Monkey(pox) Business

With a touch of hesitancy and caution.

Note: A few uses of the word “incidental” was swapped for “coincidental” as that is a more apt word.

I was considering whether I should write about the ongoing monkeypox hysteria, but of course Dr. Malone beats me to my commentary. I would consider it for the best since his writing is far more succinct and coherent than mine.

So instead of belaboring the point extensive I will encourage people to read his post, especially for those who need a bit more sanity and rationality in their life.

Monkey Pox

But I will add a few additional points to discuss as well.

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For one, monkeypox is a viral infection that comes from the, well, monkeypox virus. The monkeypos virus itself comes from the orthopoxvirus genus of viruses which include the strains of viruses that causes both smallpox and cow pox (Grant, et. al.):

Monkeypox is caused by the monkeypox virus, member of the orthopoxvirus genus in the Poxviridae family. This genus includes three other human pathogens: variola virus (causing smallpox), cowpox virus and vaccinia virus. Monkeypox and smallpox yield similar clinical presentations, with monkeypox causing lymphadenopathy, as a distinguishing feature, early in the disease course.2 Smallpox infection leads to long-lasting immunity; repeat attack rates of smallpox are just about 1 in 1000 for 15–20 years.3 Smallpox vaccination with vaccinia, a first-generation vaccine, also yields long-lasting immunity, with an efficacy of 80–95%. The current recommendation for revaccination is every 10 years, although longitudinal studies suggest that protection may last much longer.4 Vaccinia is also known to deliver long-lasting immunity against monkeypox, with 85% efficacy.5 Furthermore, studies of antibody responses to orthopoxvirus species suggest perfect cross-immunity between smallpox and monkeypox.

As indicated above, monkeypox tends to present with flu-like symptoms with the addition of swollen lymph nodes (lymphadenopathy). What’s interesting is that typical smallpox infection leads to long lasting immunity, and there’s evidence of cross-reactive immunity between monkeypox and smallpox.

The long-lasting immunity likely derives from the nature of the virus’ genome. Orthopoxviruses are double-stranded DNA viruses. On the grand scale of viral mutations, these viruses show the least mutations relative to other viruses.

The effect here is two-fold¹. One, the double-stranded genetic code means that there’s a “reference” strand to compare- essentially an error in one strand during replication would be noticed and not likely to carry on into future successive generations. Double-stranded genomes are also less likely to suffer oxidative damage, which is likely to lead to mutations in the nitrogenous bases as well.

Two, the genome being comprised of DNA means that it is more stable/less volatile compared to RNA, and thus less likely to mutate. Many RNA viruses also lack proofreading ability via 3’ exonuclease activity and thus cannot correct for errors to the same extent as DNA-based viruses.

From Sanjuán, R., & Domingo-Calap, P. Viral mutation rates as a measure of mutation/nucleotide. dsDNA such as those in the orthopoxvirus genus show some of the lowest mutation rates relative to other viruses.

Overall this means that monkeypox shouldn’t experience rapid mutations seen in other viruses such as SARS-COV2 (remember that SARS-COV2 is a ss(+)RNA virus).

Adding a bit more additional ease, Coffee & COVID suggested through independent sources that the genomic sequence of the currently circulating monkeypox is one sequenced from Israel in 2018. There’s no way of verifying this information, including whether it truly is accurate, but if it does turn out to be accurate it would suggest that this is not something drastically new, and something that may have been “tampered with” so to speak.

Bioterrorism or Power Grab?

So speaking of being “tampered with”, a few people have posted this article² pointing to a global exercise in dealing with a monkeypox outbreak. Given what we’ve been going through I can see how it can rile people up. It doesn’t help that the outbreak date mentions May 15, although it appears that the first reported case on US soil occurred a few days prior. But hey, what’s a couple of days if you are committing bioterrorism? But that’s a big IF.

There also appears to be this article from Yahoo!News from November 2021 in which Bill Gates mentions that countries should practice “germ games” to prepare for a potential smallpox outbreak.

Again, the more conspiratorially-minded may take these as indications that something nefarious may be going on. We still don’t know the original origins of SARS-COV2 even two years into a pandemic so what’s to say that other pandemics will not be natural in origin?

So why conduct such an exercise? Well the exercise appears to have been conducted in 2021- well into COVID, and it seems it is meant to reflect the unprepared state of many nations in regards to the pandemic. More concerning would be the fact that this exercise seems to validate the draconian measures that took place during COVID.

If we look at Move 2 they mention this paragraph:

Pat on the back for the fictitious Republic of Dranma for taking such aggressive measures, and boo to the fictitious country of Cardus for daring to keep their economy open!

And so this exercise probably wasn’t meant to reflect an up-and-coming scenario we aren’t privy to, but possibly was intended to validate and ossify the need for government intervention through lockdown measures, social distancing and mask mandates. It’s a way for them to enforce future power grabs for any possible future pandemic that may arise.

