The discussion of hypocrisy brought to mind this old story (I forget where I read it):
An Indian mother was worried about her young son eating too much candy, so she brought him to Gandhi and asked the great man to tell her son to give up candy, hoping that Gandhi's moral authority would make an impression on the boy.
Gandhi told her, "I cannot do this now, but come back in a month and I will tell him then."
The mother was puzzled, but she did as Gandhi said. A month later, she came back with her son, and Gandhi told him: "Young man, listen to your mother. Candy is bad for you. You shouldn't eat so much."
The mother said, "Gandhiji, thank you, but I don't understand. Why couldn't you have told my son this a month ago?"
Gandhi replied, "You see, a month ago *I* was eating too much candy."
The challenge of pandemic preparation is to find a way for our society to protect itself from diseases in a way that's actually sustainable and comes with a minimal risk of overreacting to non-entities like monkeypox is likely to be. And I think most of that work happens below the hood (by improving testing and funding research and other good ideas you have advocated that work against infectious disease in general), not by opening up a vaccine to a bunch of hypochondriacs at zero risk.
Michael Lewis's book about COVID praised its protagonists, who were actually a bunch of alarmist "experts" who wanted to shut down society for swine flu. Obviously this would have been stupid, would have tanked Obama's presidency, and would have left us even worse prepared for the actual pandemic when it hit. But Lewis praised those experts because he thought the precautionary principle is good (it is bad).
I appreciate that this post isn't praising the precautionary principle. But if we treat Monkeypox as a unique threat the way that Lewis's protagonists saw swine flu as a unique threat (as opposed to a common problem where we just need a better response infrastructure), then we'll see it as a success once it goes away on its own like swine flu did, and there will be even less motivation to fix the underlying issues.
OK, as to safety of the ACAM2000, which we all remember from Terminator - Judgement Day:
It is routinely administered to incoming US soldiers, who may one day have an exotic deployment. So, roughly 900,000 vaccine recipients in the surveillance population.
Incidence of myocaridits/ pericarditis was about 218/million in men under 40, 85/MM in women
As a possible comparison, folks remembering the COVID vaccine scares may recall that the MRNA vaccines (esp. seond shot) had an issue with myo- annd pericarditis, especially with young men. Incidence was 12.6/MM across all ages, genders. For young men it varied with age: 56/MM for 18-24, 20/MM for 25-29, 10/MM for 30-39.
So ACAM2000 is 4 to 20 times as risky as the MRNA COVID vaccines (on the myo- and pericarditis metric). IDK - is that daunting?
TWiV had a good discussion on Monkeypox the other day. Basically the same message as you - pay attention but this isn’t new and we have strategies for dealing with it, so let’s use those.
"My radical idea is to urge the public health community to drop its aversion to voluntary action."
Well, that is something that should have been done some decades ago, but today would be better than tomorrow. But in addition shouldn't the CDC have some sort of (pseudo) randomized surveillance, the kind they should have had for COVID?
And as for "don't panic" the end result of that with COVID was that we DID panic, impose a lot of non-cost effective restrictions and messaging on social interactions (like closing schools) while making such a big deal out of vaccine "safety" (to the vaccinated person) that little effort went into telling people ow good it was for preventing infection of other people and reducing the reproduction space for the development of new variants.
Ah, but the public health community often coincides with the medical community. The public policy rationale for the existence of doctors is that people cannot be trusted to make rational decisions about their own health, and should instead submit to the decisions of a trained professional; see https://www.science.org/content/blog-post/drugs-and-money-and-feels for an evocative description of how and why. And voluntary action is precisely one of those rational decisions that medicine doubts! So public health officials will always be saying "don't act on your own; follow the medical community's advice about such-and-such"; then they must always fight their self-interest to not say "don't act on your own; follow the medical community's advice in all things."
I partially agree about the thinking. But ... 1) The basic reason for PUBLIC health is to inform policy about externalities or public goods. 2) Basic. There is no particular harm in PH experts being a conduit for advice relevant to large numbers of people on how to acct in their own self interest like don't smoke (even if smoking produced no externalities.) Neither of these is inconsistent with self testing.
