I actually kind of find the name amusing and it's making it harder for me to take the problem as seriously as I should. And then there are all the other animal poxes! Is there a pigpox, goatpox, dogpox, catpox, or ratpox?
I won't repeat the gravest sin of the public health establishment and those in their circles: I won't tell a well-meaning lie to try to coax the behavior I want.
I will tell them the truth: they are operating at a severe credibility deficit, and I am *very* reluctant to say a version of "I will let the CDC tell me when I can stop paying close attention to issues that people at the CDC personally think are important".
I just can't muster it right now. I think most can't. I hope the establishment attempts to engage the population where it is rather than where it wishes we were, but lol.
Experts absolutely should tell "well meaning lie[s]." They should tell you not to smoke cigarettes, although the chance it will kill you varies both with your genetics and with random chance. They cannot merely "present the evidence" because very few people can decipher statistics and most will instantly stop listening.
However, they need to be far more aware of the tightrope they are walking between maintaining credibility and delivering guidance. They need to understand how social media and the internet in general have reshaped access to valid and absurd criticism of public guidance. They need to choose their words very carefully and hedge.
The chance that anything will kill you always depends on genetics and random chance. If that ‘anything’ is known to hasten death on average then there is no lie in telling people not to do it.
Getting hit by a Mac truck will kill you independent of genetics and random chance. Taking a significant amount of cyanide will kill you independent of genetics and random chance. Clearly everything does not depend on genetics and random chance.
Just because not everyone gets lung cancer doesn’t mean smoking is harmless to anyone—it interferes with intake of oxygen and messes with your heart rate in all cases (when I was in high school our biology teacher did an in-class demonstration with one of the students, showing that it had an effect even on a teenager)
Slow Boring’s first annual subscriber orgy is hereby suspended indefinitely. Please submit your receipts to Milan to obtain reimbursement for your feathered mask.
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.
Gotta believe there's a very tired public health officer briefing a bunch of politicians right now who are all asking "wait, what do you mean there's a second disease?"
On the whole, I'm much more sympathetic to the idea that there are a bunch of tired politicians right now who are explaining to few public health officers, the latter of whom are asking "wait, what do you mean there's more than one public-good factor to consider?"
Yea, the correct response as of now is mostly as Matt describes. Say “here’s a vaccine that works but side effects suck, you can have it if you want. We’re ordering 200 million doses of a better one, which will be made available to the public at no cost when it arrives. Wrap the fuck up when you’re having sex with new partners, folks.”
Gay bars, bathhouses, and party organizers could have informational flyers warning people to be extra attentive to any rash (on themself or a partner). And maybe the CDC could allow people to set up testing at some of these locations like they often have for HIV/syphilis/gonorrhea/chlamydia.
No it is worse than nothing because it provides completely false feelings of security. Many sexually transmitted diseases spread by skin to skin contact mainly and monkey pox isn't even a sexually transmitted disease. It's the skin to skin contact that matters. Is it really that big of an ask not to have sex with strangers for a couple months while we figure out how widespread this is?
Uh. No surprises there. But since MY mentioned stocking up and you gave a specific figure it gave me the tiniest glimmer of hope. I suppose we’re lucky to have the stockpiles of the older vaccines thanks to the greater wisdom of previous generations. Seriously, I sometimes feel the world has devolved to some kind of Moronland twilight zone…
Maybe the CDC or the Government should say that having "a lifestyle that includes touching the skin of people you don’t know well in darkened conditions" (quite the euphemism for an orgy) is a bad idea and you shouldn't do it.
Nah. That would be judgmental and we can't have that.
It would be counterproductive, and thus moronic. It’s like sex Ed. Of course you should tell the teens the safest thing is not having sex at all, but if you stop there (adding some hypocritical moralizing on top) you’re not more likely to prevent them from actually having sex. What you are doing is making it less likely for them to have *safe* sex. Ditto for most things, within reason. In general our government should supply us with clear honest information, and enforce our democratically legislated constitutional laws, but it’s not its job to preach or moralize to us. Citizens are not children, government ain’t our parent or our priest etc. Beyond giving the information and enforcing the laws, free citizens can and should make their own choices.
