Why I spoke to the New York Times

I, and my colleagues, have bore witness to the carnage monkeypox has caused. Over 1000 cases have occurred in NYC in a little over a month. We've also heard the pleas from physicians trying to get their patients limited treatment, and the anguish in the voices of patients suffering with monkeypox proctitis. This disease does not often kill, but it can cause excruciating pain. Departmental leadership have stood by like Nero fiddling while Rome burned. DOHMH public messages on how to prevent monkeypox have been disingenuous at best, misleading at worst by not stating that in all likelihood monkeypox is being transmitted sexually, and possibly by persons without symptoms. I believe the evidence that monkeypox is being transmitted sexually is in fact overwhelming:

• The location of lesions on penis, perianal region, inside the rectum, and mouth
• Studies coming forth demonstrating the virus is present in semen and saliva
• Reports from patients that their sex partners did not have any visible rash
• The explosive increase in cases unlike any previous outbreak of the disease
• Sexual transmission documented in other viral infections, such as HIV, Ebola, and Zika.

The foundation of public health is prevention, and there is a long tradition of not waiting for irrefutable proof before ringing the alarm bell. John Snow, using the epidemiology alone, warned of the risk of cholera in well water years before microbiologists identified the bacterium. Ignaz Semmelweis recognized the cause of puerperal fever and recommended hand washing as prevention just by observation, again before there were tests to prove him right. When sickness is connected to a commercial product people are often warned before the offending contaminate is documented. I raised my concerns regarding confusing and unclear messaging with the department on several occasions, being told by Incident Commander and Deputy Commissioner Dr. Celia Quinn and Public Information Officer Maura Kennelly, that "we are working with community partners on messaging." I was not alone, others have questioned the national dialogue about monkeypox. Then, on Friday July 15, 2022, the department released a press release suggesting that even if one was ill, sex could be safe if you avoided kissing and covered your lesions. Utterly preposterous, dangerous, and without a shred of proof. After conferring with colleagues, I decided that my only recourse to alert the MSM community about their risk was to come forward publicly. That is what I did. Not to prescribe anyone's sexual behavior, but to give people accurate information so they could make their own decisions. That's our job in public health.