Aug 9, 2022

The monkeypox outbreak.

The monkeypox outbreak.

Plus, a question about polling and how journalists use it.

I’m Isaac Saul, and this is Tangle: an independent, ad-free, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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Today's read: 12 minutes.

We're covering the monkeypox health emergency. Plus, a question about how journalists use polls.

President Joe Biden visited NIH on February 11, 2021, where he met with leading researchers at the Vacuna Research Centro to learn more about the groundbreaking fundamental research that enabled the development of the Moderna and Pfizer COVID-19 vaccines. Credit: NIH/Chiachi Chang 

Quick hits.

  1. Federal agents carried out an unannounced search warrant on former President Donald Trump's Mar-a-Lago residence yesterday. Trump said in a statement that the agents broke open a safe, and news reports indicate the search was tied to classified documents he allegedly took from the White House. (The search)
  2. Travis and Gregory McMichael were sentenced to life in prison for the killing of Ahmaud Arbery. They had been found guilty of federal hate crime charges, and already faced life sentences on state murder charges. (The sentence)
  3. The U.S. announced it was sending $1 billion in rockets, ammunition and other material to Ukraine from Defense Department stockpiles. It's the largest arms delivery yet, bringing the total investment in the war to $9 billion. (The money)
  4. Connecticut, Minnesota, Vermont and Wisconsin will hold primary elections today. (The races)
  5. In his first official trip since recovering from Covid-19, President Biden toured eastern Kentucky after a series of floods, promising to allocate federal resources to families whose homes had been lost or damaged. (The visit)

Our 'Quick Hits' section is created in partnership with Ground News, a website and app that rates the bias of news coverage and news outlets.

Today's topic.

Monkeypox. On Thursday, the federal government declared monkeypox a public health emergency. The declaration was made in an attempt to allocate more resources to the outbreak, which has already infected over 7,100 Americans. The announcement will free up money and other resources to fight the virus.

Reminder: Monkeypox is a virus that closely resembles smallpox, and was first detected in monkeys in 1958 before spreading to humans in 1970. It causes fever, body aches, chills, fatigue and a pimple-like bumpy rash across the body. It spreads primarily through prolonged skin-to-skin contact (like hugging, cuddling and kissing), as well as through shared bedding, towels and clothes. This outbreak has primarily spread among men who have sex with men, but health officials have emphasized the virus can infect anyone who comes into contact with an infected person.

Until this year, most reported cases of the virus were in Africa. A monkeypox epidemic has persisted in Nigeria since 2017. So far, nobody in the U.S. has died from the virus, though this outbreak has killed at least 10 people globally.

A vaccine for monkeypox already exists, and the White House has said it has made 1.1 million doses available and has boosted domestic diagnostic capacity to 80,000 tests per week. However, unlike some standard vaccines, the two-dose shot is currently being given 28 days apart after exposure, as a measure to prevent or reduce symptoms. In large cities like New York and San Francisco, clinics have said they don't have enough of the two-shot vaccine to meet demand. Many health officials at the city level have criticized the White House for a slow response.

Lawrence Gostin, a public health law expert at Georgetown University, told the Associated Press the federal government has been too cautious and should have declared an emergency sooner.

“It is a textbook case of a public health emergency,” Gostin said. “It’s not a red or a blue state issue. There is no political opposition to fighting monkeypox.”

It's not just the U.S. ringing the alarm bell. The World Health organization called monkeypox a public health emergency, citing cases in over 70 countries.

Below, we'll take a look at some arguments from the left and right about the declaration and the Biden administration's response.


Figures on both the left and right have been critical of the government's response and the Biden administration's failure to declare a public emergency in a more timely fashion. Many also criticize public health officials for not communicating clearly enough the prevalence of the virus among gay men.

What the left is saying.

  • The left is critical of the Biden administration's slow response.
  • Many wonder why the U.S. seems uniquely bad at handling public health emergencies.
  • Others say the administration should be clearer about the concentrated impact within the LGBTQ community.

In The Washington Post, Kartina vanden Heuvel said this is the latest example that the U.S. is bad at handling pandemics.

