Monkey Pox declared a Global Health Emergency

[Keelan]

So just found this on NBC:

https://www.nbcnews.com/nbc-out/out-health-and-wellness/sex-men-not-skin-contact-fueling-monkeypox-new-research-suggests-rcna43484

Since the outset of the global monkeypox outbreak in May, public health and infectious disease experts have told the public that the virus is largely transmitting through skin-to-skin contact, in particular during sex between men.

Now, however, an expanding cadre of experts has come to believe that sex between men itself — both anal as well as oral intercourse — is likely the main driver of global monkeypox transmission. The skin contact that comes with sex, these experts say, is probably much less of a risk factor.

In recent weeks, a growing body of scientific evidence — including a trio of studies published in peer-reviewed journals, as well as reports from national, regional and global health authorities — has suggested that experts may have framed monkeypox’s typical transmission route precisely backward. 

[CopperLily]

For reference, my thoughts are while that *might* be true, there's a lot of different types of contact where it's difficult to unravel what's the role of the actual act of sex vs. things around it, being intimate generally, etc. Also, the ability to find virus in seminal fluid and that being a transmission route are two very different things (*waves at Ebola*).

Broader guidance seems, at this point, to be an approach more aligned with the precautionary principle at this point.

[Secretwriter]

To me it honestly seems like a witch hunt and it's very divisive. I can't,  after Covid, trust the CDC anymore.  They and others like them,  seem to be a mass of educated idiots. Of course they didn't know what to do with Covid.  We've just been lied to too much for me to be a believer.  Ebola, which I was pregnant during and terrified of without losing my head over, they had no clue then and they have no clue now. 

[Vekseid]

To me it honestly seems like a witch hunt and it's very divisive. I can't,  after Covid, trust the CDC anymore.  They and others like them,  seem to be a mass of educated idiots. Of course they didn't know what to do with Covid.  We've just been lied to too much for me to be a believer.  Ebola, which I was pregnant during and terrified of without losing my head over,

Vapid cynicism like this is why a million Americans are dead, including one I wrote a memoriam and put a banner up for. There's no actual criticism, just vague accusations of lies to taint an entire group.

Not being wrong, as can happen with extraordinarily complex subjects.

Not having alternate priorities to direct resources to where they are most effective.

Not being forced to operate under a hostile administration.

Just calling them liars with no source, facts, or explanation, except...

they had no clue then and they have no clue now.

Except this falsehood.

You can demand the CDC be better. A better baseline education for the country. More independence in operation. More transparency in studies. More pay and better retention for infectious disease experts. More equipment and gear for emergencies.

But trying to pretend the world is simple is just going to get more people killed.

[RedRose]

In France, we were first FORBIDDEN to wear masks (because they were for professionals) and then forced to, including women giving birth. We were also invited to go and vote, and they also didn't prevent football meetings - until they did. Being told black and then white basically. Many people do not trust anyone anymore, including those who tried their best.

[stormwyrm]

It's too bad but that's how science is and how it works. Scientists are wrong all the time. They think something goes one way and then they see data that shows that it doesn't quite work the way they originally thought and so they have to amend their theories to take that into account. They just get less and less wrong over time. A real scientist has to have the humility to accept that the universe can and does throw curve balls all the time and they need to deal with that. The general public doesn't seem to understand this, and they think that these scientists were wrong before so why should they be right now. Isaac Asimov wrote a famous essay on the relativity of wrong that really should be read a lot more widely:

https://hermiene.net/essays-trans/relativity_of_wrong.html

[Thufir Hawat]

In France, we were first FORBIDDEN to wear masks (because they were for professionals)

I seem to remember that, though I don't live in France. Wasn't it because there wasn't an adequate supply for the professionals (which were the most exposed)? And then masks were made mandatory when there was an adequate supply that everyone could wear one?

[RedRose]

Unfortunately they presented it as MASKS DONT WORK. And then... We've had a huge problem of "people not trusting" (google gilets jaunes complotistes) and this has been la goutte d'eau qui fait déborder le vase.

[Vekseid]

Importantly, refining our understanding is something society is going to have to accept as our world gets more complex. Trying to spin this as lies and changing minds is lethally dangerous.

As in, it has already killed people. It needs to fucking stop.

Unfortunately they presented it as MASKS DONT WORK.

There were a number of factors confounding this.

It was shown that a pure cloth mask a la a t-shirt actually made things worse, though inserting a simple paper towel made them reasonably effective. Supply of quality masks were so constrained they had a sample size of 2 for N95 masks.

This was further compounded by an incorrect understanding of how much aerosolization was a concern, though I'm having trouble finding the specifics. Regardless, that got corrected and now people know better.

At least in the US, this would not have been such a drastic issue if the Trump administration was not actively sabotaging efforts through various means, up to and including confiscating and stockpiling gear.

[CopperLily]

Would people actually like a breakdown of some of the reasoning behind how the masking guidance happened?

[RedRose]

Interestingly after this post I was suggested an article of Olivier Véran apologizing for being wrong...

