The Future of Monkeypox

The World Health Organization has recommended a new name for monkeypox, asking countries to forget the original term in favor of a new one, “mpox,” that scientists hope will help destigmatize the disease. But in the United States, the request seems to be arriving late. The outbreak here has been in slow retreat for months—and has already left many Americans’ minds.

About 15 cases are now being recorded among Americans each day, less than 4 percent of the tally when the surge was at its worst . After a sluggish and bungled early rollout, tests and treatments for the virus are more available; more than a million doses of the two-shot Jynneos smallpox vaccine have found their way into arms. San Francisco and New York —two of the nation’s first cities to declare mpox a public-health emergency this past summer—have since allowed those orders to expire ; so have the states of New York and Illinois. “I think this is the endgame,” says Caitlin Rivers, an infectious-disease epidemiologist at the Johns Hopkins Center for Health Security.

But “endgame” doesn’t mean “over”—and mpox will be with us for the foreseeable future. The U.S. outbreak is only now showing us its long and ugly tail: 15 daily cases is not zero daily cases; even as the number of new infections declines, inequities are growing . Black and Latino people make up a majority of new mpox cases and are contracting the disease at three to five times the rate of white Americans, but they have received proportionately fewer vaccines . “Now it’s truly the folks who are the most marginalized that we’re seeing,” says Ofole Mgbako, a physician and population-health researcher at New York University. “Which is also why, of course, it’s fallen out of the news.” If the virus sticks around (as it very likely could), and if the disparities persist (as they almost certainly will), then mpox could end up saddling thousands of vulnerable Americans each year with yet another debilitating, stigmatized, and neglected disease.

[Read: America should have been able to handle monkeypox ]

At this point, there’s not even any guarantee that this case downturn will persist. “I’m not convinced that we’re out of the woods,” says Sara Bares, an infectious-disease physician at the University of Nebraska Medical Center, in Omaha. Immunity , acquired through infection or vaccines, is now concentrated among those at highest risk, says Jay Varma, a physician and epidemiologist at Weill Cornell Medicine. But researchers still don’t know how well those defenses can stave off another infection, or how long they might last—gaps in knowledge that may be tough to fill, now that incidence is so low. And although months of advocacy and outreach from the LGBTQ community have cut down risky sexual activities , many cautionary trends will eventually reset to their pre-outbreak norm. “We know extensively from other sexually transmissible infections that behavior change is not usually the most sustained response,” says Boghuma Kabisen Titanji, an infectious-disease physician at Emory University.

At the same time, this year’s mpox outbreaks are stranger and more unwieldy than those that came before. A ballooning body of evidence suggests that people can become infectious before they develop symptoms , contrary to prior understanding; some physicians are concerned that patients, especially those who are immunocompromised, might remain infectious after the brunt of visible illness resolves , says Philip Ponce, an infectious-disease physician at the University of Texas Health Science Center at San Antonio and the medical director of San Antonio’s Kind Clinic. (Some 40 percent of Americans who have been diagnosed with mpox are living with HIV.) Researchers still don’t have a good grip on which bodily fluids and types of contact may be riskiest over the trajectory of a sickness. Cases are still being missed by primary-care providers who remain unfamiliar with the ins and outs of diagnosis and testing, especially in people with darker skin. And although this epidemic has, for the most part, continued to affect men who have sex with men, women and nonbinary people are getting sick as well, to an underappreciated degree.

[Read: What should worry most Americans about our monkeypox response ]

Intel on the only mpox-fighting antiviral on the shelf, a smallpox drug called tecovirimat, also remains concerningly scant, even as experts worry that the virus could develop resistance . The treatment has been given a conditional green light for use in people who are currently, or at risk of becoming, severely sick. Anecdotally, it seems to work wonders, shaving days or weeks off the painful, debilitating course of symptoms that can send infected people into long-term isolation. But experts still lack rigorous data in humans to confirm just how well it works, Bares, who’s among the scientists involved in a nationwide study of the antiviral, told me. And although clinical trials for tecovirimat are under way , she added, in the U.S., they’re “struggling to enroll patients” now that infections have plummeted to such a sustained low. It’s a numerical problem as well as a sociocultural one. “The urgency with which people answer questions declines as case counts go down,” Varma told me.

