Dr. Emily Dolwiega and registered nurse Maggie Butler of the University of Illinois College of Health prepare a monkeypox vaccine at the Test Positive Aware Network nonprofit clinic in Chicago, Illinois, July 25, 2022.
Eric Cox | Reuters
Dr. Ward Carpenter, co-director of health services at the Los Angeles LGBT Center, said the monkeypox outbreak across the country is more serious than anyone imagined.
“We are living as busy, stressed and confused as we were in the early days of COVID-19.
The Los Angeles LGBT Center has lost its ability to provide emergency and no-appointment care for patients as it has had to shift many of its staff to accommodate the pandemic, Carpenter said. The center offers monkeypox vaccination, testing and treatment, in addition to the usual services such as primary care, HIV care, sexual health, women’s health and mental health.
“People who have nothing to do with this kind of work are quitting their regular jobs and starting to work on this response,” Carpenter said.
U.S. health officials have declared monkeypox Thursday’s National Health Emergency The number of cases is increasing rapidly, and the clinic is struggling.STD clinics in major cities across the country serve as the first line of defense as the United States attempts to contain the virus, We provide care and guidance to gay and bisexual men who currently face the greatest threat of the disease.
The surge in patients needing vaccines, testing and treatment, as infections rise, is putting pressure on an already underresourced system after years of underfunding, doctors say.
Monkeypox is spread primarily through skin-to-skin contact during sex. Since the UK first alerted the world to the presence of the virus in her May, sexual health clinics around the world have become the eyes and ears of the nation’s public health system, and the usual description of the disease in the medical literature. Identifies unusual symptoms that are different from .
Physicians at clinics in Los Angeles and Chicago, who are major epicenters of the current U.S. outbreak, are struggling to keep up with demand for vaccines, tests and treatments from the communities they serve, and are responding He said he needs financial support to do so. outbreak.
According to the Centers for Disease Control and Prevention, more than 7,000 monkeypox cases have been reported in 48 states, Washington, DC, and Puerto Rico in the United States. The outbreak has spread rapidly since Boston health officials confirmed the first case in the United States in May.
Monkeypox is rarely fatal and no deaths have been reported in the United States, but some patients suffer excruciating pain from a rash that often occurs on the genitals and anus, requiring hospitalization. is.
“Unless you’ve potentially experienced pain in these sensitive areas, it can be difficult to understand what this is, but this is not something that will go away in a few days with antibiotics. People live with this pain for weeks. Dr. Hazra is a physician and infectious disease specialist at Howard Brown Health in Chicago.
Gay and bisexual men are currently at highest risk, but public health officials say monkeypox can be contracted through physical contact with an infected person or through contaminated materials such as towels and bed sheets. It repeatedly emphasizes that there is
“Monkeypox doesn’t care if you’re gay. It doesn’t care what kind of sex you have,” Hazra said. “Monkeypox only bothers you if you come into close contact with another person who has monkeypox.”
Carpenter said the U.S. has an opportunity to contain the outbreak, but it’s mostly confined within close-knit communities of gay and bisexual men, but as infections rise, the risk of the virus starting to spread more widely increases. said.
“We are now experiencing two consecutive outbreaks that were not managed in a manner that enabled containment,” Carpenter said. We’ll go top to bottom and treat it just as seriously as Covid,” he said.
According to Carpenter, the Los Angeles LGBT Center announced that monkeypox would become a major disease in the communities it serves after showing cases reported in Europe occurred in sexual networks of homosexual and bisexual men. I knew in early May that it was going to be a health problem.
Center staff had never had monkeypox, so they began educating themselves about the virus. However, the patient presented with symptoms not described in the medical literature, including single lesions in the genital and anal regions. I didn’t know my first patient had monkeypox until the results came back because the symptoms didn’t match the textbook description.
“We knew very early on that this wasn’t going to act like a book,” Carpenter said. We’re really learning what this new fad looks like and how it’s different.”
After Pride Month ended, more and more patients began to be screened in late June, Carpenter said. A full skin exam is now required to see if you may have it.
Hazra said the number of people being screened for monkeypox at Howard Brown Health in Chicago has increased exponentially since May.
While some U.S. lawmakers and communities have criticized the federal government’s pace of response, Health Secretary Xavier Becerra said last week that the Biden administration will increase the availability of vaccines, tests and treatments to combat the outbreak. He said he did everything he could to
More than 100 members of parliament told the president Joe Biden They called on Biden, Becerra and CDC director Rochelle Wallenski to fund at least $30 million for clinics fighting the outbreak through the CDC’s STD prevention division.
