There must be something in the air.

This week, on Bug-eyed and Shameless, we’re talking about how the current monkeypox paranoia is showcasing an innate human inability to learn a goddamn lesson.

Then, we check in on ol’ Alex Jones and the financial pickle he’s found himself in. Can his crypto holdings bail out Infowars?

So let’s get to it

It’s been about three months since the monkeypox outbreak first caused the world to proclaim: “Oh, god, not another one.”

Since then, there’s been north of 25,000 cases, predominantly — but not exclusively — affecting queer men. The United States and the World Health Organization recognize it is a public health emergency.

The emergence of a second pandemic has the usual conspiracy theorists beside themselves — as I wrote in the first-ever edition of Bug-eyed and Shameless. Since then, it's only gotten wilder.

One QAnon-y channel said monkeypox would lead to a “push for masks, same playbook as before, push vaccines, setup for riots, and cheat in the elections.” Another account posted images of Pride events and smugly proclaimed it “POLITICALLY SANCTIONED MONKEYPOX.” Gavin McInnes, the far-right Proud Boys flunkie, just cut out all the innuendo and blamed monkeypox on “fags.” Representative Marjorie Taylor Greene implied kids were getting the virus because gays are pedophiles. Her bosom buddy Tucker Clarson, not to be outdone, decided to rename it “schlong COVID.” (Admittedly very funny, but also pretty homophobic!)

Society may have convinced itself that it would never return to the moral terror of the AIDS crisis, but society is often delusional.

The actual lessons we learned from the AIDS crisis were fairly clear: Communicate clearly and fully, don’t demonize, fund research and treatment.

Richard Burr, Republican senator for North Carolina, took a surprisingly enlightened view of the public health challenge, chiding the Biden administration for “failures to act are a threat to public health, and especially for gay and bisexual men who are at highest risk. The government failed this population at the beginning of the HIV/AIDS epidemic, we should not fail them again.” He wanted better testing, better communication, and vaccinations.

Since he wrote that letter last month, it emerged that America’s 20 million smallpox vaccine stockpile (vaccines that have also proved effective against monkeypox) expired. The stockpile, in fact, had 2,400 doses. Oops. (Luckily, the country still has vaccine doses available, although supplies are constrained.)

Communication around the novel virus has also left something to be desired. Fears about stigmatizing queer people obviously led some public health officials to withhold or muddle crucial information — which is, to be clear, the opposite of what queer people want.

There’s one particular aspect to that which has become a real source of frustration.

If you go looking for how monkeypox is transmitted, public health authorities — from the Centres for Disease Control, to the World Health Organization, to the Public Health Agency of Canada — offers a variety of answers. Certainly, they all list the main driver: “Close, personal, often skin-to-skin contact,” as the CDC puts it. They also warn about “touching objects, fabrics (clothing, bedding, or towels), and surfaces,” “contact with respiratory secretions,” and touching infected animals. (Which was the driver behind a 2003 outbreak, but not a pressing concern at the moment.)

The Public Health Agency of Canada has underscored that “respiratory droplets may transmit monkeypox virus, but this is not well understood at this time.” The World Health Organization added that this non-contact transmission requires “prolonged face-to-face contact.”

Some have deciphered that hodgepodge of routes of transmission into a rather succinct hashtag: #MonkeypoxIsAirborne.

The hashtag rocketed up to the trending topics tab of Twitter in recent days, propagated by people who think they’re making a rather clever point.

What it exposes, however, is that the misinformation pandemic COVID-19 hath wrought isn’t a one-way street. It’s not just kooky anti-vaccine weirdos who have fallen prey to paranoid ways of thinking during this pandemic, but also those who have grown too alarmist, to the point where they have begun disregarding good science and public health advice in favor of whomever will proffer the most worrying diagnosis of the situation.

As you’ll likely recall, early in the COVID-19 pandemic we were inundated with messaging from public health officials telling us to wash our hands, avoid touching our eyes, and to wipe down the mail because COVID-19 is primarily spread through fomites — viruses living on surfaces that, with our help, will wiggle their ways into our mouths, noses, and eyes.

It was catastrophically bad advice that still lingers today. We know that COVID-19 is spread, primarily, through aerosolized particles. Accepting that result means masking and good ventilation, not hand-washing, are the most effective mitigation strategies. (The jury is still out on the overall effect of respiratory droplets. We’ll come back to that in a second.)

Last year, I wrote about how stubborn public health officials were doing themselves no favors by clinging to this error. They could have certainly helped their cause, and rebuilt that trust, by admitting that a half-century-old mathematical screw-up informed their belief that COVID-19 could not linger in the air. Alas, the CDC and other public health bodies are still sticking to the hand washing myth. (They have, at least, dropped the fiction about washing surfaces.)

We know that during the COVID-19 pandemic, people were given so many methods to protect themselves, they eventually started picking-and-choosing — I’ve seen people wearing cloth masks outdoors and obsessively covering their hands in alcohol sanitizer, a set of rituals that are simultaneously very onerous while doing virtually nothing to protect them from the virus. If we had, early on, made high-quality N-95 masks and opening a window the prime tactics to beat the virus, things may have turned out quite differently. Alas, hindsight.

As mask mandates become a thing of the past, those who feel that we have surrendered in the fight against COVID-19 are (perhaps somewhat reasonably) anxious that we are once again ignoring a prime mode of protection against a pathogenic threat. To that end, #MonkeypoxIsAirborne is a broader political statement.

Dana Parish @danaparish

Good Gd. Here is the archived @CDCgov #Monkeypox page before it was scrubbed. AIRBORNE (respiratory) IS PRIMARY MODE OF TRANSMISSION. Just like COVID. The science doesn’t change; only the story does! H/T @J30607610 #MonkeyPoxIsAirborne #CDCLies

July 31st 2022

1,589 Retweets3,055 Likes

But this is tilting at windmills.