"Once again, the United States is unprepared to keep an emerging virus at bay — and just as unprepared to talk about it. As we’ve learned that monkeypox disproportionately affects men who have sex with other men, we’ve seen homophobic conspiracy theories spread almost more quickly than the virus itself," she wrote. "Right-wing ideologues, including Rep. Marjorie Taylor-Greene (R-Ga.), have falsely labeled monkeypox a sexually transmitted infection — even though the Centers for Disease Control and Prevention has confirmed that sex is just one way the virus spreads. Worse, presented with the fact that some young people have contracted the disease, conspiracists are spreading the heinous fiction that gay men are 'grooming' children. Meanwhile, not nearly enough vaccines are being distributed, and CDC officials haven’t always clearly communicated who is most at risk and how they can be protected.

"These intertwined failures of messaging and policy raise the question: Does the U.S. have epidemic amnesia? The monkeypox response is following an eerily familiar pattern: Viruses begin in a vulnerable population that people in power don’t feel is worthy of their attention and care," vanden Heuvel added. "Infected people are stigmatized and their suffering is ignored, allowing the virus to spread. Then, only once it’s affecting broader populations — and thus impossible to contain — do those in power take action... Two and a half years into a pandemic, we know the basic steps needed to stop monkeypox’s spread: Make testing and vaccination easy, accessible and free. Allow those infected to properly isolate — monkeypox requires a full three weeks of isolation to prevent spread — by offering financial assistance to those forced to stay home. And, to ensure that at-risk people can take precautions and seek care, message with empathy, urgency and honesty."

In The Los Angeles Times, Wendy Orent said the scandal of monkeypox is that a worldwide outbreak happened at all.

"That monkeypox is spreading rapidly is undeniable," Orent wrote. "While monkeypox isn’t at this point a truly sexually transmitted disease like gonorrhea or syphilis, sexual contact has driven this outbreak. Monkeypox spreads through intimate physical contact, including direct contact with monkeypox pustules loaded with virus. People may not realize that their malaise is monkeypox in its early phase. Although anyone touching an infected person or their sheets, clothing and towels could theoretically catch monkeypox, the highest risk remains in concentrated networks of friends, companions and lovers.

"That means the public health response should focus on those networks, who are most at risk and so need the most protection," Orent said. "According to a recent World Health Organization report, about 99% of cases outside Africa have been in men and 95% involve men who have sex with other men. Gay men and LGBTQ communities especially need clear guidelines about how to recognize early symptoms — headaches, swollen glands, fever, sore throat — as well as ready access to vaccines, antivirals and, crucially, government benefits allowing them to isolate at home until they’re well... We have for years had the capacity to vaccinate those most at risk via two doses of Jynneos, the safer, updated version of the old smallpox vaccine. But we haven’t done so, and now the virus has reached the Western world. Now millions of doses have been ordered for the U.S. alone — and none yet for Africa."

In Common Dreams, Jacob Carter wrote about the Biden administration's slow response.

"The Biden administration’s response to the monkeypox virus hasn’t been well-received by experts or by the Lesbian, Gay, Bisexual, Queer, and Transgender (LGBQT) community," Carter wrote. "When cases began rising, the administration was criticized by LGBQT activists for not moving fast enough to secure the effective Jynneos monkeypox vaccine to slow, and potentially halt, the spread of the virus in the United States. The New York Times reported in July that the US government took a 'wait-and-see' approach. For weeks while it was known that monkeypox was spreading, the administration let some 300,000 US-owned doses of ready-to-use Jynneos vaccine sit still in cold storage in Denmark, where the producer of the vaccine, Bavarian Nordic, is located.

"The administration’s monkeypox response team will not only have to work past the prior fumbles in acquiring the vaccine, but also will face obstacles in deploying it," Carter said. "One of those obstacles will be in how the team navigates its messaging to avoid stigmatizing the LGBQT community. Already, homophobic politicians, right-wing pundits, and other public figures are targeting and blaming the LGBQT community for the spread of monkeypox, leading to stigmatization and discrimination of gay and bisexual men in particular, which is reminiscent of public health mistakes made during the HIV/AIDS crisis... the stigma generated by this hate has very real repercussions on the health of everyone. Infected people who may not want to be open about their sex lives are less likely to seek treatment or vaccinate themselves, which inevitably makes controlling the monkeypox outbreak more difficult."

