Ten Things to Know About Monkeypox

Peaceful Hawaii ocean. (Dr. Noorali Bharwani)
Peaceful Hawaii ocean. (Dr. Noorali Bharwani)

In July, the World Health Organization (WHO) classified the escalating outbreak of the once- rare disease (monkeypox) as an international emergency. The outbreak marked the first time monkeypox has spread widely outside Central and West Africa.

The initial cluster of cases was found in the United Kingdom, where the first case was detected on 6 May 2022 in an individual with travel links to Nigeria. Since then, more than 18,000 people across 78 countries have been infected with monkeypox virus. So far, only five people have died, and no one outside of Central and West Africa.

1. What is monkeypox?

Monkeypox is a viral infection that manifests a week or two after exposure with fever and other non-specific symptoms. Then it produces a rash with lesions that usually last for two to four weeks before drying up, crusting and falling off.

Monkeypox belongs to the family of poxviruses, which includes smallpox. The disease got its name after scientists discovered it among laboratory monkeys in 1958. The first monkeypox case in a human was diagnosed in 1970.

2. Who is getting monkeypox?

According to WHO officials 99 per cent of all the monkeypox cases beyond Africa were in men and that of those, 98 per cent involved men who have sex with men. Experts suspect that monkeypox outbreaks in Europe and North America were ignited by sex at two raves in Belgium and Spain. Cases have emerged in other groups too, including few children.

3. Is this another pandemic?

No, this is not a pandemic (prevalent over a whole country or the world). Monkeypox has been endemic (prevalent in a particular area) for decades in parts of central and west Africa, where people have mostly been sickened after contact with infected wild animals like rodents and squirrels.

4. How does it spread?

Monkeypox spread typically requires skin-to-skin or skin-to-mouth contact with an infected patient’s lesions. People can also be infected through contact with the clothing or bedsheets of someone who has monkeypox lesions.

5. What are the signs and symptoms of monkeypox?

Fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. The time from exposure to onset of symptoms ranges from five to twenty-one days. The duration of symptoms is typically two to four weeks. Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.

6. How is it diagnosed?

The U.S. Food and Drug Administration is advising people to use swab samples taken directly from a lesion (rash or growth) when testing for the monkeypox virus.

7. Is there a vaccine?

IMVAMUNE vaccine has been authorized by Health Canada for active immunization against smallpox, monkeypox and related orthopoxviral infection.

With supplies limited, health officials are not recommending mass vaccination. They are suggesting the shots for health workers, people who have been in close contact with an infected person, and men at high risk of catching monkeypox.

8. Prevention

Prevention is always better than treatment. Get vaccinated. Maintain good hand hygiene and respiratory etiquette, including wearing a mask or covering coughs, along with limiting sexual partners and practising safer sex. Anyone with monkeypox lesions should isolate until they are completely healed, which can take up to three weeks.

9. What is the treatment?

There is no known cure. A study in 1988 found that the smallpox vaccine was around 85 per cent protective in preventing infection in close contacts and in lessening the severity of the disease.

Other measures include regular hand washing and avoiding sick people and animals.  Antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin may be used during outbreaks.

10. What is the prognosis?

The illness is usually mild and most of those infected will recover within a few weeks without treatment. Estimates of the risk of death vary from one per cent to 10 per cent.

Monkeypox can be serious in children, pregnant women and people with underlying health conditions, like cancer, tuberculosis or HIV.

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COVID-19 Reinfection Among Vaccinated Individuals

Photo of African artwork. (Dr. Noorali Bharwani)
Photo of African artwork. (Dr. Noorali Bharwani)

This virus is smarter than us!

According to Dr. Anthony Fauci, President Biden’s chief medical adviser and director of the National Institute of Allergy and Infectious Diseases, the highly contagious Omicron variant will find just about everybody.  Fauci also said, if you are vaccinated you will fare better. Your risk of hospitalization and death is reduced.

But those who are not vaccinated are going to get the brunt of the severe aspect of the disease fueled by the highly transmissible Omicron variant. However, small number of people amongst fully vaccinated may not do well. For example, the very old, very young, and immunocompromised will have weakened responses.

Now the focus should be on making sure hospitals and essential services continue to function effectively. COVID-19 is going to be part of our life. The best way of controlling the infection is for people to get vaccinated, wear a mask in public places and avoid large indoor gatherings.

Third dose of vaccine is 95 per cent effective against hospitalization and death. It also brings vaccine efficacy to 97 per cent for Delta and 61 per cent for Omicron. Unfortunately, only 56 per cent of Canadians 12 and older have at least three doses of a COVID-19 vaccine.