Just to add onto this point, there appears to have been a smallpox pandemic exercise that occurred between 2018-2019 called Pacific Eclipse³ which reiterated the same sentiments for massive lockdowns and vaccinations. The following excerpt is long, but I think it’s worth considering as it brings in politics as well (emphasis mine):

We saw the importance of case isolation and contact tracing on pandemic control and countries that failed to recognise this lost of control of the epidemic [18]. One impact we did not fully realise was the loss of pandemic control in high income countries such as the US and UK due to poor leadership (including lack of utilization or disruption of existing pandemic plans, which assumed an influenza pandemic, and lack of standard disaster management protocols), insufficient pandemic planning, cultural factors and lack of appropriate expert advice [19]. We did exercise the impact of the 2020 federal election in the US and Brexit in the UK on the smallpox pandemic, but did not anticipate the complete failure in organised public health response in these countries at critical junctures. This was similarly not predicted by the Global Health Security Index, which ranked the US first among all countries in pandemic preparedness [20]. Therefore funding, resources and scientific expertise alone do not guarantee a successful pandemic response. Cultural factors, such as emphasis on individual freedoms in the US, impacted on the ability to use public health measures such as masks and lockdowns. In such cases, leadership could overcome cultural biases, but the combination of poor leadership and cultural factors in the US proved catastrophic.

Although we discussed vaccine shortages in our scenario, one issue that we did not explore was the role that vaccine hesitancy plays in pandemic response. Although smallpox vaccines are not new, it is reasonable to believe that there would be hesitancy due to its unusual mode of administration. Currently, there are high levels of COVID-19 vaccine hesitancy in many countries worldwide [21], [22], [23], even in countries with adequate vaccine supplies and high disease incidence such as the US. In response, some countries have had to impose strict vaccination policies. For example, during a severe delta-strain outbreak in Fiji, the prime minister imposed a ‘no jab, no job’ policy that required all workers to be vaccinated against COVID-19 and and in the US, a large number of companies have imposed mandatory vaccination [24], [25]. Thus, future pandemic planning should not only focus on vaccine supply and distribution, but also how to promote vaccine acceptance.

The vaccination part is critically important. Monkeypox has been on the rise the past few years, and this increase is being attributed to reduced global smallpox vaccination rates⁴ (emphasis mine):

The geographic spread of monkeypox cases has expanded beyond the forests of central Africa, where cases were initially found, to other parts of the world, where cases have been imported. This transmission pattern is likely due to the worldwide decline in orthopoxvirus immunity, following cessation of smallpox vaccination, once smallpox was declared eradicated in 1980. Monkeypox could therefore emerge as the most important orthopoxvirus infection in humans.2

We’ve been hearing how many countries (including the US) recently bought millions of vaccines for only a handful of cases of monkeypox. Taken into consideration smallpox vaccine rates have been on the decline, that COVID has exacerbated further vaccine skepticism, and that there have been articles circulating that call into question the actual effectiveness of the original smallpox vaccines, and we can see what the possible intent of these exercises are.

I’m open to other reasons, but it appears to me that all of this just serves to drive home a narrative that suits those in power. It’s a way of disseminating a message and changing public perception through complacency, fear, and manipulation.

What better way to improve perceptions of vaccinations than to utilize an outbreak and stoke fear?

Overall, there doesn’t appear to me much evidence to support that this monkeypox outbreak is due to gain-of-function research. Maybe we will find more evidence on the contrary, but for now it appears that this is only serving as an opportune moment to push fear and influence public perception to bolster support for future aggressive measures, as well as to gain a hold on vaccine perception in the public.

Is Monkeypox only targeting the gay community?

So I want to clear the air on this point as I’ve seen many people provide their own commentary. From the reporting we have so far it appears that many of the reported cases of smallpox have occurred in men who have sex with other men. This includes both gay and bisexual men, and it appears that these cases are being reported due to men coming into sexual clinics.

The country with the highest outbreak so far is Spain, and there appears to have been over 20 reported cases being traced to a sauna in Madrid, with a sauna possibly serving as a place for sexual encounters.

From Reuters.

Because of these reports there has been a widespread misconception that this is a disease predominately targeting the gay community. There have even been a few news outlets suggested that monkeypox may be spread through sexual transmission, and I may have made a few comments in that regard based on lack of research.

But there is no concrete evidence to suggest that this outbreak is only targeting gay men. Keep in mind that monkeypox is transmitted through bodily fluids, respiratory droplets, and open contact with skin legions- not necessarily through intercourse. In fact, it could very well be that sex could be more coincidental than the actual mode of transmission.

Like the famous phrase we have all become well aware of, this could be monkeypox with some naughty sexcapades rather than from.

So why is are reported cases occurring so often with gay and bisexual men?