Recent CDC reports show that a growing proportion of new infections aren’t being reported with a known sexual-contact history, stymieing efforts at contact tracing. That might in part be a product of the outbreak’s gradual migration from liberal, well-off urban centers, hit early on in the epidemic, to more communities in the South and Southwest . “In small towns, the risk of disclosure is high,” Bares told me. In seeking care or vaccination, “you’re outing yourself.” When mpox cases in Nebraska took an unexpected nosedive earlier this fall, “a colleague and I asked one another, ‘Do you think patients are afraid to come in?’” Those concerns can be especially high in certain communities of color, Ponce told me. San Antonio’s Latino population, for instance, “tends to be much more conservative; there’s much more stigma associated with one being LGBT at all, let alone being LGBT and trying to access biomedical interventions.”

Hidden infections can become fast-spreading ones. Monitoring an infectious disease is far easier when the people most at risk have insurance coverage and access to savvy clinicians, and when they are inclined to trust public-health institutions. “That’s predominantly white people,” says Ace Robinson, the CEO of the Pierce County AIDS Foundation, in Washington. Now that the mpox outbreak is moving out of that population into less privileged ones, Robinson fears “a massive undercount” of cases.

Americans who are catching the virus during the outbreak’s denouement are paying a price. The means to fight mpox are likely to dwindle, even as the virus entrenches itself in the population most in need of those tools. One concern remains the country’s vaccination strategy , which underwent a mid-outbreak shift: To address limited shot supply, the FDA authorized a new dosing method with limited evidence behind it—a decision that primarily affected people near the back of the inoculation line. The method is safe but tricky to administer, and it can have tough side effects: Some of Titanji’s patients have experienced swelling near their injection site that lasted for weeks after their first dose, and now “they just don’t want to get another shot.”

The continued shift of mpox into minority populations, Robinson told me, is also further sapping public attention: “As long as this is centered in BIPOC communities, there’s going to be less of a push.” Public interest in this crisis was modest even at its highest point, says Steven Klemow, an infectious-disease physician at Methodist Dallas Medical Center and the medical director of Dallas’s Kind Clinic. Now experts are watching that cycle of neglect reinforce itself as the outbreak continues to affect and compress into marginalized communities , including those that have for decades borne a disproportionate share of the burden of sexually associated infections such as syphilis, gonorrhea, and HIV. “These are not the groups that necessarily get people jumping on their feet,” Titanji told me.

Some of the people most at risk are moving on as well, Robinson told me. In his community in Washington, he was disappointed to see high rates of vaccine refusal at two recent outreach events serving the region’s Black and American Indian populations. “They had no knowledge of the virus,” he told me. Titanji has seen similar trends in her community in Georgia. “There’s some sense of complacency, like, ‘It’s no longer an issue, so why do I need to get vaccinated?’” she said.

[Read: America is zooming through the pandemic panic-neglect cycle ]

The tide seems unlikely to shift. Even tens of thousands of cases deep into the American outbreak, sexual-health clinics—which have been on the front lines of the mpox response—remain short on funds and staff. Although the influx of cases has slowed, Ponce and Klemow are still treating multiple mpox patients a week while trying to keep up the services they typically offer—at a time when STI rates are on a years-long rise . “We’re really assuming that this is going to become another sexually associated disease that is going to be a part of our wheelhouse that we’ll have to manage for the indefinite future,” Klemow told me. “We’ve had to pull resources away from our other services that we provide.” The problem could yet worsen if the national emergency declared in August is allowed to expire, which would likely curb the availability of antivirals and vaccines .

Rivers still holds out hope for eliminating mpox in the U.S. But getting from low to zero isn’t as easy as it might seem. This current stretch of decline could unspool for years, even decades, especially if the virus finds a new animal host . “We’ve seen this story play out so many times before,” Varma told me. Efforts to eliminate syphilis from the U.S. in the late ’90s and early 2000s , for instance, gained traction for a while—then petered out during what could have been their final stretch. It’s the classic boom-bust cycle to which the country is so prone: As case rates fall, so does interest in pushing them further down.

Our memories of public-health crises never seem to linger for long. At the start of this mpox outbreak, Titanji told me, there was an opportunity to shore up our systems and buffer ourselves against future epidemics, both imported and homegrown. The country squandered it and failed to send aid abroad. If another surge of mpox cases arrives, as it very likely could, she said, “we will again be going back to the drawing board.”

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‘THIS YOU?’ Marjorie Taylor Greene Mocked For Tweet Saying ‘Of Course’ She Denounces White Supremacist Nick Fuentes

Marjorie Taylor Greene

Controversial Rep. Marjorie Taylor Greene (R-GA) sparked a strong reaction online Tuesday after she tweeted that “of course” she denounces “Nick Fuentes and his racists [sic] anti-semitic ideology.”