Getting a third dose is important to boost our immunity. Experts believe each shot you receive reduces the severity of disease. Canada’s vaccine advisory body recommends ‘rapid deployment’ of fourth dose for people aged 80 and over.

Scientists are trying to figure out why some fully vaccinated individuals keep avoiding Covid-19 infection and why other fully vaccinated individuals keep getting recurrent infection.

Scientists are warning against lowering our guard. Our current defenses like vaccine may not hold up against the latest version of Omicron, BA.5, which is remarkably good at spreading and evading vaccine protection.

Experts agree avoiding infection is more challenging with BA.5. Omicron and its subvariants have made our social interaction riskier. BA.5, in particular, has increased the odds that people who’ve avoided COVID thus far will get sick.

BA.4 and BA.5 are subvariants of the Omicron variant that popped up late last year and then spread like wildfire all over the world. They were first discovered in South Africa and have recently grown to dominate the transmission of COVID.

BA.5 accounts for more than 50 per cent of new cases and BA.4 20 per cent. These two new subvariants seem better able to evade immunity afforded by vaccination and previous infection.

Majority of people in the U.S have had COVID-19 at least once – likely more than 70 per cent of the country. Other statistics from U.S. show many have been infected multiple times. Canada is no different. COVID-19 has infected roughly half of the Canadian population.

The emergence of an even more contagious version (Omega BA.4 and BA.5) of the virus means some people may be in for another round of infection. We don’t know the long-term effect of Omega variants on infected people.

Scientists are warning people that even if you are fully vaccinated including booster shots and have had COVID-19 after that, there is no guarantee you will not be infected again and again. But the risk of severe outcome may be quite low.

Who is getting reinfected and why? Scientists are looking for an answer to this. Risk of reinfection will always be there. We have to be careful. Hopefully, immunity in the population, whether from vaccines or prior infection, will build up and allow us to reduce transmission and hospitalization. We hope!

How many types of other variants are going to be there? Nobody knows.

Loss of smell and taste. Research shows five per cent of people who had COVID are dealing with long-lasting loss of smell or taste. Some 27 million people worldwide are estimated to have suffered a long-lasting loss of smell or taste. Losing smell has been linked to higher death rates in older adults and has been shown to have major impacts on people’s emotional and psychological well-being.

Get vaccinated. Get your booster shot. Remember, this virus is smarter than us!

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How effective are different types of masks?

A farm in Alberta, Canada. (Dr. Noorali Bharwani)
A farm in Alberta, Canada. (Dr. Noorali Bharwani)

“Face masks work best to prevent the spread of SARS-CoV-2 when everyone wears one. But experts say it is still worth wearing a mask to protect yourself, even if no one else does,” says an article in the Canadian Medical Association Journal (CMAJ March 16, 2022) written by Lauren Vogel, news editor with CMAJ.

Our government has given in to public demand for freedom from wearing a mask to protect oneself and protect others. If you go to a party or shopping mall then almost nobody is wearing a mask. You go to a popular busy restaurant which is packed with people and nobody is wearing a mask.

There is a price to pay for this kind of freedom – more people are starting to get sick. People who are fully vaccinated with third and fourth booster shots are getting sick.

A friend of mine, who had his fourth COVID-19 vaccine shot three months ago recently came down with all the classic symptoms of COVID-19 infection. After two weeks of isolation, he is still recovering. What people forget is that vaccines do not provide 100 percent protection.

Third dose of vaccine is 95 percent effective against hospitalization and death. It also brings vaccine efficacy to 97 percent for Delta and 61 percent for Omicron. What about Omicron BA.4 and BA.5 subvariants? Do the current vaccines protect us from these variants?

The other thing people forget is the protection you get from COVID-19 vaccines can wane over time (4-6 months); so, booster doses are necessary. Boosters can help improve protection against severe outcomes by up to 90 percent. They may also reduce the risk of post COVID-19 condition.

What kind of mask is worth using to protect yourself and others?

Wearing a mask is very important especially if you are indoor in a crowded place with poor ventilation.

