This is a special post for quick takes by Rachel Shu. Only they can create top-level comments. Comments here also appear on the Quick Takes page and All Posts page.
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.
The putative method by which leucovorin (folinic acid) might be a cure for some subtype of autism is that folate receptor autoantibodies (FRAAs) block normal sources of folate reaching the brain, causing a form of Cerebral Folate Deficiency (CFD). It's claimed that folinic acid is an atypical source of folate which can still reach the brain in someone with those antibodies. On this theory, that subtype of autism is an autoimmune disease.
No conclusive evidence links vaccinations to autoimmune diseases, but conditional on folinic acid working, we should maybe look more closely at what would cause the autoimmune disorder, and update positively on some version of the vaccine theory?
I don't think so
Autism has a very strong genetic component to it, vaccines don't have any effect over heredity
As for CFD it seems to be a genetic condition as well, a result of a mutation in the FOLR 1 gene and it is incredibly rare it can't explain any sizable fraction of autisms prevalence
At best you could hypothesize that CFD is more prevalent then originally thought and due to similarities in the symptoms some individuals with CFD are accidentally diagnosed witb Autism instead but i don't see how vaccines have anything to do with this
Specifically the folinic acid hypothesis is that this is an atypical autoimmune-instigated form of CFD, not the genetic type which typically manifests very rapidly. Look up Folate Receptor Alpha Autoantibodies. My strongest claim is that something environmental may be causing an uptick in autism, even accounting for its strong heritability; with a subset of that claim being "maybe vaccines". I don't believe this strongly enough to write more than a shortform pondering it.
I still don't see this hypothesis going anywhere
The "rise" in autism's prevalence is far more easily explain by a mix of better diagnosis and a more tolerant attitude towards autistic individuals allowing them to reproduce, especially when you consider that the rates of autism don't differ all that much between the developed and the developing world
Plus the primary candidate mechanism for autisms symptoms is a lack of synaptic pruning not the lack of a particular nutrient