Pox-Math

You’ve probably seen the reports today that three states have declared Monkeypox a public health emergency – first New York, and today California and Illinois. The US has declared it a national public health emergency as well. Back in May, there were just a handful of cases. Today, there have been 6,600 cases reported in the US.

This viral illness has an incubation period of 14-21 days. During that time, you have no symptoms. I suspect that because the most efficient means of transmission are contact with the skin lesions or perhaps inhalation of virus laden respiratory secretions, the asymptomatic phase is probably much less contagious than the weeks following the manifestation of rash and/or cough. The illness lasts a few weeks and up to a month before it resolves. Resolution means death for some 3-6% of infected individuals who are disproportionately, immunocompromised, pregnant, very young or very old.

The reported doubling time for cases is somewhere from 8-14 days. If it is 8 days, there will have been 1.2 million US cases by the end of September or start of October. If the doubling time is 14 days, there will have been only 106K cases by then. So, expect between 5,000 and 60,000 deaths during the next two months unless something happens to stem its spread. Sigh.

Things got out of control with this emerging pathogen because the CDC and the administration downplayed the first few cases as sporadic with little chance of spreading among the population. They made the same mistake with the SARS-CoV-2 virus that brought us the COVID Apocalypse. Sometimes, I think that out public health system and its political masters are just too stupid to live. All of us have known and even worked with people whom we knew were too stupid to live, but for most people in high public office to be among them is most unsettling.

What we should have done from the get-go was initiate contact tracing and ordered the distribution of vaccine on hand to high-risk groups. Then we should have ordered a shitload more vaccine. The administration has done the latter two things, but they were slow to start. It seems that foot dragging is a practiced art in DC. We need to be doing vigorous outreach among the LGBTQ community – harnessing their activist networks in the process. We need to ensure that every community has access to rapid testing. We need another Lightspeed project to develop antivirals effective against this DNA virus. We need a properly funded and staffed Office of Pandemic Preparedness too.

The hour is late, and the longer this epidemic continues on our shores, the more likely that this virus will find a non-human (zoonotic) host in which to establish a permanent reservoir. At that point, boys and girls, we will be fucked. The Monkeypox virus in Central and West Africa already infects Gambian pouch rats, tree squirrels, dormice, non-human primates, and other critters that are sometimes imported to the US as pets. There is good reason to expect that this virus will find suitable hosts among our own rodent species and perhaps other animals that share space with people. When that happens, eradicating the virus from our midst will be no more possible than eradicating the coronavirus is – not at all.

Mind you, there is no reason to believe that this illness will remain confined to the LGBTQ (primarily MSM) community as it is now – any more than AIDS did. When it begins to spread among heterosexuals, it will likely be among young people who have bisexual partners or an infected family member. Later, anyone will be a likely candidate for infection regardless of travel, sexual orientation, religion, occupation, or ethnic food preference. Alas.