Rachel Shu's Shortform
post by Rachel Shu (wearsshoes) · 2024-08-29T12:47:52.850Z · LW · GW · 1 commentsContents
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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:
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Presymptomatic transmission seems likely.
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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.
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Less clearly associated with sexual contact than 2022, good evidence of nonsexual skin-skin transmission being prevalent.
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Some possible reported cases of reinfection in people who previously had MPOX (I can't track this down)
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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.
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People vaccinated for smallpox a long time ago have probably lost their immunity by now.
Reasons to not worry:
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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.
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No stupid refusal to test potential cases this time
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Probable cross-protection from 2022 outbreak (given that the vaccine is made from an even more distant virus and is protective)
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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.
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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:
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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.
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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.