Excuse me, but that’s precisely not what John was saying nor what I was saying, these are two straw men you have there. He was saying that the government should tell people that “ [it] is a bad idea and you shouldn't do it.” A moralizing, paternalistic and *prescriptive* formulation like that is quite different, indeed drastically different from merely providing autonomous citizens with accurate information to help them with good risk assessment. Likewise, I’m not hysterical, and not at all averse to educating the public. But the public are adults, and aside from emergency situations (such as was indeed the COVID pandemic at its height) government prescription, as opposed to providing of information, should be minimal. Moreover, one cannot ignore the historical (and not only historical) context of homophobia in society, and by the government, including the horrifying way the response to the aids pandemic was botched. So yes ,people can be justly skeptical of a suggestion that a useful and justified solution to our woes is for Uncle Sam to tell “the gays” to control their libido or some such.
I didn't reference "the gays" (your words) in my comment. I presume attending events where casual sex occurs in darkened rooms with strangers is a bad idea whether between homosexual or heterosexual partners.
That you took my generic statement and went to "moronic" and tied it to homophobia is on you.
Sure you didn't, you just happened to suggest it in the context of specifically gay events being mentioned, as your recommendation for governments response to those events, and lamenting the govenment's current supposed laxity and liberalization ("overstepped" in your words). I wonder which groups benefitted the most from those trends of liberalization you lament? But of course I am totally imagining the gaslight.
I'll be more clear: I have nothing against gay people, gay marriages, gay rights or gay parades. I was for gay marriage long before it became the accepted position in society and well before the SCOTUS decision regarding it.
To the extent, as Matt wrote, there is "a lifestyle that includes touching the skin of people you don’t know well in darkened conditions", then I think that lifestyle is bad and should be discouraged. And I don't care which genitalia are being used in the process.
yes, yes, consenting adults. But consenting adults do lots of stupid things and I think it is fine for the CDC or the government to make some statement that some of those things are dangerous.
Perhaps government health regulators could simply state don't fucking fuck any random people for a measly couple months while we figure out how widespread this is and maybe have the potential to nip it in the bud. You can still go to the bar and meet people or even online date (no online sex apps isn't online dating) and have sex with those people even though that is at least somewhat high risk if you're doing it more than rarely with a different person, but please just don't fuck completely random ppl you didn't even buy a drink. And for the love of God don't go to any massive orgies which is how a chunk of these cases were identified.
So would you be in favor shaming GOP congressmen into getting together and making statements about how foolishly risky it is to not have your firearms locked up in a safe(or trigger lock)?
These two things seem largely equivalent. It is absolutely obvious that both serious dedication to firearm safety and safe sex (apparently many-many gay men take the prophylactic AIDS cocktail regularly) are the right way to go. Browbeating your constituents about it might save a few lives. It would also annoy the hell out of the vast majority of them who vote (and probably also do the right thing already).
own a gun at the very fucking least use safety measures. I also think men (and I say men bc this is a men thing not a gay thing average straight men would be just as hedonistic if women weren't cautious about sex and for the critics just look at lesbian sexual dynamics to see even without the fear of rape by men women are just not that into anonymous sex with strangers for the most part the ratio of places catering to anonymous gay male sex compared to ones catering to anonymous lesbian sex has to be 500 to 1) need to stop having random anonymous or semi anonymous sex with strangers for at least a couple months while we figure out how prevelanent spread is and hopefully nip said spread in the bud while we still feasibly can.
It encourages all kinds of behavioral modifications, both more significant ones like avoiding sex or kissing with anyone outside your social bubble, and additional modifications for people who aren't going to do that, acknowledging that some people might even find some of these modifications to be turn-ons.
I think probably more effective would be the CDC printing up informational flyers that give appropriate warnings without being graphic in a way that turns people off from looking at them, and encouraging bath houses, gay bars, and party organizers to post them in prominent locations. (Better yet, have the New York State Department of Public Health print these flyers, because they've been pretty good at getting information across in ways that don't feel preachy.)
Even better would be permitting a test that could be offered in these locations, which already often offer rapid HIV, syphilis, gonorrhea, and chlamydia tests.
Ehh, they tried telling us that not wearing a mask in enclosed spaces was a bad idea and we shouldn’t do it.
Didn’t work well. Turns out people don’t really give much of a damn about extremely low-order risks.
In principle I kinda agree, but then I’m in a committed relationship and have been since 24, so I’m not in a position to understand what drives one to participate in an orgy.
While I was extolling the virtues of shame and opprobrium the other week, that was regarding decisions that directly harm the most vulnerable people in society. We shouldn’t want to go back to the straitjacket that was life prior to liberalism hitting critical mass in the early 20th century, not in general.
There are places on the continuum between the social mores of 1920 and today. One needn't desire to go back to the early 20th century in order to think today's culture has overstepped in some ways.
