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Description

For those overwhelmed by the news of yet another infectious disease outbreak by the name of monkeypox, this episode is for you. With an equal dose of relief and urgency, Andy invites one of the world’s leading experts on monkeypox, UCLA professor Anne Rimoin, to explain why the disease is spreading now and how concerned we should be. You’ll be reassured but also encouraged to pay attention — at the very least for the sake of those at risk around the globe.

Keep up with Andy on Twitter @ASlavitt.

Follow Anne Rimoin on Twitter @arimoin.

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Check out these resources from today’s episode: 

• Read Anne Rimoin’s research explaining why human monkeypox cases are returning decades after smallpox vaccination campaigns ended in the Democratic Republic of Congo: ​​https://www.pnas.org/doi/10.1073/pnas.1005769107
• Find vaccines, masks, testing, treatments, and other resources in your community: https://www.covid.gov/
• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Anne

Andy Slavitt  00:00

Before we get started with the show today, I want to take a moment to acknowledge the news out of Uvalde, Texas on Tuesday. At the time of this recording, we know that at least 14 people, children, and one teacher were killed by an 18 year old gunman. This is a terrible situation. And on Friday, we’re going to have a conversation about school shooting. And our Friday conversations episode, including with a guy named Brian Boosie, who is the author of gunfight my battle against the industry that radicalized America, and some other great guests. That’ll be the show for Friday. And when we know more about these tragic events, we’ll have time to process and focus on them. Today, I want to bring you a conversation that is on everybody’s mind. And that’s one about this new outbreak we’re hearing about called Monkey Pox. I’m about to set it up after you hear her wonderful theme music.

Andy Slavitt

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. It is Wednesday, May the 25th. Anne Rimoin has been studying monkey pox for over 20 years. She has a team of people in Republic of Congo, which has been her life’s work. That work has really led to an understanding of all the emerging infectious diseases going on in the world in 2010, and wrote a paper warning that monkey pox was likely going to be on the rise in the US and other places, largely as a result of the eradication of smallpox. Smallpox was eradicated people stopped getting vaccinated for smallpox and to smallpox vaccination was actually as you’ll soon hear, not a smallpox vaccination itself, but a vaccination that contained smallpox, but also contains monkey pox. But it didn’t come from smallpox. And is graced us with your presence today on the show to help us understand monkey pox. And the principal question on everyone’s mind is, oh, boy, is this a here we go again, should I be worried about monkey pox? And the approach that we try to take to the topic with ants help, is to just begin to help by understanding what it is and how it works. Because I think removing the mystery. And this is something that’s been studied for decades, including most prominently by hand for the last two decades, but by others before her, a lot is known. So at this early stage, even when there are still open questions, it is useful to go down the path and understand what it is and what it means. And, you know, I think you’ll see that the answer to the question of should I be worried depends on what you should be worried about? If the question is, I am going to worry. If this is something that it puts me in danger, I think you’ll end up with one answer to the question.

Andy Slavitt 

If your question is, should I be worried about an outbreak that could cause suffering, and even some loss of life for people going about, essentially, their normal lives? And could that in effect, cause future problems? Then, yeah, it’s something we should be curious about, at a minimum, try to understand. And I’d like to think that even if something doesn’t happen to us personally, it’s the kind of thing that’s worth worrying about. Because if we don’t worry about others, as I think we’ve learned here, eventually, two things happen. One is when it comes our turn, nobody’s gonna worry about us. And secondly, with these infectious diseases, the more that we let them do their thing and stay out there, the fitter they can become, and the more they can change. So I think you’ll hopefully learn those things here. We have a more virus knowledgeable population. That’s a good thing. I mean, let’s take that knowledge and apply it to this new situation. You know, I’m on this President’s Council on Science and Technology, looking at the future of pandemic responses. We have an ever meeting today. And it was actually very interesting, because we talked about monkey pox. You know, the President over the weekend said monkey pox is something you should worry about. And then he corrected that and said, monkey pox isn’t something you should worry about. I push and to answer questions, which we don’t have answers to yet. These are all of the same mistakes that you know, we all make the beginning of pandemics where we try to do have more knowledge than we actually have. And some things are just unanswerable. And we got to be comfortable with that. So that’s what our conversation is about today. And was terrific to spend so much time with us, I believe you will leave this conversation far better informed. And I’m betting that your reaction will be one of both of reassurance, but also one of curiosity and awareness. Here comes Ann.

