If you’re on my private mailing list you received an e-mail on June 28th warning that we are in a global monkeypox pandemic. I was hoping WHO would take action in the following week, but they have not, so here I am with this extra post.
Monkeypox is related to smallpox and kills about 1% of the people who get it. It was first identified in monkeys—thus the name—but infects a wide variety of animals, including humans. This is the first time it has become pandemic outside of Africa, where it has circulated at a low level for decades.
First, a graph, showing new confirmed world-wide cases by week on a log scale:
That’s seven weeks of data, each X being the count of new confirmed monkeypox cases for that week over the whole world. The line is a very good exponential fit with a doubling time of two weeks.
There are a few small features in the data that should be ignored, but I’ll point them out as our eye is drawn to them. There was a big drop in new cases over the past week that is now being rapidly caught up. This indicates a jam in the data pipeline, not a reduction in the rate of spread, unfortunately. You can see something similar happened in the week of June 8th.
One of my particular areas of expertise is in robust estimation, which focuses on getting actionable intelligence out of noisy data, so I’ve spent a lot of time learning what to ignore, and training not to let my limited attention get absorbed by irrelevant detail. Robust estimates tend not to be as accurate under ideal circumstances as the best possible estimate, but they degrade much more gracefully as assumptions get violated and the data get noisier, which means they depend on very little other than global features like exponential shape.
The numbers tell us about the world, and the exponential shape of the curve tells us we are in a monkeypox pandemic because there is no way to get exponential growth without being in a pandemic.
I want to really emphasize this point: the goal of data analysis is to find numerical metrics that are unquely correlated with particular states of the world. That’s what lets us infer from the data how the world is.
Exponential growth is a terribly good metric because there really is only one plausible state of the world that can produce it: every infected person infecting more than one additonal person over the course of their disease.
So when we see world-wide monkeypox new confirmed cases are growing exponentially, we can say with confidence that we are in a monkeypox pandemic.
We can also say with confident that it is global. Here is a graph of the number of countries that have reported at least one confirmed case, which is growing by just under one country per day:
As with any public health dataset there tends to be a “turn on time” before the robust pattern of behaviour gets clearly established. This can be clearly seen in the spread across nations.
Like covid, monkeypox is an airborne disease, and it is spreading as one would expect an airborne disease to spread. It also spreads via droplets and close contact: the fact that it has several other modes of spreading does not mean it is not airborne. Children and others are being infected, although most cases are being reported in men because most testing is being done in men.
In March 2020 there was a major dental conference in British Columbia that resulted in rapid spread of covid across the province. No one said, "Covid is primarily a disease of dentists." In May of 2022 travel for Pride was ramping up just as monkeypox arrived in Europe. This apparently has led health authorities in some jurisdictions to say, "Monkeypox is primarily a disease of gay men." It is not.
You can protect yourself from monkeypox by wearing an N95 mask or respirator in indoor public places, and by avoiding the three C’s: closed-in (poorly ventilated) spaces, crowds, and close (< 1 m face-to-face) contact. This works for covid too.
Once pox and scabs form, the disease can be spread from puss and dried scab material, which can cling to cloth as dust for long periods. Unlike covid, monkeypox can remain viable on surfaces for many hours, so hand-washing and disinfecting, which are useless against covid, are actually valuable. Monkeypox can also remain viable in the air for much longer than covid, which only lasts tens of minutes even where ventilation is poor.
As with any airborne disease, improving ventilation and filtration helps. So does upper-room UV, although that’s a significant upgrade. Ventilation can be much improved by opening windows, and monitoring CO2 so you can adjust ventilation to keep the CO2 level below 800 PPM is definitely empowering. Filtration can be improved with a portable HEPA filter or a home-built Corsi-Rosenthal box. Although nominally focused on “stopping covid in your home” this summary thread by Canadian HVAC engineer Joey Fox is full of practical advice on ventilation that applies to all spaces.
The global analysis of monkeypox I present above is very similar to what I ran on February 18th 2020 for covid. Here’s a mesage I sent to a friend after doing that: “I did a fit to the last three weeks of covid-19 data outside of China. It looks pretty reasonable, noise-wise, as you'd expect, but it's really well-fit by a simple exponential. The e-folding time is just over 9 days, or doubling time of about a week (6.5 days). Which suggests public health measures aren't doing a lot to slow it down, unless they happen to acting in exact proportion to the disease, which is not very plausible. There are currently 1000 cases outside of China, so if there are 2000 by the 26th I think I'll be officially worried, although I dunno how that would actually help.”
