▶️ Extensive discussions about potential protection from #monkeypox from pre-1980 smallpox (vaccinia) vaccinations.

▶️ What do we actually know, and
▶️ how well do we know it?

a thread.
1/n Four main issues:

A. How long did vaccines protect against smallpox?
B. How often was/is 𝙧𝙚𝙫𝙖𝙘𝙘𝙞𝙣𝙖𝙩𝙞𝙤𝙣 recommended?
C. How common were smallpox infections after 𝙧𝙚𝙫𝙖𝙘𝙘𝙞𝙣𝙖𝙩𝙞𝙤𝙣 ?
D. How well does smallpox vax protect against #monkeypox?

2/n

▶️ How 𝙢𝙞𝙜𝙝𝙩 the current #monkeypox situation progress in non-endemic areas?

A thread,

1/n ▶️ There are 3 likely #monkeypox scenarios IMHO (from most to least likely)
A. Semi-rapid mitigation and elimination.
B. Low-level endemicity.
C. Major expansion, mortality and a concurrent pandemic.

Why this range, and what are the 🃏?
(fig from pubmed.ncbi.nlm.nih.gov/28351976/)
2/n

▶️ Things the scientific community may have largely forgotten about regarding #monkeypox.

A thread,
1/n ▶️ 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 !
2/n

▶️▶️ 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

https://twitter.com/CT_Bergstrom/status/1342760611927638017

▶️ 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).

2/n

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

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
nymag.com/intelligencer/…
1/n Big grand ideas, an amazing prototype, and a high profile demo!

and then.... crickets.

Or actually,🦟 🦟 🦟 🦟 🦟 buzzing.

2/n

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 Thread 2/n