Mpox (Monkeypox) 20221219: Dallas County Health is disappointing. Things are better.

Yes, the cases are way down, but there are still serious deficiencies, slack reporting, missing vital information.

Dec 19, 2022

Share so the Dallas Gay community can be informed.

Why is this criticial review important?

Mpox won’t be the last pandemic impacting Gays. There is likely something out there that will show up and hit the Gay community. So far mpox and HIV have shown up, and we should expect something else might come.

What we need to do is identity what might be done to prevent the next epidemic, and make sure that at the county, state and national level the response to the next epidemic is the best it can be.

We shouldn’t settle for good enough.

How can you say Dallas County Health is disappointing?

How many vaccinations were done, or at least how many vaccine doses have been handed out in Dallas County? Without this information we can’t make even a guess as to whether the Gay community has achieved herd immunity.

There are other disappointing aspects. Links to the earlier reports will be at the end of this post. They are now collected together as links in a post.

Let’s start by looking at the numbers.

I am going to switch to either monthly, or bimonthly or quarterly reports on mpox depending on what happens. If there is a flare up, I will of course report more often.

12/19/2022 Early Monday morning looking at the numbers.

It is 98.6% men and 1.4% women.

It is a disease whose victims are men who have sex with men. As for the 1.4% women, I suspect it was women who discovered that their husband or boyfriend had sex with men. This whole wailing and moaning about it not being a Gay disease I think served to lessen Gay concerns about the disease and not to focus on how well Dallas County Health was performing. The Respectability Gays are a serious detriment to the Gay community’s health.

The following is a plot of the total cumulative reported cases by date with fit lines through different stages of the to filter out issues of late reporting of cases.

The five regions are somewhat arbitrary divisions of the mpox epidemic so I could show how the pandemic was slowing, but give an idea of the phases. The charting by Dallas County Health had problems. Notice that the intial period is a power curve. The response really didn’t get underway until we had nearly 200 cases. How many cases might have been avoided had serious intervention started at 100 cases or even 50 cases?

The rate seems to be dropping, but it is hard to know if it is a reporting artifact at this point since the rate is much lower than it has been. It appears to have at least dropped down to about one-half case a day. It might be lower.

Given that the rate of mpox has dropped so much it will be a while before we know how low it has dropped. Even if drops down to one case every ten days we are still talking about 36 cases next year.

This is the graph presented by the Dallas County Health with its deficiencies.

They are still plotting an 7-day rolling average into a time period where data is incomplete due to delay in reporting. The footnote explaining that the date is incomplete in the blue regions is really small. The rolling 7-day average isn’t bad, but the graph nowhere indicates the rate of cases per day.

Racial Equity

Note that there are no dates assigned for the following tables. They say weekly, but there are seven days in a week. This is just slack reporting.

The outreach to the Latino and African American MLM (Men who have sex with men) seems to have been a real fail. This percentage breakdown is based on the table seen 12/19/2022 Monday morning, because again, no dates.

The percentage of Gays who are white is likely close to the percentage of Dallas County residents who are white and it is much higher than 20%. The total for African Americans and Latinos is 59%. Since 13% is unknown, when you normalize the statistics excluding the unknown, you get 59%/87% to get 68% of the known cases are Latino or African American.

This is a serious fail. Underserved groups or groups for which Dallas County Health fails to reach might be the cause of a reservoir of ongoing mpox cases that have the potential to flair up and cause another pandemic.

I have raised the issue of failing to reach effectively the African American and Latino community but didn’t get any real response from Dallas County Health.

Eligibility

Eligibility needs to be any person who has MLM sex. Vaccination needs to be available to Gays without Dallas County Health probing Gay men’s sex lives. Otherwise there will be people who won’t go.

Also, it needs to be available to any Gay person who wants it. I don’t see why if my sex life is slow, I should be at higher risk for mpox when I do have sex. To really eradicate it and to reach herd immunity we will need as many Gay men as possible and MLM men who aren’t Gay like Bi’s to get vaccinated even if they don’t get laid that often.

These are the current requirements as of 12/19/2022 Monday morning.

I don’t want to hear the excuse that maybe some providers are skirting the rules.

It is good that the qualifications have expanded, but until we have every Gay person or person who has sex with men eligible, Dallas County Health is making it difficult to reach herd immunity.

It would also be very important to know whether currently the restrictions are driven by the issue of the supply of vaccine. Dallas County Health might provide that info.

Availability

The supply is limited to a set of providers. I suspect that this is due to the fact that the supply of vaccine has to be stretched by special techniques and so there has to be training on the administration. There were reports that there were issues in the method to stretch the supply of vaccine.

I don’t see Dallas County Health as being able to do much about this. It is going to have to be something the national administration does.

At some point mpox vaccine will need to be generally available. Until then it is going to be difficult to achieve herd immunity and to reach high levels of vaccination in the Gay community.

Herd Immunity without probability functions.

It has come to my attention that some people actually didn’t enjoy their algebra classes in school. Epidemologists have an algegraic expression for probability which explains herd immunity. I am not going to use that here.

So let me explain it for others avoiding math as much as possible.

No vaccine is 100% effective. Even if the vaccine is 80% effective, which is considered fairly effective, there is still a 20% chance of you getting it.