We have three cases now in Sacramento that are all linked to the original patient who was at one of those raves I guess, but the news coverage is still coy and just says that the three people were "close contacts" which I assume means that they were sexual partners, but those words mean something broader to me and I wish they would just be factual and precise so we could better understand how this virus is moving. I am old enough to be headed to get my second shingles vaccine today, but young enough that I just missed small pox vaccination (literally it was declared eradicated days before I was set to get the vaccine) so I feel a little naked right now and part of me would just like to get a small pox vaccine and not have to worry.
I’m not saying you’re wrong, but I am saying I have a limited amount of fucks to give these days and I’m not convinced yet that this qualifies for one.
International travel (and orgies) was a mistake. Shut it down!
Or, for the more neoliberally inclined, perhaps we could collect a tax to properly price the negative public health externalities associated with antisocial behavior like sex partying or going to an international professional conferences.
Well, having just read on smallpox, it is thought most respiratory transmissible at the beginning of the rash, and has also had some airborne transmission documented. In other aspects similar to what has been described as the transmission model for monkeypox.
It could be though that because it was a publicly announced orgy at a rave it was just easy to trace the cases back to that event and test other attendees and find more cases whereas much more common anonymous sex you're not likely to get a notification that you were exposed to monkey pox. The fact that this has spread to so many countries so so fast suggest we're looking at the tip of a giant iceberg.
Slow Boring’s first annual subscriber orgy is hereby suspended indefinitely. Please submit your receipts to Milan to obtain reimbursement for your feathered mask.
I'm back in my office & everyone is shaking hands again. Two new people yesterday. Can we just learn to bow instead? Or would that be cultural appropriation?
"Human-to-human transmission – Human-to-human transmission can occur through large respiratory droplets. Transmission can also occur through close contact with infectious skin lesions or from contact with lesion material.
For droplet transmission, prolonged face-to-face contact may be required for transmission to occur (eg, within a six-foot radius for ≥3 hours in the absence of personal protection equipment [PPE]) .
In general, transmissibility from person-to-person is very low. However, in May 2022 an outbreak of monkeypox in several non-endemic countries was reported with over 90 confirmed cases. In this outbreak, close contact with infectious skin lesions during sexual contact may be the likely mode of transmission. More detailed information will be available following further investigation. Additional information about this outbreak in specific geographic locations is found below. (See 'Geographic distribution' below.)"
Smallpox:
Smallpox can only be spread through humans. It is mainly spread by respiratory viral shedding (eg, via sneezing or coughing) and requires fairly prolonged direct contact between people. Patients with smallpox become contagious as the first lesions appear in their mouth and throat, and infectivity appears to be the highest at the beginning of the rash. Patients remain contagious until their last scabs fall off.
Transmission can also occur through contact with the fluid found in the patient's sores, since they also contain variola virus. The virus can spread through direct contact with these materials or through the objects contaminated by them, such as bedding or clothing. Rarely, smallpox has spread through the air in enclosed settings, such as a building (airborne route)."
Is this the same CDC that said masks don't work, that bumbled the COVID testing strategy, that took the masks off too early, that failed to recommend vaccines based on Israeli data?
Important addendum or caveat: aren’t the smallpox vaccines (at least the older ones?) only 85% effective for monkeypox? Obviously that would still be very good. However, for high risk groups, that’s a point worth taking into account in the calculus, esp. re: MY’s suggestion of having people volunteer to take the riskier older the vaccine to protect themselves from monkeypox.
The discussion of hypocrisy brought to mind this old story (I forget where I read it):
An Indian mother was worried about her young son eating too much candy, so she brought him to Gandhi and asked the great man to tell her son to give up candy, hoping that Gandhi's moral authority would make an impression on the boy.
Gandhi told her, "I cannot do this now, but come back in a month and I will tell him then."
The mother was puzzled, but she did as Gandhi said. A month later, she came back with her son, and Gandhi told him: "Young man, listen to your mother. Candy is bad for you. You shouldn't eat so much."
