I'm not actually in Canada, so my perception of things is going to be skewed somewhat.
However, I'm not sure the phrase "mandatory quarantine" is correct, based on my reading of the Health Canada announcement. Indeed, the announcement does not actually indicate a quarantine within Canada of any kind.
The paragraph that seems to have triggered the article you linked is this one:
"During your travel, you may be subject to procedures at your destination put in place to limit the spread of monkeypox, such as isolation, should you become infected. You may have limited access to timely and appropriate health care should you become ill, and may experience delays in returning home."
However, this paragraph appears to refer to potential conditions OUTSIDE of Canada. Even if it is targeted at the disease situation within Canada, this is still not an implementation of a mandatory anything.
The announcement itself is simply setting Canada's travel advisory level to Level 2.
The CDC has similar alert levels for Americans traveling abroad.
This may be a situation much like Belgium's mandatory isolation protocol, which was rather egregiously miscast in the press (and by those who really should know better).
Reading the actual travel advisory, I don't see anything in it that is egregiously wrong--the comparison to chickenpox is a bit cringey, as chicken pox is a completely different virus--herpes zoster--that has no connection to the orthopoxvirus genus. The respiratory droplet statement is a bit problematic, as there is some scientific literature which argues monkeypox has the ability to aerosolize (a capacity it would then share with its more infamous cousin smallpox).
As much as corporate media has been a disgrace when it comes to covering public health crises, much of the alternative media also comes up short journalistically, conflating terms and misrepresenting facts as well as public health pronouncements, some of which are arguably not at all inappropriate. The recommendations made by Health Canada are not at all unreasonable, all things considered, and do not appear, from the text, to include mandatory isolation or quarantines at this time.
There are a whole lot of reasons why Canada might be considered "done"--most of which involve the lamentable and frequently execrable statements of Canada's Prime-Minister-In-Hiding. However, this travel advisory does not to my mind appear to number among those reasons.
Well, Canada is the only country not allowing non-vaxxed to travel within its own borders, still...so seems vindictive and NOT based on any science that other countries are using....so, anything at this point is on the table with this regime....I appreciate you taking the time to give your take on this new development......I just don't trust anything coming out of this govt's mouth....again, thank you....love your substack!
Frankly, I'd be more worried about the rather Orwellian aura surrounding the ArriveCAN app--the tone of the webpage describing the app and entry requirements into Canada sound vaguely fascistic. However, the vaccination and similar requirements mentioned all appear to pertain to COVID, and I don't see any mention of monkeypox.
Of course, by the time the sun rises tomorrow that situation could change completely. Justine Trudeau is nothing if not mercurial!
(Can you tell I don't exactly cotton to the Canadian Prime Minister?)
So that may have suggested a possible high degree of mutation has been taking place at that time. As to why it is happening, I'm not sure. It could be lack of surveillance did not catch this, in which case it would mean that there's a lot about the mutation rate of monkeypox we clearly don't know about. It could be due to artifacts from sequencing, although having that occur across many different samples may narrow the scope of that issue.
What's interesting is that a few of the samples show microevolution via small SNPs in between samples, which again may suggest that the virus is mutating much more quickly than it should.
Also interestingly, as I mentioned in my post, there doesn't appear to be any egregious insertions at this moment similar to the 12 nucleotide insertion for the furin cleavage site of SARS-COV2. That was one of the biggest red flags. So if anything was done with this virus it may have been done through serial passage to accrue the mutations it has. A big caveat to this is that the virus itself is not any more virulent (as far as I am aware), although it may be more pathogenic.
Maybe this is monkeypox's version of Omicron where it maybe has mutated quite extensively to disregard prior immunity? I think we'd have to wait to see how the mutations translate into proteins and their activities.
Also, thanks for mentioning my post! I think that article was strange, but at the same time I believe a lot of people may have been extracting too much from it.
The big question mark with monkeypox is how did so many mutations accrue so fast? With Omicron the number of mutations was remarkable because they appeared to arise within a single host. Timewise the number of mutations was not entirely remarkable for a single strand ribovirus.