It is very likely that these saunas could be serving as hot spots for outbreaks. As to why these saunas are experiencing outbreaks is another matter. It could be that someone who travelled internationally visited these saunas, or there may be an incident involving the importing of exotic animals into the region. In several outbreaks outside of Africa monkeypox cases could be traced back to the release of animals which can transmit the virus through various animal reservoirs. A good example would be a monkeypox outbreak from 2003 in which animal to human transmission appears to have come from prairie dogs which may have been infected by rodents from Africa.

Therefore, it could very well be that a specific cite may be serving as the epicenter of the outbreaks. Remember that churches and areas with public gatherings were considered to be hot spots for COVID, so we should be careful to immediately assume that it is the sexual actions when it could really be coincidental to the location and traffic levels.

But there’s also another factor worth considering.

Remember that smallpox has been virtually eradicated in the Western world. Monkeypox, as well as smallpox, presents with skin legions on many parts of the body- including genitalia. Factoring in that many people may have never seen images of smallpox legions (or at least remember seeing them) how would you respond if you began to see legions on your genitals?

What I believe may be occurring is that these legions may be mistaken for STIs, and it’s only after their presentation that men are likely to visit a sex clinic to get a diagnosis. I highly doubt monkeypox would be their first guess when getting tested!

In essence, this may be a form of selection bias in which the presentation of a virus rather foreign to an overwhelming number of people gets easily mistaken for an STI. It would at least explain why these reports are coming predominately from sex clinics.

All this to say that we should not be so quick to assume that this is a “gay disease” akin to AIDS in the 1980s, nor should assume that this disease is one that is spread sexually.

We should be mindful not to make assumptions based on preconceived notions. So far there is not much evidence as to what’s going on, so it may be wise to not begin casting blame or pointing fingers to specific demographics.

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Let’s not lose our heads

I was going to add a few more points, but as of now I’ve gone against the idea of “not belaboring the point”. Instead, I will emphasize that people read Dr. Malone’s post on the matter (linked above).

And we should also keep in mind that we should not be so quick to rush to conclusions, make bold assertions that may not be readily substantiated, and keep calm in the midst of more turmoil.

We’ve all gone through this before, and we can see what happens when institutions of power take advantage of paranoia and capitalize on our fear. Make sure to remain level headed until more evidence comes out to substantiate further concerns.

And remember that we are being inundated with information meant to exhaust us mentally. If you are feeling fatigued from the overwhelming amount of information, think about taking a break and removing yourself from social media.

I’ll leave this post with this quote on “infodemics”⁵ I’ve been using more often. Remember that just because we are seeing massive reporting on a topic doesn’t mean that we should become hysterical. Let’s remember to keep our heads on straight and stay grounded.

SARS is the story of not one epidemic but two, and the second epidemic, the one that has largely escaped the headlines, has implications that are far greater than the disease itself. That is because it is not the viral epidemic but rather an "information epidemic" that has transformed SARS, or severe acute respiratory syndrome, from a bungled Chinese regional health crisis into a global economic and social debacle.… [T]he information epidemic—or "infodemic"—has made the public health crisis harder to control and contain. […]

What exactly do I mean by the "infodemic"? A few facts, mixed with fear, speculation and rumor, amplified and relayed swiftly worldwide by modern information technologies, have affected national and international economies, politics and even security in ways that are utterly disproportionate with the root realities. It is a phenomenon we have seen with greater frequency in recent years—not only in our reaction to SARS, for example, but also in our response to terrorism and even to relatively minor occurrences such as shark sightings.

— David Rothkopf, The Washington Post, 11 May 2003

But anyways, I’d like to hear your thoughts on the matter. There’s plenty I’m forgetting and likely to have left out so please leave a comment and open up some discussion.

1. Sanjuán, R., & Domingo-Calap, P. (2016). Mechanisms of viral mutation. Cellular and molecular life sciences : CMLS, 73(23), 4433–4448. https://doi.org/10.1007/s00018-016-2299-6

2. I won’t even comment on how eerie it is that the made up country where the virus originated from is named Arnica! That is a bit too coincidental for my liking.

3. MacIntyre, C. R., Heslop, D. J., Nguyen, P., Adam, D., Trent, M., & Gerber, B. J. (2022). Pacific Eclipse - A tabletop exercise on smallpox pandemic response. Vaccine, 40(17), 2478–2483. https://doi.org/10.1016/j.vaccine.2021.10.081

4. Grant, R., Nguyen, L. L., & Breban, R. (2020). Modelling human-to-human transmission of monkeypox. Bulletin of the World Health Organization, 98(9), 638–640. https://doi.org/10.2471/BLT.19.242347

5. Taken from Merriam-Webster. I have not been able to corroborate this quote so keep that in mind.

https://www.merriam-webster.com/words-at-play/words-were-watching-infodemic-meaning