Andy Slavitt 

Hey, Anne, how are you?

Anne 

I’m well, Andy, I’m so happy to do this. You know, I keep thinking I want to reach out to you because you live here in Los Angeles, right?

Andy Slavitt 

Yeah, exactly. Circumstances bring us together.

Anne 

That’s exactly right.

Andy Slavitt 

It was gonna happen eventually. We needed a needed a reason and I think we found it will bring us to today. The summary of the news is basically, that there’s been an outbreak in a number of countries with a small number of cases, and at least Alaska and here in the US, two or three confirmed cases. Is that about right, or what am I missing in that summary?

Anne  06:10

So, you know, I’m not even really concerned about the cases here in the United States. I’m just more worried about the pattern in general, right. So what we’re seeing is we’ve seen, I think that they’re like 100, maybe 100 confirmed cases at this point, globally. So we’re seeing clusters around the world of human monkeypox. And this is a virus that is traditionally endemic in central and west Africa. And in the cases only occur there except for rare importations. I think, up to this point, there have been nine cases over the last several years of monkey pox being imported from West Africa, into either Europe, or the United States. And these were contained cases, you didn’t see onward transmission. And so these were just very contained events.

Andy Slavitt 

Unfortunately, they just had some isolated cases, not a lot of community spread. And before he talked about what exactly we’re seeing today, maybe just ground us in what monkey pox is, what a pox virus is and how monkey pox fits in to I think people have obviously heard of smallpox, and people all know about chickenpox. Tell us what’s different about monkey pox.

Anne

Okay. Well, monkey pox is a viral zoonosis. And so what that means is it’s a virus that normally resides in an animal, and it from time to time spills over into human populations. Now, monkey pox is a cousin of smallpox. And we were able to eradicate smallpox disease from the planet, it was declared eradicated in 1980. And that was a singular. You know, it was the greatest achievement in public health history to be able to actually eradicate this disease that caused significant amount of death and disability from the planet. And to truly eradicate it. You know, as a result, we didn’t have to spend the resources on vaccinating people against smallpox anymore, because the diseases, disease no longer existed. And so you can focus your resources elsewhere. But as a result, over time, the world has lost population immunity to pox viruses. If we come in contact with a pox virus, we’re going to, you know, potentially become infected. And some pox viruses are more infectious than others, some are more capable of spreading, you know, in and of itself, this is not surprising, we have a population that no longer has immunity to pox viruses. If it gets introduced, we’re going to see cases.

Andy Slavitt  08:43

So up until today, up until I should say recently, monkey pox has had its share of outbreaks, as you’ve explained, we’ve seen outbreaks in some part coming out of places where it’s endemic, like Republic of Congo, because we’re not all taking smallpox vaccines all the time. So that means when there is an outbreak, it’s more likely to spread. Okay. So that’s up until recently. Why is it spreading now? And what do you think is different about what you’re observing about how it’s spreading?

Anne 

So what we’ve seen recently is an uptick in these importation of monkey pox cases. Now, we had just recently in the United States a case we’ve had a couple of cases in the UK and the frequency of this is increasing, right. So that’s likely because we’re seeing more and more cases in places like Nigeria and West Africa, and also in the Democratic Republic of Congo, and that, again, you know, related to the changing epidemiology and ecology of poxviruses. What appears to be going on here is that, you know, there have been introductions into populations now. And now we think that there have been a couple of events where, you know, a person or persons who had monkeypox went to these events. And there were a lot of people, there apparently, at least two different festivals or rave, like parties where there were a lot of people together, probably a lot of sexual contact, which is one way that monkey pox spreads by close contact. So you know, sexual contact is close contact. So it’s very, very easy way for this virus to spread.

Andy Slavitt  10:27

So what type events of events were these? And do we know where they were?

Anne 

So right now there are two events that are being looked at closely, one sort of a festival of some sort in the Canary Islands and one in Antwerp, in particular, where there were just 1000s of people at these events. Countries all over the world. And are likely events that are linked to the seeding of outbreaks globally. Now, I’m not sure that this is the only reason I mean, the monkey pox could have been spreading quietly, in other places for without anybody noticing. Because this is a more mild form of monkeypox. Oftentimes, we’re seeing now that it may be these lesions may really only be on the genitals, in which case it’s not going to be as noticeable as something else. And so it may have been spreading somewhat silently, cryptically discreetly, and people just weren’t looking for it. because they

Andy Slavitt 

Because they normally begin on the face and this is not beginning on the face.

