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Now Monkeypox

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118 points_Microft209 comments

If not for our COVID-19 reflexive memory would this still be a huge story or does it just get hits? I'm genuinely asking, it's good to be informed and help out those afflicted but is this just an easy way to get eyeballs? (I just realize I may sound like a kook saying `it's the media` but I'm genuinely curious)

Probably.

As far as I know, they aren't air transmittable, so I don't see the problem.

It can spread by droplets (lesions do develop in the mouth).

SARS, MERS, and Swineflu all garnered attention at the time. An outbreak of a new disease is interesting, regardless of what happened the last 2+ years.

It's noteworthy for sure, however I am more annoyed by how it is reported. It was always like that for sure, however when the same medium proclaims being the arbiter of truth (fact checkers) I get really disgusted.

Probably not, there have been countless outbreaks and epidemics in the past, all got some attention and media scare. But we haven't had a pandemic since 1920s, so I would bet on the 99.9% chance of it being just a media scare, rather than a new pandemic.

You mean, haven't had a pandemic since 2020?

there were zero pandemics for 100 years between 1920s and 2020s

That's complete BS. Swine flu was a full blown pandemic barely a decade a ago and HIV is still ongoing one.

> pandemics... between 1920s and 2020s

1956-58, 1968, 1981- ...

Not counting the current ongoing pandemic, the last pandemic was 2009/10's swine flu pandemic, which went on to infect 20%+ of the world's population and kill 1M+.

This was certainly my bet in January and February 2020 -- "this is like H1N1, it won't be that bad" or "it'll be like SARS and be contained."

Even if COVID-19 did not happen, this would still get a lot of play because of the name which lends itself to sensationalism and fear. Monkeypox, flesh-eating bacteria, mad cow disease ... these are the things that get played up, while Clostridium difficile, Shigella, and other infectious diseases with obscure names mostly get a collective shrug.

Wait wait wait, are you sure it's not the other way around? That those things don't get those names because they're played up? Monkeypox, flesh-eating bacteria, mad cow disease all have boring scientific names but these are the names the media uses to play them up!

I don't know how these names are assigned or created, but regardless when you have something like "Mad Cow Disease" instead of Bovine Spongiform Encephalopathy it's more likely to be covered and even sensationalized by mainstream media.

I think some scientists have recognized this, after such terms caused stigma and misplaced concern. "Crack baby" was one of them:

The term “crack baby” is an urban legend masquerading as a medical diagnosis. It is a label that stigmatizes, marginalizes and endangers children and their mothers who are desperately in need of care. Born from the combination of an ongoing crisis in urban health care and draconian zero-tolerance drug policies, the crack-baby myth thrives even though it has no basis in science.

Due to a combination of insufficient data and public fears that followed the crack cocaine epidemic of the mid-1980s, crack was alleged to be harmful to the cognitive and emotional development of children. Sensational news stories warned of the damage that crack would inflict on a generation of children and thus on society in general. A few scientists went beyond the data from incomplete research and contributed to the hype with inaccurate comments.

https://www.brown.edu/Administration/News_Bureau/2003-04/03-...

> I don't know how these names are assigned or created, but regardless when you have something like "Mad Cow Disease" instead of Bovine Spongiform Encephalopathy it's more likely to be covered and even sensationalized by mainstream media.

I don't think you've established this though. It may be more likely to be covered for entirely unrelated reasons and have that name as a consequence or coincidence. You're confusing correlation with causation.

> The term “crack baby” is an urban legend masquerading as a medical diagnosis

There are thousands of these and the media doesn't play up let alone care about most of them.

mad cow / cjd / prion disease is in a different league from all the others you mentioned; there's very little recourse and it is scary how difficult it is to sterilize anything that may have been exposed.

and there's no way of knowing if you have prions in your body, and when your brain will turn to mush. CJD is nightmare fuel.

Don‘t forget bird flu and swine flu

> The biggest outbreak of monkeypox in the U.S. occurred in 2003, when health authorities found 47 confirmed and probable cases in six states — Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. “All people infected with monkeypox in this outbreak became ill after having contact with pet prairie dogs. The pets were infected after being housed near imported small mammals from Ghana. This was the first time that human monkeypox was reported outside of Africa.” During this outbreak, 28 adults and two children were given the smallpox vaccine and “no serious adverse events were reported.” Not only did this outbreak not turn into a major public-health crisis, it barely made the national news. When the New York Times wrote about it back in June 2003, the story ran on page A20.

Emphasis added, source:

https://www.nationalreview.com/the-morning-jolt/what-you-nee...

With some exceptions the youngest people who received the smallpox vaccine in America are now 50, so it’s possible that we’ll see more monkeypox cases than previously (the smallpox vaccine provides 85% protection). We were able to eradicate smallpox completely because it has no animal reservoir, unlike monkeypox which also infects rodents and monkeys.

Ebola was big in the 90's, even made a best-selling book and film about it (with Dustin Hoffman) but it only impacted certain African nations, and for decades. I feel the same way as you, and my gut tells me it is a little of both: an actual scary virus that probably won't explode COVID-like, but media hype worthy because every new outbreak of something awful has always been good sensationalism. I look at articles from science sources versus USA Today-like sources for my own opinion.

There were at least two Tom Clancy novels about ebola as well (though it was a genetically modified and weaponized version in one of those instances)

Since we are sharing Ebola in pop fiction, There is 2008 Tamil movie with a weaponized Ebola[1] as well.

[1] https://www.imdb.com/title/tt0479651/

I have an alternative. Maybe it’s not sensationalism, maybe it’s just that journalists do not know the future, and this could potentially become a significant health issue.

So I got to spend an afternoon with one of those mad scientists from Porton Down, the UK biological and chemicals weapon testing place. The stuff they have there makes Ebola look like a walk in the park.

So there are parts of the body the immune system cant go, like the gonads, and eyes, the viruses like Ebola can get in there like toxoplasmosis (eye floaters from cat faeces) and then you become a carrier. Men can pass on Ebola through semen which was being seen in Africa not so long ago and yet still test negative for Ebola!

And then there is global warming like the Artic permafrost thawing that has the potential to release long since forgotten threats. https://www.esa.int/Applications/Observing_the_Earth/Permafr...

