The COVID lessons the US still needs to learn to fight monkeypox

COVID-19 and monkeypox are quite different diseases. But the parallels between the nation’s languid response to the coronavirus pandemic and the emerging outbreak of monkeypox are many — and potentially harrowing.

“Without even ending the COVID pandemic, we are already dealing with monkeypox,” said Dr. Caitlin Rivers, senior researcher at the Center for Health Security at Johns Hopkins University and founding member of the Center for Forecasting and Outbreak Analytics. from the CDC.

The health secretaries have declared both viruses public health emergencies, urging greater coordination, pushing for more urgent action and freeing up more funding and resources at federal, state, local and tribal levels. But despite all that, the US response to the monkeypox virus (or MPXV) has been criticized in familiar ways, said Dr. Saskia Popescu, an infectious disease epidemiologist and assistant professor at the Schar School of Policy and Government in George mason. University.

“We see a lot of Groundhog Day,” she said. “The lessons we thought we learned with COVID didn’t make as much of a difference as we would have liked.”

While COVID circulates through respiratory aerosols that linger in the air after someone coughs or sneezes, monkeypox is usually spread through close physical contact, including sex, or through shared clothing or bedding. When most confirmed MPXV transmissions were identified among men who have sex with men, public health officials failed to work effectively with the LGBTQ community, Popescu said, just as they failed to beginning of the coronavirus pandemic to include historically marginalized communities where infection rates, hospitalizations and deaths were disproportionately high.

The fumbling messages around prevention and interventions have created avoidable confusion about what people should do to protect themselves and others, especially when explaining nuanced risks and infectious diseases, said Dr Joshua Barocas , who studies the modeling of social determinants of health and disparities at the University of Colorado.

From masks to vaccines for which patients are considered at risk, Barocas said some public health officials, including those from the federal government and the CDC, used language that failed to acknowledge the unknown and what can happen when a highly dynamic virus moves and changes. the rules of engagement. This rigidity – which seems more sure of something than it really is – can have short-term benefits, but in the long term it can confuse and discourage the public from trusting the advice put out there. day, he said.

“When we talk about absolutes and don’t give ourselves wiggle room, we get stuck in the corner,” Barocas said. He said he feared the United States had already done so.

A grim reality of competing crises is that the health care providers needed to protect the United States from these pathogens are stretched thin, he said. While the Biden administration may brag about bringing in more tests to detect MPXV and vaccines to prevent its spread, Barocas said, “You can’t test and you can’t provide treatment if you don’t. have no manpower.”

It also fosters disparities, Barocas said, because the tools to avoid another pandemic are only effective if someone is there to deploy them. Otherwise, he said, they sit idle while people suffer, especially in black and brown communities: “We’ve made all of these things more available, but that doesn’t mean we’ve made them accessible.”

Weakened by COVID, public health systems struggle to meet a second challenge

In mid-May, a sick patient arrived at Massachusetts General Hospital in Boston, where he was diagnosed with a rare virus, monkeypox.

In a conference call two days later, senior Biden administration and public health officials provided an update, warning that “there may be additional cases in the coming days” with an update. surveillance and testing on the rise, but the virus “appears to be a low risk to the general public at this time. In that May 20 call, officials talked about ‘stopping outbreaks at their sources.’ Unlike COVID , monkeypox virus “is not a new disease,” an official said, adding that vaccines, treatments and tests already exist to contain it and prevent its spread.

The United States last faced a major monkeypox outbreak in 2003 – a time when America’s public health infrastructure had not yet been decimated by the coronavirus pandemic, workforce burnout. work and decades of budget cuts and lack of investment.

At the time, contact tracers quickly mapped how the virus entered the country through imported pets. People infected or exposed in six states have been identified, isolated and, if necessary, treated. In total, dozens of people fell ill across the country.

