Pride: What Not to Do This Weekend

Sorry to be a killjoy, but it’s not just sex that’s dangerous. Kissing or skin-on-skin contact can probably spread monkeypox. And even if you were one of the lucky few to get vaccine, you won’t be fully protected until August.

This is a good week to avoid the New York Pock Exchange/Shutterstock

Happy New York Pride 2022. Some pro tips:

1. Don’t have sex with men you don’t know, even with a condom.
2. Don’t rub your bare skin against the bare skin of men you don’t know.
3. This year, kiss your friends on the cheek, not the mouth.

I know: Mr. Killjoy. Sister Mary NoFun.

Sorry. But for the moment, it’s good advice.

Don’t be fooled by reassurances like: “There are only 39 cases in New York — what are the chances of me meeting one of them?”

The U.S. is way behind on testing. In addition, most men don’t get tested until they get multiple pox, which usually doesn’t happen until they’ve been infected for two to three weeks. They may have been infectious for days.

Given how fast cases rose in Europe, where this outbreak was first detected, we probably have close to a thousand still-undetected cases. A month ago, all of Britain had 20 cases. It now has more than 900.

Sex spreads it and skin-on-skin contact spreads it. Why assume that kissing does? Because there are several case reports from Africa and Europe of spread between parents and children, which probably is parents hovering over a sick child and getting droplets coughed in their face — or perhaps a parent kissing or breathing closely on a child. In some people, the first symptom is mouth sores, which probably shed virus into those coughed droplets.

Good news: On Thursday, New York City’s Chelsea Clinic began offering Jynneos vaccine to men who have multiple male partners or anonymous ones.

Long lines formed immediately. But the city has only 1,000 doses, not nearly enough to meet demand.

Also, it is given as two doses a month apart, so full, long-lasting protection may not be achieved until August.

Does that mean offering it was a bad move? I don’t think so. Nothing creates demand like word of a shortage. Remember the first time you heard toilet paper was disappearing from the shelves? What did you do?

What it has done is force the C.D.C. to confront the next big question: Since there’s not enough Jynneos vaccine to go around, should it release the 100 million doses of ACAM2000 in the Strategic National Stockpile?

The agency and its experts are debating whether the benefits are worth the risk.

On the one side: Although monkeypox can make you miserable for a month, it probably won’t kill a healthy adult.

(But let’s define “miserable.” Some men are now describing their symptoms. While some have had mild cases, some have suffered large pus-filled blisters inside their rectums. Some have bleeding sores and pain so intense that they are hospitalized on IV pain meds. Some have unsightly lesions on their faces. Also, some are out of work for weeks.)

ACAM2000 would let you avoid that.

On the other side: the vaccine has some very rare but very bad downsides. If it was given to someone with undiagnosed H.I.V. or another immune-suppressing condition, they could become very sick and (possibly) die. Someone with severe eczema might get necrosis (rotting flesh) at the vaccination site, which could, again (possibly) require amputation. Those risks are remote and there is an antiviral treatment, TPOXX. (People with H.I.V. who take their pills are not considered immune-suppressed.)

A more common downside — one the C.D.C. is debating — is a roughly one-in-500 risk of pericarditis or myocarditis, which is inflammation of the heart or the sac it sits in.

That sounds scary but it’s treatable with anti-inflammatory drugs like aspirin and steroids.

Is that a greater risk than monkeypox? Consider this: If you’re having bareback sex with multiple strangers, you are already a fire-jumper. You are at high risk for STIs (some of which are quite hard to cure) and at some risk of personal violence. (Men who use alcohol, amphetamines plus sometimes steroids to stay buff can be unpredictable.)

Also, there is a broader way to look at this: Most C.D.C. advisors are MD’s and therefore trained to think first of their individual patient’s risk-benefit calculation. But there is a greater risk at stake: It has taken 50 years for Americans to (mostly) accept gay relatives, gay TV characters, gay marriage, and so on. If this virus jumps out of gay men and reaches pregnant women and young kids, gay rights could be seriously set back and homophobic anger could cost lives. (In Africa, pregnant women and kids are at higher risk of death from the virus.)

So, if I were a young, gay, orgy-attending man, would I take ACAM2000? Yes, I definitely would. I’d want an H.I.V. test and a skin check first but, as I mentioned in an earlier article, I had three doses of the more dangerous 1950’s version of the smallpox vaccine when I was a child, and I’m fine.

On Saturday, the World Health Organization declared that the global monkeypox outbreak is not a Public Health Emergency of International Concern. Or not yet, anyway.

That could change. In the third week of January 2020, the W.H.O. said the same thing about Covid. That was at a time when more than 90 percent of all cases were in China. A week later, as the virus spread further and faster, it reversed course and declared the incipient pandemic an emergency.

The anti-vaccine lobby, never one to miss an opportunity to spread confusion and terror, is already floating QAnon-level conspiracy theories about monkeypox. To wit:

• That the outbreak was triggered by gain-of-function research.
• That it is a bioweapon used in Ukraine that escaped from the battle zone. (Ukraine has reported zero cases. Too busy for orgies, presumably.)
• That the outbreak is another “plandemic” plotted out during a 2021 tabletop exercise involving the Gates Foundation, Big Pharma and people from Davos so that vaccine companies can cash in.
• Or possibly that it actually stems from a traffic accident in Pennsylvania last January in which a pickup truck carrying 100 caged lab monkeys collided with a dump truck. Four monkeys escaped, and rifle-toting police were ordered to hunt them down as firefighters shone thermal detectors into the trees. (The four were recaptured but then euthanized, the Associated Press said. “No reason was given as to why they were killed,” the anti-vax article notes.)

I’m not kidding — all four of these conspiracy theories are in a single article from Children’s Health Defense, which is Robert F. Kennedy Jr.’s anti-vaccine organization.

I’m just guessing here, but I may know who their source is.

An earlier version of this article incorrectly said protective antibody levels were not achieved until after two doses of Jynneos vaccine plus a two-week waiting period. A 2004 study suggests that protection begins sooner than that. The second dose is given to make protection last longer.