Monkeypox is a double strand DNA virus, with a much slower mutation rate. Extrapolating from variola's 1-2 nucleotide substitutions per year, this latest strain of monkeypox has 6-7 times more substitutions than it should
The Rambaut preliminary research gives a good explanation of the mechanism of mutation, but its conclusion requires hidden transmission of monkeypox literally for years.
Moreover, if that transmission occurred in Nigeria, there should be way more cases in Nigeria than have been reported.
While the extant data does not lend itself to a lab origin hypothesis, a "hidden" epidemic sounds too much like a dodge. It reminds me of an old cartoon I saw in Scientific American years ago, of a mathematician at his chalkboard working on a proof --in the middle he has the phrase "and then a miracle happens".
"Hidden" transmission to me sounds just like that. It's not an explanation so much as it a bandaid covering up the lack of a good explanation.
I liked your discussion of the Wuhan paper. People are so quick to get triggered by names folks often forget to look at the details.
That paper is strange, but its gain of function aspects is yet another reminder that biological "threat reduction" all too easily mutates into threat creation.
Which is why I leave the door open in that for monkeypox. There's no evidence to support a lab origin for monkeypox so far, but it would not surprise me if we should see some evidence for that.
Yes, I think we're on the same page for the most part. I wrote about it in my first article on monkeypox arguing that it's dsDNA nature should make it less prone to mutations, but that article came before we got more genomic sequencing evidence.
The argument about Nigeria as is being relayed by the MSM is that Nigeria and other African nations were not being watched carefully, and thus the epidemic was allowed to go on without surveillance. Make that what you will, but we can't exclude the Md sample for the sake that we must posit that we should expect more cases. The fact that it's there means that we can't dismiss it and instead must contextualize it in the broader scope of the outbreak. Again, I'm not sure if this is "hidden" or something nefarious, but in the grand scheme so far there aren't serious outliers aside from the multitude of SNPs.
The reality of the Wuhan paper is that it just suggest that a virology lab may have the technology to do monkeypox research, and on that premise it doesn't differentiate itself from other virology labs. I'm sure plenty of labs are doing monkeypox research out there, which is why I made an argument that that would really impugn all labs and I think in an era of GoF research being conducted I think people are right to criticize any virology lab.
I just found it strange that not only did people extract what they wanted from that paper, but they all covered the same topics: this was conducted in a Wuhan lab, the researchers stated that there were concerns about this technology, but the researchers said that their study should be fail-safe. No mention of what the study was intended to do, or what TAR is, it was always the same 3 points made in various articles which just tells me they didn't read it.
I have a visceral dislike of "hidden" models of infectious disease spread. Just because we aren't testing specifically for one particular pathogen doesn't mean we don't have data to shed some light on the situation.
During the summer of 2020, there was much hullabaloo about "cryptic transmission" of COVID-19, particularly in the Seattle area. The contention made in the media was that COVID-19 was spreading undetected until it blossomed into a full-blown outbreak.
The problem was that, for the time period in question, that same area showed a marked DECLINE in reported cases (hospitalizations and ER/Doctor visits primarily) of Influenza Like Illness--and state and local ILI reporting data has been a routine public health metric for years. Given that COVID symptoms are essentially ILI symptoms, a broad decline in ILI cases means that it was mathematically IMPOSSIBLE for there to be the sort of "cryptic transmission" of COVID the "experts" were positing.
Similarly, with the current outbreak of monkeypox occurring primarily among gay and bisexual men, the question becomes explaining how to get the numbers of undetected cases that are necessarily implied by a period of years of "hidden" transmission. A few cases each year of monkeypox that are mistaken for syphilis or herpes is quite believable--but most STD clinics are going to do some level of diagnostic testing to confirm whether a genital rash is herpes or syphilis--or something else altogether. Herpes is a viral infection and syphilis is a bacterial one, and so different treatments are required for each.