The mother said, "Gandhiji, thank you, but I don't understand. Why couldn't you have told my son this a month ago?"
Gandhi replied, "You see, a month ago *I* was eating too much candy."
The challenge of pandemic preparation is to find a way for our society to protect itself from diseases in a way that's actually sustainable and comes with a minimal risk of overreacting to non-entities like monkeypox is likely to be. And I think most of that work happens below the hood (by improving testing and funding research and other good ideas you have advocated that work against infectious disease in general), not by opening up a vaccine to a bunch of hypochondriacs at zero risk.
Michael Lewis's book about COVID praised its protagonists, who were actually a bunch of alarmist "experts" who wanted to shut down society for swine flu. Obviously this would have been stupid, would have tanked Obama's presidency, and would have left us even worse prepared for the actual pandemic when it hit. But Lewis praised those experts because he thought the precautionary principle is good (it is bad).
I appreciate that this post isn't praising the precautionary principle. But if we treat Monkeypox as a unique threat the way that Lewis's protagonists saw swine flu as a unique threat (as opposed to a common problem where we just need a better response infrastructure), then we'll see it as a success once it goes away on its own like swine flu did, and there will be even less motivation to fix the underlying issues.
OK, as to safety of the ACAM2000, which we all remember from Terminator - Judgement Day:
It is routinely administered to incoming US soldiers, who may one day have an exotic deployment. So, roughly 900,000 vaccine recipients in the surveillance population.
Incidence of myocaridits/ pericarditis was about 218/million in men under 40, 85/MM in women
As a possible comparison, folks remembering the COVID vaccine scares may recall that the MRNA vaccines (esp. seond shot) had an issue with myo- annd pericarditis, especially with young men. Incidence was 12.6/MM across all ages, genders. For young men it varied with age: 56/MM for 18-24, 20/MM for 25-29, 10/MM for 30-39.
So ACAM2000 is 4 to 20 times as risky as the MRNA COVID vaccines (on the myo- and pericarditis metric). IDK - is that daunting?
https://www.sciencedirect.com/science/article/pii/S0264410X21010744
Per Madison Cawthorn, Republican officials in Washington deemed the most at-risk group.
TWiV had a good discussion on Monkeypox the other day. Basically the same message as you - pay attention but this isn’t new and we have strategies for dealing with it, so let’s use those.
https://youtu.be/dMiT73ycw-I
"My radical idea is to urge the public health community to drop its aversion to voluntary action."
Well, that is something that should have been done some decades ago, but today would be better than tomorrow. But in addition shouldn't the CDC have some sort of (pseudo) randomized surveillance, the kind they should have had for COVID?
And as for "don't panic" the end result of that with COVID was that we DID panic, impose a lot of non-cost effective restrictions and messaging on social interactions (like closing schools) while making such a big deal out of vaccine "safety" (to the vaccinated person) that little effort went into telling people ow good it was for preventing infection of other people and reducing the reproduction space for the development of new variants.
Ah, but the public health community often coincides with the medical community. The public policy rationale for the existence of doctors is that people cannot be trusted to make rational decisions about their own health, and should instead submit to the decisions of a trained professional; see https://www.science.org/content/blog-post/drugs-and-money-and-feels for an evocative description of how and why. And voluntary action is precisely one of those rational decisions that medicine doubts! So public health officials will always be saying "don't act on your own; follow the medical community's advice about such-and-such"; then they must always fight their self-interest to not say "don't act on your own; follow the medical community's advice in all things."
I partially agree about the thinking. But ... 1) The basic reason for PUBLIC health is to inform policy about externalities or public goods. 2) Basic. There is no particular harm in PH experts being a conduit for advice relevant to large numbers of people on how to acct in their own self interest like don't smoke (even if smoking produced no externalities.) Neither of these is inconsistent with self testing.
