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Friday 29 July 2022

The Monkeypox Puzzle

It was inevitable that the World Health Organisation (WHO) would up the pandemic ante regarding monkeypox. All the signs were there such as the possibility of more dangerous variants, airborne spread and asymptomatic spread; mandatory isolation for cases, and those old chestnuts: test and trace and mass vaccination. It is reported that any reluctance on behalf of the WHO members to declare a Public Health Emergency of International Concern over monkeypox was overruled by Director General Tedros Adhanom Ghebreyesus.

So, what are the facts to date regarding monkeypox? The latest estimate from the WHO is that there are now around 15,000 cases of monkeypox across the globe, a mere 0.0001% of the world population (one in a million) and a grand total of five deaths. If these deaths were evenly spread across the globe, then the case fatality rate would be 0.03% (three in 10,000). Since these are estimates and with such a disparity between cases and deaths this is also a reasonable estimate of the infection fatality rate which is the risk an individual infected person has of dying of the infection. To reiterate, the present figures indicate that you have a one in a million chance of being infected with monkeypox and if you are infected you have a three in 10,000 chance of dying.

However, mortality is not evenly distributed across the globe. The recently recorded deaths are all in Africa, which is where deaths from monkeypox always occur. The disease is endemic in West Africa and the Congo Basin where general levels of health are poor and people have access to a healthcare system described as one of the worst in sub-Saharan Africa. HIV/AIDS is also endemic which, along with malnutrition and dehydration, means that even a mild virus such as monkeypox may kill. It is estimated in Africa that the mortality rate ranges from one in a hundred to one in ten but the risk outside of Africa where people tend to have a much better level of general health and access to much better healthcare is negligible.

Moreover, the risk of catching monkeypox is even less evenly distributed across the population because the present spread of monkeypox is almost completely restricted to a single high-risk group, men who have sex with men, who constitute 95% of cases. CDC guidance is careful to state that monkeypox can be spread by any kind of penetrative sex (anal, vaginal or oral) without any specific warnings about anal sex. But if this is the case then less than 5% of cases are likely to be spread by vaginal sex which, if WHO estimates are correct, means that internationally fewer than 750 people have contracted monkeypox through vaginal sex. Clearly, the carnal act that defines 'the love that dares not speak its name' is a prime route of transmission but our public health officials are too woke to be so specific and careful to avoid stigmatising gay men. This seems like very poor public health advice given, as described in one case of monkeypox, the infected person had "excruciating internal and external lesions around his anus". If people are specifically at risk for something, they ought to be told...<<<Read More>>>...