So with increased numbers of people travelling and the global population going up, the risks keep going up so I'm not surprised WHO want to take control of this globally. At least they issued a directorate to reduce the number of cycles a PCR test goes through. Putting aside somewhere between 80 and 85 different PCR testing machines, which are not standardised, some countries were only using a cycle threshold of 18 whilst others were using a higher cycle threshold of 45. The cycle threshold can be likened to microscope magnifications, at some point the fluorescence of past viral debris will show up like a live virus the higher the cycle threshold goes.

Now with out this WHO directorate, you would probably be seeing more lockdowns in some parts of the world and other parts spreading Covid like wildfire. Sure its hard to argue things could have been better or worst when we cant jump into parallel universes, but COVID isnt over yet and monkeypox could trigger more lockdowns.

It also shows that countries need global guidance.

Don't get me wrong, I'm not saying the WHO and CDC and similar orgs shouldn't be all over this, but maybe the press should wait until the experts start sounding alarms, instead of sounding it themselves? I honestly don't know, given the train wreck that happened with COVID.

The news is a soap opera for serious people.

Of course it would. Look at the attention paid to past Ebola outbreaks that mostly didn't even leave West Africa. Hell, one single doctor was repatriated and treated at a CDC isolation lab, and that single case led to a huge amount of panic and controversy. Monkeypox is a mysterious new disease that is much less deadly (good!) but has made it to several continents (surprising!) and has done it against all historical precedent.

https://www.cnbc.com/2022/05/23/belgium-introduces-mandatory...

Well, this is the reason why a big deal is being made out of monkeypox. Covid is no longer an adequate reason to justify locking the world down.

Perhaps as big as h1n1 however decade+ long ago that was.

Of course all diseases gain traction in the media in some way. That's normal.

I'm sure this is hyperinflated in the media due to covid however. This monkeypox news is everwhere and most countries have literally a handful of cases, most of them traced to sexual contact (which means large spread is not likely). Really, this warrants the same disinterest as we had in covid in early Feb 2020. But instead it's getting treated as if it's covid-2022. Some caution is of course warranted but I think this is really a knee-jerk reaction.

They're already talking about mandatory quarantines and reporting here (monkeypox dashboard, lol). It would probably be a postage stamp on page 10 if it hadn't been for covid, less than bird flu or swine flu was. Even though the mandatory measures are mostly gone, we still have a ways to go to be really 'back to normal' where people are not constantly worried about diseases. A pandemic is a once-in-a-century event and we shouldn't treat every disease as one until it is.

Belgium already has a compulsory 21 day quarantine for monkeypox in place after some cases were linked to two rave events, one in Spain and the other in Belgium.

People are already spreading misinformation online about the disease.

This article is from an Utah and most likely Mormon news source, so expect some bias:

https://www.deseret.com/2022/5/23/23138042/monkeypox-2022-be...

It sounds like these 'rave' events weren't really dance events but more like orgies. Because also there the infections were identified to be not from incidental contact but from sex.

Broadly speaking:

1) Diseases are a growing issue, with increased human population and travel.

2) It's hard to predict which ones will become pandemics.

It's kind of like asking whether a game of Russian Roulette is a big deal or just a story to get hits. You don't know until you pull the trigger.

It can still go either way. It's likely enough that the global spread will end with identified cases in the low thousands though (people that are shedding virus tend to have readily identified symptoms).

Also, this one is likely similar to AIDS where it’s actually spreading as an STD. In that case you wouldn’t learn it as the media would think that’s gross and not want to report it.

I'm not sure why you're being downvoted. As of a few days ago all but one of the cases was someone with recent male/male sexual contact and presented with lesions around the anus.

It would be incredibly foolish to think, however, that sexuality has any impact on your vulnerability. Do not come into bodily contact with someone exhibiting lesions, period.

Of course. But most transmission happens without any visible lesions.

The crazy thing about exponential growth is how quick it is, almost regardless of the base.

If I see 1 case one week, then 10 cases two weeks later, and pushing 100 two weeks after that, it’s pretty scary.

I think it would - people have mostly forgotten about Smallpox due to a very successful vaccination campaign but it is still in public memory.

WHO is meeting this week to vote on amendments to international health regulations, https://www.ejiltalk.org/the-far-reaching-us-proposals-to-am...

> proposed US amendments to Article 12 IHR will both considerably extend the executive powers of the WHO Director-General to declare global emergency-like situations and centralise this power further by removing the need to consult and find agreement with the respective state party ... Articles 9 and 10 IHR moreover strengthen WHO’s powers to assess alleged global health risks by relying on information received outside official channels, giving the respective states only 24 hours to verify such information.

> ... if WHO’s powers are extended in this way, is there a need to also answer the question quis custodiet ipsos custodes (who guards the guards?), and to thus set up mechanisms ensuring that WHO complies with its obligations under the IHR and its Constitution, as well as its responsibilities for human rights deriving from customary international human rights law?

WHO's Intergovernmental Negotiating Body (INB) site has videos from their April 2022 meeting: https://inb.who.int

> centralise this power

That's the part I take issue with. Any time power becomes centralized (including during emergency situations) it leads to loss of individual freedoms, and often increased anthropogenic (=human-caused) suffering.

If you were wealthier you would understand the importance of centralized power

There's a big difference between centralized power and coordinated action facilitated by wise leadership.

The latter does not require the former, contrary to what some people might say -- those who wish to hold unfettered power, or those who wish to be ruled over by one holding such power.

The issue is you and I know this, but they don't

Or the opposite.

ETA: I made this comment before the author clarified they were being sarcastic.

I'd propose that if you made more of an effort to be empathetic with people who lack access to wealth and privilege, you'd understand better the criticisms of centralizing power and power structures in general.

"You don't understand because you can't see my perspective" goes any which way, and so is not an argument. If their are artifacts of your perspective that we need to form a full and coherent view - then share them with us. If you're just looking to be patronizing and dismissive because you only value a certain perspective - then please reconsider.

Pretty sure the parent comment was just missing a /s

yeah sorry. I'm not going to support a country that can't even talk about Taiwan "centralizing" its power.

What is the “power” here? Does the power to declare things itself result in consequences?

Nb America has too many elected positions; most democracies have fewer (are more “centralized”) but also it’s easier to fire them if you don’t like them (here it’s difficult to impossible). For instance the best reason to elect both a mayor and supervisors of SF is if you want them to fight instead of getting things done, and indeed that’s what they do.