We have three cases now in Sacramento that are all linked to the original patient who was at one of those raves I guess, but the news coverage is still coy and just says that the three people were "close contacts" which I assume means that they were sexual partners, but those words mean something broader to me and I wish they would just be factual and precise so we could better understand how this virus is moving. I am old enough to be headed to get my second shingles vaccine today, but young enough that I just missed small pox vaccination (literally it was declared eradicated days before I was set to get the vaccine) so I feel a little naked right now and part of me would just like to get a small pox vaccine and not have to worry.
On the general theme of "we're not doing enough to build anti-pandemic state capacity", it's time to rebrand public health as bio-security.
I’m not saying you’re wrong, but I am saying I have a limited amount of fucks to give these days and I’m not convinced yet that this qualifies for one.
International travel (and orgies) was a mistake. Shut it down!
Or, for the more neoliberally inclined, perhaps we could collect a tax to properly price the negative public health externalities associated with antisocial behavior like sex partying or going to an international professional conferences.
Well, having just read on smallpox, it is thought most respiratory transmissible at the beginning of the rash, and has also had some airborne transmission documented. In other aspects similar to what has been described as the transmission model for monkeypox.
Is no one mention that the super-spreader events were two raves where there was widespread group sex?
For now it seems like this context is something that we should keep in mind while evaluating the risk.
People, please refrain from Orgies for the next few weeks just to be sure.
It could be though that because it was a publicly announced orgy at a rave it was just easy to trace the cases back to that event and test other attendees and find more cases whereas much more common anonymous sex you're not likely to get a notification that you were exposed to monkey pox. The fact that this has spread to so many countries so so fast suggest we're looking at the tip of a giant iceberg.
Or that people in to Orgies like to travel.
Slow Boring’s first annual subscriber orgy is hereby suspended indefinitely. Please submit your receipts to Milan to obtain reimbursement for your feathered mask.
Best comment in this thread.
I'm back in my office & everyone is shaking hands again. Two new people yesterday. Can we just learn to bow instead? Or would that be cultural appropriation?
Monkeypox
"Human-to-human transmission – Human-to-human transmission can occur through large respiratory droplets. Transmission can also occur through close contact with infectious skin lesions or from contact with lesion material.
For droplet transmission, prolonged face-to-face contact may be required for transmission to occur (eg, within a six-foot radius for ≥3 hours in the absence of personal protection equipment [PPE]) .
In general, transmissibility from person-to-person is very low. However, in May 2022 an outbreak of monkeypox in several non-endemic countries was reported with over 90 confirmed cases. In this outbreak, close contact with infectious skin lesions during sexual contact may be the likely mode of transmission. More detailed information will be available following further investigation. Additional information about this outbreak in specific geographic locations is found below. (See 'Geographic distribution' below.)"
Smallpox:
Smallpox can only be spread through humans. It is mainly spread by respiratory viral shedding (eg, via sneezing or coughing) and requires fairly prolonged direct contact between people. Patients with smallpox become contagious as the first lesions appear in their mouth and throat, and infectivity appears to be the highest at the beginning of the rash. Patients remain contagious until their last scabs fall off.
Transmission can also occur through contact with the fluid found in the patient's sores, since they also contain variola virus. The virus can spread through direct contact with these materials or through the objects contaminated by them, such as bedding or clothing. Rarely, smallpox has spread through the air in enclosed settings, such as a building (airborne route)."
I’m not worried; the CDC has got my back.
Is this the same CDC that said masks don't work, that bumbled the COVID testing strategy, that took the masks off too early, that failed to recommend vaccines based on Israeli data?
The very same! Those people are awesome!
"The CDC has got my back." Yes, but is there a monkey on it? (Sorry, couldn't resist.)
Fixed the name issues?
Yes. Turned out the problem was that I have two Substack accounts.
Important addendum or caveat: aren’t the smallpox vaccines (at least the older ones?) only 85% effective for monkeypox? Obviously that would still be very good. However, for high risk groups, that’s a point worth taking into account in the calculus, esp. re: MY’s suggestion of having people volunteer to take the riskier older the vaccine to protect themselves from monkeypox.