Thus there are question marks that arise no matter how the data is interpreted. If we take the current outbreak and work backwards to 2017, how did no cases get detected for so long, and now they are getting detected with increasing frequency? If prior to 2022 the virus was circulating elsewhere and not among gay and bisexual men (and we should note that not all of the cases are in that cohort), where was it circulating--and (again) how did it escape even routine detection?
Are cases being overlooked in Nigeria and West Africa? Probably, but the aggressive spread outside of West Africa is distinctly at odds with a DECLINING case rate in Africa: reported cases (either suspected or confirmed) are half of what they were in 2021, according to the WHO. Given the seeming virulence outside of West Africa, how is the virus seemingly LESS virulent within West Africa? Even assuming a large measure of unreported cases, unless there is a demonstrable breakdown in the reporting systems that do exist, no matter what proportion of actual cases go undetected, a 50% decline in reported cases is incompatible with a model of increased virulence and pathogenicity.
All of this is why I have to wonder if the endemic region for monkeypox has somehow expanded, if Europe (or Portugal or UK individually) has a reservoir of the virus somewhere, so that travel to Africa is no longer a factor. Bear in mind the expansion of the endemic region is part and parcel of the history of smallpox; the historical models suggest spread from China to Japan, China to the Middle East, Middle East to Africa and Europe, Europe to the Americas and Australia. Left to its own devices we should expect similar migration patterns for monkeypox as well--the notion that the disease is only going to be endemic in Africa is simply not realistic.
Ultimately, I come back to that Rumsfeld quote about "unknown unknowns". Right now the unknowns greatly exceed the knowns, by several orders of magnitude. There are things that just don't make sense with the current information at hand.
As a result, I'm asking questions for the most part, not giving answers. Right now answers are in short supply.
I agree with the hidden transmission being suspicious. I'm a bit OCD on these matters which is why I either try to dive into a lot of the information or if it's lacking I may leave it be. It's why I'd like to see genomic data from 2020 and 2019 to at least see if there was a trail of evidence suggesting very rapid mutation within that timeframe.
The whole start of COVID was filled with ridiculousness. I remember the whole Seattle situation and it just seemed like a hodgepodge of all types of information. I also don't doubt that the erratic behavior by doctors and scientists early on clouded a lot of the actual information such as modes of transmission leading us to the weird Frankenstein's moster-like knowledge we have of SARS-COV2.
As far as I am aware, this monkeypox appears more transmissible but not virulent- I don't think we're seeing severe cases and death yet. I'm not sure of why now, and my best guess is it was just a large mix of many factors that came to a head and caused this outbreak. It is very likely that the endemic nature has expanded. I saw some article suggesting that the outbreak may be two strains of monkeypox, in which case I'd need more evidence.
As to the gay and bisexual men, I did see an article that most men are presenting with legions on their genitals first, which again suggests why this is being reported on in sex clinics first. From what I can tell, monkeypox doesn't have any viable medications outside of the smallpox vaccine, so I do wonder if misdiagnosed cases of other STDs may have cleared up on its own without the proper interventions. Like you said though, I would assume that these health clinics would at least take samples to check, but depending on the test they run they may misdiagnose it. I think we have to remember that, for all intents and purposes, these types of viruses aside from chickenpox have been eradicated in the West for decades now, meaning that many of the practicing physicians now are likely to have never come across smallpox or monkeypox outside of some Doctors without Borders work I suppose.
For me, I mostly want to see what the protein functions are. The SNPs are very random, and unless we find out that they all mutated in a way that did increase transmission/virulence then I'm going to remain a bit skeptical with the lab question. Unless I find prior papers on monkeypox research at least.
Is Canada done....just asking for a friend.....https://thecountersignal.com/canada-to-introduce-mandatory-monkeypox-quarantine/
I'm not actually in Canada, so my perception of things is going to be skewed somewhat.
However, I'm not sure the phrase "mandatory quarantine" is correct, based on my reading of the Health Canada announcement. Indeed, the announcement does not actually indicate a quarantine within Canada of any kind.
https://travel.gc.ca/travelling/health-safety/travel-health-notices/229
The paragraph that seems to have triggered the article you linked is this one:
"During your travel, you may be subject to procedures at your destination put in place to limit the spread of monkeypox, such as isolation, should you become infected. You may have limited access to timely and appropriate health care should you become ill, and may experience delays in returning home."
