Andrew Lover Profile picture
May 23 15 tweets 6 min read
▶️ Things the scientific community may have largely forgotten about regarding #monkeypox.

A thread,
▶️ In 1988 DA Henderson and colleagues at WHO published the smallpox eradication "redbook" (1473 pages, 3.1 kg!).

𝙒𝙝𝙮?? Because they were concerned their hard-won knowledge would evaporate.

▶️ And guess what?
▶️ There's a whole chapter on #monkeypox !
But 𝙒𝙝𝙮?? Because monkeypox was a major barrier to eradication.

▶️ It was clinically indistinguishable from mild(er) smallpox, so every single case had to be confirmed as NOT smallpox for eradication certification.
▶️ For most of a decade, there was a large-scale clinical-surveillance study where data were collected from approx.400 #monkeypox cases across West and Central Africa.
▶️ And what was learned from all these #monkeypox 𝙛𝙞𝙚𝙡𝙙 𝙨𝙩𝙪𝙙𝙞𝙚𝙨 ?? (details below)
Note: all Central African clade:
1. Most infections occurred in sporadic clusters.
2. Serial interval (DRC) was 7-23 days.
3. 31.5% (of 210 cases, DRC) appeared to be H-to-H

▶️ And what was learned from all these #monkeypox 𝙛𝙞𝙚𝙡𝙙 𝙨𝙩𝙪𝙙𝙞𝙚𝙨 ?? (cont; details below).

4.90% were in small villages, 10% medium (1k-5k pop), very few in larger towns.
5. Subclinical cases were not uncommon in unvaccinated pops (DRC, est. at 18%).
1. Many infections occurred in sporadic clusters, suggesting a "spillover" with limited subsequent human-to-human transmission.

2. Serial interval (DRC) was 7-23 days.

3. 31.5% (of 210 cases, DRC) appeared to be H-to-Human

89% were in small villages, 10% medium (1k-5k pop), very few in larger towns.

5. Subclinical cases occurred in unvaccinated pops (DRC, est. at 18%).

▶️▶️ These findings are largely consistent with 2018-2019 outbreak in Nigeria (same as currently circulating strain), with the exception of rural-urban gradient.

▶️▶️ What does this all this mean for the current #monkeypox situation?

▶️ Very mild/subclinical/(asymptomatic) cases should be expected (but risk of onward transmission unknown).

Data from: @BNODesk
▶️ Human-to-human transmission 𝙬𝙞𝙡𝙡 occur.
▶️ We have essentially no understanding of transmission in modern (unvaccinated) and hyper-mobile populations.
▶️▶️ Given these major gaps: we should be proactive, err on the side of caution, and then be pleasantly surprised.
High-quality and indexed scan of WHO book here:…

15/n (end).

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More from @AndrewALover

Dec 28, 2020
▶️▶️ Great to see @rockefellerfdn taking the lead in some ambitious thinking around how we proactively address our pandemic response.

A few additional thoughts... (in no particular order)

▶️ 1/n
▶️ Massive-capacity testing centers.

24-hr turnaround goal essentially 𝙧𝙚𝙦𝙪𝙞𝙧𝙚𝙨 courier delivery daily from testing sites.

4-hour drive seems maximal (logistics) so...
W Coast alone would require 5-6 sites?

(& Broad had automation and skilled staff in spades).

▶️ HIPAA (& FERPA, higher ed).

While covered, impt to note a waiver has existed since March with little impact.

▶️ Catastrophically huge HIPAA fines ----> staff at all levels are wary of ANY potential violations.

▶️ Unambiguous waiver essential.…

Read 12 tweets
Jul 19, 2020
Mass media: reinfection with SARS-CoV-2.
Largely dismissed- no peer review so 'just ' anecdata....

▶️ However, "strange" epi might have very important messages for us: 🚨

▶️ Guinea worm- Chad
▶️ Polio- Hispaniola
▶️ "Strange" malarias- Malaysia/Brazil

🔽 A thread #COVID19 1/n
In 2014, reports of "peculiar" Guinea Worm infections in dogs in one river basin in Chad.

▶️ Initial explanation: unusual pop of dogs in isolated areas feeding on fish; risk to humans was "sporadic and incidental."
🚨 Reality: many areas in Chad; plus baboons in Ethiopia. 2/n
In 2001, report of circulating-vaccine derived polio on Hispaniola .

▶️ Initial explanation: very rare occurrence in low vaccine settings.
🚨 Reality: Currently (a or 𝙩𝙝𝙚) major challenge for the entire polio eradication campaign. 3/n
Read 5 tweets
Jul 11, 2020
Short thread on why "quick and easy" fixes are not going to get the US out of this pandemic quagmire.

▶️ A deathray system to zap malaria mosquitoes had a splashy TED talk and a flurry of press coverage- in 2010.


#Covid_19 #COVIDー19…
Big grand ideas, an amazing prototype, and a high profile demo!

and then.... crickets.

Or actually,🦟 🦟 🦟 🦟 🦟 buzzing.

Why though?

▶️Things were a bit more complicated than anyone anticipated,
▶️ the nuts and bolts weren't 𝘲𝘶𝘪𝘵𝘦 as advertised, and
▶️ the system wasn't 𝘲𝘶𝘪𝘵𝘦 ready.

"Just a few minor wrinkles to work out!"

More 🦟 🦟 🦟 🦟 🦟 buzzing.

Read 9 tweets
Mar 6, 2020
Simple practical guidance on steps you can take
▶️▶️ right now
▶️▶️ to prepare yourself, your family and within your community
▶️▶️ in the event of widespread #COVID19 transmission.

Thread 1/n Image
Thread 2/n Image
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Read 8 tweets

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