I will take the liberty of going back to Lauren Vogel’s article titled, “Is one-way masking enough?” She makes the following points:

  1. Quality of mask: Better quality masks offered greater protection. Wearing an N95 or KN95 respirator lowered the odds of infection by 83 percent, whereas wearing a surgical mask or cloth mask lowered the odds by 66 percent and 56 percent, respectively.
  2. Indoor public settings: Recent data from the United States shows that people who always wore a face mask in indoor public settings were less likely to test positive for SARS-CoV-2 than those who never wore a mask. Crowded indoor environments with poor ventilation is very risky.
  3. Mask fitting: Properly fitted N95 respirators should filter at least 95 percent of virus particles. That’s notably better than the protection offered by universal masking with cloth and surgical masks, which would have fallen on the lower end of 75 – 91 percent.
  4. Other types of masks: Surgical masks filtered 47 – 50 percent of particles, while a simple cotton mask filtered 17 – 20 percent. Cloth or surgical masks are very poor in protecting the wearer or other people.

We need to find more effective masks which are affordable and available to all levels of population. Our fight for survival is not over yet. Governments could also offer clearer guidance on separating good quality masks from the sea of unregulated and sometimes counterfeit options. Some European countries are making it mandatory for people to use high-quality masks and respirators that block 90 – 95 percent of particles.

Wearing a mask is like wearing a seat belt in a vehicle. It saves lives.

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Can we prevent heart disease and cancer by taking vitamins and minerals?

Cypress Hills, Alberta. (Dr. Noorali Bharwani)
Cypress Hills, Alberta. (Dr. Noorali Bharwani)

On June 21 2022, US Preventive Services Task Force released updated evidence report and systemic review of vitamin and mineral supplements use for the primary prevention of heart disease and cancer.

Cardiovascular disease and cancer are the two leading causes of death and combined account for approximately half of all deaths in Canada and US annually.

Canadians spend more than $1.4 billion a year on vitamins and supplements. People in the U.S. spent nearly $50 billion on dietary supplements in 2021. Can this money be put to better use? Today, we will review what the Task Force said.

The Task Force reviewed 84 studies and found vitamins and supplements offer little to no benefit in preventing cancer or heart disease. For healthy individuals there is no need to spend precious dollars on consuming vitamins and minerals supplements.

Recommendations for healthy individuals is that instead of taking vitamins or supplements, eating a balanced diet high in fruits and vegetables and exercising regularly are the best ways to lower one’s risk of cancer or heart disease. A healthy diet is still the first line of defense against chronic disease.

In the past it has been common for health care professionals to recommend vitamin and mineral supplements to their patients for a variety of reasons such as overall health, bone health, musculoskeletal pain, viral infections and immune health.

Independent panel of experts at the U.S. Preventive Services Task Force have concluded that it had insufficient evidence to either recommend or discourage the use of multivitamins or supplements to prevent health outcomes.

The American Heart Association recommends that healthy persons receive adequate nutrients by eating a variety of foods in moderation, rather than by taking supplements.  The US Department of Health and Human Services 2020-2025 dietary guidelines suggest that nutritional needs should be met primarily from foods and beverages.

Task Force says unnecessary use of vitamins and minerals can cause harm. For example – lung cancer incidence was reported with the use of beta carotene by persons who smoke tobacco or have occupational exposure to asbestos.

The review examined the impacts of popular supplements like beta carotene, folic acid, calcium, magnesium, selenium and zinc, as well as multivitamins and vitamins A, B, C, D and E. More large-scale studies have come out since 2014, and there is no convincing proof that vitamins and supplements in general are helping with prevention of heart disease and cancer.

There are exceptions to this advice. In the right circumstances, supplements have health benefits. Vitamin and mineral deficiencies cause myriad illnesses. For individuals who are or may soon become pregnant, folic acid is recommended to prevent neural tube defects and iron is recommended to prevent preterm birth and low birth weight, as well as improve fetal brain development, says the Task Force. Supplements should be used for older adults who struggle to absorb nutrients through food.

The new review found strong evidence that vitamin E in particular did not prevent cancer or heart disease, while beta carotene was associated with an increased risk of lung cancer and death from heart disease. Consequently, the Task Force advised against taking either supplement to prevent heart disease or cancer, the same recommendation it gave in 2014.


  1. The current evidence is insufficient to assess the balance of benefits and harms of the use of vitamins for the prevention of cardiovascular disease or cancer.
  2. The Task Force specifically recommends against the use of beta carotene supplements for prevention of cardiovascular disease or cancer because of a possible increased risk of mortality, cardiovascular mortality, and lung cancer.
  3. The Task Force also specifically recommends against the use of vitamin E supplements for prevention of cardiovascular disease or cancer because it probably has no net benefit in reducing mortality, cardiovascular disease, or cancer.

Remember, healthy diet is still the first line of defense against bad health.

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