Meh. “Consenting adults” is generally a good rule, and orgies fit the bill. Children being raised in poverty doesn’t.
Risks are inevitable, how much risk aversion do you want to ram down people’s throats? My answer is “less than modernity seems to want, because I don’t want to be sheathed in bubblewrap.”
Governments -- state, local and federal -- have been putting out messages around dangerous activity for a long while and more-so in the past 2 years. Seems like this would be a fine time to continue that tradition.
It’s getting worse from such an incredibly low base that it reminds me much more of Ebola, for which I have no concern at all, than COVID in late 2019, for which I had a ton of concern.
I’m not planning on changing that assessment unless something breaks badly.
I have no concern about Ebola right now. I did have a bit of concern about Ebola in 2016, when there tens of thousands of cases in countries thousands of miles from its endemic region, and individual medical workers coming back to the United States while infected. I also had a bit of concern about SARS in 2003, when hundreds of people in Canada, Singapore, and China were spreading the virus and it was unclear at any time whether a new cluster would pop up connected to travel.
If you don’t go to Pride events, then there’s not likely anything relevant for your concern in the next few weeks, and hopefully not ever. But those of us that do should pay some attention and encourage some caution among other members of our community.
And I guess I’m illustrating the innate problem here: in order to keep it from being a “me” problem, we all need to care at least a bit while it’s still a “you” problem.
Which means that you’re correct and I shouldn’t be quite *this* cavalier.
That’s true enough, I suppose. But the truth is we don’t know enough. And in any case individual action only goes so far. That’s precisely why we have a government, including a public health agency, formerly with a reputation as the finest in the world, whose no. 1 job is to prevent the spread of new pandemics. It’s therefore extremely disconcerting that they appear not to have learned some of the top lessons from the failure of the century, which moreover occurred only two years ago.
Out of the 600 or so cases on that list, a bit under half have their sex indicated, and out of those it appears that a single digit number are female. There are big clusters in Madrid, Lisbon, Montreal, London, and Berlin, as well as several smaller Spanish cities, that all appear to be male.
Anecdotal reports suggest that the biggest cluster appears to be people who went to the Pride festival in Gran Canaria in the second week of May. It makes sense that a gay event Gran Canaria would be a point of intersection between Africa and men in this particular set of cities. I would sort of expect Paris, Boston, New York, and possibly Tel Aviv, to also have connections to this event and good conditions for local spread from anyone who was there, but it's only been three weeks, and some national health agencies may be slower to test and report than others.
Thanks, interesting. So for the time being it is particularly concerning for the gay community. That's important for understanding the current outbreak.
MY's concern is a bit different if I read his post correctly. He's worried that a mutation will happen that will send R above 1 and the disease will sweep the globe and infect tens of millions. I don't see the current outbreak happening within the West as contributing much to that global pandemic risk. If a mutation happens I guess it will likely happen in Africa where there's a steady drip of who knows how many cases year after year. That seems like a much larger and more fertile ground for mutations.
Ebola was contained because it has a very high mortality, so people took it seriously and worked very hard to keep it contained. Monkeypox and COVID are both low mortality viruses which is why they get ignored and therefore have the potential to kill far more people.
If Ebola required the heroic measures needed to prevent COVID transmission it would have slipped the leash all the same, which would have been the literal apocalypse.
If Ebola was spreading and people all over the world were bleeding from their eyeballs, no one would question a strategy of zero-Ebola. We would do total lockdowns until the spread had stopped and that would be the end of it. Even with an R0 like COVID I still think ebola would kill fewer people.
I mean, the nature of exponential growth is that the base can be arbitrarily small (as long as nonzero) but you end up with massive infection so long as R0 > 1. Ultimately keeping that number below 1 is the entire name of the game here.
“Keeping that number below 1” is only (maybe kinda sorta) within reach of policy efforts if R0 is just a hair above 1 on its own. The second you get past 1.2 or 1.3, nothing any policymaker or public health person can do will keep Rt below 1.
That’s simplistic, isn’t it? I think COVID wasn’t stopped not so much because of transmissibility per se (which was quite low in the original strain) but rather its pretty rare ability to both be transmissible while people are asymptomatic and the fact that a large portion of people *never* developed any symptoms. This made exhaustive contact tracing virtually impossible. Thus containment in the style of the previous SARS outbreak failed.
This is a judgment I don’t think we have the data to support. We've *never* done the sort of population surveillance of common respiratory illnesses necessary to say how common this is.