There were indeed 2000 cases outside of China by the 26th, and as predicted, my being officially worried did not actually help.
Unfortunately in my home province of British Columbia, Canada, monkeypox will coincide with the rise of BA.5 covid—our seventh wave to date, which is predicted to peak in late July or early August—and a health care system that has collapsed. At least that's what the head of the CMA has said about it.
A private, volunteer effort has been started to track BC hospital and lab closures, as our government routinely violates our human right to the data. If you find this tracker useful, please think about supporting it (I’m not involved in the site in any way other than having interacted online with the person who runs it… I just think people who do the job our public health authorities ought to be doing should get paid.)
The same site also has a nice summary of Canadian monkeypox data, although there isn’t enough for me to analyze yet. But it’s safe to say that if monkeypox is growing exponentially world-wide, it is growing exponentially here, and there, and wherever you are.
Monkeypox is a serious disease with a fatality rate in Africa in the range of 1-3%. It lasts for weeks and can be extremely painful: most hospitalizations are for pain management. It can be disfiguring or disabling even when it is not deadly. Blindness is a rare complication. It is particularly severe in children and younger people, and can lead to congential problems if a pregnant woman catches it. How long people are infectious before the onset of symptoms is still an open question.
People in their very late 50s and older have generally been vaccinated against smallpox, which should help, although the US CDC recommends vaccination within the last 3 years for robust protection. Younger people have not been vaccinated against smallpox, and I encourage them to take any opportunity offered to get vaccinated. Vaccination within four days of exposure can also help, making "ring vaccination" an effective means of stopping the pandemic, if governments were competent to do it.
Based on historical data monkeypox is comparable to the flu in terms of infectiousness, which means it should be a lot easier to stop the covid, which is now comparable to measles, the most infectious disease we know of.
Other than “wear your N95 mask indoors in public and avoid the three-C’s” I don't have any solution to any of this. It's very clear that in Canada at least our governments have lost the capacity to actually DO anything very much. This is not a partisan issue: conservative Ontario is almost as badly off as left-wing BC, and our federal government is still unable to reliably pay its own employees or process passport applications effectively, much less cope with a second pandemic.
And globally WHO seems more concerned with unfounded fears of sparking panic than reacting to the data, which show clearly we are in a pandemic.
I just wanted people to know that monkeypox is coming on top of covid BA.5, which is already here.
Despite the ineptness of our govenments, I am still asking you to write or call your MP, your MLA, your MPP, your congress-person, your senator, your Prime Minister, your president, your health minister. Ask them to take the monkeypox pandemic seriously, and to reinstate public mask mandates, especially in health care and on public transit. Ask them to commit to ventilation improvements in public buildings.
Cleaner indoor air is the sewage and water treatment of the 21st century. If the stuffy old Victorians could clean up their act, surely we can clean up ours.
Make your voice heard, because right now we are sleepwalking into a catastrophe. Don’t be one of the people your great grandchildren will look back on and ask, “Why didn’t they do something???”
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Example letter drafted by Mrs. Wonders. Your postal code is important as it tells them whose constituent you are. The Canadian Prime Minister’s e-mail address is pm@pm.gc.ca, you can find other addresses here: https://www.ourcommons.ca/Members/en
Dear Sir/Madam,
As a citizen of Canada, in particular «YOUR PROVINCE» («YOUR POSTAL CODE»), I would like to add my voice to others who are concerned that premature lifting of mask mandates and an insufficient focus on air quality are causing loss of life that could have been prevented and continue be preventable. Vaccines are an important part of the equation but clearly (according to the data) not sufficient alone.
Not only does that leave us and especially the vulnerable in our society open to multiple infections with long lasting negative consequences from Covid, we now have monkeypox. Not just on the horizon it is here already and spreading exponentially (again according to analysis of the data).
Please refer to this extremely clear and well presented article. I am responding with this in mind as well as many other pieces on the subject I have read in recent weeks: https://worldofwonders.substack.com/p/we-are-in-a-monkeypox-pandemic
Since it appears that action is not being taken, I would ask that you please take concrete action as soon as possible. As the linked article states:
“Ask them to take the monkeypox pandemic seriously, and to reinstate public mask mandates, especially in health care and on public transit. Ask them to commit to ventilation improvements in public buildings.”
The above would be a good start to protecting us all.
Thank you,
«Your Name Here»
Thanks for the heads up Tom. I am sharing this with my family members so they can take the appropriate action. Once again you are way ahead of what we hear elsewhere. Thank you.