[Vekseid]

Would people actually like a breakdown of some of the reasoning behind how the masking guidance happened?

Knowledge is always welcome.

[CopperLily]

Knowledge is always welcome.

I confess after 2.5 years of this, I'm usually mentally braced for people just wanting to be mad.

First, to be clear, the masking guidance was *wrong*. But there was reasoning behind it.

If you cast yourself back to say, March 2020, there's a few things to keep in mind:

1) The efficacy of surgical-style masks for preventing influenza infection, which is the most widely studied respiratory virus out there, is extremely lackluster.

2) There was a lot of concern that, like MERS and SARS before it (remember, this is our third major coronavirus epidemic), there would be a significant fomite-mediated transmission component. Meaning the virus lingering on surfaces, etc. Actually taking off a mask without potentially self-innoculating yourself by touching your mouth or eyes is remarkably difficult. Cloth and other reusable masks would need to be sterilized between uses, and no one thought that was a thing people were going to do. So there was a concern that even if masks were catching viral particles, they'd just be delivering them via a different route.

As it turns out, there's *not* a major fomite-transmission component to SARS-CoV-2 infection. This is one of the few things about the virus that actually worked in our favor. But you can also see this in all the handwashing advice, sterilizing surfaces constantly, etc.

3) Optimism. Again, this is our third coronavirus epidemic, and the CDC successfully contained both MERS and SARS within the U.S. There was optimism that we could be able to do the same with SARS-CoV-2. This was a belief I held at the time. The reasons that this didn't work are myriad, and are both viral and political in nature. But as the primary effectiveness of masks is reducing how much virus you're putting *out* into the world, at a fairly low prevalence, there's a genuinely question as to whether or not masks would help.

The nature of an exponential growth curve means that it was evident we were wrong about this rather quickly, hence the rapid pivot.

4) Supplies. Going back (again) to both MERS and SARS, transmission had a heavy nosocomial component (meaning hospital transmission). The South Korean MERS outbreak was entirely nosocomial. There was a clear concern that the threat from SARS-CoV-2 would come primarily through hospitals. And hospitals are *not* well supplied for disasters like this, especially without mobilizing various national stockpiles. This report, which was a survey of hospitals in April 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360941/ showed that 40% of the hospitals being surveyed reported their respirator levels as "limited" or "crisis level", and most were reusing them over an extended period of time. Healthcare desperately needed masks, and people were already stockpiling.


The pivot in advice is, to my mind, one of the great public health communication failures of our time, but the initial reasoning behind it, while wrong in retrospect, *had* reasoning behind it.

[CopperLily]

Similarly, I don't think people realize how hard pandemics are to study.

They are often, by their very nature, somehow unusual. A few examples:

SARS-CoV-2 impacts an absolutely *wild* number of organ systems for a respiratory pathogen, and the amount of asymptomatic transmission that occurs has been absolutely crushing for any effort to control it.

There's MERS in camels in Africa, but transmission to humans is vanishingly rare. We don't know why.

There appears to be both significant asymptomatic transmission of monkeypox and also it's a more mild strain. We're not sure why.

The Ebola epidemic revealed that, for large swathes of the population, Ebola is a *normal* febrile illness, perhaps with some GI symptoms, not the terrifying Outbreak-style pathogen people think of. That makes studying things like "Was Ebola in West Africa this whole time?" extremely hard to study, because measles, Lassa fever and malaria are also febrile illnesses.

There's mundane things the CDC does every day that you don't recognize because, well, it's not there. We control TB without the use of the vaccine. None of you are worried about Yellow Fever, even though it once killed 10% of Philadelphia's population. The U.S. is malaria free outside the odd importation case or some *really* weird things like airport malaria that impact at most a handful of people. Smallpox is extinct. Foodborne and water-borne outbreaks are rare, and usually process failures rather than "Sometimes that happens".

And public health does all of this on a *shoestring* budget.

[Oniya]

One of my more recent jobs was subcontracting for a company that did lab report summaries for the CDC.  If you look at the label of any disinfectant/cleaner, there's a code number that references a complete label - we're talking several pages of closely-packed text - which includes a typically massive list of what micro-organisms (bacteria, viruses, fungi) the product has been tested on.  I remember the work-load when we had the first two SARS outbreaks, and when we had the H1N1 (swine flu) pandemic.  I was going through dozens of reports, not only because companies needed to test their formulations against the new pathogen, but because they then had to test the new formulations against the old pathogens.  Can't put out a product that's 'Now effective against SARS' if it's no longer effective against Pseudomonas aeruginosa, or even the lowly Staphylococcus aureus.

[Vekseid]

I confess after 2.5 years of this, I'm usually mentally braced for people just wanting to be mad.

Well, I am pissed. Not at you or the CDC of course. But at the celebration of ignorance certain people engage in.

In any case, thank you.

[Oniya]

There's being mad/pissed because there's actually something to be mad about, and then there's being mad just because you want to be mad.

