Monkey Flu

[summit]

There is no sign of monkeypox fizzling, or even slowing down.

I never said it was fizzling now. I said it would fizzle without becoming a pandemic and thoroughly explained why.

And I was speaking of Wuhan in Feb 2020 for halting a large outbreak. And Australia, New Zealand, Taiwan... There's nothing special about those countries that prevent their approaches from working elsewhere.

You think China stopped it in Feb 2020??? Most of us don't believe the PRC numbers at all. PRC's "COVID Zero" was a mixture of propaganda and draconian policies. Now, to give credit, they may have prevented a complete collapse of functioning society after starting from a perilous point on the epidemic curve, but starting so late was the CCP's fault.

There is something special about those countries.

As many have mentioned in the past, single nation islands are very different animals than the rest of the planet when it comes to affordable and sustainable TC modifiers in an airborne pandemic. The level of draconian action for those TCs was extreme even in Australia. To achieve the same on large multinational continents is a vastly larger set of difficulties and costs. In large continental nations, it was really only able to be attempted by police states like China, where it still failed to stop COVID. That said, there were varying levels of success in managing the impact. The US could have done much better than we did.

it's a different disease now

Yes, but we also have better and different tools now that we didn't have in early 2020 (widespread cheap rapid testing, widespread cheap effective masks, widespread effective treatment, and widespread vaccine).

And I get that MSMs are immoral and deserve to get sick. During Covid's early days, it was the immoral liberals deserving sickness. (/s for anyone thick in the head)

Dunno why you think that "sarcasm" is funny. Otherwise comes across as a thinly veiled implication, which is rather obviously wrong. Either way, in the realm of epidemiology we deal with risk as matter-of-fact without moral judgement. Nobody deserves to get sick.

However, you might be interested to know about SNS releases of vaccine for proactive general vaccination of the high risk groups in certain states in including CO which has 8 cases. CDPHE vaccination criteria now includes "All gay, bisexual, and other men who have sex with men (cisgender or transgender) aged 18 and older who have had multiple or anonymous sex partners in the last 14 days." This is in addition to the strategy of reactive ring vaccination strategy: "People identified as close contacts to someone suspected or confirmed to have monkeypox."

This is fortunate given we have the Jynneos attenuated vaccinia vaccine which will have a smaller adverse effect profile than previous smallpox vaccines. The side effect profiles are a consideration of risk vs benefit in vaccine eligibility recommendations.

[bodywhomper]

Interpreting for important parody:


https://twitter.com/drleanawendv/sta...0YCvh63cAa6TWw

[LongShortLong]

Fauci doesn't want people to worry about coronavirus, the danger of which is "just minuscule." But he does want them to take precautions against the "influenza outbreak, which is having its second wave."

That's downplaying from mid-Feb 2020 (timewise about where monkeypox is). Wuhan had been locked down for 3 weeks at this point with a rapidly falling infection rate. Anyone looking at China's numbers leading up to lockdown, and after that point could see Covid was serious virus.

Maybe all CCP data is fake, but the Covid data sure looked real to me. Their actions matched the data. Their data matched the pandemic in other countries (cases double every few days). Besides the reflexive "commies bad" I see no reason to mistrust it. Also several weeks from discovery to cordon a major city is very responsive for any human endeavor. And CCP is bad, covid response just wasn't and example of that.

Anyway for monkeypox, CDC/USG et al better get on those vaccine problems. That article I linked said NYC injected all their Jynneos on day 1. It also says a bunch of virus is in Danish freezers, but the bureaucrats are still deciding whether and how to use it. If they don't move fast, there won't be enough. And they're bungling testing again (not as badly). And several other issues.

[LongShortLong]

As for the "implication," I inferred that you meant MSMs just needed to cool it for awhile and monkeypox would go on its own. You seem to also imply the CCP is to blame for Covid getting loose. I'm less confident blaming the "others" will solve our problem. In both cases, I find them indistinguishable from other humans in any way that matters.

If you didn't mean that, say so, and sorry for mis-inferring your implications

[jono]

You guys need to read slower. Summit described heterogeneous population effects, not xenophobia. LSL said "change the trend" and Summit described things that could/should change it. But might not. What's the big disagreement? Maybe I need to read slower.

[LongShortLong]

Maybe I'm oversensitive to people downplaying diseases. Played too much "Pandemic" (a race against fictional pathogens) and think the CDC should be more on it. Although for monkeypox so far, the bulk of the cases are on the Euro agencies. But CDC is slowrolling too, so I'm not happy. And I mean CDC generically as I understand that specific agency is limited in actions it can take.