Anne 

Face, palm of the hands, soles of the feet. Normally monkeypox, the distribution of this rash is usually seen on the extremities. And we don’t think of monkey pox is something that has a localized infection, or a localized rash. It’s usually a you know, disseminated rash. But certainly I think that these events would serve as amplifying events, even if it’s not the seat, you know, the original event where there was an importation, they certainly seed cases. And so that’s why we’re seeing it now spread in the sexual networks.

Andy Slavitt  12:13

So I want to make sure that I get this theory and explain it right. What could have happened is somebody from a country that were monkeypox is endemic, showed up at one of these festivals or both of these festivals, and that there was very likely some close contact, maybe sexual contact, and people went back to their own countries. And because my understanding, it takes several weeks for the monkey pox to show up. That we started to see, hey, we’ve got people in multiple countries, who all are showing these peculiar symptoms that are monkey pox, but it’s in a different, slightly different presentation, different part of the body. So that theory, that could be a partial explanation, and I guess the question you’re asking is, is everybody who’s been infected, somehow connect to that source event? Or in close contact with someone who has those events? And can we trace that, that’s the contact tracer you referred to, or something else going on? Where it’s spreading by some other means in some secondary fashion?

Anne 

How much of this is from a primary, you know, from being either infected from an original source, the animal source or from, you know, contaminated clothing or something else? And then how many of these cases are human to human? And I think that that’s really the big question about monkey pox and why people are watching this carefully, because we’ve only seen this kind of human to human transmission in limited chains. So what we don’t want to see is Monkey pox actually establishing itself in human populations and being able to continue to spread with uninterrupted chains. So that’s why people are concerned about it.

Andy Slavitt  14:08

So let’s talk a little bit about how it works and what it looks like. You talked about the rash. I think if three years ago, we would have said to talked about incubation periods, and r-naughts. And all these other things people would have said, I don’t know what any of this stuff means we’ve got an educated, we’ve all educated ourselves, we all understand some of these things. So maybe using some of our newfound knowledge of the features of a virus, can you maybe walk us through how it spreads, what the symptoms are, how contagious it is, and that I think there’s some key catchy figures that we now know are important. Like, is there asymptomatic spread? Can it be spread without knowing? Could it be spread through aerosols? Could it be spread through contact with your grocery bags? That’s a favorite memory of all of ours. What’s a little bit of a primer on how it works, what it looks like?

Anne 

Okay, well, so monkeypox, first and foremost, monkeypox needs to jump from an animal species into a human. And so usually, the first case or this in this case is usually from a bite or scratch from an infected animal or ingestion of meat. One of these things don’t reminder, monkey pox, the maintenance host or the host is not necessarily monkeys, monkeys are just incidental hosts, just like humans, this is really about rodents and rodent species, it’s just identified first a monkey. So that’s why we call it monkey pox. So usually, there’s some sort of ingestion or you know, contact with a wild animal that’s been infected. And once a person is infected with monkey pox, they can spread it to others by close contact. And so, you know, the work that has been done in Africa has really demonstrated the primary modes of transmission are when a person comes in contact with respiratory droplets, the lesions from the rash that it causes, or bodily fluids, or an object that’s been contaminated with those fluids. That’s how person to person transmission usually occurs. And so you see this primary, these cases that come from the animals, then normally we see chains of transmission, you know, these human to human cases usually burn out after just a few cycles. So that’s why, again, why we’re watching carefully.

Andy Slavitt  16:30

So there’s a breadth of things she said they’re ranging from, okay, most people are going to know if they’re touching someone with a lesion, maybe they will, maybe they won’t, but at least, that’s very different from something that’s aerosolized or comes to the droplet form, where you can be people can really be infected without knowing it, you said, is that close contact? And also, I think I understand, from my own previous knowledge, that people are not infectious until they’re symptomatic. So can you talk a little bit and I really, what I’m aiming to help people into the question is how easy it is, for someone to protect themselves, in their kind of ordinary activities, if they’re concerned about the contagion of monkey pox.

