Rachel Shu's Shortform

post by Rachel Shu (wearsshoes) · 2024-08-29T12:47:52.850Z · LW · GW · 1 comments

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comment by Rachel Shu (wearsshoes) · 2024-08-29T12:47:52.982Z · LW(p) · GW(p)

Preliminary thoughts on MPOX 1b:

Most recent WHO report: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report-35--12-august-2024

Released every other week so next one due in a day or two.

Agree with medical consensus that lockdown-qualifying global pandemic still seems unlikely, but I am concerned enough. I'm guessing <10% chance of global pandemic, <1% chance the median LessWronger gets infected, including tail risk (as in I don't think that even 10% of Westerners get infected even if it becomes a global pandemic.) Nonsexual transmission is more likely this time around than 2022 but sex parties still seem like a key locus. If you intend to go to sex parties in the next 3-4 months you should get the Jynneos vaccine soon, as it takes 2 doses, and there is some chance of a temporary supply shortage.

Things to worry about:

  • Presymptomatic transmission seems likely.

  • This is more deadly, and higher transmission, than 2022's MPOX Clade 1I outbreak. 3-5% death rate, more severe among children than adults (opposite of COVID). Unfortunately kids also tend to be in closer proximity to each other than adults.

  • Less clearly associated with sexual contact than 2022, good evidence of nonsexual skin-skin transmission being prevalent.

  • Some possible reported cases of reinfection in people who previously had MPOX (I can't track this down)

  • Virus is already being reported in non-endemic countries. No person-to-person contact in the West yet, but seems probable in the near future.

  • People vaccinated for smallpox a long time ago have probably lost their immunity by now.

Reasons to not worry:

  • Not a zero-day exploit like COVID was, we already have several proven, reasonably effective vaccines and a process for delivering them, and a decent number of previously vaccinated people. I haven't looked into supply constraints on vaccine production, and naively expect production to scale well.

  • No stupid refusal to test potential cases this time

  • Probable cross-protection from 2022 outbreak (given that the vaccine is made from an even more distant virus and is protective)

  • A lot of potential superspreaders (assuming sex parties are still a large component of the risk of superspreading) are already vaccinated/recovered, at least in the US.

  • Aerosol or droplet transmission isn't likely, and the limited evidence we currently have suggests that we're still looking at skin-skin contact transmission as with MPOX Clade 1I. However, smallpox was primarily droplet-transmitted (with some evidence for aerosol transmission) so it's not out of the realm of possibility. <Of course, that's what we said with COVID too.>

Random other things I've learned or thought about:

  • After the point at which droplet transmission is established, it seems like co-infection with other, more cough-inducing respiratory diseases is an underexplored risk factor for superspreading, but that's not super common.

  • Shedded smallpox scabs were not very infectious. Surface-based transmission was most likely during periods peak illness, when it was very obvious that it was smallpox and people knew to stay away.