I would be entirely unsurprised to learn that any of the dozen-odd common cold viruses have asymptomatic carriers outnumbering symptomatic patients throughout the winter.
Regrettably, a noted Giant Idiot made some comments about "you only have high case counts because you're testing", or whatever, which were Giantly Idiotic in early 2020 but will very possibly make sense in 2023 or maybe tomorrow.
As you say, we have *no* population-scale baseline for what boring everyday respiratory transmission and infection (as distinct from *illness*) looks like.
I am hoping that Abbott and other companies will start making rapid tests with multiple lines, that indicate flu, RSV, and possibly some other common viruses, in addition to covid. Of course, unless the CDC also sets up a site for people to at least voluntarily report results from these tests, we may not be able to gather statistics from these at-home tests.
Yes, I should have added, “in combination with also leading to hospitalization and death in a significant percentage of symptomatic cases”. It’s this combination of being, in significant numbers, totally harmless to some, deadly to others, and weirdly and obscurely debilitating to others still (“long COVID”) that is the evil “genius” of this disease.
I’m quite confident, based on the pile of circumstantial evidence now available, that every “common cold” virus started this way before they transitioned to endemicity.
And as I said elsewhere, we do not have the technological capacity to stop that transition or roll it back, only to make it less lethal.
EDIT: which, COVID online warrior whining to the contrary, we have done reasonably well at.
Right, that's why ultimately people with some sense saw that Covid would not be stopped, only slightly delayed.
But it sounds like monkey pox has an r0 much closer to one, and moreover, since it seems to spread primarily through skin to skin contact there's a lot of leverage to modify r0. Presumably this is why it's been stopped many times in the past.
Perhaps some anonymous sex sites/events should be shut down by public health regulators if this turns into a noticeably big problem. But of course it's 2022 and there's an app for that.
This seems overly pessimistic to me. Isn't the fundamental essence of vaccination campaigns that we can maintain containment of diseases like measles (R0 apparently 12+), polio, mumps, etc. that are famously *incredibly* infectious precisely because we have public health interventions that are even more powerful than that sky-high R0?
EDIT: While I think it was implicit in my comment and you seem to have understood its meaning despite my being terminologically loose, obviously the number we're striving to keep below one is probably more properly characterized as Rt rather than R0. My mistake for lack of of precision in terminology.
And I think COVID has proven that long-term endemic and brand new pandemic diseases require very different toolkits and approaches.
The reality is that we just don’t have a technological toolkit that can stop and contain pandemics, only one which can limit the death toll until it becomes a steady-state endemic.
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.
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.
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.
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 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.
There is no such thing as “the R0” of a virus. As you note, it depends on your behaviors. And when there have been only a few hundred cases detected in the current outbreak, and not a lot of details of contact tracing noted, it’s not going to be easy to estimate.
Considering the indications that it’s at least somewhat airborne I would guess non negligible. However I would also imagine it’s too early to tell. But regardless MY’s point is well taken, even for disease whose transmission is only fluid based, which this one unfortunately it seems is not, that’s no guarantee they will stay “with strangers in the dark” if they are not contained (see HIV).
At least this one has a scary name and gross effects.
Sometimes it’s the little things that get people to act more rationally.
I actually kind of find the name amusing and it's making it harder for me to take the problem as seriously as I should. And then there are all the other animal poxes! Is there a pigpox, goatpox, dogpox, catpox, or ratpox?
It does have a bit on a Monty Python feel to it -- but have you seen the pictures?!
No, I'm avoiding them.
The plague doctor squishable is incredible.
The scary name and visible effects do grab people's attention. My God who wants the pox!
I thought this was a well-reasoned article.
I won't repeat the gravest sin of the public health establishment and those in their circles: I won't tell a well-meaning lie to try to coax the behavior I want.
I will tell them the truth: they are operating at a severe credibility deficit, and I am *very* reluctant to say a version of "I will let the CDC tell me when I can stop paying close attention to issues that people at the CDC personally think are important".
I just can't muster it right now. I think most can't. I hope the establishment attempts to engage the population where it is rather than where it wishes we were, but lol.
Experts absolutely should tell "well meaning lie[s]." They should tell you not to smoke cigarettes, although the chance it will kill you varies both with your genetics and with random chance. They cannot merely "present the evidence" because very few people can decipher statistics and most will instantly stop listening.
However, they need to be far more aware of the tightrope they are walking between maintaining credibility and delivering guidance. They need to understand how social media and the internet in general have reshaped access to valid and absurd criticism of public guidance. They need to choose their words very carefully and hedge.