Anne 

When somebody’s contagious? So we assume from the data that we’ve seen so far, that people tend to start to be contagious, when they develop symptoms. That’s, that starts with the feeling of, you know, flu, like symptoms, malaise, fever, and then the rash appears, people have to be symptomatic, they have to at least be not feeling well at the time. And really, it’s the bodily fluid, you know, it’s coming in contact with that virus. It’s not this is not airborne. So even if somebody’s not feeling well, as long as you’re not getting the respiratory droplets in your face, and you’re not touching these lesions, or, you know, in close contact with bodily fluids, I would say that this is something that you don’t have to be particularly concerned about. Also, these are clusters of cases I mean, up, you know, maybe 100, couple 100. If we get you know, as this goes on cases, globally, if your average person is very unlikely to come in contact with a potential case of monkey pox in particular, when somebody is infectious. So I think people need to understand that this is something that is still relatively very rare occurrence and can be controlled.

Andy Slavitt  18:40

So, I was in the government during the Ebola crisis, you obviously have a lot of direct experience with Ebola. But what I found is that we’re either tend to either way under react or way overreact to a new outbreak, largely based on the last outbreak. And so Ebola and other factors, I mean, Ebola had a very scary kind of presentation. But it was, but it was much less contagious. And yet, we overreacted. Like then I think SARS-CoV-2 came around, and you can make the argument certainly that at least governments and others contributed to there was generally an under reaction, at least among some of the population. And I think there’s this bouncing back and forth and I think It’s important point which you point out, which is, as I, if I hear you correctly, please correct me if I’m wrong, unlike SARS-CoV-2 one of the things that was most challenging about […] we do it still remains challenging is you could run in, we could run into each other in the street, you could be perfectly healthy, I can be perfectly healthy. We could spend time in an elevator or in a restaurant together, neither of us could […], but if one of us has SARS-CoV-2, we could be exposing each other with before we have symptoms, or even never get symptoms. And that is, again, as you said, as far as we know, is not the case with monkey pox. And so, you know, generally speaking, if you’re avoiding sick people, which is generally what we do, that’s a pretty good way of avoiding infection of all types, unless you get any symptomatic spread.

Anne  20:51

That’s exactly right. I think that you put that perfectly. And I think that your point is very well taken that we react to the next pandemic, or epidemic or outbreak is really predicated on what our most recent experiences with the last one, even if it has nothing to do, if the biology of the disease and the science might tell us otherwise, it’s you know, emotionally and then in terms of policy we and collectively, that’s really what we see happen. I agree with that.

Andy Slavitt

And there’s two levels of worry. And I think there’s a level of worry that all of us have. And we’re just going to admit this as am I or someone I love going to get this, okay, that’s one level of worry. But that’s not the only level of worry, then there’s a level of worry that people like you having that all of us should have to some extent, which is our people going to get sick and die, even if we don’t know them and even if it’s not a lot of people, because that in itself, after that you could take that deep breath and say, I think I’m largely safe. But beyond that, we then still have to act because you know, something is emerged that people who were doing activities that were perfectly healthy and normal and fine before going to festivals, having sex, whatever it is that people do, that are very human things have become more dangerous. And so I think I want to distinguish between the question, should we worry? Should you worry about yourself and your loved ones?  not a big cause to worry? Should we be worried about the fact that there’s an outbreak and that that has some negative impacts? Yes, that’s something we should be as humans worried about?