What the right is saying.

  • The right is also critical of the Biden administration, saying the characteristics of the virus should have made it easy to control.
  • Some criticized the inexperience of Biden's top health officials.
  • Others said fears of offending the LGTBQ community has hampered the Biden administration's response.

In City Journal, Joel Zinberg said the features of monkeypox should make it easy to control — but this administration failed.

"Monkeypox is less severe and transmissible than Covid-19," Zinberg said. "It spreads through intimate contact, primarily skin-to-skin. Respiratory transmission is far less common and requires prolonged face-to-face contact. Unlike Covid-19, which can spread before symptoms are apparent, monkeypox is only transmitted after symptoms—rash, fever, lethargy—occur. And, perhaps most important, unlike Covid-19, for which there were no vaccines or treatments during most of the first year of the pandemic, approved vaccines and antivirals exist for monkeypox... [and yet] the Centers for Disease Control and Prevention waited until late June to expand monkeypox testing. As a result, through the end of June, the U.S. had tested only 2,009 suspected monkeypox cases. And despite owning 372,000 FDA-approved Danish vaccines, Biden administration officials reportedly left most of the supply in Denmark, ordering only small shipments of vaccines for importation.

"[New York City's] response has not been flawless, either," he added. "Instead of encouraging gay and bisexual men—the population that, to date, accounts for nearly all cases— to change, at least temporarily, their sexual behavior during the outbreak through abstinence or limiting relationships to known partners, the city health department issued an advisory in mid-July suggesting that having sex while infected with monkeypox could be made safer by avoiding kissing and covering sores. Such advice is unrealistic and irresponsible. Health officials were reportedly worried about stigmatizing gay men. Yet such wishy-washy advice is hurting the very people that public officials are afraid of defaming. Officials had to target the gay and bisexual community with information about monkeypox symptoms and access to testing so that they could confirm their infection status and, if positive, avoid sexual contact until their infection clears."

In The Washington Examiner, Tim Carney blamed Health Secretary Xavier Becerra's limited experience.

"How the hell during a pandemic did President Joe Biden name a health secretary with no competence in public health?" Carney asked. "And is anyone surprised that HHS Secretary Xavier Becerra is making the monkeypox outbreak worse? Part of Becerra’s incompetence is his inability to clear away red tape or prioritize anything at a time when we were supposed to have learned something about infectious diseases. Another part is his lame political correctness in talking about a disease that is overwhelmingly spread by men having sex with men... . Becerra (beyond having no competence, experience, or training in public health) can’t fight this fight because he was brought here precisely to be a left-wing culture warrior.

"Becerra met Biden’s standards for health secretary because Becerra is an abortion extremist and a culture warrior who relishes in persecuting religious conservatives," Carney said. "Becerra’s qualification for HHS secretary was pressing a felony prosecution against pro-life activist David Daleiden because Daleiden exposed Planned Parenthood’s trade in the organs of aborted babies. Even the Los Angeles Times called Becerra’s crusade 'a disturbing overreach.'... Xavier Becerra was obviously unqualified to run HHS during the COVID pandemic, and his incompetence is worsening the monkeypox outbreak."

In National Review, Pradheep Shanker called it the "newest failure of public health policy."

"In the U.S., public-health leaders have been reluctant to sound warnings, out of fear of possible backlash against communities hardest hit by the disease — in particular, gay and bisexual men," Shanker wrote. "Discussing the Biden administration’s efforts to stop the spread, White House health-policy adviser Dr. Ashish Jha spoke specifically to this concern. 'I think it’s very clear at this point that the community most affected is the LGBTQ community,' he said. 'It’s really important that we do not use this moment to propagate homophobic or transphobic messaging, and stick to the science.' This is absolutely the right way to walk the fence. It is essential to point out who is being hit hardest by the virus. Communicating to those populations will be essential to getting the disease under control. Meanwhile, it is prudent to be wary of the prejudices that exist in our society, and how those people may abuse the facts in these cases to target at-risk populations for their own ends.

