Ebola emergency simulation in Malpensa Airport, Milan, Italy. November 2014. (Image by Davide Calabresi / Shutterstock.com)

Monkeypox infection: It could have been much worse than how it turned out

Five Singapore residents where identified as having come in close contact with the 38-year old Nigerian who had contracted monkeypox prior to his arrival in Singapore on 28 April. They, along with 18 others are under quarantine now.

The Nigerian man in question had attended a workshop on 29 and 30 April. However, on 30 April he developed symptoms which included a fever, muscle ache, chills, and skin rash. Subsequently, he decided to stay in his hotel for the next few days instead of going out. He was then taken to a hospital by ambulance on 7 May. There, he was referred to the National Centre for Infectious Diseases (NCID) on the same day who a day later (8 May) confirmed that he was infected with monkeypox.

Having identified the virus, the Ministry of Health (MOH) worked quickly to track people who had come into close contact with the patient. Thus far, they’ve identified 23 individuals, most of whom had attended the same workshop as the patient on 29 and 30  April. They’ve been offered vaccines to prevent the disease or reduce the severity of the symptoms and they are being monitored under quarantine for 21 days from their contact with the patient as a precaution.

This recent monkeypox case is an example of how close Singapore came to an outbreak if it weren’t for a little luck on its side.

It was a close call. If even one thing played out differently, we would be writing a whole different set of news articles. The man contracted a rare viral zoonosis (virus transmitted from animals to humans) with symptoms similar to but less severe than smallpox and is very difficult to transmit. It is also self-limiting, with symptoms lasting between 14 – 21 days at most. There is also no evidence to date that person-to-person transmission of monkeypox can sustain the infection in human population. All that works in favour of Singapore to some extent.

On top of that, the man had decided to stay in his hotel room when he started experiencing symptoms, meaning he had limited contact with the general population with also greatly reduced the spread of the virus.

Singapore was lucky this time

But imagine if he had decided to just weather through the symptoms and go out anyway, to enjoy whatever time he had in Singapore to see the sights and enjoy himself? That alone could have made the situation worse.

And what if the man had a more easily transmittable and deadlier virus?

Here’s a nightmare scenario to consider:

Imagine if the patient had Ebola instead – a virus that killed thousands in West Africa during epidemic between 2013 to 2016 –  and he didn’t have the good sense to stay indoors despite his symptoms but instead decided to go out, meet friends, and make full use of his time here in Singapore by visiting tourist attractions like Universal Studios Singapore or the Singapore Zoo and Night Safari?

Now, the patient who brought the virus into Singapore didn’t know at the time that he was infected. No one else knew either until after he was taken to the hospital a week after developing severe symptoms. Of course, it’s difficult in a case like this put a finger on any one thing that could have been done to prevent this. As the man didn’t develop symptoms until a few days after his arrival in Singapore, there was no way for anyone to know that he was carrying the virus into the country. For their part, the NCID and MOH worked quickly to contain the virus as soon as the patient was diagnosed and Singapore was fortunate that they managed to track down those who were exposed to the virus.

But while MOH’s tracking system was efficient, it was largely luck that kept the situation from spiraling out of control. Imagine the scale of exposure just one infected person’s short trip would have created and the resulting panic and damaged it would have caused if locals and visitors in Singapore came in contact with the virus unknowingly