Anne  22:41

That’s exactly right. And I really liked how you how you broke that down? Because when I get this question about how concerned we should be what we should be, you know, it depends upon whose perspective you’re talking about. And I think that that’s the that’s really the key on an individual level for most people. It’s something that won’t impact them. If you’re if you are somebody who has attended one of these festivals or is in contact with somebody who did or is in contact with just a, you know, people who might, you know, coming from someplace where there is endemic Bunky box, you might think about it, who are actually in contact with wild animals, it’s not, it just doesn’t happen. Just you know, it doesn’t just happen in Africa, either you have to come in contact with a wild animal or person who is sick before you’re gonna get that virus. Right. But I think that from a global perspective. Yeah, we worry when we see viruses doing things that they don’t normally do and spilling over into populations that they haven’t been in before. Because we want to be able to prevent pandemics before they start and to get in front of problems and to understand what’s happening to be able to protect people in general. And then for people who work on pox viruses, you know, like myself, these are things we look at this a signal saying, okay, well, what could potentially happen here, and I’m not talking about this is definitely going to happen, but you think okay, well, if we start seeing extended chains of transmission, and in particular, it’s spreading in populations, that you know, there may be people who are immunocompromised or maybe people who are co-infected with other things, you know, that often gives the virus a little bit of a jumpstart to be able to change a little bit more pox viruses are very stable. I’m not particularly worried about that, per se, but you have to think about those kinds of things in a in a bigger scheme of things. The other thing we worry about, you know, we had the monkey pox outbreak in 2003 that was a result of Gambian rats being imported from Ghana, housed next to prairie dogs. In a in an animal holding facility. Those prairie dogs don’t hogs were infected and then sold to people through the exotic pet trade. And, and those people got monkey pox. Now, you know, that’s also a signal that we have to be, you know, we have to be really thoughtful that this virus has a lot of animal, can infect a lot of animals species had this spilled into wild prairie dog populations, we could have ended up with a real problem of monkey pox being endemic in animal species. So that’s why from a bigger scientific, public health, global perspective, we worry about these things. Yeah. You know, as somebody who works on poxviruses Yeah, that’s why I’m concerned about it. But am I worried about getting it myself? Are you getting it? Or are my neighbors getting it? You know, not in the same way.

Andy Slavitt 

right. And I think this is, I don’t want to cement this and then then move on. It’s just, if we’ve learned nothing from HIV AIDS crisis, it’s that you don’t have to only be concerned, if you are having high risk sex, or using a needle, you can be concerned because other people are dying. And we as a country, have had a tendency that if it wasn’t happening to us, or it was happening in Africa, that we’d say, Oh, I’m safe, and therefore I’m not worried. And I think the one thing that I hope is clear, is that that attitude will result in lots of death. And it will result in lots of suffering, even if it doesn’t result in lots of death. And it’s also so this level of empathy, that we sometimes don’t feel when we feel a sense of our own safety is actually dangerous. But before I get to the could haves and what might happen and so forth, I want to make sure we make another couple points around what is different. Number one, we actually have effective vaccines. Yes, we do. Already. This is not a novel virus, right. Number two, we have super effective therapeutics. Number three, this is not a disease, particularly in Western countries, which we think is going to be highly lethal, it’s going to be uncomfortable, painful, potentially disfiguring. No picnic. But we’re not talking about something that given the science and the medicine we have, that we should be worried about killing people. Is that Is that fair?

Anne 

You’re correct. We have vaccines, we have therapeutics, we know a lot about this virus we’ve been studying it for decades.

Andy Slavitt 

And you specifically have been studying this since 2002. You’ve been studying this for 20 years.

Anne 

Correct. And there are people that have been studying it for longer than I have. So, you know, I think it’s just really important to remember that this is not a completely new scenario. And to me just the biological reality of what’s happening makes sense. So it isn’t something that we say, Oh, well, we don’t just we just doesn’t make any sense at all. It’s just I think we don’t understand the epidemiology yet. It’s not that the biology doesn’t make sense. That’s right. So we’re dealing with something that’s known. Something that that we can wrap our arms around, even if things have changed slightly, or the virus is, you know, changed in its terms of how it’s presenting. That’s, that’s just important, important part of the knowledge base. But that doesn’t change fundamentally how we fix this problem. And that’s what vaccines that’s what therapeutics, that’s what good disease surveillance. And that means getting the word out, getting the word out to clinics, getting the word out to the right groups to be looking for it, because if you don’t look for it, you’re not going to find it, having good case investigations, good contact tracing, using quarantine and isolation as needed. I mean, you know, the good news, if there’s some good news from the pandemic is it just as the world has become more familiar with all of these terms, also, the world has become more familiar with what it means to do case investigations and contact tracing and all of these other things that were not common terms.