"This is a far cry from others in the health-policy arena. Former Biden White House senior adviser Andy Slavitt, for example, tweeted, 'The myth that sexual activity is the cause of monkeypox & that reducing it is a valid strategy for managing a disease does not, on its face, make any sense.' This was moral preening of the worst order," Shanker said. "The facts are obvious: Right now, monkeypox is mostly infecting gay and bisexual men. This isn’t opinion; this is fact. Monkeypox traditionally has had no sexual, racial, or cultural predilection. But this current outbreak clearly does, as Dr. Jha admitted. And it is totally reasonable for health professionals to consider that stigma created over describing any illness as being associated with a singular minority group of any kind. But by trying to eliminate the risk of prejudice caused by the evidence in this case, health-policy experts are prioritizing fighting the social ills of prejudice and hate over focusing on stopping the virus."

My take.

Reminder: "My take" is a section where I give myself space to share my own personal opinion. It is meant to be one perspective amid many others. If you have feedback, criticism, or compliments, you can reply to this email and write in. If you're a paying subscriber, you can also leave a comment.

First of all, I think it's worth stating plainly that this is not Covid. Obviously, on the heels of a pandemic that has already killed over six million people and upended so many of our lives, reaching for comparisons is the knee-jerk reaction. But it's worth remembering where we are: We're talking about 7,000 cases and zero deaths on U.S. soil, with just a handful of deaths globally. That doesn't mean this isn't a big deal — it is — it just means it's not prudent to talk about this as if it's Covid 2.0. It is not.

One insight that I do think is worth remembering is just how difficult it is to manage pandemics and disease spread in the U.S. In this newsletter, specifically, I often defended former President Trump and his administration's response to Covid-19. Yes, Trump said a lot of dumb things about Covid, and made deeply erroneous predictions about what the outcomes would be, which almost certainly contributed to the U.S. having some of the worst outcomes (statistically, in terms of cases and deaths) of any nation on earth.

But I was always skeptical of the standard talking point from the left about what would have happened if Biden, Barack Obama or Hillary Clinton were in the White House. Mostly because, if you zoomed out, you could see how other nations and world leaders also struggled so much with Covid-19. The list of global leaders who navigated the crisis deftly is extraordinarily short, and typically came at major costs to the economy and the freedom of their citizens.

Now, though, the Biden administration's response to monkeypox is affirmation of just how broken our system is, regardless of who is in the White House. Given everything we just learned from Covid, and given the general outlines of monkeypox (we have a vaccine, it spreads through extremely close contact, and it spreads after obvious symptom onset) controlling this outbreak should have been a slam dunk. I don't mean to be blithe, but this was the figurative lay-up of pandemics, and so far the administration has botched it.

Part of that failure has been the cultural element. The virus is prevalent among gay and bisexual men, which has created a tightrope to walk for public health officials who need to speak clearly and honestly about at-risk communities and also not create fear or indignation toward those communities. I respect the need to walk that tight rope, and there is no doubt some horrific and bigoted talking points are spreading in the media space (Brad Polumbo, a Libertarian writer who is also gay, responded directly to some of those talking points here). But at the same time, I abhor the folks openly disregarding the reality of this outbreak in order to avoid any perceived offense.

The distinction seems obvious enough to me: the virus monkeypox can and does effect anyone, but this outbreak is currently happening among men who are sexually active with other men.

The other part of this failure is a more run-of-the-mill, administrative, typical government botched job. The New York Times did damning reporting on the Biden administration's "wait-and-see" approach, calling for more vaccines only after cases were growing exponentially (when that growth was expected and predicted). 300,000 of those vaccines, as many writers noted above, were readily available, owned by the U.S., and sitting in a facility in Denmark.

At the top of the administration, of course, is the president — so some blame does ultimately fall with Biden. But the blame should more directly be pinned on the people leading the CDC, the public health officials in New York and other major cities, and the top-down administrative incompetence.

