So at this point we seem to have significant community spread in the UK, where 7 of the first 8 cases did not travel to Africa or have any contact with UK Patient Zero.
We have 13 suspected cases in Montreal.
We have five confirmed in Portugal, with 20 suspected.
We have seven confirmed and 40 suspected in Spain.
What can we hypothesize from this? I think the two most likely scenarios are:
Something being moved internationally (animals, substances, surfaces, etc) is transmitting it within communities, but human to human transmission remains low.
Human to human transmission is occurring at an R0 greater than zero. This would either mean a change in the virus, a change in our immune systems, or that we had long-lasting herd immunity from smallpox vaccines 50+ years ago that finally waned or died off. A change in the virus is the scary one. The others we should be able to vaccinate our way out of. This could also link to covid or the vaccines somehow weakening our immune systems.
Much less likely:
The R0 is under 1 and this is a fluke. The virus got lucky. It had three or four super spreader events in a matter of weeks from an outbreak that very rarely should have gotten this big.
Even more unlikely:
Bioterrorism. I think it would be a mistake to rule this out completely, but itās very unlikely.
Thatās all Iāve got. Iām not an expert but it feels like everything under the umbrella of #2 is most likely, maybe 70%. #1 feels more like 25% range. #3 feels like 5% and #4 ~1%.
Itās also worth pointing out that if thereās human to human transmission at a higher R0 than 1.0, with a 12 day average incubation period, assuming it can spread after 3-4 days, we could already be 2-3 generations out from what is being confirmed/suspected.
So if it all adds up to like 100, at 1.5 weād have 100+150+225+337, and thatās like 800+ people potentially walking around with it.
Youād expect it to be in several other European countries and major US and Canadian cities that have flights to Boston and Montreal right now with cases being identified in the next week or so.
So if we start seeing more cases pop up in those places, then itās probably the equivalent of mid February 2020.
Last but not least, it takes the body 2-4 weeks to clear this virus. Our supply chains seem to be hanging by a thread as is. This could cause significant collapses in the supply chain. We really need this thing to not be spreading human to human.
We are fucked if this requires people to get the smallpox vaccine. Smallpox vaccine isnāt nearly as user friendly as COVID vaccine and has way more frequent side effects. If it is February 2020 the economy from here will make the Great Depression look like 1998, literally guns and ammo time.
The new vaccine isnāt as bad as the old one. There seems to be some concern that covid is causing T-cells to weaken, which is making us more susceptible and thus allowing it to spread. I donāt know if itās a given that the vaccine would work as well in that environment, I have no idea.
The evidence for smallpox vaccination being effective in humans against monkeypox is actually pretty shaky. AFAICT, the 85% effectiveness number is traceable to an observational study from 1988 that looked at attack rates in vaxed vs unvaxed contacts. Who really knows whether 35 years of viral evolution have affected that. That was also a different vaccine thatās the two that are available today. It seems that the new vaccines works against monkeypox in monkeys, but I havenāt yet found any direct evidence that they are effective against monkeypox in humans.
Thought this was interesting. Itās not at all clear whatās causing these periodic monkeypox spillovers and they seem to happen more often than the experts can explain:
McQuiston said the number of exported cases from Nigeria in particular appear to be at odds with the reported number of cases in the country itself.
āI think that we are concerned about the number of exported cases in travelers weāve seen. And to have so many of them in the last few years is simply a flag to us that thereās a lot more monkeypox transmission happening in Nigeria than perhaps the [official] numbers would suggest,ā she said.
āAnd I think it also is a flag to us that the more traditional routes of transmission that we think of such as hunting wild animals, contact with bushmeat, living at that interface between the jungle and small communities does not seem to be a driver of transmission in terms of what we see happening. And so that makes us cast a wider net about what risk factors might be.ā
Thereās talk among epidemiologists on Twitter that this may be an after effect of COVID infections weakening or deactivating T-Cells and making people more vulnerable to other infections.
It seems increasingly likely as this thing spreads to more and more places (Sweden has a case now) that weāre either seeing a mutation or a change in our immune systems or herd immunity. We currently have no evidence of a mutation, and I assume monkeypox in Nigeria is surveilled and sequenced by the WHO occasionally. But we do have some evidence of immune system issues stemming from COVIDā¦