Andy Slavitt

So you’ve helped us establish a baseline of knowledge, which would suggest that this is something that we don’t have to be particularly personally worried about unless we’re coming into close contact with people who are displaying symptoms of being sick, that it doesn’t spread typically, very long and far and then if it does, if you do get this, well, likely we have the science we have therapies, we have vaccines, but with that, we should be concerned in the context of this Is that the kind of thing we want to see going on? And that’s based on everything we know. And so give it with that baseline, it would be just useful to understand what I think we’ve become a little trained about, which is the unknowable’s, which is, I think we have a little bit of this global PTSD from we thought we understood SARS-CoV-2 and then alpha happened, then we thought we understood it and then delta happen, then we thought we understood it, and then Omicron happened. So are pox viruses, as widely as coronaviruses, are they do they create as many variants? Are we likely to see mutations? Are we worried that this is the kind of thing that could end up looking very different than what we understand in the past?

Anne  30:48

Well, you know, comparing these two viruses, monkey pox is, so SARS-CoV-2 is an RNA virus, it’s much less stable of a virus. Monkey pox is DNA virus are much more stable, they don’t change as quickly, they don’t mutate as quickly. It isn’t to say that that monkey pox couldn’t adapt and become more fit, more adapted to a population. Certainly that could happen. And that’s why we’re going to watch it. And we’re going to see what happens here. And really track it and watch if we’re seeing anything different in terms of virus in terms of clinical presentation in terms of the severity. I mean, the way that we know if that’s happening is that we watch it to see what happens. And I think that SARS-CoV-2, also has really driven home that we do have to be watching these things, we have to be humble. I think that we have less concern about this virus, doing those things in in a short time period. But certainly over time, there could be selective pressure, we could see, you know, mutations, we could see it become more adapted, it can become more fit. I mean, of course it can become more fit. It’s certainly possible, is it probable? It is certainly possible. And that’s why we need to watch it, is it going to happen overnight? Probably not. But that’s why we have to be watching all of this. And that’s why the work on emerging infectious diseases is so important to just going to have to continue.

Andy Slavitt  32:21

As you say, it’s got to be sequenced. And I wonder if you could tell us what we’re going to learn about the sequencing? Will it help us understand whether or not it is mutating, will it help us understand whether or not there are different strains will help us understand why it’s been spreading to multiple countries? Will it help us uncover any other mysteries?

Anne 

It’s going to help uncover all of those mysteries. And I think that that’s going to be you know, the genetic epidemiology and all of the, the genomic sequencing all of this, all of the genomics are really going to make a very big difference here, in truly understanding what’s happening and telling a story. That makes sense, once we, you know, it’ll, it’ll really shed a lot of light on it. You know, we’ve seen that happen. Now, we’re used to seeing that now. And the sequencing now is fairly straightforward. I mean, we know how to do this, should be being done in in, you know, every place that we’re seeing, you know, cases occur. And, and so that along with all of the epidemiologic, and, you know, data is going  to really help us, you know, refine what’s happening and really know what to expect. But, you know, as I said, we’re in early stages here of this situation, we don’t know what’s happened. As I said, it’s like jumping in and chapter three of a book. But since nobody reads books anymore, maybe I’ll say we’re in like, episode four. […]

Andy Slavitt 

A Netflix series.

Anne  34:03

We’re updating our language to the new world. The origin story we mixed, you know, with all the beginnings, so you gotta go back and watch it.

Andy Slavitt 

Has there been some sequencing out of Portugal, I heard? Did we learned anything from that?

Anne 

There has. The sequences that have been put up to date and, you know, this is again, this is very early days, we’re just getting this information all seem to track back to, to a virus that originates in Nigeria, in West Africa. So I think it’s, you know, it’s all this West African clade. And it’s, you know, I haven’t looked at you know, I looked this morning, I’m sure there are more sequences up by now. And it’s probably, there’s probably more information out there, but I would not be surprised if these are all kind of clustering in a you know a similar part of that phylogenetic tree.

Andy Slavitt 

And from what we know, there’s nothing different about the virus yet. And is there anything that would lead us to think that there’s something other than an explanation? Like the festivals? That would be more troubling, right? If it felt like this was spreading in a much more haphazard fashion without some sort of common events? Exactly. Is there anything that would lead us to think that yet?

