Monkeypox outbreak in U.S. is bigger than the CDC reports. Testing is 'abysmal' | Hacker News Reader

Monkeypox outbreak in U.S. is bigger than the CDC reports. Testing is 'abysmal'

npr.org

81 pointslnyan69 comments

I am extremely concerned that the Monkeypox outbreak seems to be growing. I don't get why, unless we do some intervention, the growth would stop. Why is it spreading in multiple countries? Why now?

COVID confirmed for me our pandemic leadership is braindead at best and actively malicious at worst. I have very little confidence they know what they're doing here or would handle Monkeypox if it turns out to be a significant problem.

The excuse I've heard is, the R0 is low enough that we are not at risk of pandemic per se. I'm not so sure about the likelihood of reaching epidemic status or similar.

Daily cases are doubling every 12 days or so. Now maybe that won’t hold up in the general population, but it’s thousands of people already. I’m very disappointed to not see a anything approaching a robust response given what we’ve gone through the past two years.

MSM (men who have sex with me) mostly right now. Seems like it's just a new STD, but perhaps someone has reading/research showing it's spreading at any significant scale further than that.

Hopefully we handle it better than we did HIV

Also it's pride right now sooo... Just like Chinese New Year couldn't have picked a more opportune time.

>men who have sex with me

Please start practicing abstinence before you get everyone sick, you sexy bastard!

Mans out here hoggin all the booty

Lol but it's pride!!!!

monkeypox is far less dangerous than HIV, as well as acute rather than an insidiously slow burn. and we have a vaccine for it, which we've already stockpiled.

also you have a hilarious typo. you must be quite the stud!

HIV was an absolute death sentence when I was growing up.

>Seems like it's just a new STD

There’s no evidence that the mode of transmission of this variant is specifically sexual. Monkeypox in general can be spread by close contact (such as e.g. holding hands, sharing bedsheets, …).

Not to be all conspiratorial but I noticed my gut reaction to this statement was “I wonder how much of that from WHO/CDC is stretching the truth to prevent stigma”.

The CDC really did a real number on its own credibility by showing itself to willfully stray from reasonable public health strategies in order to push political agendas. I wonder how much more monkeypox will spread above what it otherwise would do to this same politics over health approach that puts “prevent stigmatization” over “save lives”

I think you are being a bit conspiratorial. Monkeypox isn't a new disease and we know that it can transmit through non-sexual means. I have seen no evidence that the variant of Monkeypox responsible for the current outbreak is any different in this respect. If you know of any evidence to the contrary then by all means link to it.

Monkeypox can transmit through non-sexual means, but it transmits poorly enough amongst humans that way that those routes of transmission cannot explain the current outbreak. I think there's other hints that this is the cause too, such as the actual sites of the infection and most of the spread so far being amongst the more sexually promiscuous parts of the gay male community...

This is even kind of hinted at in the article. The symptoms people are presenting with are different from classic monkeypox outbreaks, and as far as anyone can tell the actual disease hasn't changed and this is all due to the route of transmission.

> but it transmits poorly enough amongst humans that way that those routes of transmission cannot explain the current outbreak.

Previous Monkeypox outbreaks have not been linked primarily to sexual transmission. It may be that the initial cluster of the current outbreak is caused by people meeting up for sex (although really, who knows?), but given what we already know about the disease, it would be unwise to jump to the conclusion that sex itself is necessary for efficient transmission.

If there's really a consensus among experts that sexual transmission (rather than just transmission via contact during sex) is playing a key role here, then by all means reference this. I've been unable to find anything of the sort.

>most of the spread so far being amongst the more sexually promiscuous parts of the gay male community...

Here you're moving away from informed speculation (which is already unwise at this early stage, in my opinion) and simply repeating sensationalist nonsense from less reputable sections of the news media. There is absolutely no reliable data on how 'promiscuous' the people who have been infected so far are.

The WHO's assessment does seem to suggest that it may be sexually transmitted but doesn't explicitly state it. Here's what they state:

"The clinical presentation is often atypical, with few lesions localized to the genital, perineal/perianal or peri-oral area that do not spread further, and an asynchronous rash that appears prior to the development of a prodromal phase (i.e. lymphadenopathy, fever, malaise)." [1]

[1] https://www.who.int/news/item/25-06-2022-meeting-of-the-inte...

It may be. I am not saying the possibility can be ruled out, only that we don't know at present. The WHO doesn't explicitly state that it's sexually transmitted because they don't know that it is, and neither does anyone else.

