Labcorp and Quest do not dispute that, in many cases, their phlebotomists do not draw blood from potential smallpox patients. What remains unclear, after the company’s statements and CNN’s follow-ups, is whether phlebotomists are refusing to draw blood on their own, or whether it’s company policy that prevents them. Both testing giants say they are reviewing their security policies and procedures for their employees.
Infectious disease experts who treat monkeypox patients say the denials are based on stigma and slow efforts to identify and isolate monkeypox patients at a time when the country’s health officials are under fire for struggle to control the outbreak. On Tuesday, there were 6,326 reported cases of monkeypox, an 81% increase from a week earlier, according to data from the US Centers for Disease Control and Prevention.
“This is absolutely inexcusable. It’s a serious dereliction of duty,” said David Harvey, executive director of the National Coalition of STD Directors, which represents 1,600 sexual health clinics in the U.S., some of which have phlebotomists from commercial labs like Labcorp and Quest. in their offices. Commercial laboratories employ tens of thousands of phlebotomists (healthcare professionals who draw blood) in various types of clinics and doctor’s offices across the country, as well as in their own patient service centers.
Although monkeypox is diagnosed by swabbing lesions, blood tests are needed to differentiate the virus from other types of infection, infectious disease experts say. Harvey said doctors at sexual health clinics have had to come up with workarounds when phlebotomists have refused to draw blood from patients suspected of having smallpox.
“We cannot afford a delay in diagnostic testing because commercial laboratories are not doing the right thing,” he said.
Harvey added that the denials appear to be “a modern example of discrimination,” a view shared by others.
“This reminds me of the old days when people didn’t want to take care of HIV patients,” said Arthur Caplan, a bioethicist at New York University.
Cases of monkeypox in the U.S. have mostly occurred among men who have sex with men, and when a technician doesn’t draw blood, it “perpetuates more stigma and fear and anxiety” about an already stigmatized virus, added Dr. Peter Chin-Hong. member of the California Department of Public Health’s Monkeypox Virus Scientific Advisory Committee that cares for monkeypox patients.
Chin-Hong, an infectious disease specialist at UCSF Health, said men avoid getting tested for the virus for fear of being stigmatized.
“The fact that phlebotomists are afraid to take samples makes it even more unattractive for someone to ask for a monkeypox test,” he said. “So this will make it even worse.”
Phlebotomists draw blood from people with many types of infections on a regular basis, and monkeypox is nothing new: The United States has seen cases before, including two last year and dozens in 2003. The amount of virus from smallpox in the blood is “low,” according to the CDC, which instructs health care workers to use standard precautions to prevent transmission when handling samples from patients with suspected or confirmed smallpox.
“Some of our phlebotomists have been scared”
Blood tests are needed not only to differentiate between monkeypox and other infections, but also to test for other sexually transmitted infections, such as syphilis, since people with monkeypox sometimes have STIs.
If patients suspected of having smallpox are not having their blood drawn, “the standard of care is not being followed,” said Harvey, the director of the association of sexual health clinics.
In an email to CNN Monday morning, a Quest spokeswoman wrote that “we follow CDC guidelines that state that patients with confirmed or suspected smallpox infection should be isolated. Once an individual is out of ‘isolation, we will offer them service’.
Spokeswoman Kim Gorode sent a link to those CDC guidelines to back up Quest’s policy. However, these guidelines do not say that healthcare services should be delayed until after a period of isolation. In fact, the CDC says its isolation recommendations “do not apply in healthcare settings.” CDC spokeswoman Kristen Nordlund said, “CDC’s monkeypox isolation guidance specifically states that people should remain in isolation except for medical care. Obtaining a sample for testing is medical care that could lead to a diagnosis or treatment if warranted.” Since the first case was identified in the United States in May, the CDC has issued monkeypox infection control guidelines for healthcare providers. This page provides detailed instructions on how to treat these patients safely and notes that transmission in healthcare settings has been “rarely” reported.
Later Monday, Gorode wrote in an email to CNN that “we are now evaluating our guidance in light of the updates posted on the CDC site today.” He did not specify what those updates were. CDC spokesman Jason McDonald said the only update Monday was that the sentence about isolation guidelines not applying to healthcare settings was moved higher on the page.
Gorode added that “we want to ensure that all patients have access to the tests they need while fostering a safe environment for our employees and all of our patients.”
Labcorp executive Dr. Brian Caveney told CNN last week that “up until now, we typically haven’t been doing” blood draws from suspected smallpox patients, but that the company was reviewing its policies and that “probably change”.
Caveney, the company’s president of diagnostics, said Labcorp “is trying to make sure our workforce is safe, but also make sure we’re taking care of our customers while figuring out the right workplace safety rules and policies.”
“(Monkeypox) is new, nobody knew what it was, some nurses and doctors are afraid of it. Some of our phlebotomists have been afraid of it, appropriately,” he said.
But the head of a group of phlebotomists said they should have nothing to fear, as long as they take standard precautions.
Diane Crawford, CEO of the National Phlebotomy Association, said she is “disappointed” that labs are allowing phlebotomists to refuse to draw blood from patients with suspected or confirmed smallpox.
“It’s a problem. It’s like a doctor refusing to take care of a patient,” he said.
Ask CDC to do more education
Caplan, the bioethicist, asked why Quest and Labcorp are now working on guidelines for their phlebotomists when the first case of monkeypox appeared in the US more than two months ago.
“This should have been done by now,” he said.
Caplan said the CDC needs to do more to educate phlebotomists beyond the pages of its website.
“They need an educational deployment (for phlebotomists) and not just issuing guidance. That’s very, very important,” he said.
He said education about standard safety precautions should help phlebotomists feel comfortable taking samples from these patients.
“I don’t want you to get sick or leave or take a new job, which would affect the availability of these services,” he said. “And we have an obligation to make their work as safe and risk-free as possible, and that goes beyond information on websites.”
But Caplan added that at the end of the day, phlebotomists need to draw blood from people who have or may have monkeypox.
“We want you to do that, it’s important to help control outbreaks, and that’s the kind of risk factor you’ve signed up for,” he said.
CNN’s Nadia Kounang contributed to this report.