Anne 

Well, okay, so I also think, you know, I think that these, these events may have seated several cases, we may see some connections there. But, you know, I think that we’re making, we’re, you know, all of us are still making a lot of assumptions, and we really need to understand first, it could be just those are amplifying events, and that there were, you know, we’ll see some haphazard, spread beforehand that might be concerning, you know, we all have to kind of, we have to be able to understand all of the information first. And I think that speculating, you know, while human nature, you know, we want to know, we’re, you know, guessing what’s happening, we don’t have that info, you know, I mean, there are other, of course, there are other things that could be happening. I mean, when I first started hearing about these cases, my first thought was, well, I wonder if there’s a product that’s been contaminated, that’s being disseminated. You know, globally, poxviruses are fairly stable, you know, maybe some something that was disseminated from West Africa or, you know, something they’ve been contaminated, could have seeded this, or maybe there’s another situation where one animal is, you know, exposed, another set of animals like the Gambian rat, situation, you know, and by the way, these things could be, you know, you can have several events happening, monkey pox spreads in multiple ways. And if we’re having more cases in West Africa, you know, we could have, you know, several introductions, and that could be in different ways. So I think, as scientists, we always try to keep our minds open and we want to make statements based on facts, not on guessing.

Andy Slavitt 

Well, this is really important, because you’ve been really so excellent about this, all the things that were critical about the CDC or others for statements they made early in the COVID, 19 pandemic, are all things now that we say, well, gosh, why are people speaking with such certainty? And why did they say these things that they didn’t know. But the truth is, at the time, what was happening is exactly what I’m doing to you, which is I’m pushing you to guess, I’m pushing you to speculate, because we have this thirst to know. And people want a higher degree of certainty than is possible. And it’s important that we make it clear that when you do that, when you give it a less than, it’s less than satisfying, when you say, I this is what we know. But there’s a whole lot that we don’t know, and this is how it’s behaved in the past, but there’s no way to know whether this needs to be in the future. That’s exactly what you should be doing. And every time I push you to speculate, you know, it causes the same sort of situation, that that we’ve gotten ourselves in the past. So I appreciate you sharing exactly what you have with the things we know, you’re educated opinions that I think you’ve shared with everybody based upon your years of work. And also just being very clear, that is, as much as we would love a definitive statement, which says, this will never morph into something more dangerous. It’s exactly that kind of conversation that I think has gotten us into trouble and has led to, I think less health and less support and trust to public health.

Anne 

Exactly. I mean, I agree with you. And I mean, the reason that we do research is because we, you know, when we write grants, and when we want to understand something, you know, we hypothesize, we are speculating, but then we want to prove those hypothesis, either true or false with data. So I think that’s where some of this breakdown happens is that you know, in science, that’s what we do, we hypothesize, we have a null hypothesis. And, you know, we want to prove whether the null or the alternative hypothesis is true, right? That’s just part of the scientific process. And I think that it gets very confusing for people who are not in science and not doing science when scientists start to speculate about things and are coming up with scenarios. This is part of the scientific process. And now I think that scientists often become a little bit worried about thinking out loud and talking about these things, because you don’t want it to come cannon when it’s just, you know, a thought process.

Andy Slavitt  40:12

Which it inevitably does. So look, let’s maybe close by summarizing I think what I think we covered here, which is you’re not going to get monkey pox. If you did get monkey pox, there are plenty of treatments and vaccines. But the way that could change is by saying because of that, I’m not going to worry and I’m not going to care. And when I can be concerned about this, the way that these get out of control is for all of us to turn our backs like we did with HIV AIDS, because the suffering of others, if that’s not enough, can over time become our own suffering. Anne Rimoin, thank you so much for coming in the bubble.

Anne 

It’s my pleasure.

Andy Slavitt 

Good shows come coming up, we have our Friday conversation, where we will be reacting to the news out of Uvalde, Texas. Then next week, Beto O’Rourke, we’re going to talk about some of the critical cultural issues that the country is fighting over. The Larry Summers, the great economist and former Secretary of Treasury, it’ll be honest, got Kirby, the head of United Airlines, general Gustave Perna, to talk about pandemic distribution, he ran warp speed. And it’s a fascinating guy. So lots of good episodes coming up after this week. But I hope you’ll join us on Friday. These Friday. Conversation shows have been really fun to do and bringing good feedback from you. We of course will take your feedback, even if it’s not so good. I would love to hear it. We really appreciate you sticking with us. Enjoy the next couple days. And play with us on your podcast machine on Friday.

CREDITS

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.