For example, the 'atypicality' of the presentation could simply be a consequence of MSM who are used to getting sexual health checkups being more comfortable with showing their genital sores to a doctor or nurse than other population groups.

I'm not sure if the presence of genital lesions is necessarily even a good indicator that transmission was via sex. See e.g. https://academic.oup.com/ofid/article/4/4/ofx168/4588539

They need to just publish figures... "Of 150 analyzed transmissions, XX were from sexual activities, YY were from family interaction or shared living space, ZZ were unidentified"

I don't see how this would work, as people generally don't know how they got Monkeypox. Even if you somehow know that a sexual encounter was the cause of transmission, it doesn't follow that transmission occurred through a specifically sexual route (rather than just general close physical contact).

If such figures aren't being published, it isn't because of a conspiracy – it's just because no-one knows.

It seems a survey could build a pretty conclusive picture, especially while case numbers are low... You'd identify places where someone interacted with a previously infected person.

You'd then send them a survey with questions like "how many hours were you in the same room as this person", "did you touch their bedding", "did you have sex", "which days, how many times, what type of sex?" etc.

Using those results together with information about whether each contact got infected or not you should be able to get a good indication of the causes of transmission. More importantly you can probably also find what does not cause transmission, allowing those to be eliminated from public health guidance.

I think the main limiting factor for such a survey will be people being dishonest on the survey. It only takes a few people to say "nah we just talked and didn't have sex" (when in fact they did, and got infected), and suddenly the survey results cause incorrect health guidance to be issued, putting others at risk.

Leaving aside all the usual difficulties with collecting data of that kind, it’s worth noting that such a procedure only has a hope of producing reliable results if:

* The majority if cases of Monkeypox are both symptomatic and reported.

* The majority of transmissions occur by contact between people who know each other personally (rather than e.g. brushing up against each other in a tube carriage).

* It is possible to share names and other details in a way that respects people’s privacy. (On the face of it, sending out surveys saying 'Sam Jones had Monkeypox, did you kiss them last week?' is just unlawful.)

We may eventually get reliable information about the main vectors for the current outbreak. At present, we haven’t. No-one is hiding anything. We just don’t know because it’s difficult to find out.

edit: Also note the following from the article:

>For many of the confirmed cases, health officials don't know how the person caught the virus. Those infected haven't traveled or come into contact with another infected person. That means the virus is spreading in some communities and cities, cryptically.

I think what's causing the heaviness in sexual transmission is that the hands simply are a much easier spot to detect sores etc. The carrier will know they have them and people they meet will see them before shaking hands.

And the nether skin folds also tend to have more skin conditions due to the lack of natural ventilation. And sex is often practiced in poorly lit environments at moments when people are not super observant..

Maybe STD isn't the right term. Intimate contact spread? IDK what else to call it. but the trend is pretty clear.

On the same hand it seems pretty unlikely that bedsheets are causing more infections than sex or hookups. Though the two are closely related ;)

The distinction is important, because many on the right are suggesting that ‘gay sex’ specifically is the transmission vector. This given that at present we don’t even really know that sex of any kind is the major transmission vector.

I don’t see any terminological difficulty here. You can easily catch a cold from someone by having sex with them, but no-one suggests that colds are STDs.

The ‘trend’ also has to be viewed against a background of underdiagnosis and limited testing. It may simply be that gay men are more likely to end up getting tested for Monkeypox.

> MSM (men who have sex with men) mostly right now.

“…as far as we can tell”. How do we know if we’re not testing enough and have no concept of the actual scale of the outbreak?

Is this another virus that you can contract but never know you have it?

Or like shingles, where the virus lies dormant for years and then activates if the host's immune system gets weak enough, either from age or some other cause. This would make it very hard to trace the initial exposure.

My guess is that it doesn't mutate as quickly as a corona virus - so our body can build a defense against it rather easily without high chances of re-infection, just like most other poxes. It basically is quite slow moving, and will burn through its fuel in the major population centers quickly if it does peak - unlike corona which can just keep peaking after it mutates using the same people.

>"The fact that we can't reconstruct the transmission-chain means that we are likely missing a lot of links in that chain,"<

Jennifer Nuzzo, an epidemiologist at Brown University, says.

In other words: >"We have no concept of the scale of the monkeypox-outbreak in the U.S.,"<

says biologist Joseph Osmundson at New York University.