Also there is too much wanting to believe it's going to be ok, when the math says it's not ok. I happen to be good at math. To the point where I've heard virologists and public health experts say things that just aren't true. Some admit they aren't good at math, which is less reason to give them a pass. And maybe that's a tough problem... they could go check with a mathematician, physicist, or engineer, but while those fields are better at math, many individuals in those fields are also number reasoning impaired. So they could ask an expert and still get a bad answer.

Maybe it's not a bad disease, and it's ok it becomes widespread. And if it adapts to spread better in humans, that's a bummer but not worth much effort to stop it. Monkeypox isn't ebola level virulence. Society seems to have accepted Covid level virulence for example.

[Harry]

Which thread to post this in ?

This poor chump got infected with both Covid and MonkeyPox at the same time.

https://www.nbcbayarea.com/news/loca...taboola-recirc




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[PB]

Whoa .... bats, rats AND monkies?!? Dudes a playa'

[Core Shot]

Which thread to post this in ?

This poor chump got infected with both Covid and MonkeyPox at the same time.

https://www.nbcbayarea.com/news/loca...taboola-recirc




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Hmmmm. Gay man in San Fran gets pox and Covid?

I’m shocked!!

PS. The dildo on the wall behind him is awesome.

PPS. Be gay. I don’t care. But don’t rawdog strangers and you’ll be fine.

[mcphee]

^great job on this PSA. condoms totally prevent a disease spread through skin to skin contact.

[Core Shot]

You’ll be fine. I doubt anyone wants to hug you

[mcphee]

^your wife is giving me a mouth hug right now

[Core Shot]

While anyone can get monkeypox, 96% of D.C.’s cases are in men; 82% identify as gay. The majority of cases are in people 30 to 34 years old.

Those eligible to receive the monkeypox vaccine are D.C. residents who are at least 18 years old and who are:

Gay, bisexual and other men who have sex with men and have had any anonymous sexual partners in the last 14 days.
Transgender women or nonbinary persons assigned male at birth who have sex with men.
Sex workers (of any sexual orientation/gender).
Staff (of any sexual orientation/gender) at establishments where sexual activity occurs (e.g., bathhouses, saunas, sex clubs).

[mcphee]

^obsess over male gay sex much?

[summit]

It's not an obsession to quote criteria. Just because someone you don't like is saying it doesn't mean you score points by casting aspersions...

The risk factors and risk groups are apparent to public health and interventions follow to protect these at risk groups. Normally they are primarily at risk for having way more fun than everyone else.

I would be curious about the socioeconomic breakdown. I'd place a wager that cases are majority upper class and middle class as much spread has come from world and national travelers. Can't really risk stratify based on economics here, but you can based on activities.

[mcphee]

Yea, you’re right. His first instance of bigotry was in this thread this morning. I should treat him with the grace that he deserves and shows everyone else. My bad.

[DBdude]

There are not that many MSM and there is minimal vaccine deployment. Vaccine deployment is being stepped up for the high risk community in the US. There is no reason for this to be a pandemic

Ha ha ha ha

I’m sorry

This is a slow moving disaster


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[Core Shot]

Yea, you’re right. His first instance of bigotry was in this thread this morning. I should treat him with the grace that he deserves and shows everyone else. My bad.

I don’t think that word means what you think it means

Gay monogamy has zero risk of monkey pox.

Follow the science

[summit]

Multiple partners isn't necessarily immoral, but it comes with risks.

[LongShortLong]

About 20 minute into tonight's PBS newshour , an epidemiologist Gregg Gonsalves opines on Monkey Flu, and how the government is bungling the response. Starting with lack of testing... where have we heard that before? The one treatment (Tpox?) is very hard to get due to paperwork requirements. He thinks we're moving too slow on vaccines. I think he vastly underestimates the vaccines needed.
https://youtu.be/BKlPuTLXj8U?t=1155

The available vaccine doses are distributed. There's 300,000 more that will be here by Thanksgiving.

He worries we'll have 10-20 thousand US cases by Thanksgiving. I say he's another expert who can't do math. Using a similar projection to that I used earlier, we could be at 25,000 cumulative cases by Labor Day, perhaps a bit earlier. Thanksgiving might see 20 million (if the growth trend continues). Note that 20 million far exceeds the available vaccine doses. We need to get ahead of this now.

My projection : https://ourworldindata.org/monkeypox. Add the United States. Change the y axis to log scale. Note the curve appears linear - that means it's spreading exponentially, and not slowing down. Note cases grow about 10x per month. 2500 today, 25,000 next month, 250k in September, etc.

