The disease continues to spread. How do doctors deal with this situation? Report in Geneva.
Until recently, the term was unknown. A first case of monkeypox monkey pox, was confirmed in Switzerland on May 21. The virus has since spread across the world and the WHO yesterday declared the organization’s highest alert level. All of this puts pressure on specialists. How do they work?
At the HUG in Geneva some patients are cared for in the HIV-AIDS unit. Which turned everything upside down. Two researchers, a clinic director, three residents and nurses devote two to three hours a day. For example, Alex Kodiyan, doctor on duty, is responsible for testing three to four people a day with symptoms reminiscent of monkeypox. Vicinity’one of twoinfection is confirmed.
In order to do justice to these patients, a biosafety concept was introduced. FFP2 mask, passage through a side corridor, consultation in a separate box, disinfection… A professional protected from head to toe takes the samples necessary for the diagnosis (swabs from the lesions or from the throat).
A colleague stands to one side, taking notes and touching the devices that will leave the room. Thus, the tube of sample handled by the first nurse is pushed into a larger container held out by his colleague. Similar precautions are taken in the laboratory. The patient must return home on foot, by car or bicycle. But not by bus.
If infection is confirmed, isolation will continue until symptoms resolve, which can take up to 20 days. The canton medical service carries out contact tracing. With one hospital stay (there were four in the HUG, but none in the ICU) we use a room with protection from aerosols.
“Mostly everything goes well. Complications such as secondary infection of the lesions, which can be treated with antibiotics, are to be feared.
Alex Kodiyan, HUG’s doctor on call, performing the tests on the patient
All this reminds of the Covid? Alex Kodiyan notes a difference: “With the monkey pox, transmissions are mainly associated with close skin or mucosal contact. Questions arise about a possible role of sperm in contagion.
Among the patients, many are wondering: is it serious? “Most of the time it’s going well, the doctor assures me. Complications such as secondary infection of the lesions, which can be treated with antibiotics, are to be feared. In most cases, the symptoms are mild. The illness usually 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 more can be seen on the genitals. “So far it looks like the usual lesions leave a small scar that is healing well. But we don’t look back,” says Alex Kodiyan.
More than 15,000 cases have been confirmed worldwide since early May, according to the website Our world in data. So far, these infections have mostly affected men who have sex with other men. in the Swiss, there were around 80 cases at the end of June. This week, that number surpasses 220. According to the WHO, the disease affects more than 70 countries. It has caused five deaths this year, all in Africa, while mortality in the African regions where this virus was already circulating has been estimated at around 1%.
Aren’t we doing too much? Pauline Vetter, Referral Clinician for the Center for Emerging Viral Diseases, disagrees: “When a new virus emerges, people who know the transmission routes and the symptoms must be informed.”
“When a new virus emerges, people who know the transmission routes and the symptoms must be informed.”
Pauline Vetter, Advisor for the Center for Emerging Virus Diseases
Above all, it is important to inform those who are most likely to be infected so that they can be tested if necessary. “Otherwise we cannot try to avoid transmission to the most vulnerable people (immunocompromised people, pregnant women and children),” concludes Pauline Vetter.
If the precautionary principle is applied, this is also because there are still many uncertainties. Although the disease already existed in Africa, it was studied very little. And around fifty mutations have been observed in the virus, which is spreading in the West, with no known effects.
To learn more, a observational study is carried out in several European countries. Ultimately, at least 500 people are to be observed for six months. In Switzerland, the HUG coordinates this project. And in Geneva, the first five patients were admitted.
“During the symptomatic phase, their viral load is measured three times,” explains Yvan Gosmain, who organizes the project in Geneva. They also have to fill out a questionnaire every day that indicates the number and type of lesions and assesses the pain.
Through the international association, doctors want to get answers quickly. They’re particularly interested in an oral antiviral drug designed specifically for monkeypox, tecovirimat. This is not yet available in Switzerland, which has been criticized. The hospital hopes to dispose of it as part of the European study.
For the record, there is a third-generation vaccine against classical smallpox that provides immunity against it monkey pox. France in particular offers it to the most exposed people. Concerned about a rise in cases of “nearly 50%” in a week, the European Commission on Monday announced it would buy around 54,000 extra doses.
“We don’t yet have the vaccines in Switzerland that would allow us to run such a campaign,” says Alexandra Calmy, head of the HIV-AIDS unit. But progress is being made and the professor is also following the clinical studies that are being set up with interest. “They will allow treatments to be better positioned as soon as the first signs appear or only in the most severely affected or vulnerable patients.”
Caroline Zuricher has been a journalist for the Switzerland section since 2005. It deals in particular with topics relating to health and health policy. Previously she worked for Swissinfo and Le Matin.More information