Lunchtime Pandemic Reading, 1-August-2022
Monkeypox spreads by skin cells
Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crises and how to manage them. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from a qualified healthcare provider who knows your specific medical situation over advice from people on the Internet.
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Monkeypox spreads through skin cells, not sex. "Is monkeypox a sexually transmitted disease/infection (STI)? The technical answer is no. Strictly speaking, sexually transmitted infections spread via semen or vaginal fluids. Monkeypox, on the other hand, is spread by close contact—primarily skin-to-skin contact with the characteristic lesions. That means that sexual activity of any kind (but also any close contact) creates favorable conditions for spread. But in truly sexually transmitted infections, touching (and even kissing) would not be sufficient for spread to occur. Think about HIV, for example. You can’t get HIV just from touching or even kissing someone. To acquire an STI like HIV, there must be unprotected intercourse. Monkeypox spreads via epithelial cells, cells found not just in the genital regions but also on the skin and in the mouth.
There has been much discussion about whether it’s such a bad thing if people think that monkeypox is an STI, even though it technically isn’t. Experts agree that it’s harmful for people to falsely believe that monkeypox is an STI. First, if someone thinks monkeypox is an STI, they might mistakenly believe that they can’t catch it from low-key romantic activity like making out or even cuddling half-naked. That’s wrong. In fact, monkeypox likely is being spread in these ways. Even sharing a drink or sleeping in the same bed (without sexual contact) can be enough to spread the virus. In fact, because monkeypox is so transmissible via close skin-to-skin contact, condom use is unlikely to prevent spread, according to the CDC. (That ought to convince you that monkeypox is not sexually transmitted: even condoms, while perhaps helpful, don’t suffice.) Second, STIs still carry stigma. That means people are less likely to volunteer their diagnoses (or even a possible exposure) to personal contacts and physicians. In effect, that makes the virus more contagious; as soon as someone knows you have the virus, they tend to keep their distance. Think about the role the stigma plays in both directions. These days, few are ashamed to admit they’ve had Covid-19. But imagine if Covid were only transmitted through intimate contact? People would be far less forthcoming—and we’d have even more spread."
Source: https://insidemedicine.bulletin.com/monkeypox-update-three-small-controversies-with-huge-implications
Commentary: The implications of how monkeypox spreads is important. Epithelial cells - your skin cells - are how the disease spreads. How do you come into contact with skin cells?
Easy. Look around your house. Look in your laundry trap. Look in your vacuum. Dead skin cells flake off you all the time, from combing your hair to washing your hands to sneezing and coughing to just sitting down on the couch.
Which means they're doing that all the time when you're around other people, too.
So how do you keep yourself safe? Some obvious things to do. First, wear a mask when you're indoors places that aren't your home. Second, wash and sanitize your hands and any other part of you that's come into physical contact with others when you've been out of your home. Shook hands? Wash 'em. Shared clothes? Wash 'em. Someone accidentally sneezed on you at the store? Wash and shower.
Right now, the probability of you contracting COVID is much, much higher than monkeypox, but the precautions you take for both pandemics will keep you safe from either disease.
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Biden highlights wrong CDC guidance. "Before President Biden emerged from coronavirus isolation Wednesday, he made double-sure he was no longer contagious. He received negative tests Tuesday night and Wednesday morning. To test at all meant Biden was going above and beyond the guidance from the Centers for Disease Control and Prevention for exiting isolation.
The CDC has built that guidance around a timeline — a prescribed minimum number of days of isolation — rather than the direct, personalized evidence of virus shedding that rapid antigen tests provide. But the usefulness of these tests was highlighted anew Saturday when Biden, who had taken the antiviral during his illness, tested positive again and returned to isolation in the White House residence.
More than 2½ years into the pandemic, and with a highly contagious version of the virus circulating, the CDC guidelines for what to do when falling ill — and when to return to public life — continue to stoke as much confusion as clarity. That’s a reflection of the changing nature of the virus, the inherent unpredictability of an infection, and the demands and expectations of work and home life.
With new research showing that people are often infectious for more than five days, the CDC guidance has drawn criticism from some infectious-disease experts. The Biden protocol strikes many of them as the right way to go — because it’s empirical evidence that a person isn’t shedding virus.
The CDC does not explicitly recommend a negative test to patients who want to resume activities. It describes such a test, which offers a direct if imperfect measure of contagiousness, as optional. The guidance states that a patient should isolate for at least five days. (Day 1 is the day after your symptoms manifest or your test was collected.) Patients who end isolation should continue to wear a well-fitting mask around others at home or in public through Day 10.
“Given that a substantial portion of people do have a rapid positive test after 5 days, I think an updated recommendation should include people having a negative rapid test before coming out of isolation for COVID,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, who was the Biden administration’s senior adviser on testing from December until April."
Source: https://www.washingtonpost.com/health/2022/08/01/biden-covid-cdc-guidance-isolation/
Commentary: The CDC's isolation requirements are just flat out wrong-headed. Now that we have plentiful and in many cases free rapid antigen tests, the answer to when you can end your isolation is simple and easy: when you have two negative tests in a row, one day apart. That's it. Forget about how many days you've had symptoms or any other time-based guidance. We have a scientific, provably true, data-driven approach to ending isolation for someone with COVID: when you are no longer infectious, proven by 2 negative rapid tests in a row.
It doesn't have to be any more complicated or confusing than that. Ignore the CDC's requirements if you want to keep those close to you safe from COVID.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. P100 respirators are back in stock at online retailers, too and start around US$40 for a reusable respirator. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're eligible to, and fulfill the full vaccine regimen, including boosters. Remember that you are not vaccinated until everyone you live with is vaccinated. For COVID, if you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if available. If it's available, choose Moderna as your first choice for both vaccine and booster, Pfizer as your second choice. However, remember that any vaccine is better than no vaccine.
4. Wash/sanitize your hands every time you are in or out of your home. Sanitize the bottom of your shoes with a simple peroxide spray using ordinary drugstore/supermarket peroxide in a spray bottle. If you've come in close contact with others (rubbing or brushing up against them, hugging, etc.) consider showering and washing your clothes as well.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemics give another crazy plot twist to the economy, or you know, a global war breaks out.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase several rapid antigen tests and/or acquire them from your healthcare provider or government. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
If you think you may have been exposed to monkeypox, contact your healthcare provider about available testing.
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/
Source: https://www.nature.com/articles/s41591-020-0820-9
Source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
There is no evidence a flu shot increases your COVID-19 risk.
Source: https://www.factcheck.org/2020/04/no-evidence-that-flu-shot-increases-risk-of-covid-19/
Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa626/5842161
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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19 or monkeypox. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19 or monkeypox, nor do I financially benefit in any way from sharing information about COVID-19 or monkeypox.
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A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
https://twitter.com/i/lists/1260956929205112834
This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.