[Azy]

I know people were getting upset about the stance changing.  At first it was you only need a mask if you're sick.  Then everyone needed them in public places.  I always figured that the change was because we found out that a lot of people were becoming carriers with no symptoms, and maybe similar viruses didn't do that to such an extent.  What the CDC was saying seemed to change when what we knew changed.  That's why when people were using it as arguments against the experts, I always brushed that off.  Every virus is a little different, and researchers were researching as fast as they could, but it takes time to figure things out.  When new information comes out, you have to adapt.   

[stormwyrm]

Say it were March 8, 2020, and you were in the position of Anthony Fauci, and had exactly the same level of knowledge we all had back then. The following things were then known:

1. Asymptomatic/presymptomatic transmission was still being hotly debated. The evidence for this was still equivocal at the time and did not clear up until several weeks later.

2. Symptomatic transmission is very well-established, and is a clear and present danger for medical experts who needed to care for those who were ill. It is pretty much certain that masks would help protect them from infection.

3. Community transmission was not yet going on in the United States at the time. This did not change until around a month or so later as I recall.

4. There was a shortage of masks and other PPE at the time.

If you were in Dr. Fauci's position at the time, and that was all you knew, what would you recommend? Remember that you won't know the truth behind #1, that asymptomatic/presymptomatic transmission is a primary driver of new COVID-19 cases until about three weeks later when scientific evidence finally settles the question conclusively. If you recommended general masking in the first week of March 2020, #4 and #2 would be against that decision, and then you'd be blasted for exacerbating the shortage of PPE by recommending masks that early and putting medical professionals at risk, when community transmission was not yet happening. Hindsight is always 20/20.

It seems to be considered a virtue in some circles not to change one's mind in the face of changing information and circumstances, but I for one believe that is a form of madness.

[Annaamarth]

Say it were March 8, 2020, and you were in the position of Anthony Fauci, and had exactly the same level of knowledge we all had back then. The following things were then known:

1. Asymptomatic/presymptomatic transmission was still being hotly debated. The evidence for this was still equivocal at the time and did not clear up until several weeks later.

2. Symptomatic transmission is very well-established, and is a clear and present danger for medical experts who needed to care for those who were ill. It is pretty much certain that masks would help protect them from infection.

3. Community transmission was not yet going on in the United States at the time. This did not change until around a month or so later as I recall.

4. There was a shortage of masks and other PPE at the time.

If you were in Dr. Fauci's position at the time, and that was all you knew, what would you recommend? Remember that you won't know the truth behind #1, that asymptomatic/presymptomatic transmission is a primary driver of new COVID-19 cases until about three weeks later when scientific evidence finally settles the question conclusively. If you recommended general masking in the first week of March 2020, #4 and #2 would be against that decision, and then you'd be blasted for exacerbating the shortage of PPE by recommending masks that early and putting medical professionals at risk, when community transmission was not yet happening. Hindsight is always 20/20.

It seems to be considered a virtue in some circles not to change one's mind in the face of changing information and circumstances, but I for one believe that is a form of madness.

There is a crucial difference here.

A vaccine exists.  Get it.

I know people were getting upset about the stance changing.  At first it was you only need a mask if you're sick.  Then everyone needed them in public places.  I always figured that the change was because we found out that a lot of people were becoming carriers with no symptoms, and maybe similar viruses didn't do that to such an extent.  What the CDC was saying seemed to change when what we knew changed.  That's why when people were using it as arguments against the experts, I always brushed that off.  Every virus is a little different, and researchers were researching as fast as they could, but it takes time to figure things out.  When new information comes out, you have to adapt.   

You're describing science.  That's good.

Unfortunately, the Other Side is bigger about Universal, Unchanging Truths.  This sounds good, except that it has very little to do with reality.

As a religious person, I consider scientific examination a form of worship - this beautiful world was created for us, and to study it and learn how it works is to grow closer the creator.  To not study it would seem perilously close to taking that gift for granted.

I don't think my perspective is shared by many people who are firm believers in Universal, Unchanging Truths.

[Thufir Hawat]

Unfortunately they presented it as MASKS DONT WORK. And then... We've had a huge problem of "people not trusting" (google gilets jaunes complotistes) and this has been la goutte d'eau qui fait déborder le vase.

Well...I think CopperLily clarified that. I didn't even remember that part of the story, because COVID got here later and we were advised to wear masks from day 1, basically.

You're describing science.  That's good.

Unfortunately, the Other Side is bigger about Universal, Unchanging Truths.  This sounds good, except that it has very little to do with reality.

As a religious person, I consider scientific examination a form of worship - this beautiful world was created for us, and to study it and learn how it works is to grow closer the creator.  To not study it would seem perilously close to taking that gift for granted.

I don't think my perspective is shared by many people who are firm believers in Universal, Unchanging Truths.

I'm a big believer in Universal Unchanging Truths. I don't usually advertise it, nor do I have the slightest desire to preach it, but it is true.
Also, I've always* believed that your perspective is the only possible one, and basically should be mandated as an universal truth.

Alas, I agree a lot of other believers don't see it the same way .

*Since I was 16, maybe? It's been a long time !