“If we don’t adequately fund our nation’s STD clinics now, it will be very difficult to eradicate monkeypox in the coming months,” said Congressman Jerrold Nadler. D-NY) and David Cicillin (D-RI) wrote in the letter. .
Hazra, of Howard Brown in Chicago, said Covid has shown public health in general to be chronically underfunded. Sexual health is being neglected even more, he said.Federal funding for STD prevention has fallen 41 percent since 2003, after adjusting for inflation.National Coalition of STD Directors Addressing Sexual Health According to the National Association of State Health Authorities.
Although monkeypox is not classified as a sexually transmitted disease, sexual health clinics are a primary point of care for many people with a virus that causes a rash that can be confused with a sexually transmitted disease. According to the coalition, a survey of 80 clinics conducted in late July found that 40% had unexpected costs in supplies and personnel due to the monkeypox outbreak, and 65% were out of capacity. Due to issues with the city, we stopped accepting walk-in patients and shifted to appointments only.
“Funding is absolutely scarce,” Carpenter said. “Local health centers like ours play a very important role in a response like this, but we are turning a dime on and shifting and increasing capacity to be able to serve those who need it. We don’t have the capacity to double.”
Demand for the monkeypox vaccine is huge and still outstrips supply, Carpenter said. Staff spent all day last week getting people vaccinated, he said. They have given 1,500 vaccinations so far.
The center recently told patients to book shot appointments after receiving more supplies. it was done. According to the county health department, Los Angeles has received about 24,000 doses from the federal government.
CDC director Dr. Rochelle Walensky last month acknowledged demands that supplies of the two-dose monkeypox vaccine Jynneos are limited, prompting protests in some cities as lines formed outside clinics. rice field. The Department of Health and Human Services has increased shipments to state and local health departments, with more than 600,000 doses delivered since May.
HHS made 786,000 doses available to state and local health departments last Friday. The City of Chicago received an additional 15,000 doses of the vaccine last weekend, in addition to the 7,000 delivered in July. But Hazra said that was still not enough to meet the demand of men at risk of having sex with an estimated 40,000 to 50,000 men in the city.
“Right now, when it comes to vaccine appointments, they’re scheduled three weeks in advance,” Hazra said.
Governors of California, Illinois and New York have all declared states of emergency in response to the outbreak to support vaccination efforts. But Carpenter said vaccination campaigns need to be scaled up so that anyone who thinks they are at risk of monkeypox can be vaccinated.
In Los Angeles, Carpenter said, vaccination campaigns are focused on people taking a drug called PrEP, which reduces the chances of contracting HIV, and those who have had gonorrhea or syphilis in the past year. . This information is used as a way to identify people who may be at increased risk of contracting monkeypox.
There are 1.7 million gay and bisexual men in the United States this week who are thought to be at the highest risk of monkeypox because they are HIV positive or taking PrEP, Wallenski said. People with weakened immune systems, such as those with HIV, may suffer more severe symptoms from monkeypox.
Carpenter says this approach is far from perfect because there are many people at risk for monkeypox, even if they haven’t had a sexually transmitted disease in the past year.
“What we really want to do is be able to vaccinate everyone who wants it,” he said. “We’re not even close to getting there yet. We’re really trying to focus on those who need it most and are most at risk. But that’s not a successful public health strategy. ”
Access to vaccines remains limited, but Hazra and Carpenter say the federal response has significantly improved access to testing and antiviral treatment in recent weeks.
Testing has become much easier since the outbreak began after the CDC installed commercial labs, increasing weekly testing capacity in the United States to 80,000 tests per week.
“We are far from that capacity at the moment,” Hazra said. “It helped ease the test bottleneck.”
But even with increased testing, the United States may still not capture the true extent of the outbreak. The clinician will swab the monkeypox rash and take a sample for testing. However, in some cases, it can take several weeks after initial exposure to the virus for the rash to appear. This means that some people who are infected cannot get tested because they do not have a rash.
The CDC has also made it significantly easier to prescribe the antiviral drug tecovarimat to monkeypox patients, Carpenter said. Because tecovirimat is only approved by the Food and Drug Administration for smallpox, prescribing this drug to treat monkeypox involves an additional layer of bureaucracy.
Initially, doctors had to fill out a 120-page form for each patient who needed antivirals, Carpenter said. The CDC has cut a lot of bureaucratic burden and greatly simplified the process through auto-filled online forms, he said.
Hazra and Carpenter said they have not experienced any problems with the supply of tecovirimat. According to HHS, the US has 1.7 million courses in its strategic national stockpile.
Hazra said the White House was responding to the outbreak, but said more resources and outreach could have been available. He said Pride Month could have been better used to vaccinate people and educate those at risk of infection.
“I think there was a lot of wasted time unfortunately,” he said.
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