A proposal cited by the EJIL article, previously rejected during a 10-year revision process for IHR:

> The proposal to grant WHO – and the US Centre for Disease Control and Prevention (CDC) which is closely associated with WHO due to its technical skills in epidemiological investigations – the right to carry out on-site assessments/send expert teams that the state party in question cannot easily reject, should be carefully analysed also in light of similar US proposals made in 2004 during the then thorough revision process of the IHR (lasting from 1995-2005). At the time, some WHO regions rejected the proposal as they suspected a US’ intention behind them to gain access to biodefence research facilities around the world, thus fearing espionage. This appeared against the background of the Iraq war which started in 2003 under the pretext of the existence of Iraqi bioweapons that UN investigators had been unable to find.

Arguably yes. For example declaring a state of emergency does have knock-on if not immediate consequences.

>What is the “power” here? Does the power to declare things itself result in consequences?

Great question, and no it doesn't. Part of the UN's push[1] around this treaty is ensuring that it actually has teeth and isn't just hot air. For example, it recommends the involvement of World Bank, International Monetary Fund, World Trade Organization and International Labour Organization in the negotiations, and suggests the treaty offer financial incentives for the early reporting of health emergencies:

>In case of a declared health emergency, resources need to flow to countries in which the emergency is occurring, triggering response elements such as financing and technical support. These are especially relevant for LMICs, and could be used to encourage and enhance the timely sharing of information by states, reassuring them that they will not be subject to arbitrary trade and travel sanctions for reporting, but instead be provided with the necessary financial and technical resources they require to effectively respond to the outbreak.

The UN also raises the question of countries being punished for non-compliance:

>[The treaty should possess] An adaptable incentive regime, [including] sanctions such as public reprimands, economic sanctions, or denial of benefits.

In other words, if you report disease outbreaks in a timely manner, you will get financial resources to deal with them. If you DON'T report disease outbreaks, or don’t follow the WHO’s directions, you will lose out on international aid and face trade embargoes and sanctions.

These proposed rules would incentivize reporting possible disease outbreaks. Some would suggest they actively encourage outbreaks.

[1]https://theindependentpanel.org/wp-content/uploads/2021/05/C...

This is probably in response to the CCP attempts to cover up the covid epidemic in Wuhan and to misreport cases and deaths.

Although I fail to see how the Xi era China would allow a WHO team investigate in a timely manner, after they placed the covid investigators in a two week quarantine more than a year after the event occured and they had plenty of time to further cover things up.

This is a really hard philosophical claim you have here. Especially given the fact that it uses vague terms like freedom and power, which philosophers don’t really know the full ramifications of, and whole books have been written on trying to understand what they even are.

I’m gonna call bullshit on this. This sentence can mean anything you want to, while being constructed in such a way to be arise suspicion.

That is, unless you care to clarify what you mean by power and freedom here, i.e. is patents on vaccines included in centralization of power? Is my freedom to infect those around me included?

And even after you have clarified these terms, some empirical data wouldn’t hurt either. To show a negative correlation with—whatever you call centralization of power and individual freedom (however you define it).

> Is my freedom to infect those around me included?

Yes.

> and centralise this power further by removing the need to consult and find agreement with the respective state party

This is discomforting. Genuinely curious how anyone would see this as anything more than a power grab.

Is it intended to remove politics from science?

By replacing it with unilateral power?

Yeah, what could go wrong with that?

1984 but instead of televisions with pee-bottles and blood-tests ;))

The WHO is not really "powerful" like a nation is, as they do not have a military or enforcement arm, and they do not pass laws.

All they can do is decide how their funds get spent. They are granted all these "powers" to spend their funds by the participating states. Furthermore, they are restricted to spending it on things that promote world health. The worst they can do is squander the money, which isn't even all that much.

Compare this to people like Jeff Bezos who have vastly more money, 100% centralized, and effectively no restrictions on how they spend it. Whether you should be concerned about that is up for argument, but by contrast, any concerns about the WHO are pretty absurd.

> The WHO is not really "powerful" like a nation is, as they do not have a military or enforcement arm, and they do not pass laws.

True, but a majority of policy makers and talking heads (that influence and approve laws) carry out their deeds under the guise of "Well, the WHO says so". Consider how frequently the "appeal to authority" tactic was used during the pandemic.

This isn't entirely without consequence.

But still consider the relativity here. The risk of a malicious WHO is insignificant next to the risk of rich industrialists like Jeff Bezos. Very wealthy and powerful entities like Jeff Bezos do lobby and influence governments and media on a totally different scale then international organizations such as WHO. And more often then not these industrialists do succeed in bending policy to their favor at the cost of everyone else.

Maybe this isn’t without consequence, but relatively speaking the risk of negative consequences are next to nothing.

Fascinating look at their new proposal

https://twitter.com/criticalsway/status/1526464386386345984

https://threadreaderapp.com/thread/1526464386386345984.html

Thanks for posting this plain-english summary.

> WHO is meeting this week

This seems off topic.

The article is about monkeypox. The WHO meeting is about regulations.

Yes, they are both public health issues, but that's about as close of a connection as there is.

Transmission information according to the CDC:

Transmission of monkeypox virus occurs when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth). Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding. Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required. Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.

https://www.cdc.gov/poxvirus/monkeypox/transmission.html

Not looking forward to seeing "bush meat preparation" turning into a red vs blue issue...

red: bush meat provides vital nutrients and is the perfect paleo diet! blue: bush meat consumption increases worldwide temperatures! If you eat bush meat, you dine with hitler!

So basically you either have to cough into someone's face, or kiss them, or get bitten, or have sex with them to transmit the virus.

Stop worrying. This isn't another coronavirus-level pandemic.

Not to mention most of the identified infections were sex-related, making it even less of an issue. Most people aren't promiscuous so it will be very difficult to spread far that way. There's other transmission routes of course but they seem to be much less potent.

FTA: "people are poring over the data right now and comparing it to "classic" monkeypox sequences to see if this a new variant, perhaps with enhanced transmissibility. So far there are no glaring signs of that, but this work is very much ongoing; it's just too early to draw any conclusions."