Monkeypox Virus (MPXV) – 2022-Outbreak (Current Cases) https://en.m.wikipedia.org/wiki/2022_monkeypox_outbreak

Cases per Country and Territory (outside of endemic African Countries)

Spread of disease as of 23 June 2022 - Confirmed 4,440 -- Suspected 168 -- Total 4,608

Edit: add;

search: >'Monkeypox Virus (MPXV) ring-based vaccination'< :@DDG : <https://html.duckduckgo.com/html/?q='Monkeypox irus (MPXV) r...>

Huh. Sounds familiar.

Six weeks into the outbreak and my local health authorities are out of vaccine doses with no timeline for when they’ll have more.

Not impressed.

A paper was recently published on the assembly of monkey pox virus through recombination technology in a lab. The work was done before the end of 2021 because that was when the paper was submitted for publication, see [1]. I don't understand why one would want go full Frankenstein and build a dangerous pathogen from scratch.

Interestingly, the work was funded by the and performed at the Wuhan Institute of Virology, from the paper:

This work was supported by the National Science and Technology Major Project of China (2018ZX10711001-006) and the Key Research Program of the Chinese Academy of Sciences (KJZD-SW-L06-02).

YouTube video, see [2].

[1] https://www.sciencedirect.com/science/article/pii/S1995820X2...!

[2] https://www.youtube.com/watch?v=4E6cD-VWhQY

> I don't understand why one would want go full Frankenstein and build a dangerous pathogen from scratch.

Especially after failing dramatically in early 2020.

I'm not seeing the connection to the Wuhan Institute of Virology. The word Wuhan doesn't appear on the page (CTRL+F), nor do I see a clear one-to-one association to Wuhan from "National Science and Technology Major Project of China" or "Key Research Program of the Chinese Academy of Sciences."

I haven't opened the YouTube video as I'm on data right now.

The affiliation of authors of academic papers is usually indicated by the footnotes associated with the authors names. You will see some small letters like superscripts next to the authors names. All of them list one or two affiliations with the first one being (a):

State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China

By definition all outbreaks will be bigger than CDC reports because the cost of testing is not zero.

The fact this outbreak is multi-country (it's here in the UK) and that it has not burned itself out (Monkey Pox isnt meant to spread from human to human easily) makes me think it's being badly underestimated in threat/risk terms...

I'm on the record as advocating a tough response to Covid in the early stages, and then changing my tune into just letting it happen once it got out of control.

I think the window of opportunity for easily containing this is closing. If we don't get this under control soon we will have to do either very broad vaccinations or just accept that we will all get it.

People just don't seem to get what a huge issue stalling is when faced with an exponentially growing problem. Bavarian Nordic supposedly has a couple million vaccine doses. That's a lot if deployed now, but insignificant if deployed later. They claim they wont be able to manufacture more this year. There is also the other vaccine, the older acam2000 but that one has serious side effects.

The vaccine for this is very different, stabbing your arm 15 times and all…

Yes that is the older vaccine I referred to. The Jynneos vaccine by Bavarian Nordic on the other hand does not require this.

Alright, so we need to prevent people from getting together and engaging in behavior that spreads the disease. Oh, we’re not doing that for this one? Ah okay.

Probably because it’s not as fatal.

The strain of monkeypox this one is derived from has a 1% fatality rate. Another strain has a 10% fatality rate.

what if monkeypox is just a sideeffect of the vaccines? any data on this possible correlation?

Very unlikely, because the stuff in the vaccines doesn't stay around for very long. Monkeypox isn't exactly new. It is around for several decades, with the occasional outbreak. Pretty much every outbreak is linked to Africa. It's a tropical disease after all.

There are some thoughts, that the stop of routine smallpox vaccination might be one of the reasons why it spreads so easily now. The vaccine would be effective up to 85%.

You can read about it here: https://en.wikipedia.org/wiki/Monkeypox

monkeypox is an orthopoxvirus, which is a completely different virus family from adenoviruses (which are used as the delivery vectors in the J+J and AZ vaccines.)

it's also like, an existing virus, with a long history of outbreaks. why would it be a side effect? how could it? how are people so gullible? it's like asking if climate change is caused by chemtrails or something..

"how could it"

- By weakening the immune system in general ( i have no idea if it's plausible, but i've seen people saying vaccines were also having detrimental side-effects for ages, even before covid)

- by having the body produce facilitating antibodies

once again, not saying those hypothesis are true. Only that it seems to me it's super hard to predict side-effects of anything in the fields of biology, especially when you're talking about rare occurrences.

You know what really messes up your immune system? Getting covid.

Good. Testing, testing, testing provided zero actionable insight for the last two years and did nothing but provide authorities with sledge hammer that glimmered like Science they could use to whip the public with into a FUD filled frenzy.

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