Pandemic Fatigue and Stigma May Help Spread Monkeypox in M’sia

KUALA LUMPUR: Fresh out of most Covid-19 pandemic restrictions with near-normal life, Malaysia and the rest of the world are now facing another global health emergency – monkeypox.

The current wave began in early May with the first case detected in the UK; it quickly spread by human-to-human transmission to other countries in Europe and North America. To date, it has been found in 99 countries, 92 of which have no history of monkeypox, an orthopoxvirus. Previously, the disease was mainly contained in Africa and transmitted from animals, mainly rodents, to humans.

So far, no cases of monkeypox have been detected in Malaysia, although almost all of its neighbors have reported cases of monkeypox, with Singapore recording the highest number at 16, according to the United States Centers for Disease Control (CDC). United States. How long Malaysia can be waterproof remains to be seen as more and more people travel in and out of the country.

“Finally, I’m sad to say, there might be a possibility of (monkey pox) coming here. It happens,” said Associate Professor Nazlina Ibrahim, a virologist at Universiti Kebangsaan Malaysia.

There have been close shaves – a 45-year-old Malaysian resident of Singapore tested positive in July during a visit to Johor, while his acquaintances tested negative – but so far all suspected cases tested negative.

Experts warn that if monkeypox were to eventually arrive in Malaysia, several factors would determine how far it spreads.

Pandemic fatigue

Considering that the world is still battling Covid-19, albeit to a lesser extent, the speed at which the new, mutated and more infectious strain of monkeypox could spread has taken experts by surprise yet again. Covid-19 precautionary measures, such as social distancing and masking, would have been effective in keeping the virus at bay if they were in effect.

The key word is if.

Many of the countries that first recorded human-to-human cases of monkeypox are in Europe and North America, which were the first to drop most Covid-19 precautions. After two years of limited socialization and no travel, people are tired of being cautious and are now eager to make up for lost time.

In other words, they suffer from pandemic fatigue.

“When we’re trying to recover from the pandemic, I think people just want to go back to where they were; the life of traveling, cuddling, not following social distancing and gatherings. And it’s an opportunity for diseases to spread,” said Dr Rachel Ting, a psychologist at Monash University in Malaysia.

In Malaysia, while many still keep their masks indoors as required by law, the nonchalant attitude towards wearing face masks is more evident now that the government has removed most restrictions. Some walk around with their mask under their chin or no longer mask indoors in offices or auditoriums.

This can backfire as this strain of monkeypox can be spread via respiratory droplets, albeit in nearby environments. Other measures, such as social distancing and limiting contact, are no longer in effect. Monkeypox is most often spread through contact with bodily fluids, direct contact with lesions or blisters characteristic of smallpox, and contaminated materials such as bed linens.

“(Before) people were diligent about health measures like washing hands and not being in close contact with people. But after Covid-19 they seem not to remember all those things,” Dr Nazlina said.

Dr Ting agreed, saying the psychological toll the pandemic has had on people, including depression and anxiety, could contribute to fatigue.

“Being hyper-vigilant and taking care of themselves – I see them all as part of self-care behavior. So I think when people are tired, their self-care behavior goes down as well. They just let go and let go,” she told Bernama.

She added that pandemic fatigue could also present as social avoidance, calling for more psychological assistance for people to recover from pandemic trauma.


Another concern of experts relates to the stigma of monkeypox. Most cases have been reported within the LGBT (lesbian, gay, bisexual and transgender) community, primarily men who have sex with men (MSM), which is illegal in Malaysia.

Associate Professor Dr Rafdzah Ahmad Zaki, an epidemiologist at the University of Malaysia, told Bernama that association with LGBT people can drive anyone who may have been exposed underground.

“We have to be clear. Do not mistakenly assume that monkeypox only affects MSM or LGBT (community). Anyone can get it,” she said.

“So we need to remove that perception, which makes people afraid to get tested.”

She added that stigma can cause people who have been exposed to delay testing, which would delay their treatment or cause them to self-medicate or seek help from traditional medical practitioners.

Worse still, they may continue to see people while they are still contagious and spread the disease to friends and family.

She added that educating clinicians was also important so that they do not confuse monkeypox with atypical varicella, which would have happened in other countries.

Current monitoring methods include doctors reporting any cases of patients showing symptoms of monkeypox, including fever, fatigue, painful swollen lymph nodes, and a blister-like rash on the hands, face, and fingers. genitals, among others. Doctors are required to take medical and travel histories of said patients and collect a sample for testing.

Health Minister Khairy Jamaluddin had said that in the event of an outbreak, monkeypox vaccines would only be available to high-risk healthcare workers and close contacts.

The smallpox vaccine, which was discontinued in 1980 in Malaysia, is said to be 85% effective against monkeypox. Dr Rafdzah warned that the varicella vaccine, however, is not.

Some facts about monkeypox remain murky. The incubation rate has been listed between five and 21 days, while the illness can last two to four weeks. Cases of sexual or asymptomatic transmission of monkeypox have been reported, though the CDC was careful to say that more research was needed. To date, nearly 50,000 cases have been reported worldwide with 16 deaths, with the last death occurring in the United States on August 30, according to the CDC.

Although complacency could be a concern, Dr Nazlina said monkeypox would likely be easier to contain than Covid-19 because it is not as infectious as coronavirus. According to the World Health Organization, the basic reproduction number of monkeypox cases among the MSM population is greater than one and less than one in other settings.

“Carry on with the SOP (standard operating procedure) we have for Covid-19 and be aware of the virus if you are (at risk) of catching it from people who engage in this type of sexual activity,” she said. added. – Bernama

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