The chance that anything will kill you always depends on genetics and random chance. If that ‘anything’ is known to hasten death on average then there is no lie in telling people not to do it.
Getting hit by a Mac truck will kill you independent of genetics and random chance. Taking a significant amount of cyanide will kill you independent of genetics and random chance. Clearly everything does not depend on genetics and random chance.
Getting hit by a Mac truck would be by random chance, unless you did it on purpose..
Just because not everyone gets lung cancer doesn’t mean smoking is harmless to anyone—it interferes with intake of oxygen and messes with your heart rate in all cases (when I was in high school our biology teacher did an in-class demonstration with one of the students, showing that it had an effect even on a teenager)
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.
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.
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.
Gotta believe there's a very tired public health officer briefing a bunch of politicians right now who are all asking "wait, what do you mean there's a second disease?"
On the whole, I'm much more sympathetic to the idea that there are a bunch of tired politicians right now who are explaining to few public health officers, the latter of whom are asking "wait, what do you mean there's more than one public-good factor to consider?"
Yea, the correct response as of now is mostly as Matt describes. Say “here’s a vaccine that works but side effects suck, you can have it if you want. We’re ordering 200 million doses of a better one, which will be made available to the public at no cost when it arrives. Wrap the fuck up when you’re having sex with new partners, folks.”
It’s not at all obvious that condoms are relevant, if the issue is contact with a bodily rash, or bedsheets.
No argument, but it’s better than nothing and we’ve repeatedly proven that “don’t have sex with strangers” messaging just doesn’t work.
Not in any community, to be clear.
Gay bars, bathhouses, and party organizers could have informational flyers warning people to be extra attentive to any rash (on themself or a partner). And maybe the CDC could allow people to set up testing at some of these locations like they often have for HIV/syphilis/gonorrhea/chlamydia.
Does no one else regard it as odd that the CDC would need to allow that measure?
No it is worse than nothing because it provides completely false feelings of security. Many sexually transmitted diseases spread by skin to skin contact mainly and monkey pox isn't even a sexually transmitted disease. It's the skin to skin contact that matters. Is it really that big of an ask not to have sex with strangers for a couple months while we figure out how widespread this is?
Yes.
Are they ordering 200m of the new one?
No, because they’re idiots.
Uh. No surprises there. But since MY mentioned stocking up and you gave a specific figure it gave me the tiniest glimmer of hope. I suppose we’re lucky to have the stockpiles of the older vaccines thanks to the greater wisdom of previous generations. Seriously, I sometimes feel the world has devolved to some kind of Moronland twilight zone…
The figure I’ve seen is 13 million.
That public health officer is played by a very tired 90’s Dustin Hoffman.
We better not get a sudden "it's airborne!" moment like he did.
No one both frustratedly and condescendingly explains viral pathology like 90’s Dustin Hoffman.
Maybe the CDC or the Government should say that having "a lifestyle that includes touching the skin of people you don’t know well in darkened conditions" (quite the euphemism for an orgy) is a bad idea and you shouldn't do it.
Nah. That would be judgmental and we can't have that.
It would be counterproductive, and thus moronic. It’s like sex Ed. Of course you should tell the teens the safest thing is not having sex at all, but if you stop there (adding some hypocritical moralizing on top) you’re not more likely to prevent them from actually having sex. What you are doing is making it less likely for them to have *safe* sex. Ditto for most things, within reason. In general our government should supply us with clear honest information, and enforce our democratically legislated constitutional laws, but it’s not its job to preach or moralize to us. Citizens are not children, government ain’t our parent or our priest etc. Beyond giving the information and enforcing the laws, free citizens can and should make their own choices.
Excuse me, but that’s precisely not what John was saying nor what I was saying, these are two straw men you have there. He was saying that the government should tell people that “ [it] is a bad idea and you shouldn't do it.” A moralizing, paternalistic and *prescriptive* formulation like that is quite different, indeed drastically different from merely providing autonomous citizens with accurate information to help them with good risk assessment. Likewise, I’m not hysterical, and not at all averse to educating the public. But the public are adults, and aside from emergency situations (such as was indeed the COVID pandemic at its height) government prescription, as opposed to providing of information, should be minimal. Moreover, one cannot ignore the historical (and not only historical) context of homophobia in society, and by the government, including the horrifying way the response to the aids pandemic was botched. So yes ,people can be justly skeptical of a suggestion that a useful and justified solution to our woes is for Uncle Sam to tell “the gays” to control their libido or some such.