For all the talk of what we learned and how much better prepared we are for the "next Covid," this first test run is anything but encouraging. We're lucky, frankly, that we're dealing with a much less deadly disease that’s much harder to spread than any of the dozens of others out there we could spend our time worrying about. Hopefully, the emergency declaration helps, the administration’s plan gets executed quickly and we ramp up testing and vaccines to the point we can contain this thing — but my optimism is waning.

Your questions, answered.

Q: I have not paid attention to politics at all until the past few years. I’ve been really puzzled  about the wide and definitive use of polls throughout the entire media landscape to both create and promote narrative. Have you ever done any thinking or writing about this?

— Avia, Stoddard, New Hampshire

Tangle: We've definitely given polls a skeptical eye in this newsletter before. One of the more popular pieces we did was a reflection on 2020 polling, and to what degree they were right or wrong (that's a subscribers-only piece). The spoiler there is that in the end the polls were actually more accurate than people gave them credit for.

A lot of people have written about this, but the general thrust of the issue with polls right now is that the people most likely to take them are typically more liberal. There are a lot of reasons for this, but the big one is a social psychology phenomenon where people who are left-leaning politically tend to be more trustful generally, which makes them more likely to pick up a call from a random number and then divulge their worldviews to a stranger for 20 minutes on the phone. As such, polls need to correct for this imbalance, which they were very bad at doing in 2016, but only somewhat bad at in 2020.

As for the media creating narratives, the answer is pretty simple: A writer wants a sense of their audience’s opinions, but it's impossible to talk to everyone. As a reporter, let me tell you that every journalist's dream would be to have the omniscient power to speak to every living American on every important political question and get a crystal clear, perfect view of the pulse of the country. The fact that we can't do that limits us. We are left, instead, to interview a dozen or so people (if you're good at your job), look at publicly available polling, and then look at the previous work related to the topic you're covering.

That last part is where the narrative comes in. Most journalists are, in some ways, building on the knowledge and work done by other journalists. This is true in every profession: Musicians sample each other's music; doctors work off of research done by predecessors or contemporaries; police officers learn from more experienced partners or steal ideas from other departments.

But in journalism, the effect of many reporters using the same set of polls and referencing the same previous reporting is the inadvertent (or sometimes, intentional) formation of narrative. The danger, of course, is that when such reporting and polls are wrong, misleading, or in some way inaccurate, the entire narrative becomes divorced from reality, and eventually the story falls apart.

So, polls can be informative. They are probably most informative when the results are from the same pollsters observing a change (which reliably indicates a new trend or movement on an issue). They are necessary context for reporters and audiences given the limitations of any person’s abilities to speak to thousands or millions of people. But, when paired with incomplete reporting, they can also be used to build narratives that belie reality. And that's the challenge of doing great reporting!

Want to ask a question? You can reply to this email and write in (it goes straight to my inbox) or fill out this form.

A story that matters.

The Department of Homeland Security said on Monday that it ended the Trump-era "Remain in Mexico" policy, which required asylum seekers to wait in Mexico for hearings in U.S. immigration court. The announcement came hours after a judge lifted an order that it be reinstated. On June 30, the Supreme Court ruled in favor of the Biden administration, saying it could end the policy. Now, DHS says the program will be unwound in a "quick and orderly manner." About 70,000 migrants were subject to the policy between the time Trump enacted it and Biden ended it (on his first day in office). In July alone, the U.S. Border Patrol reported nearly 200,000 encounters with migrants along the U.S.-Mexico border. The Associated Press has the story.

Have a nice day.

On June 29, 1988, Patrick Combs was walking to work when he came across a woman on a street corner giving birth. The shocking happenstance left Combs receiving a baby in his outstretched arms, a story so surprising and miraculous that it landed him on the front page of The San Francisco Chronicle. The child, Searcy Hughes, was later adopted and raised in Virginia. But as she grew up, she heard strange tales of her birth, and that it was "kind of a big deal." So she had a friend look up the story on, which featured the old Chronicle story, and led Hughes directly to Combs. This year, the 34 year old Hughes finally met the 54 year old Combs. Naturally, the San Francisco Chronicle has the story.

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