The Hitchhiker's Guide to Monkeypox

Don't Panic

In the latest installment of “Republicans would rather blame than govern,” most GOP members of the House voted against emergency funding to get baby formula back on the shelves. In the first piece below, I explain why we’re facing this shortage, what the Biden Administration is doing to fix it in the short term, and what some experts believe needs to change to make sure it doesn’t happen again. But here I just wanted to point out that there’s a baby formula shortage in this country and when asked for a money to help fix it, 192 Republican members of Congress said no.

As far as I can tell from their own comments, they said no because it’s more important that they have ammunition against Biden than it is for parents to have food for their newborns. They complained that the bill wasn’t bipartisan, said the Administration should have had a plan months ago, and tried to make “Bare Shelves Biden” happen. What they didn’t do was help or—as we like to call it—govern. Rep. Eric Swalwell, a Democrat from California, said it right in a tweet: “Republicans aren’t interested in solutions. They’re interested in theater and chaos.”  

I suppose that’s their prerogative once elected. If their constituents either don’t notice or don’t care, there’s nothing much that the rest of us can do about it, except this: do not ever let anyone tell you that the abortion debate is about saving babies. If anything proves that these politicians don’t give a s**t about babies, this is it.

(The fact that they haven’t done anything about school shootings despite the frequency of these horrific events—news of a gunman at an elementary school in Texas is unfolding as I type this—is further proof that they have no interest in protecting children.)

Why Is There a Formula Shortage? And What Can We Do About It?

Whether you have a newborn, a college freshman, or a fur baby who only eats kibble, by now you’ve heard that there is a baby formula shortage in this country. Shelves are empty and parents around the country—especially those whose children are limited to special formulas like those without dairy products—are frantically searching for available bottles or cans of powder.

To understand why this is happening now, we have to go back to 2020 and take a refresher class in economics (supply/demand/monopolies) and trade regulations (tariffs).

In 2020, while most of us were hoarding Charmin, parents and expectant parents were stockpiling Enfamil on fears of global shortage. Sales soared, and manufacturers made more. In 2021, sales lagged partly because families were still working through what they already had in the pantry, and we all acknowledged that hoarding was bad. Production slowed. Enter 2022 with more babies, a shortage of workers, and global shipping delays, and you start to see shortages.

Then came the death knell. In February, Abbott Laboratories (the same company that was lambasted for throwing out boxes of their at-home Covid test right before a new surge) was forced to recall products and shut down a Michigan plant after four children became ill, two of whom later died. (A direct connection between the formula and these illnesses has not been confirmed.) The recall meant that existing product was pulled from the shelves of both stores and pantries while the shut down meant that new product was getting made at a slower rate.

The heart of the problem is that baby formula manufacturing in this country is basically a monopoly. There are four companies that make 90% of the formula sold in this country. A disruption to one of those companies can send the whole industry into a scramble.

At the root of this monopoly situation is a complex web of domestic policy and foreign trade regulation, as well as plain old capitalism: the birth rate has been dropping for decades making baby formula a less-than-appealing market for entrepreneurs.

Trade policy discourages the importing of formula from other places. The same four companies struggling to keep up with production in the U.S. have overseas plants where they make roughly the same products. Some of these products can’t be sold in the U.S. because they haven’t been cleared by the FDA which regulates formula (though it’s likely that they do meet requirements since European standards for formula are much the same as our own).  For formula that is FDA-approved, the tariffs are unusually high (up to 17.5% on some bulk imports) so the companies don’t want to pay to bring product over. Moreover, the Trump administration entered the U.S. into a new North American trade agreement that imposes export charges if “too much” formula is imported from Canada.

Domestic policy has an impact as well. The Special Supplemental Nutrition Program for Women, Infants, and Children, nicknamed WIC, helps low income women buy formula and other necessities. Under the program, each state contracts with one manufacturer of baby formula. In exchange for selling all of the WIC baby formula in the state—which also gets them significantly more shelf space at retailers—the company heavily discounts the product. The goal of saving the state money while feeding kids in need is noble. The result, however, is that the domestic market heavily favors the big players.    