This was an interesting development:

Health officials are investigating whether a number of monkeypox cases in the UK were sexually transmitted – in what one expert fears could be the first recorded instances of their kind.

The UK Health Security Agency (UKHSA) has detected seven monkeypox cases in total, all of which were diagnosed between 6 and 15 May. Four new ones were confirmed last week. Three of the new cases are in London and one linked case is in the north east of England. All four sufferers are men who identify as gay, bisexual or as men who have sex with men (MSM).

https://inews.co.uk/news/health/monkeypox-uk-outbreak-first-...

AIDS had even less avenues for transmission and it became a pandemic.

HIV is nowhere near the coronavirus in transmissibility. It's been around for decades, and even now only around 1-2% of the population got it, mostly drug addicts who shared needles and people who have unprotected sex (mostly anal) with strangers.

Monkeypox is symptomatic quickly and once resolved in the next couple of months, the infected person ceases to be infectious. That's very different than HIV, which rarely goes away in an infected person and doesn't develop into symptomatic AIDS on a similar timeframe as monkeypox. This makes HIV much more difficult to control.

Obviously you have a point about the different timescales, but the CDC lists 7−14 days as a typical incubation time and a fuller range of 5−21 days. That's fairly long and nice for cases which are being successfully contact traced, but also generous room for sh*t to happen in cases where the trail is lost.

Monkeypox already has observed fomite transmission (i.e. via contaminated materials), but what's more: it is a poxvirus! It's next of kin of an pathogen known to display true airborne transmission. Maybe for now it's not adept enough at infecting humans to manage on small amounts of the finest aerosols or dried out excretion smoke, but how long is that going to last if this (already atypical) strain can manage to build up variance infecting large numbers of people in densely populated areas?

HIV is not that difficult to control in theory. You just test everyone, recurringly, and have the infected individuals strictly adhere to measures to prevent spreading the contagion. Problem managed. As we know, in practice that's prohibitively difficult to bring about.

Several weeks to symptoms with ability to contaminate shared environments and potential to develop ability for mass transmissions could be a nasty thing to manage in practice too.

This is already on several continents and health authorities don't seem all that on top of what could well emerge over the next few weeks, as incubations time out. So I wouldn't be wildly surprised if we can look back in a month or so and say by late May it was already technically a pandemic. But let's hope, of course, that the transmissibility really is fairly low, that the current reach is a quirk of circumstances, and that all the outbreaks can still be contained.

Otherwise I guess it's time to urgently draw on prior research in vaccines for the second time in a small number of years.

> cough into someone's face

That is not a necessary limited interpretation of «prolonged face-to-face contact».

> Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required

On no, not this droplet thing again. The CDC said the same thing about SARS-COV-2. Hopefully they are right this time.

They didn't realize covid was essentially airborne at the time. Monkeypox is definitely not an airborne virus (yet).

YES, they did.

The definition of droplet/airborne was wrong and it took a very long time to correct it.

https://www.wired.com/story/the-teeny-tiny-scientific-screwu...

I think the biggest failure wasn't the CDC being wrong at first, it was society not being receptive to changes. It's impossible to be correct every single time. The only thing they can do is say what they know so far.

Nope, that was not it: the definition of droplet was f'd up. It is corrected now. https://www.wired.com/story/the-teeny-tiny-scientific-screwu...

...that article says exactly what I said. The CDC was initially wrong, and after some good science and convincing, they changed their stance.

That's how science works... and numbers like 5 microns which have been ingrained for a while take some real work to change.

What exactly is wrong with my statement?

The rise of zoonotic infections should not be surprising at all given the rate of deforestation and general disregard for nature.

Yeah, but monkeypox isn't a new one. It's been around since the 70's.

We were averaging a potential pandemic every 3 or so years for the last ~20 years.

Original SARS, Bird Flu part 1, MERS, Swine Flu (arguably an actual pandemic), Bird Flu part 2, Covid.

No one should be surprised that there's a new possible pandemic 3 years after Covid.

If this ends up being another actual pandemic - that would be surprising.

Add gain of function / deliberate bio-terrorism in there as well.

Feb 1992 - a Soviet defector revealed to Western intelligence that he had overseen an extensive, illegal programme to develop smallpox into a highly effective biological weapon:

> Ken Alibek believes that, following the collapse of the Soviet Union in 1991, unemployed or badly-paid scientists are likely to have sold samples of smallpox clandestinely and gone to work in rogue states engaged in illicit biological weapons development.

https://www.bbc.co.uk/history/worldwars/coldwar/pox_weapon_0...

June 1998 - The WHO recommends that all smallpox samples should be destroyed https://www.nejm.org/doi/full/10.1056/NEJM199808203390811

Feb 2002 - WHO says that Russia and US can keep their smallpox samples https://www.cidrap.umn.edu/news-perspective/2002/02/wide-ran...

Nov 2002 - CIA claims that Russia, France, Iraq and North Korea have "secret" stashes of small pox (erm you already know Russia has them, that's not a secret) https://www.cidrap.umn.edu/news-perspective/2002/11/cia-beli...

Sep 2019 - Explosion and fire break out at Russian lab known for housing deadly smallpox virus https://www.cnn.com/2019/09/17/health/russia-lab-explosion-s... https://www.livescience.com/russia-lab-stores-smallpox-explo...

To summarize the linked blog post (emphasis because this is not a news article, an urgent bulletin, or a report on research findings):

Cases of Monkeypox have been popping up around the world. Monkeypox is not a new disease, is "not particulary contagious", and is rarely fatal. The provocative thing is that numerous cases are popping up at the same time in different parts of the world.

Its a blog post from an author with a long history of effectively communicating complex things without extra hype and with entertainment value. Don't miss the "things I wont work with" posts.

Interesting context: WHO officials said: "the most recent surge in cases appears to have been spread among men who have sex with other men"

https://www.cnbc.com/2022/05/23/monkeypox-outbreak-is-primar...

If the close contact during sex is a good way to get infected then it makes sense that a group that are largely cut off sexually from the rest of the population would see it first.

I think this information is from the UK where MSM are more likely to be engaged with their sexual health (ie get tested more often) than the population generally

I'm seeing a lot of conspiratorial thinking on Twitter and elsewhere where people think it's just too suspicious that a new virus has popped up so soon after COVID-19. If you're harboring these suspicions, it might be worth reading a little about the Poisson Distribution[1] and Frequency Illusion[2].

