, the equivalence of COVAX will buy vaccines for countries who can’t afford it. At the same time, the cost is determined clearly by the volume. If we only need one million doses, as opposed to a 400 million doses, then companies will probably have to charge a little bit higher because margins will be lower at those sorts of volumes. I’m not expecting this to be a very expensive vaccine.
That’s reassuring. How have leaders responded to monkeypox? President Biden felt compelled to answer a question about it during his trip abroad in South Korea. Have we learned things from our fight with covid at a policy level that are particularly useful in dealing with monkeypox?
The good thing is, as we’ve said already, that this is not a disease which we’ve never dealt with before, even if it may not be necessarily the living memory of many people. It’s only 50 years ago or so that we stopped the smallpox vaccination programs. Bavarian Nordic, one of the manufacturers of a smallpox vaccine, apparently already had meetings with health authorities from several countries just in the past few days, which were arranged six months ago. That shows countries were already thinking about this — whether it was more smallpox than monkeypox that they were thinking of doesn’t really matter.
Is there any reason to think monkeypox is seasonal?
At the time of year when people are more outdoors than indoors, you’d expect most infections, especially respiratory ones, to decline. This is transmitted by contact. So I don’t think we can classify it as seasonal.
What about variants – which have been a real issue with covid? Has the monkeypox virus shown any sign of developing new variants that are resistant to the existing treatments?
It’s way too early to know. Nigeria gathers great epidemiology data, but with the number of monkeypox cases, it’s not anywhere near the scale of SARS-CoV-2. With SARS-CoV-2 also being an RNA virus, it probably has a higher opportunity to mutate.
The early data that we do have from the Portuguese scientists suggests the virus’s genome is similar to what it was in 2018 and 2019, and that’s quite reassuring. When viruses multiply at high levels, you can’t escape the fact that mutations will occur. So we’ll have to monitor it.
What do we do to protect ourselves from monkeypox?
We’ve had this with covid. There are choices that we can all make in our lives relative to our own circumstances, such as opting to wear a mask. If you’re worried or feel threatened, you can take precautions. I think the expectation by most scientists is that this will self-limit eventually, especially when the awareness is so heightened, because it doesn’t transmit that easily.
Now that it’s been a couple of weeks since the story broke and there have been cases reported in various countries, are we already seeing more research being devoted to this outbreak?
I know that the genomics folks are working 24-7 on sequencing the genomes of the virus to better understand the epidemiology. That’s the best way when you only have 200 cases of knowing how these incidents are potentially related to each other. We already have at least two drugs that could treat the virus and two vaccines, at least. So I don’t think we need to do enormous amounts of research. What we do need to do here is to have the right healthcare public health policy in place to manage it and decide where do we go next. Do we go back and vaccinate everybody that wasn’t vaccinated, or do we just manage it using ring vaccination?
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.