I didn't reference "the gays" (your words) in my comment. I presume attending events where casual sex occurs in darkened rooms with strangers is a bad idea whether between homosexual or heterosexual partners.
That you took my generic statement and went to "moronic" and tied it to homophobia is on you.
Sure you didn't, you just happened to suggest it in the context of specifically gay events being mentioned, as your recommendation for governments response to those events, and lamenting the govenment's current supposed laxity and liberalization ("overstepped" in your words). I wonder which groups benefitted the most from those trends of liberalization you lament? But of course I am totally imagining the gaslight.
I'll be more clear: I have nothing against gay people, gay marriages, gay rights or gay parades. I was for gay marriage long before it became the accepted position in society and well before the SCOTUS decision regarding it.
To the extent, as Matt wrote, there is "a lifestyle that includes touching the skin of people you don’t know well in darkened conditions", then I think that lifestyle is bad and should be discouraged. And I don't care which genitalia are being used in the process.
yes, yes, consenting adults. But consenting adults do lots of stupid things and I think it is fine for the CDC or the government to make some statement that some of those things are dangerous.
Perhaps government health regulators could simply state don't fucking fuck any random people for a measly couple months while we figure out how widespread this is and maybe have the potential to nip it in the bud. You can still go to the bar and meet people or even online date (no online sex apps isn't online dating) and have sex with those people even though that is at least somewhat high risk if you're doing it more than rarely with a different person, but please just don't fuck completely random ppl you didn't even buy a drink. And for the love of God don't go to any massive orgies which is how a chunk of these cases were identified.
So would you be in favor shaming GOP congressmen into getting together and making statements about how foolishly risky it is to not have your firearms locked up in a safe(or trigger lock)?
These two things seem largely equivalent. It is absolutely obvious that both serious dedication to firearm safety and safe sex (apparently many-many gay men take the prophylactic AIDS cocktail regularly) are the right way to go. Browbeating your constituents about it might save a few lives. It would also annoy the hell out of the vast majority of them who vote (and probably also do the right thing already).
Yes. I both think if you must
own a gun at the very fucking least use safety measures. I also think men (and I say men bc this is a men thing not a gay thing average straight men would be just as hedonistic if women weren't cautious about sex and for the critics just look at lesbian sexual dynamics to see even without the fear of rape by men women are just not that into anonymous sex with strangers for the most part the ratio of places catering to anonymous gay male sex compared to ones catering to anonymous lesbian sex has to be 500 to 1) need to stop having random anonymous or semi anonymous sex with strangers for at least a couple months while we figure out how prevelanent spread is and hopefully nip said spread in the bud while we still feasibly can.
I'm not sure where you get the idea about what is "unacceptable". Look at this guide the NY Department of Health has about covid and safe sex: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf
It encourages all kinds of behavioral modifications, both more significant ones like avoiding sex or kissing with anyone outside your social bubble, and additional modifications for people who aren't going to do that, acknowledging that some people might even find some of these modifications to be turn-ons.
I think probably more effective would be the CDC printing up informational flyers that give appropriate warnings without being graphic in a way that turns people off from looking at them, and encouraging bath houses, gay bars, and party organizers to post them in prominent locations. (Better yet, have the New York State Department of Public Health print these flyers, because they've been pretty good at getting information across in ways that don't feel preachy.)
Even better would be permitting a test that could be offered in these locations, which already often offer rapid HIV, syphilis, gonorrhea, and chlamydia tests.
Ehh, they tried telling us that not wearing a mask in enclosed spaces was a bad idea and we shouldn’t do it.
Didn’t work well. Turns out people don’t really give much of a damn about extremely low-order risks.
In principle I kinda agree, but then I’m in a committed relationship and have been since 24, so I’m not in a position to understand what drives one to participate in an orgy.
While I was extolling the virtues of shame and opprobrium the other week, that was regarding decisions that directly harm the most vulnerable people in society. We shouldn’t want to go back to the straitjacket that was life prior to liberalism hitting critical mass in the early 20th century, not in general.
There are places on the continuum between the social mores of 1920 and today. One needn't desire to go back to the early 20th century in order to think today's culture has overstepped in some ways.
Meh. “Consenting adults” is generally a good rule, and orgies fit the bill. Children being raised in poverty doesn’t.
Risks are inevitable, how much risk aversion do you want to ram down people’s throats? My answer is “less than modernity seems to want, because I don’t want to be sheathed in bubblewrap.”
What’s yours?
