Written by: Sam Orlando
STAUNTON, VIRGINIA - Thailand has confirmed its first case of the highly dangerous Clade 1 variant of mpox, raising significant concerns for global health authorities. The patient, a 66-year-old European man who arrived from an unnamed African country on August 14, tested positive for Clade 1 after seeking medical attention the day following his arrival. This variant is known for its higher fatality rate and greater transmissibility compared to the more common Clade 2 variant that spread globally in 2022.
The man had limited contact with others, and Thai authorities have placed 43 people under observation who may have been exposed to the virus. Initial tests strongly suggested the presence of Clade 1, and with final lab results now confirming the variant, this marks the first known case of Clade 1 in Thailand.
The Global Threat of Clade 1 Mpox
Mpox, formerly known as monkeypox, is a viral disease that has two distinct clades: Clade 1 and Clade 2. Clade 1, primarily found in certain African regions, is significantly more dangerous than Clade 2, with mortality rates reported as high as 10-15%. Clade 2, responsible for the 2022 global outbreak, has a lower fatality rate, typically between 1-3%. The confirmation of Clade 1 mpox outside its endemic regions raises the specter of a more severe global health threat.
The World Health Organization (WHO) recently declared a public health emergency due to an emerging outbreak of mpox in several African countries. The spread of Clade 1 to Thailand represents a serious escalation, prompting Thai authorities to increase screenings at international airports and ports, particularly for travelers from Africa. The European patient remains in quarantine, and efforts to prevent the further spread of Clade 1 are underway.
Comparing a Clade 1 Mpox Pandemic to the COVID-19 Pandemic
A global pandemic involving Clade 1 mpox would present a unique set of challenges, distinct from those posed by the COVID-19 pandemic, due to differences in transmission, severity, and required public health responses.
Transmission and Infectiousness
Clade 1 Mpox: Clade 1 mpox spreads through close contact with bodily fluids, skin lesions, and prolonged face-to-face interactions. It can also spread via contaminated objects, such as clothing or bedding. While less contagious than COVID-19, Clade 1 is more transmissible than Clade 2 and could spread more easily in high-density populations or environments where close contact is unavoidable, such as healthcare settings or households.
COVID-19: COVID-19 spreads primarily through respiratory droplets and aerosols, making it highly contagious in a wide range of settings. Its ability to transmit through airborne particles over both short and long distances, even during brief interactions, led to its rapid and widespread dissemination
Severity and Mortality
Clade 1 Mpox: The most concerning aspect of a Clade 1 pandemic would be its severity. With mortality rates as high as 10-15%, Clade 1 is far deadlier than Clade 2 and could cause a substantial number of deaths if it were to spread globally. Patients with Clade 1 mpox can suffer from severe complications, including pneumonia, sepsis, encephalitis, and long-lasting skin lesions, with vulnerable populations—such as immunocompromised individuals, children, and pregnant women—at particularly high risk.
COVID-19: While COVID-19 caused millions of deaths worldwide, its overall fatality rate has been lower, generally around 1-2%, though it varied significantly by region, age, and underlying health conditions. Severe respiratory complications, particularly among the elderly and those with preexisting conditions, contributed to the strain on healthcare systems during the pandemic.
Healthcare System Strain
Clade 1 Mpox: A Clade 1 mpox pandemic could overwhelm healthcare systems, particularly in regions with limited resources. The more severe nature of the virus would necessitate widespread hospitalization, isolation of infected individuals, and intensive medical interventions to manage complications. The need for quarantining patients with Clade 1 mpox would also require special containment facilities to prevent nosocomial (hospital-acquired) infections, placing additional pressure on already strained health infrastructure.\
COVID-19: The COVID-19 pandemic exposed vulnerabilities in global healthcare systems, as hospitals struggled to accommodate the large influx of patients requiring intensive care and ventilatory support. A similar strain would likely occur during a Clade 1 pandemic, but with the added challenge of managing severe skin lesions and potential long-term health effects in survivors.
Vaccination and Prevention
Clade 1 Mpox: A key advantage in fighting Clade 1 mpox is the availability of effective vaccines, such as the smallpox vaccine (Jynneos), which also works against mpox. While this pre-existing vaccine could be deployed rapidly, global supplies are limited, and large-scale vaccination campaigns would be needed, particularly for high-risk groups. Quarantine, contact tracing, and isolation of cases would be essential in containing outbreaks.
COVID-19: COVID-19 posed a more difficult challenge initially because no pre-existing vaccines were available. It took almost a year to develop and distribute effective vaccines, during which time the virus spread rapidly and evolved into more contagious variants. The global rollout of vaccines also faced logistical hurdles and inequities in distribution.
Social and Economic Impact
Clade 1 Mpox: A Clade 1 pandemic could lead to significant social and economic disruption, particularly in countries with high numbers of cases. Travel restrictions, quarantines, and targeted lockdowns might be necessary to contain the virus, especially in regions experiencing severe outbreaks. The potential for fatalities and severe illness would likely cause widespread fear and behavioral changes, affecting productivity and public life.
COVID-19: The COVID-19 pandemic caused global economic recessions, widespread unemployment, and massive disruptions to daily life due to prolonged lockdowns, social distancing measures, and travel bans. A Clade 1 mpox pandemic might not spread as rapidly, but its more severe health outcomes could still lead to serious economic and social challenges, particularly in healthcare and labor-intensive industries.
Managing an Mpox Spread
The confirmation of a Clade 1 mpox case in Thailand raises the stakes for global health officials, as this variant poses a far greater threat than Clade 2 due to its higher mortality rate and potential for severe complications. While Clade 1 is less likely to spread as rapidly as COVID-19, its severity could overwhelm healthcare systems and result in high death tolls if not contained effectively. Vaccines and targeted public health interventions will be key to mitigating its spread, but the emergence of this variant outside of Africa signals that global vigilance is crucial in preventing a Clade 1 pandemic from becoming the next major health crisis.
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