Our experience with the monkeypox virus recalls some of the most painful aspects of the response to the COVID-19 pandemic: minimization of risk, insufficient testing capacity, lack of case demographics, contact tracing difficulties, poor access to supplies in the national strategic stock, and global uncertainty giving rise to ever-increasing misinformation.
Despite calls from the AMA and others to strengthen our country’s public health infrastructure and strengthen our country’s preparedness for the next crisis, the reality is that there is still much work to be done. Our public health system is still responding to COVID-19 as it now faces an outbreak of monkeypox, which the World Health Organization recently declared a global health emergency, and the first reported case of polio in the United States. for over a decade.
Monkeypox, first identified in 1958, is an orthopox virus from the same virus family as smallpox, but it causes milder symptoms and is rarely fatal. Symptoms may include a rash that may appear as blisters or pimples, fever, chills, headache and body aches, exhaustion and swollen lymph nodes. According to the Centers for Disease Control and Prevention (CDC), those most at risk of serious illness and death are children, people with weakened immune systems, pregnant or breastfeeding women, and those with a history of ‘eczema.
The disease can be spread in several ways, including direct contact with the infectious rash, intimate physical contact, contact with an infected animal, or contact with clothing, linens, or other items contaminated with the rash. or body fluids. Illness caused by the virus often lasts between two and four weeks, and an infected person can spread the virus from the time symptoms appear until the subsequent rash is completely healed.
While monkeypox is often described as mild, some patients who contracted the virus during the current outbreak have described the skin lesions as “debilitating pain”. You can find additional information and answers to frequently asked questions from the AMA.
Until this year, monkeypox was rarely reported outside of central and western Africa. The CDC noted that only two cases of monkeypox were reported in the United States last year.
Today, there are over 15,000 documented cases in over 65 countries that have never reported monkeypox. The US tally was over 2,300 as of July 21, with cases reported in most states. However, as is the case with the current number of COVID-19 cases, the total number of monkeypox infections is almost certainly higher than these numbers indicate.
What’s different with monkeypox is the fact that we already have an effective vaccine and we have the ability to contain the current outbreak through robust testing, disease surveillance, contact tracing and administering the vaccine. But that window will close if we respond in the same uncoordinated way as we did to COVID-19 in the first half of 2020, which played a key role in its rapid and relentless spread.
Although monkeypox testing was initially made available by public health labs, many healthcare professionals are unaware of their public health departments and don’t know how to access these tests. Delays in receiving test results hampered contract research efforts. With increased testing in commercial and academic labs, access to testing should be less of an issue, although the cost of testing in these labs may be a potential barrier.
The demographics of monkeypox cases remain a challenge. It must be recognized that the CDC has no direct authority to compel the release of data. The CDC obtains data from 50 states and more than 3,000 local jurisdictions and territories, which requires signing data-sharing agreements. Experience with COVID-19 has taught us that demographics are important to inform equitable resource allocation.
Additionally, while the Jynneos vaccine is available through the National Strategic Stockpile, 780,000 doses were stored at the supplier in Denmark awaiting the completion of Food and Drug Administration field inspection and clearance ( FDA) before they can be shipped. in the United States This inspection was supposed to be completed this fall, but the deadline was accelerated and ended in mid-July. Limited access to vaccine doses, which are made available to public health services, has been frustrating, but the supply is improving.
Additionally, antivirals such as TPOXX (tecovirimat) are also available through the SNS, but physicians and other clinicians should request access through their state or territory health department or the CDC’s emergency operations center. Since the FDA initially only approved the drug for the treatment of smallpox, patients had to enroll in a clinical study to gain access to it. The testing requirements are very laborious. The CDC, in coordination with the FDA, is working on a revised and simplified protocol to reduce data collection and reporting requirements.
It is vitally important for us to recall public health lessons from the early days of the HIV epidemic some 40 years ago, when misguided messages fueled irrational fears and fueled persistent stigma and prejudice. against the LGBTQ+ population. Viruses can infect anyone, regardless of social status, sexual orientation, or any other demographic consideration. That said, it is important to understand and clearly communicate risk factors and steps to prevent transmission.
If recent history has taught us anything, it’s that we should take nothing for granted in responding to any viral disease outbreak. We need to consistently and sustainably fund public health infrastructure, support incentives to help recruit and retain government public health staff, modernize public health data systems, and promote interoperability between health care and public health systems, and ensuring equitable access to public health funding and programs.
Improving communication between health departments and licensed healthcare professionals in their jurisdictions will also improve our response to disease threats, not just for monkeypox, but for any public health emergencies that are sure to follow. .