By popular demand (thank you!), I have adapted my original comment here into more of an article-style write up, which can be found at my Medium here.

If you don't want to read all that, no worries, I've expanded a bit on my key points below with some additional links and resources. :)

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1) It seems screening guidance may need to be further updated for NHS 111 and other point-of-contact healthcare staff, to prevent mistakenly failing to identify potential monkeypox cases.

In my original comment/article, I provide a little more context for why it seems the screening guidance may need some fine-tuning; For now, there is no publicly released version of any clinical screening guidelines, so I don't have any specifics to look over to determine what exactly the process is at the moment.

However, possibly of interest, the UK Health Security Agency (UK HSA) has been primarily handling communications and a majority of the publicly released research regarding the outbreak so far, with some related pages having been put up on the UK Government website within the past couple weeks.

Additional Related References for Context:

30 May 2022 - Principles for monkeypox control in the UK: 4 nations consensus statement

01 June 2022 - Monkeypox: case definitions

Infectious Diseases Hub Page (Includes Monkeypox Information)

Health and Safety Executive - Approved List of Biological Agents, 2021 Edition

NHS England - National infection prevention and control, 2022 Edition

UK HSA - Contraindications and special considerations: the green book, chapter 6, 2017 Edition

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2) Better public health communications are desperately needed, and internal healthcare system protocols, communications, and procedures may need further review and/or better implementation if possible.

Self-explanatory, but this has been an ongoing issue throughout COVID-19, and we're seeing some early communications flubs which have already confused quite a few people amongst the general population.

Communicating information effectively remains a big challenge, primarily for external communications with the broader public, however it is important that internal communications (protocol updates or adjustments as needed, healthcare system updates for clinicians, etc.) are also prioritised to avoid confusion or delays.

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3) Confirmation bias and possibly overly restrictive / outdated guidelines present an overall potential risk both in healthcare and among the general public, in regards to suspecting, identifying, reporting, and referring potential monkeypox cases.

I already touched a bit on this here, in regards to the confirmation bias concerns.

Effective communications and timely updates are going to play a big role in making sure the public as well as healthcare service workers are informed and up to date regarding any symptoms, risks, ways in which people who may be having symptoms of monkeypox can obtain further assistance as needed, procedure for identifying and escalating any suspected/potential monkeypox cases, etc.

We need to be sure people are aware of what constitutes risky behaviour (transmission risks), can identify any potential symptoms, are not afraid to seek out care, and are able to do so via appropriate initial point of contact healthcare services which will ideally be using up to date screening questions and criteria to help identify any potential cases and address the situation from there as necessary.

Additional Related References:

25 May 2022 - University College London Hospitals - Guidance for patients with suspected monkeypox

27 May 2022 - Royal Free London NHS Trust - Guidance for patients with suspected monkeypox

01 June 2022 - Royal College of Paediatrics and Child Health - Monkeypox outbreak 2022 - guidance

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4) In-person healthcare services and remote healthcare services are equally important, and carry different risks. Information around any healthcare system protocols may never be released publicly, at least not in full. However, it is worth paying attention to how patients progress through the healthcare system from point of initial identification onwards.

It is also worth thinking about how cases are confirmed, and where there may be logistical or other challenges which may present risk of delays or difficulties in obtaining or confirming results.

Additional Related References:

01 June 2022 - Information on taking, submitting and processing samples which potentially contain monkeypox virus

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5) Overall strain on the NHS presents a real threat to public health in the UK in general at the moment, and it is yet to be seen how this may ultimately impact any measures taken in regards to monkeypox.

I covered this more in depth in several other places, but essentially, the continuous overloading of the healthcare system is a serious concern, and it may be pertinent to take actions to identify, assess, and address any issues which may impact on the ability of the NHS to respond to the outbreak.

There are persistent staffing shortages, supply shortages, ambulance service delays, facility capacity concerns (largely due to COVID-19 on top of typical daily average number of patients for other illnesses or health concerns), backlogged appointments creating delays in accessing primary care resources or services, pharmaceutical supply chain issues causing delays in restocking certain medications, etc.

Not to mention staff burnout and staff retention problems, which were already compounded by both COVID-19 and Brexit, which resulted in a lot of NHS staff leaving the service or moving to other services; I wrote a bit about this here a while back.

All of these issues accumulate and compound on one another, and the government desperately needs to start allocating appropriate funding and resources to the NHS in order to start effectively addressing some of these concerns.

Many of these concerns (and more) are likely to persist for some time, such as the patient appointment backlog, and it has yet to be seen if the UK Government may be willing to actually start focusing on some of these issues in light of monkeypox and the additional risk it presents to public health.

Additional Related References:

02 August 2021 - NHS Confederation - Why is the NHS under such extreme pressure?

11 November 2021 - The Health Foundation - Pressures on the NHS are far from ‘sustainable’

12 March 2022 - The Health Foundation - Why is the NHS really under 'record pressure'?

31 March 2022 - UK Department of Health and Social Care - 2021/2022 Revised Government Mandate to NHS England and NHS Improvement

British Medical Association - An NHS under pressure

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6) While vaccines are available and ring vaccination is underway, there is a high rate of refusal already being observed in both healthcare workers and close contacts of confirmed infected individuals. This could present a serious risk to early containment of any further transmission.

Additional Related References:

01 June 2022 - Recommendations for the use of pre and post exposure vaccination during a monkeypox incident

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7) Jubilee activities may end up playing a role in spreading the virus further, however of course there is no proof of this as of yet, and it may be some time before we notice any symptomatic cases that may result from any Jubilee events due to the fairly long pre-symptomatic stage of monkeypox.

Lots of big crowds with close contact with hundreds of strangers, most people are taking public transportation via maximum or high capacity buses or trains, lots of food sharing at picnics and other events, due to warm weather many people are wearing short sleeves or no sleeves (so lots of skin to skin casual close contact), and of course, people will be having intimate relations as well, because it is a Bank Holiday weekend during summer.

That's not a full list of risks, but needless to say, there is the possibility that some transmission of monkeypox may occur due to Jubilee celebratory events.

With an incubation period of 7 to 14 days on average, depending on how contagious an infected person may be during that stage of illness, it may be the case that not-yet-recognisably-symptomatic people may be attending events in close proximity to others.

It may also be the case that some symptoms may not be immediately identified by a person as being possible monkeypox.

For example, a rash may potentially be interpreted as a lingering sunburn from being outside all weekend, or a fever might be mistaken as part of a brutal hangover post-partying, or the onset of any lesions may be mistaken as an acne outbreak after several days of eating sugary sweets and treats at events.

Of course, there's no way to tell yet, but it'll be interesting to keep an eye on the statistics, as there will be a delay in catching up on the numbers from the Bank Holiday period, and if any cases do potentially develop following any Jubilee events, it will be several days to potentially a few weeks before any such cases may be identified, confirmed, and counted.

Additional Related References:

23 May 2022 - CDC - Clinical Recognition of Monkeypox

UKHSA - Monkeypox cases confirmed in England: latest updates

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As with any ongoing outbreak, more data is pending; Stay tuned!

At time of writing, there are 225 confirmed monkeypox cases in the UK.

Thanks for reading, and I hope this was interesting / helpful! :)