In the wake of the shortage, experts are suggesting we change these regulations and trade rules to prevent another crisis in the future. In the meantime, the Biden Administration has taken a number of measures to stock shelves and get manufacturing chugging again. It made a deal with Abbott to get the plant back online. It launched Operation Fly Formula (no, not a Jeff Goldblum movie), which is using military planes to bring existing bottles of formula over from Europe, thereby skipping the shipping delays. It has eased FDA regulations on formula manufactured in Europe, and it has invoked the Defense Production Act to require private businesses to shift more supplies to the manufacturers of baby formula.

On Saturday, Congress also passed a bill that will allow recipients of WIC to buy whatever formula is available rather than have to wait for the state contracted brand. (All but 9 Republicans voted yes on this one, but trust me, it’s not because they like poor babies.)   

Must We, Monkeypox?

With COVID cases on the rise again, the last thing we needed is another virus to worry about, but that’s what 2022 decided to throw at us this month with cases of Monkeypox on the rise in at least 16 countries. The first U.S. case was identified in Massachusetts last week in a person who had traveled to Canada. 

So, what is Monkeypox, and how much do we have to worry about it?

Let’s pretend that this is the Monkeypox Q&A from The Hitchhikers’ Guide to the Galaxy, with apologies to the late Douglas Adams, of course. There’s more anxiety-provoking news by the minute. At some point, if we can’t laugh a little, we might simply implode.

• I was vaccinated for smallpox, I threw chickenpox parties when my kids were little, and I was sure that poor Neville Longbottom would end up with dragonpox, but what the funky monkey bulls**t is this?

  Monkeypox is a virus. We can think about it as the lesser-known, lesser-risk cousin of smallpox. It’s endemic to parts of Africa where it is most often spread from animals to people. Previous outbreaks in other countries have almost always been traced back to travel to places where monkeypox is more common. A 2003 outbreak here in the United States that sickened 47 people in six states turned out to be the fault of pet prairie dogs who had been housed near small mammals from Ghana.

• I like monkeys. They’re cute and eat bananas upside down. Is monkeypox caused by monkeys?
  Probably not. Monkeypox got its name in 1958 when an outbreak occurred in a group of monkeys being used for research. The first cases of monkeypox in people were reported in 1970 in the Democratic Republic of Congo. Scientists still don’t know what animal acts as the primary disease carrier, but it’s not usually monkeys or prairie dogs. African rodents are often blamed.

• Will monkeypox turn me into a monkey?
  Unlikely, though you’d look cute with a tail. The symptoms of monkeypox can start like many other common illnesses with fever, chills, body aches, and fatigue. Swollen lymph nodes often follow, and then comes the rash (it is a pox after all). These are liquid filled bumps that can be painful. They can appear anywhere—inside the mouth and on the palms of the hands or soles of the feet. In this most recent outbreak, some cases have presented with rashes in the genital and perianal area which can look like syphilis or Herpes. The pox usually clear up in two to three weeks and most people usually recover without needing hospitalization. In previous outbreaks, there has been a 1% mortality rate from the disease, but it’s important to note that most outbreaks have taken place in resource-poor areas of the world.

• Wait, I stockpiled that horse medicine when Trump was president. I know it helps foxes with mange. It’s gotta be good for monkey diseases, right?
  Nope. Continue to stay away from the Ivermectin and all other veterinary medicines. Though there are no specific approved treatments for Monkeypox, the CDC says that in the United States, health care providers can turn to antivirals and vaccinia immune globulin (VIG), in addition to the smallpox vaccines.

• Is Monkeypox the hip, new sexually transmitted infection (STI)?
  No. And yes. Monkeypox is not technically an STD because it isn’t primarily transmitted through semen and vaginal fluids, but you do have to get really close to another person to become infected. Human-to-human transmission of monkeypox occurs through large respiratory droplets, direct contact with bodily fluids or the material from the pox themselves, and indirect contact with the lesions (such as through dirty clothes or linens). Before we all freak out about respiratory droplets and start replaying mask mandate debates, these droplets cannot travel more than a few feet. Prolonged face-to-face contact is necessary for transmission. Unless you’re into macking on the guy behind you in the grocery checkout line, he’s not a risk to you this time around. The guy you’re hooking up with might be. Some experts believe that this most recent outbreak kicked off with sexual contact among gay and bisexual men at two raves held in Spain and Belgium. Many—but certainly not all—of the cases that have been identified thus far have been among men who have sex with men (MSM).