However, this paragraph appears to refer to potential conditions OUTSIDE of Canada. Even if it is targeted at the disease situation within Canada, this is still not an implementation of a mandatory anything.
The announcement itself is simply setting Canada's travel advisory level to Level 2.
https://travel.gc.ca/travelling/health-safety/travel-health-notices#level2
The CDC has similar alert levels for Americans traveling abroad.
This may be a situation much like Belgium's mandatory isolation protocol, which was rather egregiously miscast in the press (and by those who really should know better).
https://allfactsmatter.substack.com/p/belgiums-monkeypox-quarantine-historical?s=w
Reading the actual travel advisory, I don't see anything in it that is egregiously wrong--the comparison to chickenpox is a bit cringey, as chicken pox is a completely different virus--herpes zoster--that has no connection to the orthopoxvirus genus. The respiratory droplet statement is a bit problematic, as there is some scientific literature which argues monkeypox has the ability to aerosolize (a capacity it would then share with its more infamous cousin smallpox).
As much as corporate media has been a disgrace when it comes to covering public health crises, much of the alternative media also comes up short journalistically, conflating terms and misrepresenting facts as well as public health pronouncements, some of which are arguably not at all inappropriate. The recommendations made by Health Canada are not at all unreasonable, all things considered, and do not appear, from the text, to include mandatory isolation or quarantines at this time.
There are a whole lot of reasons why Canada might be considered "done"--most of which involve the lamentable and frequently execrable statements of Canada's Prime-Minister-In-Hiding. However, this travel advisory does not to my mind appear to number among those reasons.
Well, Canada is the only country not allowing non-vaxxed to travel within its own borders, still...so seems vindictive and NOT based on any science that other countries are using....so, anything at this point is on the table with this regime....I appreciate you taking the time to give your take on this new development......I just don't trust anything coming out of this govt's mouth....again, thank you....love your substack!
Thanks! I'm glad you find my work useful.
Frankly, I'd be more worried about the rather Orwellian aura surrounding the ArriveCAN app--the tone of the webpage describing the app and entry requirements into Canada sound vaguely fascistic. However, the vaccination and similar requirements mentioned all appear to pertain to COVID, and I don't see any mention of monkeypox.
Of course, by the time the sun rises tomorrow that situation could change completely. Justine Trudeau is nothing if not mercurial!
(Can you tell I don't exactly cotton to the Canadian Prime Minister?)
Very nice — learned a lot here, and in that I now know less ;)
Thanks! (I think!)
In my post I mentioned that a sequence taken from a resident of MD who visited Nigeria in late 2021 showed a high degree of mutations:
https://virological.org/t/update-to-observations-about-putative-apobec3-deaminase-editing-in-the-light-of-new-genomes-from-usa/847
So that may have suggested a possible high degree of mutation has been taking place at that time. As to why it is happening, I'm not sure. It could be lack of surveillance did not catch this, in which case it would mean that there's a lot about the mutation rate of monkeypox we clearly don't know about. It could be due to artifacts from sequencing, although having that occur across many different samples may narrow the scope of that issue.
What's interesting is that a few of the samples show microevolution via small SNPs in between samples, which again may suggest that the virus is mutating much more quickly than it should.
Also interestingly, as I mentioned in my post, there doesn't appear to be any egregious insertions at this moment similar to the 12 nucleotide insertion for the furin cleavage site of SARS-COV2. That was one of the biggest red flags. So if anything was done with this virus it may have been done through serial passage to accrue the mutations it has. A big caveat to this is that the virus itself is not any more virulent (as far as I am aware), although it may be more pathogenic.
Maybe this is monkeypox's version of Omicron where it maybe has mutated quite extensively to disregard prior immunity? I think we'd have to wait to see how the mutations translate into proteins and their activities.