Because the appearance of an emerging disease isn't generally correlated to the appearance of another, different disease (big assumption here), there is no guarantee of even spacing. Furthermore, we've had over 30 emerging infection diseases pop up in the last 30 years[3]. They're much more likely to receive increased attention now however, due to heightened worldwide awareness of infectious disease from COVID-19.

I'm not saying that there's definitely no conspiracy, but Occam's Razor says cognitive bias is a much more likely explanation for why monkeypox seems so oddly-timed than Bill Gates's secret world domination plan.

[1] https://en.wikipedia.org/wiki/Poisson_distribution

[2] https://en.wikipedia.org/wiki/Frequency_illusion

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618832/

This virus is a great place for effective altruism biosecurity projects to focus. By building up expertise solving real challenges, we'll be in a better spot with future pandemics. Anti-fragility by figuring out small challenges so we're better prepared for the big ones.

You might be happy to learn about CEPI [0][1], the "Coalition for Epidemic Preparedness Innovations". They have the goal to ship vaccines 100 days [2] after outbreak of a pandemic by doing a lot of the research and testing in advance. They plan to create "templates" for vaccines for two dozen different viruses that pose a risk of causing a pandemic and test these in advance for safety and dosage, so that they only need to be slightly tweaked for an actual pandemic.

[0] https://cepi.net/

[1] https://en.wikipedia.org/wiki/Coalition_for_Epidemic_Prepare...

[2] https://100days.cepi.net/100-days/

I had smallpox growing up in a third world country, how protective would the immunity be going against that?

Apparently the smallpox vaccine protects against monkeypox, I imagine recovering from one would protect against the other.

Not total but some protection. The last article I read suggested a fully vaxxed person still had a couple of lesions (how it was detected). Definitely better than a full blown attack.

As Lowe notes in the blog piece, statements of about 85% protection from the smallpox vaccine are going around.

I haven't seen anything in particular about the protection resulting from a full-blown, non-attenuated infection, but as I understand it from discussions apropos another pathogen of fame lately, the rule of thumb is more comprehensive and lasting immunity from going through the disease as compared to vaccinations.

That is, I believe you ought to be in great shape compared to most of the world population.

What was it like? If it can be meaningfully described...

Big caveat: we don't actually know, because it hasn't been studied, because human monkeypox is very rare. Still, some conjecture:

You're very probably immune. Recovery from smallpox almost always meant life-long immunity and re-infection was basically unknown when it was common. The orthopoxviruses are known to have a lot of cross-immunity. People who get cowpox are immune to smallpox, and vice versa. The classic smallpox vaccine used widely in the 20th century was just a very mild strain of pox (genetically somewhere between smallpox and cowpox, and of uncertain origin now lost to history) which causes almost no illness in humans.

Now this is totally unfounded, and verging on the nutty conspiracy theory side of life .. so please do feel free to cut me down; but is there a possibility that this type of unusual virus / unusual pattern of transition, could be part of a larger terrorist type plot?

The western world is currently at loggerheads with Russia. Russia has a track record of subterfuge (e.g. Salisbury poisoning in the UK).

Feels like the gay community have been the most affected, which seems odd to me. The Russian government definitely doesn't hold much love for the LGBT community.

Many of the people who have become symptomatic haven't been able to be traced to other people who've been similarly infected.

Am I nuts for thinking along these lines?

Or a globalist conspiracy to distract and divide people, while allowing more power to be centralized?

Are there mid terms this year?

In our globalized world, everyone suffers in a pandemic. This kind of attack would be as likely to devastate the attacker as their opponents, so there's really no motivation for a government to carry out attacks like this. It's another form of MAD deterrence.

If it was possible to target people with specific genetics, it might be a slightly more realistic scenario. But considering that viruses regularly evolve enough to jump between species, it could still easily evolve to hurt the 'favored' population group as much as 'enemy' groups.

On that note, if there's any silver lining at all to pandemics, they really do align the interests of all humans like no other threat/problem, save perhaps for some sci-fi scenarios like an impending asteroid impact or alien invasion. When it comes to viruses, we're all in the same boat.

In my nutty conspiracy, the agent would simply disseminate the virus at bath houses.

The more I think about it, the more it does seem like a nutty conspiracy.

I did watch twelve monkey's many years ago!

But putting further stress on the countries opposing might help a cut-off Russia in the short term...

I mean they already have virtually no travel across their borders, and what happens in next few months is probably of greater urgency to them than later.

By the same token though, a renewed pandemic in Russia could push them to a political and economic breaking point at a time when they're already stretched thin and vulnerable.

If they want to lash out, they have many other ways to do so that carry far lower risk of crippling blowback.

Covid showed that even strict border controls aren't sufficient to keep viruses out if they're contagious enough. No borders are 100% secure, and it only takes a single person getting through to light the match.

https://metro.co.uk/2022/05/20/russia-planned-to-use-monkeyp...

"Russia’s military scientists researched using monkeypox as a bio-weapon until at least the early 1990s, according to newly resurfaced interviews with a former Russian army colonel."

Russia performed very poorly in the Covid pandemic, it had one of the highest death rates in the world.

It would be a pretty dumb plan for them to start a new pandemic.

> Am I nuts for thinking along these lines?

Probably. Unless some "gay gene" was identified and this virus was targeting carriers very specifically, any weapon like this is completely indiscriminate. Even if they somehow deliberately infected them, it would not be contained in the community for long.

> Feels like the gay community have been the most affected, which seems odd to me.

It can be sexually transmitted (among other vectors). Homosexual behavior is not the issue. Unprotected sex is (much higher chance if it's anal, as in most sexually transmitted diseases). And, it seems, any sort of close contact is sufficient. It's understandable that the gay community would be the canary for this issue. There's also some percentage of the population that will engage in unprotected sex regardless of orientation.

I like your candour :)

> It can be sexually transmitted (among other vectors). Homosexual behavior is not the issue. Unprotected sex is (much higher chance if it's anal, as in most sexually transmitted diseases). And, it seems, any sort of close contact is sufficient. It's understandable that the gay community would be the canary for this issue. There's also some percentage of the population that will engage in unprotected sex regardless of orientation.

