Testing is crucial to bringing monkeypox under control, but there’s a ‘shocking’ lack of demand



CNN

Testing for monkeypox, a crucial part of containing the growing epidemic, has gotten off to a slow start at the five commercial labs that do nearly all of the testing nationwide, CNN has learned.

Mayo Clinic Laboratories, for example, has the capacity to process 1,000 monkeypox samples per week, but has only received 45 samples from physicians since monkeypox testing began on July 11. Another of the labs, Aegis Sciences Corp., can perform 5,000 tests a week but has received no samples in the past two weeks. At Labcorp, one of the largest commercial labs in the United States, adoption was higher but still “extremely low,” according to Dr. Brian Caveney, president of the diagnostics lab.

These numbers are “shocking,” said Dr. Peter Chin-Hong, a member of the California Department of Public Health’s Monkeypox virus scientific advisory committee.

“It’s really, really worrying. It’s like Covid PTSD,” he said, referring to the early phase of the pandemic when coronavirus testing was extremely limited. If the anxiety is the same, the reasons are different as for Covid-19 testing capacity was low, and for monkeypox capacity is plentiful but demand is low.

The first U.S. case of monkeypox in this outbreak was reported on May 17, and the virus has spread rapidly to 4,639 probable or confirmed cases, almost all of them in men who have sex with men. Bringing the outbreak under control has been a challenge for the US Centers for Disease Control and Prevention and the Biden administration, which is expected to appoint a monkeypox coordinator and is considering declaring the virus a public health emergency.

Dr. Anthony Fauci, President Biden’s chief medical adviser, described testing as a “pillar” of the government’s response to monkeypox Tuesday on CNN. He and other health officials have repeatedly assured Americans that there is high capacity to handle testing, with labs capable of processing 80,000 samples a week. Most of this capacity – 70,000 specimens – is in private laboratories.

The CDC has hired the five labs to handle the growing number of cases. Two of them, Quest Diagnostics and Sonic Healthcare, declined to tell CNN how many monkeypox samples they have received, but “the capacity of the five commercial labs at this point far exceeds what we are seeing in demand,” according to Susan Van Meter, president of the American Clinical Laboratory Association.

Testing is an important part of the monkeypox containment effort for two reasons: it’s the first step in identifying and isolating patients, and it gives public health officials an idea of ​​the extent of the outbreak. and geographic areas most in need of resources.

“Without a test, you’re flying blind,” said Dr. William Morice, chairman of the board of the American Clinical Laboratory Association and president of Mayo’s lab. “The biggest concern is that you are not going to identify the cases and [monkeypox] could become an endemic disease in this country. This is something we really need to worry about.

Chin-Hong likened the lab’s low numbers to “walking around with Vaseline in your eyes: you don’t see the whole picture.”

Dr Matthew Hardison, senior vice president of Aegis, warns that “if you don’t test enough, you’re not going to find it, and it will continue to spread, and we’re already seeing significant growth in some number of different states across the country right now.

Prior to this year, there had only been a few dozen cases of monkeypox in the United States. As with any newly emerging pathogen, the CDC has set out to educate health care providers on how to detect the disease, order tests to detect it, and treat it.

The agency sent out emails through its Health Alert Network, hosted two calls involving more than 17,000 doctors and other clinicians, and set up a phone line for doctors to ask questions. The CDC also sent emails to doctors announcing the availability of tests at the five private labs.

A CDC spokesperson said there had been “strong outreach from clinicians and the general public to increase awareness of risk factors, symptoms, and testing options for monkeypox.”

JAMA and other medical journals have also provided information on how to diagnose, test for, and treat monkeypox.

“The message is definitely getting out,” said a federal health adviser who requested anonymity because he is not a government employee and does not speak on behalf of any federal agency. “Our hope is that every clinical provider in this country now knows monkeypox and knows when to test for it.”

But even with that education, detecting a case of monkeypox can be difficult, in part because the rash isn’t always distinctive, Caveney said.

“It just looks like a pimple or something,” he said.

Since monkeypox is transmitted through prolonged skin-to-skin contact, the physician should also obtain a detailed and thorough history from his patient.

“It’s really difficult for clinicians to get an accurate history of someone’s contact maybe a week or two ago and then look at a lesion and say, ‘Oh, that’s not just , you know, just a normal thing that would be in your skin. It’s something I should test,” he said.

Caveney added that as doctors learn more about monkeypox, he expects the number of tests to increase.

Experts say education is just one reason for the slow uptake of testing.

On the other hand, some people who show symptoms of monkeypox may not seek treatment for fear of being stigmatized.

“They might think, ‘I’m going to identify as someone who is frowned upon in society: I have sex with men, I have multiple sexual partners, or I haven’t used protection. ‘ That’s what monkeypox is saying now, and you can imagine people don’t mean all of that,” said Chin-Hong, an infectious disease expert at UCSF School of Medicine who has treated people with the monkeypox.

Additionally, many members of the LGBTQ community are used to seeking treatment at sexual health clinics, which are now overwhelmed with treating patients with monkeypox as well as their regular caseloads, according to David Harvey, executive director of the National Coalition of STD Directors, which represents the public. and private sexual health clinics and programs.

He said about half of the clinics in his organization don’t send samples to private labs because it’s too expensive to hire staff to handle the paperwork, which could help explain why the volume of monkeypox testing in private labs has been so low.

“It is very frustrating for us in the field (of sexually transmitted infections) to hear information from the White House and the CDC about testing capacity and access to vaccines when what is not discussed , these are all implementation issues in your day-to-day clinic,” says Harvey.

The CDC spokesperson said the agency “encourages anyone who suspects they have monkeypox to contact their clinician to get tested as there is more than enough testing capacity.”

On Monday, more than 100 members of Congress wrote a letter to the Biden administration asking for additional funding for sexual health clinics to improve the monkeypox response effort.

“As monkeypox cases continue to rise, states and communities rely heavily on the expertise of health clinics for disease detection, contact tracing, symptom monitoring and community education. , as well as their community relationships, to help slow the spread of this virus,” the letter stated.

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