Also, thanks for mentioning my post! I think that article was strange, but at the same time I believe a lot of people may have been extracting too much from it.
The big question mark with monkeypox is how did so many mutations accrue so fast? With Omicron the number of mutations was remarkable because they appeared to arise within a single host. Timewise the number of mutations was not entirely remarkable for a single strand ribovirus.
Monkeypox is a double strand DNA virus, with a much slower mutation rate. Extrapolating from variola's 1-2 nucleotide substitutions per year, this latest strain of monkeypox has 6-7 times more substitutions than it should
The Rambaut preliminary research gives a good explanation of the mechanism of mutation, but its conclusion requires hidden transmission of monkeypox literally for years.
Moreover, if that transmission occurred in Nigeria, there should be way more cases in Nigeria than have been reported.
While the extant data does not lend itself to a lab origin hypothesis, a "hidden" epidemic sounds too much like a dodge. It reminds me of an old cartoon I saw in Scientific American years ago, of a mathematician at his chalkboard working on a proof --in the middle he has the phrase "and then a miracle happens".
"Hidden" transmission to me sounds just like that. It's not an explanation so much as it a bandaid covering up the lack of a good explanation.
I liked your discussion of the Wuhan paper. People are so quick to get triggered by names folks often forget to look at the details.
That paper is strange, but its gain of function aspects is yet another reminder that biological "threat reduction" all too easily mutates into threat creation.
Which is why I leave the door open in that for monkeypox. There's no evidence to support a lab origin for monkeypox so far, but it would not surprise me if we should see some evidence for that.
Yes, I think we're on the same page for the most part. I wrote about it in my first article on monkeypox arguing that it's dsDNA nature should make it less prone to mutations, but that article came before we got more genomic sequencing evidence.
The argument about Nigeria as is being relayed by the MSM is that Nigeria and other African nations were not being watched carefully, and thus the epidemic was allowed to go on without surveillance. Make that what you will, but we can't exclude the Md sample for the sake that we must posit that we should expect more cases. The fact that it's there means that we can't dismiss it and instead must contextualize it in the broader scope of the outbreak. Again, I'm not sure if this is "hidden" or something nefarious, but in the grand scheme so far there aren't serious outliers aside from the multitude of SNPs.
The reality of the Wuhan paper is that it just suggest that a virology lab may have the technology to do monkeypox research, and on that premise it doesn't differentiate itself from other virology labs. I'm sure plenty of labs are doing monkeypox research out there, which is why I made an argument that that would really impugn all labs and I think in an era of GoF research being conducted I think people are right to criticize any virology lab.
I just found it strange that not only did people extract what they wanted from that paper, but they all covered the same topics: this was conducted in a Wuhan lab, the researchers stated that there were concerns about this technology, but the researchers said that their study should be fail-safe. No mention of what the study was intended to do, or what TAR is, it was always the same 3 points made in various articles which just tells me they didn't read it.
We are mostly on the same page.
I have a visceral dislike of "hidden" models of infectious disease spread. Just because we aren't testing specifically for one particular pathogen doesn't mean we don't have data to shed some light on the situation.
During the summer of 2020, there was much hullabaloo about "cryptic transmission" of COVID-19, particularly in the Seattle area. The contention made in the media was that COVID-19 was spreading undetected until it blossomed into a full-blown outbreak.
The problem was that, for the time period in question, that same area showed a marked DECLINE in reported cases (hospitalizations and ER/Doctor visits primarily) of Influenza Like Illness--and state and local ILI reporting data has been a routine public health metric for years. Given that COVID symptoms are essentially ILI symptoms, a broad decline in ILI cases means that it was mathematically IMPOSSIBLE for there to be the sort of "cryptic transmission" of COVID the "experts" were positing.
Similarly, with the current outbreak of monkeypox occurring primarily among gay and bisexual men, the question becomes explaining how to get the numbers of undetected cases that are necessarily implied by a period of years of "hidden" transmission. A few cases each year of monkeypox that are mistaken for syphilis or herpes is quite believable--but most STD clinics are going to do some level of diagnostic testing to confirm whether a genital rash is herpes or syphilis--or something else altogether. Herpes is a viral infection and syphilis is a bacterial one, and so different treatments are required for each.