I thought all that was needed was close physical contact (rubbing against a sore, sharing a towel etc). I don't think unprotected sex / anal sex is the issue here. Definitely doubt a condom is going to help much ..

.. and as far as I know, Monkey Pox isn't a sexually transmitted disease. All seems very odd to me.

However, as for me being nuts; maybe there is a high probability :)

Financial terrorist plot perhaps, if there could be hundreds of billions to be made in vaccine contracts.

Let's wait and see who makes the most accusations, and most importantly, who stands to gain from all of this.

>Feels like the gay community have been the most affected, which seems odd to me.

Why would that seem odd, HIV/AIDS has always predominantly affected the gay community so this wouldn't the first virus to do that.

Because HIV/AIDS is a sexually transmitted disease.

Monkey Pox just requires close contact.

The virus is spread through close contact with people, animals or material infected with the virus. It enters the body through broken skin, the respiratory tract, the eyes, nose and mouth.

Though human-to-human transmission is believed to occur through respiratory droplets as well, that method requires prolonged face-to-face contact because the droplets cannot travel more than a few feet, according to the CDC.

https://www.cnbc.com/2022/05/23/monkeypox-outbreak-is-primar...

Apparently the initial wide spread may be due to sexual transmission at two raves:

https://www.nbcnews.com/health/health-news/monkeypox-likely-...

Expert: Monkeypox likely spread by sex at 2 raves in Europe

[1] https://apnews.com/article/health-world-organization-united-...

I'm starting to wonder if monkeypox was always a real threat for wide spread in principle, but it never did because the global population was, coincidentally, largely immune to it because of widespread smallpox vaccination.

A paper from 2010 suggests that the outbreaks in Nigeria started around the time when herd immunity from the last smallpox vaccination campaigns in the area (1980s) would be substantially fading, with the majority of the population not immunized, having been born after:

> Factors associated with increased risk of infection included: living in forested areas, male gender, age < 15, and no prior smallpox vaccination. Vaccinated persons had a 5.2-fold lower risk of monkeypox than unvaccinated persons (0.78 vs. 4.05 per 10,000). Comparison of active surveillance data in the same health zone from the 1980s (0.72 per 10,000) and 2006–07 (14.42 per 10,000) suggests a 20-fold increase in human monkeypox incidence.

> [...]

> More than 90% of cases identified in our surveillance program were born after mass smallpox vaccination campaigns officially ceased, and less than 4% of infected individuals had evidence of previous smallpox vaccination. Furthermore, our data suggest that vaccine-induced immunity is long lasting because individuals who were vaccinated against smallpox over 25 y ago still appear to be at significantly reduced risk of monkeypox.

https://www.pnas.org/doi/10.1073/pnas.1005769107

You should be FAR more worried about PFAS, micro plastics, environmental estrogens, and their links to cancer.

However, DuPont, Dow, 3M, and BASF are very skilled at giving their poisons very innocuous names. Maybe viruses would be wise to have in-house PR teams as well…

I have read that the outbreak is concentrated in gay men via sexual transmission. The article doesn't say anything about that, which I would say is par for the course for public health communication, if this is indeed the case.

From what I've read, you're partially right in that many are from "gay, bisexual or have sex with men," but have not concluded that it is specifically due to sexual transmission. The WHO used the term "leading theory" when talking about "sexual transmission."

> In an interview with The Associated Press, Dr. David Heymann, who formerly headed WHO's emergencies department, said the leading theory to explain the spread of the disease was sexual transmission among gay and bisexual men at two raves held in Spain and Belgium. Monkeypox has not previously triggered widespread outbreaks beyond Africa, where it is endemic in animals.

> "We know monkeypox can spread when there is close contact with the lesions of someone who is infected, and it looks like sexual contact has now amplified that transmission," said Heymann.

> Other scientists have pointed out that it will be difficult to disentangle whether it is sex itself or the close contact related to sex that has driven the recent spread of monkeypox across Europe.

> U.K. officials have said "a notable proportion" of the cases in Britain and Europe have been in young men with no history of travel to Africa and who are gay, bisexual or have sex with men. Authorities in Portugal and Spain also said their cases were in men who mostly had sex with other men and whose infections were picked up when they sought help for lesions at sexual health clinics.

The only concrete thing I think we can reasonably conclude is that it is easier to spread via 2 naked people who have a lot of skin on skin contact vs say 2 clothed people hugging, regardless of the specific activity engaged in.

https://www.cbsnews.com/news/monkeypox-spread-sex-raves-euro...

From CDC.gov

TLDR: Yes the Smallpox vaccine is effective against Monkeypox but it's not generally available.

https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment....

Appropriately, 2022 is the Year of the Monkey.

"The scenario (from march 2021) simulates a monkeypox outbreak in starting in 'brinia' on 15 May 2022 that was an engineered strain for vaccine resistance."

https://www.nti.org/wp-content/uploads/2021/11/NTI_Paper_BIO...

It's some coincidence there is an actual outbreak in May 2022 in Britain.

Kinda funny that you are being downvoted. Even the date was spot on. But you're getting the downvotes from the "oh they do these things all the time" crowd.

The same post got 12 upvotes so I'll call it even...

https://news.ycombinator.com/item?id=31455056

HN works in mysterious ways, so I just upvoted you. =)

"the outbreak takes place during a national holiday with extensive domestic and international travel by Brinians"

"population 250 million"

Doesn't sound like Britain at the moment

I think it's a big deal because viruses get clicks now in the age of covid. The articles often include graphic images to drive engagement. It's a hard to spread virus that currently appears to be concentrated in men engaging in homosexual intercourse. No one has died and they respond well to the existing smallpox vaccine. It's currently media driven and nothing to worry about. That could change but currently nothing to do.

>> I think it's a big deal because viruses get clicks now in the age of covid.

SARS, MERS, bird flu. These were all big news too.

>> It's a hard to spread virus that currently appears to be concentrated in men engaging in homosexual intercourse.

Do these people not matter? Also, have you forgotten HIV? Really struggling to find your point here.

Sars, mers, etc. were airborne, monkey pox is not. Monkey pox has hit the US before in 2003, not much media hysteria. I am saying that in the age of covid , viral infections generate clicks. I have not forgotten about hiv, this is not hiv. It's an easily cured, well understood virus with an existing effective vaccine. The point was that with the current method of spread already understood and identified as requiring direct intentional contact that this is not a virus we should all be panicking and isolating over.