Monkeypox can be aerosolized, but that’s not how it’s being spread right now.

Before we get to that, let’s define some terms.

There continues to be vagueness between “droplet transmission” and “aerosolized transmission.” The difference, in stupid terms (which is exactly the level I tend to operate on), is that droplet transmission follows the trajectory of the saliva or spit that the virus is piggybacking on — like firing a bullet, it will eventually fall to earth — whereas aerosolized viruses can bounce around the air, riding on gasses. This has been further complicated by the use of the phrase “respiratory droplets.” (Which is the same as droplet transmission.)

It’s hard to escape the idea that public health officials deliberately created vagueness in these terms in order to cover for their massive COVID-19 screwup. We know that We know COVID-19 can linger in the air of a room for hours, so that tells us (depending on humidity and other factors) it’s aerosolized — although it is also contained in saliva, so it also can be spread through droplet transmission.

Exactly what the size threshold is for a virus to become aerosolized is a matter of some debate: We used to think viruses over 1μm were too heavy to be aerosolized, but we now know the real number is bigger than 1μm but less than 100μm. Not super helpful, I realize, but we know that COVID-19 is about 0.1μm in diameter, making it fairly prime to become airborne.

Monkeypox is somewhere between two and three times larger — still, small enough to be carried through the air. That’s why there’s been a huge stack of papers written in recent decades asking whether these orthopoxviruses, as the family is called, can be spread through air. Scientists, largely concerned with the bioterrorism implications of smallpox, have proven that the virus can be aerosolized and effectively delivered to mammals — but those trials required the virus be deliberately pumped into the air, often through a pretty complicated process.

In the 1970s, two different smallpox outbreaks suggested that the virus may have been circulating through the air, as those affected had no physical contact with the source case — notable, however, that both occurred in hospital or research settings and did not lead to a second round of transmission. (A bulletin from the time, noting the extent of the patient’s cough and risk compounded by the dry air and poor ventilation at the hospital, suggests that the conditions may need to be just right.)

That’s what’s led to places like the CDC and WHO concluding that it could be spread through the air.

But it’s not quite that simple.

The majority of our experience with monkeypox suggests a pretty clear route of transmission: A primary case from contact with an infected animal, passed on to a household via sharing a bed or playing with children. A 1998 paper analyzing hundreds of cases concluded: “Direct physical contact increased the risk of infection while air borne transmission appeared minimal.” More recent studies have looked at decades of cases in West Africa and the Democratic Republic of Congo and concluded that human-to-human transmission of monkeypox is incredibly inefficient, and has an attack rate lower than chickenpox (people sharing a household with someone symptomatic with chickenpox are between 60% to 100% likely to contract the virus, whereas it is more like 50% for monkeypox.)

Scientists have, however, warned that monkeypox was becoming more efficient in its existing pathways of transmission. And that’s exactly what we’re seeing.

A review of 528 cases, across 16 countries conducted by the New England Journal of Medicine — about a tenth of all confirmed cases at the time — found sexual contact was the likely mode of transmission in 95 percent of cases. Another two percent of cases occurred via nonsexual close contact or were in the same household as someone who had monkeypox. 

CDC data, meanwhile, shows that upwards of 99 percent of patients with monkeypox are men. If the monkeypox virus dispersed through the air, it would not be sex-selective. Circuit parties in the Canary Islands might be overwhelmingly male-dominated, but gay men do interact with women in their daily lives.

All that data means we have a very, very good understanding of how monkeypox spreads, and it maps almost exactly onto decades of cases observed in endemic countries — albeit this current outbreak appears significantly more transmissible.

We are not in the same situation as we were in the early days of COVID-19, where we had a totally novel virus causing superspreader events, leaving us bewildered as to who had the virus, where they caught it, and by what method it had traveled.

Currently, there’s a ton of research going on to determine the full epidemiology of the cases. We may yet find that some cases are the result of airborne transmission — but there’s currently no evidence on the table that it will be anything more than a small fraction of overall cases. If that evidence comes back differently, I’ll be the first to put my hand up and admit error. (Bookmark this page for later, if you’d like.)

It is possible, for example, that monkeypox is aerosolized not through a patient’s breathing or coughing, but by the flaking of the lesions on their skin. Given most patients have experienced relatively few lesions might explain why airborne transmission is less prevalent.

We come back to what makes this #MonkeypoxIsAirborne shtick so tiring. Just because you’re the most alarmist doesn’t mean you’re the most right. Being a doomsayer can actually thwart good public health responses, not improve them. And in this incessant need to internalize and exaggerate this risk, there are busybody straight people are who are making it harder to communicate to the community who has been actually affected: Queer men.

By confidently asserting that everyone is at risk for monkeypox, or that masks mandates must be renewed to protect the general population, we obscure the proven strategies that will actually help. Namely: Get vaccinated, get checked out if you have symptoms, and isolate if you suspect you’ve got it. (Masks are appropriate for those with suspected cases, however.) Overwhelming the world with preventative measures that are unlikely to do much is only going to exacerbate pandemic fatigue and make compliance harder if we actually need to ask people to sacrifice once again.

Worse yet, a general panic may push a bunch of people who are at very low risk (which is currently you, straight people) queuing up for a limited supply of vaccines.

Public health officials don’t get everything right. But that doesn’t mean they get everything wrong.

*claim subject to change based on best-available evidence.

Below the paywall: Are Infowars fanboys rushing to their cryptowallets to bail out Alex Jones? And what’s up with Jones’ mysterious $50 million loan to himself?