I'm less libertarian than saying that anything between consenting adults is fine.
So what’s the line, then, in terms of sexual activity? What’s fine, why, and who decides on everyone’s behalf?
Governments -- state, local and federal -- have been putting out messages around dangerous activity for a long while and more-so in the past 2 years. Seems like this would be a fine time to continue that tradition.
I'd settle for "don't have sex with a new partner until they have been tested for STDs." Still too judgmental?
That's a good message, but you also want a message to reduce risk for people who won't follow this one.
It’s getting worse from such an incredibly low base that it reminds me much more of Ebola, for which I have no concern at all, than COVID in late 2019, for which I had a ton of concern.
I’m not planning on changing that assessment unless something breaks badly.
I have no concern about Ebola right now. I did have a bit of concern about Ebola in 2016, when there tens of thousands of cases in countries thousands of miles from its endemic region, and individual medical workers coming back to the United States while infected. I also had a bit of concern about SARS in 2003, when hundreds of people in Canada, Singapore, and China were spreading the virus and it was unclear at any time whether a new cluster would pop up connected to travel.
If you don’t go to Pride events, then there’s not likely anything relevant for your concern in the next few weeks, and hopefully not ever. But those of us that do should pay some attention and encourage some caution among other members of our community.
Point.
And I guess I’m illustrating the innate problem here: in order to keep it from being a “me” problem, we all need to care at least a bit while it’s still a “you” problem.
Which means that you’re correct and I shouldn’t be quite *this* cavalier.
That’s true enough, I suppose. But the truth is we don’t know enough. And in any case individual action only goes so far. That’s precisely why we have a government, including a public health agency, formerly with a reputation as the finest in the world, whose no. 1 job is to prevent the spread of new pandemics. It’s therefore extremely disconcerting that they appear not to have learned some of the top lessons from the failure of the century, which moreover occurred only two years ago.
Indeed. But as long as that government agency is letting us down, we can use other means of coordinating public behavior, such as Substacks and Vox articles (https://www.vox.com/future-perfect/23140258/monkeypox-pandemic-covid-public-health) and probably other forms of organization within the gay community.
I haven't followed this story whatsoever, outside of what I read here, today.
Is this issue particularly concentrated in the gay community? Apart from your comments nothing else has really given me that impression.
At the moment, yes. Someone has been gathering a spreadsheet of publicly announced cases with some of the relevant statistical information: https://docs.google.com/spreadsheets/u/0/d/1CEBhao3rMe-qtCbAgJTn5ZKQMRFWeAeaiXFpBY3gbHE/htmlview#gid=0
Out of the 600 or so cases on that list, a bit under half have their sex indicated, and out of those it appears that a single digit number are female. There are big clusters in Madrid, Lisbon, Montreal, London, and Berlin, as well as several smaller Spanish cities, that all appear to be male.
Anecdotal reports suggest that the biggest cluster appears to be people who went to the Pride festival in Gran Canaria in the second week of May. It makes sense that a gay event Gran Canaria would be a point of intersection between Africa and men in this particular set of cities. I would sort of expect Paris, Boston, New York, and possibly Tel Aviv, to also have connections to this event and good conditions for local spread from anyone who was there, but it's only been three weeks, and some national health agencies may be slower to test and report than others.
Thanks, interesting. So for the time being it is particularly concerning for the gay community. That's important for understanding the current outbreak.
MY's concern is a bit different if I read his post correctly. He's worried that a mutation will happen that will send R above 1 and the disease will sweep the globe and infect tens of millions. I don't see the current outbreak happening within the West as contributing much to that global pandemic risk. If a mutation happens I guess it will likely happen in Africa where there's a steady drip of who knows how many cases year after year. That seems like a much larger and more fertile ground for mutations.
Almost all the cases outside of Africa are in the gay male community.
Ebola was contained because it has a very high mortality, so people took it seriously and worked very hard to keep it contained. Monkeypox and COVID are both low mortality viruses which is why they get ignored and therefore have the potential to kill far more people.
If Ebola required the heroic measures needed to prevent COVID transmission it would have slipped the leash all the same, which would have been the literal apocalypse.
If Ebola was spreading and people all over the world were bleeding from their eyeballs, no one would question a strategy of zero-Ebola. We would do total lockdowns until the spread had stopped and that would be the end of it. Even with an R0 like COVID I still think ebola would kill fewer people.
Yep, agreed, but it would still have been the damned apocalypse first.