Will there be a new mass-vaccination and contact-tracing on our phones?

Will Astra Zeneca's large vaccine factory suddenly burst into flames when they are about to begin production?

Will the lion's share of contracts then go to U.S. Big Pharma?

Will their prices conveniently go up by 20% the year after?

Will we discover once again that Moderna patented specific genetic sequences of this virus a whole year before it was even spoken of in the news?

Let's see if there's a repeat of events, and if we can learn something this time around.

> Will the lion's share of contracts then go to U.S. Big Pharma?

What is this comment supposed to mean? Do you want the contracts to go to the small mom-and-pop pharma companies?

Monkeypox, if it becomes a real big problem, will likely be very different than Covid-19. I think if we learn anything its that we should let the experts do their job and just listen to their advice, and not automatically think that everything we learned from Covid-19 will transfer over. It's pretty straightforward to do that, but we haven't even mastered that yet.

Read the line above, and put one and one together.

What's your point? Smaller companies have a better chance of success? Why would that be?

Will you tell about the aliens and 5G again?

Here's one that's already making the rounds - Wuhan Institute of Virology was experimenting with constructing monkeypox virus last year: https://www.sciencedirect.com/science/article/pii/S1995820X2...

Meanwhile apparently on Chinese social media the claim is that the US released it intentionally: https://www.dailymail.co.uk/news/article-10845749/Conspiracy...

Aaaand their basis for that is remarkably similar to Event 201, a simulation about a coronavirus pandemic that happened in 2019, that originated in bats ( https://www.centerforhealthsecurity.org/event201/scenario.ht... ).

> Will there be a new mass-vaccination [...]?

Probably not. It's not so contagious, for transmission is necessary close proximity and there are no asymptomatic cases. So I guess they will use ring vaccination https://en.wikipedia.org/wiki/Ring_vaccination I.E. If you get sick, they will vaccinate everyone that met you and everyone that met someone that met you, and perhaps everyone that met someone that met someone that met you.

> and contact-tracing on our phones?

If it's solved soon as I expected: no.

If it takes more time, perhaps. Explaining ring vaccination is difficult and people will complain that the government is only vaccinating X and not Y. So they must do something for everyone, and an app is an easy solution. Also, remember that Big Telco already has all your data, and the government can get that easily, so a contact-tracing doesn't give them much more info.

tldr: "Overall, I would say that this is in the don't-panic-but-keep-a-close-eye-on category."

I have always felt angry they stopped smallpox vaccination before I was born. Now all the boomers are immune and we are not.

Why not just get your smallpox vaccination? Hint it's 35 swiss franks. ...when you visit Switzerland (in the tropical institute) ;)

afaik no smallpox vaccine is currently approved in Switzerland (according to https://www.nau.ch/politik/bundeshaus/affenpocken-swissmedic...)

Why do you link a monkeypox article?

That is smallpox:

https://en.wikipedia.org/wiki/Smallpox

And that's the vaccine in 1980:

https://collection.sciencemuseumgroup.org.uk/objects/co14865...

Your article means that the smallpox vaccine is not approved for monkeypox...please read at least your article.

https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten...

>>Unser Land verfügt zudem über einen Notfallplan (Isolierung der Erkrankten, Quarantäne, Impfung exponierter Personen und Dekontamination von Gegenständen) sowie über eine genügende Menge eines Pockenimpfstoffes der 1. Generation, der für die Impfung einzelner Bevölkerungsgruppen bis hin zur Gesamtbevölkerung ausreicht. Zudem werden derzeit antivirale Medikamente entwickelt.

>>Our country also has an emergency plan (isolation of the sick, quarantine, vaccination of exposed persons and decontamination of objects) and a sufficient quantity of a 1st generation smallpox vaccine for vaccination of individual population groups up to the entire population. In addition, antiviral drugs are currently being developed.

Because the article talks about the theoretical effectiveness of smallpox vaccines against monkeypox but that no vaccine (smallpox or monkeypox) is currently approved in Switzerland (the smallpox vaccine was approved in the past but is not anymore since its eradication)

Vaccine does not need to be re-approved. If it is approved it stays like that, if nothing happens, but it's not approved for monkey-pox.

And this is the vaccine:

Smallpox (J07BX)

https://www.swissmedic.ch/dam/swissmedic/de/dokumente/marktu...

The smallpox vaccine is still administered (but not mandatory anymore) and that report is from 2015, it's about side effect from vaccines.

Side Effects = administered

And why is that if it is "eradicated"?

https://www.forbes.com/sites/brucelee/2016/08/28/smallpox-co...

>>Ein Heilmittel gegen die Pocken existiert nicht. Lediglich eine vorbeugende Schutzimpfung ist möglich.

>>There is no cure for smallpox. Only preventive vaccination is possible.

https://tropeninstitut.de/krankheiten-a-z/pocken

A friend of mine got one ~2 years ago for traveling to Mongolia.

So what it boils down to: The old (1st generation) vaccine is still being held in storage but currently not available to the general public (says https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten..., FAQ number 10). It could be made available in case of an outbreak. There is no approval for any of the more modern vaccines.

> please read at least your article

Please refrain from accusations of someone not having read the article, it's unconstructive and against site guidelines.

I don't know how you come up with a different reading of the nau.ch article. It states (even though it's an inaccuracy as there are still some 1st generation vaccines available as we figured out):

"Der Pockenimpfstoff gilt als erster der Geschichte. Nur nützt das die Schweiz in der aktuellen Situation mit immer mehr Fällen von Affenpocken nicht. Denn hierzulande ist kein Impfstoff zugelassen."

It originally had a higher rate of side effects than many other vaccines because it was a locally replicating live virus. This is why vaccinated people typically have scars because it would create a local infection and a lesion on the arm. In some rare cases this would go systemic and result in a full scale infection, so when it was locally eradicated the mass vaccination program ended in the US (1972).

Apparently the modern vaccine uses an attenuated virus so it’s less likely to cause issues. I assume that’s what is used if you elect to take it for travel in Switzerland.

If the smallpox vaccine has not changed a lot in the meantime... Probability of death: 1 in 1 million. Probability of death for infants: 5 in 1 million.