• I’ve been checking the COVID community spread maps every day since March 2020. I take a little extra Xanax every time my town is painted red.  Will there be more cases of monkeypox in the United States?
  Yes. In the next few weeks, we will undoubtedly hear about more cases of monkeypox, but this does not necessarily mean that the virus is continuing to spread. Monkeypox has a very long incubation period (up to 14 days) which means that the people who are diagnosed two Wednesdays from now may have already been exposed. Plus, there are probably some people who showed up at their doctor with strange spots last week and were misdiagnosed as a Dalmatian.  

• It turns out dystopian futures aren’t as fun as they looked in the Hunger Games. Am I going to have to go back to the abandoned K-Mart to get another shot? Probably not, and wasn’t it a Sears? This isn’t COVID-19. Widespread outbreaks are unlikely as this requires much closer contact to spread. The people most at risk are partners and families of those infected and health care workers caring for patients. We’re also far more prepared for this than we were for COVID-19. There are two smallpox vaccines that are known to prevent monkeypox and already approved for this purpose. Officials in the U.S. said we have 1,000 doses of the preferred vaccine ready to go, and more should be available soon. The U.S. also has 100 million doses of another smallpox vaccine stockpiled should it become necessary, though this one has more side effects. Since the risk is limited to those in close contact with patients, a large scale vaccine initiative is unlikely. Instead, public health experts will use a ring vaccination strategy—offering the vaccine to close contacts of those people who are infected, then offering it to the close contacts of those close contacts, and so on and so on if need be.

The bottom line on monkeypox is that it’s low risk for most people: there’s low risk of getting it and a low risk of it requiring hospitalization. Moreover, we’re prepared for this one. We have vaccines and antivirals. Public health experts will treat patients, trace contacts, and offer vaccines. With these strategies in place, we should be able to avoid anything resembling an epidemic.

Republican Senator from Louisiana Opens Mouth, Inserts Racist-Sounding Foot

Senator Bill Cassidy from Louisiana has some explaining to do. In a podcast interview with Politico, the politician seemed to blame Black women for the state’s high rate of maternal mortality.

Cassidy is a doctor, specifically a gastroenterologist, and was being interviewed as part of a series sponsored by Harvard’s Chan School of Public Health. When asked about his state’s abysmal maternal mortality rate, he said this:

“About a third of our population is African American; African Americans have a higher incidence of maternal mortality. So, if you correct our population for race, we’re not as much of an outlier as it would otherwise appear. Now, I say that not to minimize the issue but to focus the issue as to where it would be. For whatever reason, people of color have a higher incidence of maternal mortality.”

It’s the “for whatever reason” that gets me because that certainly sounds like someone who is trying to suggest that there’s something intrinsic to Black women’s bodies or biology that make them more likely to die to during childbirth. He didn’t help himself sound less racist when he went on to say:

“Sometimes maternal mortality includes up to a year after birth and would include someone being killed by her boyfriend.”

While he didn’t specifically mention Black women that time, it seemed to be implied. 

The U.S. has the highest maternal mortality rate in the developed world and our rates have been steadily rising. Black women in this country are 3 to 4 time more likely to die during pregnancy or birth than white women. As a physician, Cassidy knows damn well that the reasons for this have everything to do with structural racism, poverty, and access to quality health care (he even said some of this in the interview). He also knows that the solution isn’t just to stop counting the deaths among black women, give ourselves a pat on the back, and say: “Oh, see, it wasn’t really so bad.”

The Senator took to twitter to defend himself saying his words were taken out of context by those looking to “create a malicious & fake narrative.” In an attempt not to be one of those people, I will note that Cassidy seems to be working on the issue. He is the co-sponsor of the Connected MOM Act which would require Medicaid to provide coverage for remote devices that can monitor blood pressure, glucose levels, and other health metrics during pregnancy (good for people in rural areas where it’s hard to see pre-natal providers). He also co-sponsored the John Lewis National Institute on Minority Health and Health Disparities (NIMHD) Research Endowment Revitalization Act to support the study of health disparities.   

Still, the only context in which someone says something like “if you take the people who are really suffering out of the equation, we’re doing just fine,” is one in which they are trying to defend the status quo. How about instead you acknowledge that the status quo is indefensible. At the very least, you can spend the time you wasted getting your foot out of your mouth (or your head out of your ass) fixing the problem.