Standard disclaimer about forward looking statements, especially so with projecting exponential growth. I'm unconvinced this will stay in MSMs. It's already being seen in their close contacts. Even if it does, it's unclear we run out of susceptible population before 20 million cases, though probably?

[SumJongGuy]

So maybe you can get it from high fiving someone at work or handling someone's clothes, handing them their jacket, maybe even picking up something on a store shelf that someone else handled 10 minutes prior? Don't know but kinda sounds like you don't really have to be intimate with an infected person to get it.. What if the person cutting your hair has it?

[summit]

We have over 250 million doses of vaccine if we need it, if such wild numbers came to pass. It is the ACAM2000 vaccine, completely effective, but there is a higher risk than the brand new two dose Jynneos vaccine we are using preferentially, although ACAM2000 is a slightly lower risk than the previous smallpox vaccines like we were giving before 2007.

It is all about risk v benefit.

Remind me how many people are dead of Monkeypox in this outbreak? 1? Now you get why TPOXX , which isn't approved under the animal rule, hasn't been pushed to EUA. So, that is an option, CDC declaring an emergency allows the FDA to consider an EUA, but that is about it. It would be nice to EUA Tpoxx.

I do agree that testing has lagged, much to our frustration, but it is getting rapidly better with about a half dozen major commercial reference labs now newly participating.

I'm not worried, and I gave a good chunk of my Friday, Saturday, and even last night dealing with this stuff either in the form of briefings, calls, or consults.

I'm more worried (but not that worried) about whether home antigen tests are still an effective strategy for COVID. That shit actually kills people and infections are random and cryptic.

[summit]

So maybe you can get it from high fiving someone at work or handling someone's clothes, handing them their jacket, maybe even picking up something on a store shelf that someone else handled 10 minutes prior? Don't know but kinda sounds like you don't really have to be intimate with an infected person to get it.. What if the person cutting your hair has it?

Possible, but not likely. Fomite transmission (they touch something, you then touch that and become infected) outside of the healthcare setting is not well demonstrated. Hair dresser? Well if your hair dresser has hands covered in monkeypox sores well then you might notice that. And they will probably feel sick, notice lesions, not come to work. People aren't writing Monkepox off as "just my allergies" or "just a cold." The closest minimization analogy has really been "it's my genital herpes."

If you want a thorough presentation on the epidemiology and treatment challenges, listen to this: https://www.idsociety.org/multimedia...on--treatment/

It is about 90m long though. It is meant for clinicians and epis.

One striking datapoint from the UK dataset was this breakdown of risk factors:

Gay, bisexual, or men who have sex with men (96.2%)
Travel abroad prior to symptom onset (21 days) (30.6%)
Age under 30 years (21.5%)
History of STI in the last year (53.7%)
One or no sexual partners in last 3 months (15.7%)
2-9 sexual partners in the last 3 months (53%)
10+ sexual partners in last 3 months (31.3%)
Living with HIV (29.5%)
On HIV treatment (among living with HIV) (99.2%)
Ever used PrEP (among HIV negative) 222 (79.3%)

So we see young MSM, often well to do, engaging in high risk sexual activity or with those that do. This is illustrated by most monkeypox patients having had another STD in the previous year (vs <5% for adult population), and 79% had taken PRE-exposure HIV prophylaxis which is offered to folks who regularly engage in high HIV risk sex activities. 30% are living with HIV. The area transfer (sexual venues) again illustrates high risk community/activity contact. I think there is a risk of this jumping into a high risk pool like non-MSM high risk sex subgroups.

The outbreak is most contained to a subgroup of a subpopulation. Spillover occurs, but the disease doesn't rapidly spread from spillover events because the transmission rates are much much much lower outside of that subgroup.

[Core Shot]

One or no sexual partners in last 3 months (15.7%)

That stat is troubling. Assuming no one is lying or fooling around.

[summit]

One or no sexual partners in last 3 months (15.7%)

That stat is troubling. Assuming no one is lying or fooling around.

I wouldn't get too hung up on that. Having multiple sexual partners is 7 out of 8 cases even though that is a fraction of the population. You didn't intend it, but "fooling around" is somewhat apt. Reportedly these "0 or 1 sexual partners" are less-than-sex transmission (made out with someone who had oral lesions at a festival/party/bar/rave), in-household transmissions, or situations where the more promiscuous partner brings back an infection.

The other thing about this outbreak is that we are seeing some atypical presentation (for monkeypox) where the lesions are presenting first or only in the anogenital area, making it a little less obvious what is going on especially if it can be written off as a chronic STI flareup but on the other hand lesions in these areas are much lower risk to transmission outside of sexual contact to the anogenital region. We've known this for over 2 months.