Getting rid of the risk of getting a specific disease relies on a large percentage of people getting vaccinated. The exact percentage of the population that needs to be vaccinated varies depending on the effectiveness of the vaccine.

Below a certain percentage effectiveness the percentage has to be so high as to be unachievable. That is why the Chinese Communist government is having a crisis with Covid, their vaccines are not terribly good.

Herd immunity without too much math.

Looking at it from the view of the vaccinated person.

If you are vaccinated and the percentage of the Gay population vaccinated is really high, then whether you trust the person’s word that he is vaccinated isn’t that relevant to your risk. But with both of you vaccinated, one of you has to have a breakthough infection despite the vaccination and the other has to then have a breakthrough infection from the guy who got the breakthrough infection. That already lowers the risk alot even if not a lot of others are vaccinated.

If most of the persons that the other guy had sex with were vaccinated, and most of the guys they had sex with were vaccinated, there would have to be a whole series of breakthrough infections for a person to get monkeypox.

Don’t be terrified by the math, but a grossly simplified math would be, four guys having breakthrough infections.

(0.20) X (0.20) X (0.20) X (.20) = 0.0016 or 0.16% chance of four breakthrough infections.

Or in fractions (1/5) X (1/5) X (1/5) X (1/5) = 1/625 or one chance out of 625.

Even then the chance is lower since likely the 4th in a series isn’t getting a breakthrough anyways since herd immunity.

From the reference point of the unvaccinated person.

The person who is unvaccinated is protected from a disease since most of the people he has sex with are vaccinated and have sex with people who are mostly vaccinated.

He is unlikely to get the disease and even if he does, the chance that he can spread it is low, and even if someone gets infected the chance they can spread it is low.

One of the problems with this, is that the unvaccinated person gets a free ride while he is often spouting his anti-vax idiocy.

Even though what is protecting the anti-vaxxer is the vaccinations that everyone else has gotten, they will spout their nonsense and some health quakery.

Summary on herd immunity

If the vaccine has high enough effectiveness, even if a certain percentage of a population doesn’t get vaccinated, herd immunity can be achieved.

How fast that is achieved and whether it is achieved, depends on people getting vaccinated, and every Gay anti-vaxxer undermines the health of the Gay community and needs to be serverely regarded.

Summary and Assessment

[1] Mpox is still out there. It might mutate around the current vaccine. The risk of this is not much, but it isn’t zero, and if the current vaccine is no longer effective for a new strain of mpox it could flair up again. We need to have mpox vaccine generally available to all Gay persons regardless of the level of sexual activity. I don’t consider 30 cases a year as tolerable.

[2] We have no information as to whether the Gay community is approaching herd immunity. This is totally unacceptable. This is a vital piece of information and the Gay community is left in the dark. Dallas County Health could at least report the total cumulative vaccine doses delivered to Dallas County.

[3] For the next pandemic, likely the response of Dallas County Health will be slack. Poor reporting, improper graphs, racial inequities and missing vital information will be part of the response.

[4] For the next pandemic, like HIV and like mpox, it is likely minorities will get really slammed. We need to find out why the mpox program grossly underserved the African American and Latino communities and have a real plan for the next epidemic.

[5} There needs to be a plan to eliminate mpox and not collect excuses it can’t be done. It maybe difficult to do so, but smallpox was eliminated, mpox can be eliminated. Is is likely that mpox can be eliminated with just one action? Probably not, but there can be constant activity to find the next step for the further reduction of mpox.

[6] Reducing mpox by shutting down the sex life of the Gay community isn’t a success. It might be the immediate practical thing to do, in the case of a pandemic, but it shouldn’t part of the long term plan. The Respectability Gays might think it is, but it isn’t.

[7] Tropical diseases need to be taken seriously by the medical establishment and the U.S. government. Monkeypox was entirely avoidable and scientists in Africa had warned that it could spread to the world. With the interconnectivity of the world with shipping and airlines and highway systems, it is stupid to not expect that the next nasty disease will stay in some local.

[8] Gay nightclubs, bars, and other venues need to realize that slack responses to potential risks to new STDs could put them out of business. Gays might stop going to a Gay venue if they see an unacceptable amount of risk. Anti-Gay persons might ask that Gay businesses be shut down.

[9] Gay anti-vaxxers simply can’t be tolerated. Not just for mpox, but they are a risk for the spread of other diseases that now can be stop with a vaccine shuch as Hepatitus A&B, HPV, mennigitus.

They are free loaders on herd immunity as stated. But it might be that herd immunity in some cases will require a very high level of community vaccination. If an HIV vaccine comes out but the level of effectiveness is not super high, we might not reach herd immunity for HiV.

When an HIV vaccine comes out, anti-vaxxers will slow the end of HIV in the community. Depending on the effectiveness of the vaccine, they might also be a problem of re-introducing it into the Gay community.

Certainly, no one should have sex with an anti-vaxxer. Not just to avoid mpox or an STD. The person doesn’t get the flu shot means you have a higher risk of getting the flu.

[10] The Gay community apps need to cooperate with local health to get information to the local community. I think that if Jack’ed had really pushed info on mpox, the impact might have been much less on the African American community.

Epilog

I will print this summary out and share it with the Dallas County Court Commissioners. It would be helpful if the local LGBT+ establishment would take the risks still present with mpox and the risk of future STD pandemics seriously, but I have low expectations.

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The following are links to my earlier reports on monkeypox.