Still not something to take a risk.

[Comparatively, if this source is not mistaken: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/ad... for Covid vaccine 5 deaths per 1 million]

The smallpox vaccine is no joke, and cause actually hurt people with fairly common skin conditions like eczema:

https://www.aad.org/public/diseases/eczema/childhood/health-...

When my unit was vaccinated before Iraq the docs were concerned for me. I had to take precautions.

>skin conditions like eczema

Terrible terrible....but then let's go to iraq.

Wasn’t my choice to go to Iraq, and honestly as a 22 year old kid I had no idea what was going on in the world, I didn’t watch or read the news, I didn’t know what politics was except a vague conception of my parents voting habits… I was focused on surfing, finding some beer, and trying to find a girl. Being there changed all that.

Crazy when i was 12 i already knew it's wrong to invade other country's...

>Wasn’t my choice to go to Iraq,

Ah they forced you? Land of the free?

No Girls and surfing in Iraq right?

Yes. They did force me. That’s how the military works. If you’d like to express anger over this, I’d suggest starting with Dick Cheney and George Bush, and not popping off on a low ranking enlisted person.

Ah that's new to me that the US has mandatory military service after Vietnam.

However, sorry for being angry toward you. You are just partially (a really small part) responsible for the war.

I joined in 1999. There was no war going on and the last military conflict the US was in was peacekeeping in Somalia or the Balkans. I was 17 when I signed up, and like many low income people saw it as the only way to pay for college, because I couldn’t afford any other route.

Once you sign up, refusing orders will get you sent to military prison plus a dishonorable/OTA discharge.

I’m glad you’ve lived the privileged life that has allowed you to think that this was some ascetic choice, like picking a school or an outfit, but this was the only way I could figure out how to exist because I had no money and no skills, and no help.

I’m not sure what you’re trying to accomplish, but you’re punching down. Never a good look. You have no idea the burden put on people like me, lower class that have no options because capitalism has ripped away most sources of a better life, and then sold at 17 a way out, you just have to offer to serve for a chance for it. Then you end up in a war. Sounds like you haven’t had to make a hard choice in your entire life.

>I’m glad you’ve lived the privileged life that has allowed you to think that this was some ascetic choice

I had to do military service too (Switzerland) so you don't talk to a complete stranger -> military prison etc.

But you had the chance not to do it...just saing, and 1999 what war was then? Kosovo conflict.

Military service in Switzerland... lol, I'll repeat my previous comment, you've never made a hard choice in your life. Living in one of the richest countries in the world that is famously neutral and cosplaying as a soldier, what a joke.

Was vaccinated before deploying to Korea and that was not fun. That thing itched like crazy. But then it was nice when we deployed to Iraq and everyone else had to get the vaccine and I didn't :)

correction: all the boomers are probably immune.

https://pubmed.ncbi.nlm.nih.gov/16804475/

The thing about public health is that it's a game of averages. Smallpox vaccination, because of the specific details of the vaccine itself, has significant potential side effects well beyond any other modern commonly-administered vaccine. These side effects can be permanently disabling, or in some cases even cause smallpox-like illness itself. When smallpox was widespread, the downside of vaccination (side effect risks) was much smaller than the downside of not vaccinating (dying of smallpox). Now that smallpox has been eradicated, the calculation is changed - on average the damage that will be done by side-effects in a wide-spread vaccination campaign are outweighed by the extremely small risk caused by not vaccinating.

That leaves the question of whether a better (safer) smallpox vaccine could be developed - I don't know enough about medical science to know if that's feasible, but even if it is it's likely not worth the cost and effort to develop a new vaccine for a disease that is no longer really a threat.

> That leaves the question of whether a better (safer) smallpox vaccine could be developed.

I found this last week in Wikipedia: https://en.wikipedia.org/wiki/Smallpox_vaccine#MVA-BN is a new non-replicating vaccine available since 2013.

"another less in [sic] real-time virology"

A typo in the first sentence? In Science? Wow...

Yes, but it's a blog.

"In the pipeline" is a blog by Mr. Lowe and was only recently moved to the science.org domain (it could be found at blogs.sciencemag.org before). I wouldn't expect his articles to be proof-read by anyone else but himself to be honest.

Since Science Magazine was also at sciencemag.org until recently, I don't really see that the move indicates anything about change in the relation between it and "In the Pipeline".

I pretty much agree about the proof-reading though.

Was it? I didn't remember that. Thanks for the correction.

Looks like speech-to-text gone bad. I'd call it an editing error.

Yeah, I saw that too, and thought he probably uses a speech-to-text approach to drafting his articles. That seems like the sort of mistake speech recognition would make. But it could also be auto-correct or even a real typo.

Typo in the first sentence of an article is never a good sign.

Too bad it’s your first exposure to this publication/author.

>"No one died in the 2003 outbreak"

Yet we will be stripped of our rights again for the exclusive benefits of a fews mega-corps and the "news" reportings are preparing the ground for it. At least this time I'll have some money to invest in the company producing the vaccine.

Look up "ACAM2000" and "JYNNEOS", those are the candidate vaccines for widespread use in the US.

Smallpox was an issue, and since we can't really be sure it's eradicated it's still an issue and one of the very few potentially dangerous vaccines worth risking in the childhood, instead of many other risky, useless at best, normally only dangerous but economically interested from the criminals against humanity commonly known as "Big Pharma" and their "public" branches like WHO. So it MIGHT BE true and MIGHT BE a certain danger.
However since the n-th commercial pandemic declarations such aforementioned criminal institutions have ZERO credibility, so until their heads got arrested and sentenced to life imprisonment along with their subjects fellow politicians and private top investors NOTHING they say can be credible.

So my dear real* scientist you have a social duty: asking for IMMEDIATE incarceration of such criminals for the sake of Democracy and humanity in general. If you keep silent for profit and tranquility beside being held accountable in the not too near future in court for fairness with them you'll probably concur to a such big genocide that nazi crimes will be remembered as a small event in human history.

NO, I'm not joking.

I think that the world in entering in a mass hysteria mode with virus, pox, flu cow, influenza A, B, C, D etc.
Please... start to live more.

I see people that are afraid to "go outside" and have a coffee with a friend or that won't go lunch because its afraid to have *put a disease in here**"...

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