I mean, the nature of exponential growth is that the base can be arbitrarily small (as long as nonzero) but you end up with massive infection so long as R0 > 1. Ultimately keeping that number below 1 is the entire name of the game here.
“Keeping that number below 1” is only (maybe kinda sorta) within reach of policy efforts if R0 is just a hair above 1 on its own. The second you get past 1.2 or 1.3, nothing any policymaker or public health person can do will keep Rt below 1.
That’s simplistic, isn’t it? I think COVID wasn’t stopped not so much because of transmissibility per se (which was quite low in the original strain) but rather its pretty rare ability to both be transmissible while people are asymptomatic and the fact that a large portion of people *never* developed any symptoms. This made exhaustive contact tracing virtually impossible. Thus containment in the style of the previous SARS outbreak failed.
Broadly, I don’t disagree.
But… “pretty rare ability”
This is a judgment I don’t think we have the data to support. We've *never* done the sort of population surveillance of common respiratory illnesses necessary to say how common this is.
I would be entirely unsurprised to learn that any of the dozen-odd common cold viruses have asymptomatic carriers outnumbering symptomatic patients throughout the winter.
Regrettably, a noted Giant Idiot made some comments about "you only have high case counts because you're testing", or whatever, which were Giantly Idiotic in early 2020 but will very possibly make sense in 2023 or maybe tomorrow.
As you say, we have *no* population-scale baseline for what boring everyday respiratory transmission and infection (as distinct from *illness*) looks like.
I am hoping that Abbott and other companies will start making rapid tests with multiple lines, that indicate flu, RSV, and possibly some other common viruses, in addition to covid. Of course, unless the CDC also sets up a site for people to at least voluntarily report results from these tests, we may not be able to gather statistics from these at-home tests.
Yes, I should have added, “in combination with also leading to hospitalization and death in a significant percentage of symptomatic cases”. It’s this combination of being, in significant numbers, totally harmless to some, deadly to others, and weirdly and obscurely debilitating to others still (“long COVID”) that is the evil “genius” of this disease.
I’m quite confident, based on the pile of circumstantial evidence now available, that every “common cold” virus started this way before they transitioned to endemicity.
And as I said elsewhere, we do not have the technological capacity to stop that transition or roll it back, only to make it less lethal.
EDIT: which, COVID online warrior whining to the contrary, we have done reasonably well at.
Right, that's why ultimately people with some sense saw that Covid would not be stopped, only slightly delayed.
But it sounds like monkey pox has an r0 much closer to one, and moreover, since it seems to spread primarily through skin to skin contact there's a lot of leverage to modify r0. Presumably this is why it's been stopped many times in the past.
Perhaps some anonymous sex sites/events should be shut down by public health regulators if this turns into a noticeably big problem. But of course it's 2022 and there's an app for that.
This seems overly pessimistic to me. Isn't the fundamental essence of vaccination campaigns that we can maintain containment of diseases like measles (R0 apparently 12+), polio, mumps, etc. that are famously *incredibly* infectious precisely because we have public health interventions that are even more powerful than that sky-high R0?
EDIT: While I think it was implicit in my comment and you seem to have understood its meaning despite my being terminologically loose, obviously the number we're striving to keep below one is probably more properly characterized as Rt rather than R0. My mistake for lack of of precision in terminology.
And I think COVID has proven that long-term endemic and brand new pandemic diseases require very different toolkits and approaches.
The reality is that we just don’t have a technological toolkit that can stop and contain pandemics, only one which can limit the death toll until it becomes a steady-state endemic.
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.
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.
Per Madison Cawthorn, Republican officials in Washington deemed the most at-risk group.
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 worried; the CDC has got my back.
"The CDC has got my back." Yes, but is there a monkey on it? (Sorry, couldn't resist.)
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!
Fixed the name issues?
Yes. Turned out the problem was that I have two Substack accounts.
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.
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.
What's the R0 of this thing, assuming you aren't having sex with strangers in the dark.
There is no such thing as “the R0” of a virus. As you note, it depends on your behaviors. And when there have been only a few hundred cases detected in the current outbreak, and not a lot of details of contact tracing noted, it’s not going to be easy to estimate.
Considering the indications that it’s at least somewhat airborne I would guess non negligible. However I would also imagine it’s too early to tell. But regardless MY’s point is well taken, even for disease whose transmission is only fluid based, which this one unfortunately it seems is not, that’s no guarantee they will stay “with strangers in the dark” if they are not contained (see HIV).
Gotta wonder if Alito is feeling stirrings regarding Lawrence vs. Texas.