Thus there are question marks that arise no matter how the data is interpreted. If we take the current outbreak and work backwards to 2017, how did no cases get detected for so long, and now they are getting detected with increasing frequency? If prior to 2022 the virus was circulating elsewhere and not among gay and bisexual men (and we should note that not all of the cases are in that cohort), where was it circulating--and (again) how did it escape even routine detection?
Are cases being overlooked in Nigeria and West Africa? Probably, but the aggressive spread outside of West Africa is distinctly at odds with a DECLINING case rate in Africa: reported cases (either suspected or confirmed) are half of what they were in 2021, according to the WHO. Given the seeming virulence outside of West Africa, how is the virus seemingly LESS virulent within West Africa? Even assuming a large measure of unreported cases, unless there is a demonstrable breakdown in the reporting systems that do exist, no matter what proportion of actual cases go undetected, a 50% decline in reported cases is incompatible with a model of increased virulence and pathogenicity.
All of this is why I have to wonder if the endemic region for monkeypox has somehow expanded, if Europe (or Portugal or UK individually) has a reservoir of the virus somewhere, so that travel to Africa is no longer a factor. Bear in mind the expansion of the endemic region is part and parcel of the history of smallpox; the historical models suggest spread from China to Japan, China to the Middle East, Middle East to Africa and Europe, Europe to the Americas and Australia. Left to its own devices we should expect similar migration patterns for monkeypox as well--the notion that the disease is only going to be endemic in Africa is simply not realistic.
Ultimately, I come back to that Rumsfeld quote about "unknown unknowns". Right now the unknowns greatly exceed the knowns, by several orders of magnitude. There are things that just don't make sense with the current information at hand.
As a result, I'm asking questions for the most part, not giving answers. Right now answers are in short supply.
I agree with the hidden transmission being suspicious. I'm a bit OCD on these matters which is why I either try to dive into a lot of the information or if it's lacking I may leave it be. It's why I'd like to see genomic data from 2020 and 2019 to at least see if there was a trail of evidence suggesting very rapid mutation within that timeframe.
The whole start of COVID was filled with ridiculousness. I remember the whole Seattle situation and it just seemed like a hodgepodge of all types of information. I also don't doubt that the erratic behavior by doctors and scientists early on clouded a lot of the actual information such as modes of transmission leading us to the weird Frankenstein's moster-like knowledge we have of SARS-COV2.
As far as I am aware, this monkeypox appears more transmissible but not virulent- I don't think we're seeing severe cases and death yet. I'm not sure of why now, and my best guess is it was just a large mix of many factors that came to a head and caused this outbreak. It is very likely that the endemic nature has expanded. I saw some article suggesting that the outbreak may be two strains of monkeypox, in which case I'd need more evidence.
As to the gay and bisexual men, I did see an article that most men are presenting with legions on their genitals first, which again suggests why this is being reported on in sex clinics first. From what I can tell, monkeypox doesn't have any viable medications outside of the smallpox vaccine, so I do wonder if misdiagnosed cases of other STDs may have cleared up on its own without the proper interventions. Like you said though, I would assume that these health clinics would at least take samples to check, but depending on the test they run they may misdiagnose it. I think we have to remember that, for all intents and purposes, these types of viruses aside from chickenpox have been eradicated in the West for decades now, meaning that many of the practicing physicians now are likely to have never come across smallpox or monkeypox outside of some Doctors without Borders work I suppose.
For me, I mostly want to see what the protein functions are. The SNPs are very random, and unless we find out that they all mutated in a way that did increase transmission/virulence then I'm going to remain a bit skeptical with the lab question. Unless I find prior papers on monkeypox research at least.
There is a reason I refer to media coverage of both COVID and monkeypox as an "epic fail". So much of the reporting is pure garbage.
If misinformation were a criminal offense the whole of the corporate media would warrant life imprisonment without the possibility of parole.