Greene responded to a tweet from PBS News Hour white house correspondent Laura Barrón-López regarding GOP House leader Rep. Kevin McCarthy (R-CA) being pressed by reporters earlier on Tuesday about members of his conference being associated with Fuentes – the neo-Nazi who grabbed headlines last week by dining with former President Donald Trump.

“McCarthy was asked about House GOP members associated w/Fuentes, specifically Greene. He said ‘she denounced him,’” Barrón-López tweeted, adding:

There’s no public evidence Greene denounced Fuentes. She claimed she didn’t know about his “controversial” views when she spoke at his white nationalist conference

Greene replied, “Of course I denounce Nick Fuentes and his racists [sic] anti-semitic ideology. I can’t comprehend why the media is obsessed with him.”

“Do you actually report real news or just use CNN for your political activism? Have you questioned Democrats if they denounce Israel hating Ilhan Omar?” the Republican added.

Twitter users were quick to mock Greene’s reply, which ignored the fact that Greene and Fuentes do have a history.

Greene spoke at Fuentes’s white nationalist America First Political Action Conference in February of this year and was introduced on stage by Fuentes who led the crowd in a chant of “Putin! Putin!” before bringing up the congresswoman.

Confronted later by CBS News’s Robert Costa, Greene claimed, “I do not know Nick Fuentes. I’ve never heard him speak. I’ve never seen a video. I don’t know what his views are, so I’m not aligned with anything that may be controversial.”

“What I can tell you is I went to his event last night to address his very large following because that is a young. It’s a very young following and it’s a generation I’m extremely concerned about,” she added.

Twitter users pulled no punches in making sure Greene recalled that she did in fact know Fuentes and once embraced him on stage:

The post ‘THIS YOU?’ Marjorie Taylor Greene Mocked For Tweet Saying ‘Of Course’ She Denounces White Supremacist Nick Fuentes first appeared on Mediaite .

Court green-lights execution of Missouri man who presented evidence of racist prosecutor

Court green-lights execution of Missouri man who presented evidence of racist prosecutor

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For the second time in less than a week, the Supreme Court declined to block the execution of Kevin Johnson, paving the way for Missouri to carry out his lethal injection on Tuesday night.

Johnson, who is Black, argued in his final appeal that his execution should be put on hold in light of recent findings from a special prosecutor that Johnson’s original prosecutor was routinely biased against Black defendants.

Justices Sonia Sotomayor and Ketanji Brown Jackson dissented from the court’s brief order allowing the execution to proceed.

Johnson was convicted and received the death penalty for the 2005 shooting death of William McEntee, a police officer. Johnson, who is Black, came to the Supreme Court on Nov. 10, arguing that his death sentence was tainted by racial bias and that his execution would violate the Eighth Amendment’s ban on cruel and unusual punishment. On Nov. 23, the justices declined to postpone his execution to give him time to pursue those arguments.

Johnson returned to the Supreme Court on Tuesday morning, once again asking the justices to stay his execution. He said a stay was necessary to give the Missouri Supreme Court time to review his claims that the prosecutor in his case had discriminated against Black defendants in deciding whether to seek the death penalty and also “routinely discriminated in jury selection.”

Last month, a state trial court appointed a special prosecutor to investigate the original prosecutor’s alleged racism. The special prosecutor found “clear” evidence that the original prosecutor “consistently made race-influenced decisions in his handling of capital homicides.” Based on those findings, the special prosecutor filed a motion to invalidate Johnson’s death sentence.

Calling Johnson’s new stay request a “transparent refusal to accept moral responsibility for his crimes,” Missouri urged the court to allow Johnson’s execution to go ahead as scheduled. The state dismissed Johnson’s claims of racial bias as “completely baseless.” But in any event, it continued, a Missouri Supreme Court decision denying Johnson’s plea to stay his execution rested on its conclusion that Johnson’s claims were not covered by a new state law that allows prosecutors to make post-conviction motions on behalf of inmates. Therefore, the state concluded, the Missouri Supreme Court’s decision was based on an independent state-law ground, which bars the U.S. Supreme Court from reviewing it.

This article was originally published at Howe on the Court .

The post Court green-lights execution of Missouri man who presented evidence of racist prosecutor appeared first on SCOTUSblog .