Smallpox of the monkeys: ‘Brazil repeats the same mistakes made with Covid’, warns president of Conass

Expand testing, update case isolation guidelines and run after vaccines.

For health doctor Nésio Fernandes, president of Conass (National Council of Health Secretaries), these are the three urgent actions that Brazil needs to take to contain monkeypox before it becomes an even more serious crisis.

The specialist, who is also Espírito Santo’s Health Secretary, points out that the country’s response to the new disease is “protocol” so far and may become “insufficient” in the coming months.

​”In our assessment, Brazil runs the risk of repeating the mistakes made at the beginning of the Covid-19 pandemic”, he warns.

“With the coronavirus, we didn’t have testing criteria for suspected cases right from the start. At the time, this prevented the country from knowing the real size of the problem we were dealing with”, he contextualizes.

Fernandes explains that, at the moment, there is a kind of “epidemiological silence” about the monkeypox virus, the cause of the condition, in some Brazilian regions.

In other words, this means that the pathogen may be spreading through the population without being adequately detected by the health services.

“For now, each state is acting independently and has its own criteria for testing and monitoring cases”, he evaluates.

“We need national coordination to update and standardize the strategy across the territory and not allow monkeypox to become an even greater threat.”

“Without national coordination, the acquisition of inputs, medicines and technologies is also much more difficult”, he adds.

According to Our World In Data, there are more than 17,000 confirmed cases of monkeypox in the world. Of these, 813 were diagnosed in Brazil.

‘A matter of time’

In Fernandes’ assessment, the decree of public health emergency of international importance issued by the WHO (World Health Organization) on June 23 was a hit.

“The decision makes it possible to accelerate surveillance actions and the development of technologies to respond quickly to the disease.”

“Without this state of emergency, communication and actions to contain the problem vary greatly from country to country”, he analyzes.

The sanitary doctor explains that, in aspects such as the characteristics of transmission and the action of pathogens, it makes no sense to compare the coronavirus and monkeypox.

“We cannot use Covid as a criterion to recognize other situations as a public health emergency. The disease caused by monkeypox, even with a lower lethality, circulates at a relevant speed and in international proportions”, he says.

Fernandes also argues that the distorted notion that the disease only occurs in specific groups, such as young people, gays, bisexuals or men who have sex with men, represents a major trap.

“It is normal and expected that some diseases affect more frequently some specific groups”, he explains.

“However, given the monkeypox’s own characteristics, it is a matter of time, perhaps just a few weeks, before it starts to be found more and more in other groups, such as heterosexuals or the elderly.”

But what needs to be done?

Asked by BBC News Brasil about the concrete actions that Brazil needs to take now to deal with monkeypox, the president of Conass summarized the need to change public policies in three aspects.

First, recognize that all States are at risk and must already have community transmission of this virus.

“From this, we need to increase our testing capacity and increase clinical suspicion, which defines when a person should undergo such an exam”, he suggests.

Second, Fernandes says that special attention must be paid to the criteria for isolation of confirmed cases — the main form of transmission of the pathogen happens through direct contact with a patient’s wounds. Other routes of infection are saliva droplets and the sharing of contaminated objects.

Restricting contact with someone who has monkeypox is essential to breaking the chains of transmission of the virus in the community and preventing an even faster increase in the number of cases.

“We are concerned about the current scenario, in which it is recommended only the isolation of those who had direct contact with someone infected. We see that, in many cases, the disease evolves with mild symptoms and few injuries, which can go unnoticed”, he evaluates.

“We should have objective public health measures and create clear communication about what to do,” he adds.

The third and last urgent action, in the specialist’s view, is to accelerate the search for vaccines that protect against the disease.

“Brazil is slow and needs more vigorous efforts to acquire these immunizers”, he criticizes.

“Apart from the fact that we have internationally recognized institutions in the country, which could be mobilized for the production of this vaccine. Our country also has great international weight, and could use this influence on the WHO or on the market to guarantee doses”, he indicates.

“We need to understand that Brazil is a point of great movement of people. Having this uncontrolled disease in our country represents a risk not only for us, but for Latin America and the whole world.”

Finally, the sanitarian understands that there is still time to control the health crisis related to monkeypox.

“If we have updated responses, which increase testing, blocking transmission and vaccination, we can talk about controlling this disease over the next few years”, he believes.

“However, countries that underestimate monkeypox now will have a much greater impact,” he concludes.

BBC News Brasil contacted the Ministry of Health to seek an official position on the actions being taken to deal with monkeypox in the country, but we have not received any response until the publication of this report.

– This text was originally published in https://www.bbc.com/portuguese/brasil-62309648