READ MORE: What are the symptoms of monkeypox? Here’s what you need to know

Today, more than 10,000 people in virtually every state in the United States have been infected with MPXV, according to the latest data from the Centers for Disease Control and Prevention. In the United States alone, confirmed cases are doubling every eight days, said Dr. Theresa Chapple, an epidemiologist and public health expert in Illinois. Epidemiologists say that estimate most likely underestimates true infection rates.

According to the CDC, people with monkeypox typically develop a painful, itchy rash on or near their genitals that can also appear on their hands, face, feet, or chest. Their symptoms may also include fever, muscle aches and headaches, swollen lymph nodes, and fatigue. Although few people died in this latest outbreak, the virus can cause blindness and severe scarring. And public health experts say this suffering can be avoided.

Compared to the start of COVID, there are fewer people today who are trained to stop these cases in overwhelming communities. Hundreds of public health workers have retired, been fired or resigned. Many of these people have left state and local public health departments “due to burnout, due to treatment by the public, due to the politicization of public health,” Chapple said.

“Now we’re up against something that we should have been able to jump on and fix and slow down and stop, but we can’t because we don’t have the people right now,” she said.

Although the Biden administration has prioritized funds to get people back into those roles, it’s not happening fast enough, according to Barocas. For him, it’s like the United States is back where it started two years ago.

“All this infrastructure is already there, and yet we wasted everything we learned,” Barocas said.

What problems probably await us

It’s too early to tell how the United States will get the better of the MPXV outbreak, Rivers said, but more publicly available and transparent data could be “crucial” in helping gain an advantage. In addition to investigating every positive case, Rivers said data on community transmission and vaccine distribution are key to understanding how to locate the greatest needs and reduce the deepest disparities.

The CDC does not have the authority to release this monkeypox data — which belongs to public health officials at the state and local levels. But just like with COVID, when this data is made public, it can help inform people’s decisions about the risks of navigating daily life. Above all else, “the elimination of transmission in the United States should be our goal” for America’s public health infrastructure, Rivers said.

WATCH: As monkeypox cases rise, so do concerns over disparate access to care

Popsecu said U.S. health officials also need to work with international partners “who have worked with monkeypox for decades.” In 1970, health officials diagnosed the first case of human monkeypox in the Democratic Republic of Congo, according to the World Health Organization. Subsequent outbreaks have been largely confined to West and Central Africa, with the largest outbreak occurring in 2017 with 500 suspected cases in Nigeria.

In the United States, more coordination and integration could make the difference, said Dr. Luciana Borio, who led medical and biodefense preparedness at the National Security Council and served as acting chief scientist for the Food and Drug Administration. After years of neglect and lack of funding at the state and local levels, Borio said it was not enough for the White House to install high-level leadership, she said. Instead, “you need to have strong components at every level of government.”

“At the end of the day, you can’t keep adding to the top,” she said. “The work happens in ministries and agencies, and really, it happens at the local level.

Thinking about the state of the outbreak and its current trajectory, Chapple said his “brain goes to two different places.”

“We could either turn a corner and move forward, or we could be further down the hole and take a horrible fall,” she said. “I have no idea.”

To prevent this virus from becoming endemic, Chapple said public health officials need to relay messages in a way that the public isn’t relying on a false sense of security, assuming only men who have sex with of men remain vulnerable to MPXV infection: “That’s the current landscape, but that doesn’t mean that’s where it stops.

A recent report from a daycare worker with monkeypox in Illinois exposing young children to the virus showed that people can also get sick from sharing bedding and eating utensils, noting that, “in an outbreak situation , the information changes almost daily”. Barocas said.

Communication should be proactive, not reactive, while being “concise and empathetic,” said San Diego-based epidemiologist and public health expert Dr. Katelyn Jetelina. It involves being honest about what we know – and don’t know – about the effectiveness of the MPXV vaccine: “In crisis communication, that’s really important, and it’s been missed during COVID and continues to be missed. during monkeypox.”

“We need a consistent message that shows this is changing,” Barocas said, later adding, “We’re really lucky with monkeypox. We have tools. We need to leverage our COVID experience.


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