Clinics treating sexually transmitted diseases, which are already struggling to contain an explosive rise in infections such as syphilis and gonorrhea, are now at the forefront of the country’s fight to control the rapidly growing smallpox outbreak.
After decades of underfunding and two-and-a-half years of a pandemic that severely disrupted care, clinic staff and public health officials say the clinics are ill-equipped for another epidemic.
“America doesn’t have what it needs to properly and totally fight monkeypox,” said David Harvey, executive director of the National Coalition of STD Directors. “We’re already exhausted.”
Smallpox, a cousin of smallpox, is not technically considered a sexually transmitted infection. But it spreads through close contact and is now largely transmitted through networks of men having sex with men.
- Monkeypox: What we know about outbreaks, vaccinations, and treatments
Because the current outbreak of monkeypox causes blisters or pimples on the genitals, many patients seek attention for what appears to be herpes, syphilis, or another sexually transmitted infection. Patients often prefer to seek anonymous care in public clinics, rather than visiting their primary care physicians, due to the stigma of sexually transmitted infections.
Although most people with smallpox recover on their own in two to four weeks, about 10 percent need hospital care, said Dr. Peter Hotez, dean of the Baylor College of Medicine’s National School of Tropical Medicine.
The degree of monkeypox complications “has been much higher than any of us expected,” said Dr. Mary Foote, an infectious disease expert with the New York City Department of Mental Health and Hygiene. speak on July 14 during a webinar presented by the Society of Infectious Diseases of America. In addition to severe pain, some people with monkeypox run the risk of having permanent scars. Foote said the pain can be unbearable, making it difficult for patients to swallow, urinate or make bowel movements.
Sexual health clinics have been stretched so much that many do not have staff to perform such basic tasks as contacting and treating couples of infected patients.
These clinics are some of the most neglected safety nets in the country’s shattered public health system, which has less authority and flexibility to fight outbreaks today than before the COVID-19 pandemic.
With 1,971 cases of monkeypox reported since May in the United States, and about 13,340 worldwide, doctors warn that the epidemic may have grown too large and diffuse because it contains it.
Dr. Shira Heisler, medical director of the Detroit Public Health STD Clinic, said she is proud of the quality of care she provides, but simply does not have time to see all the patients who need care. “We just don’t have the bodies,” he said. “It’s a total collapse of infrastructure.”
Funding from the Centers for Disease Control and Prevention to Prevent Sexually Transmitted Infections has dropped nearly 10 percent since 2003, to $ 152.5 million this year, although only cases of syphilis have been reported. they have more than quadrupled in that time. Taking inflation into account, this funding has fallen 41% since 2003, according to an analysis by the National Coalition of STD Directors.
Meanwhile, hundreds of local and state health professionals tracing the origins, tracing the trajectory and slowing the spread of cases reported by sexual health clinics have abandoned or been replaced since the pandemic began. Some left because of exhaustion and others were fired from their jobs by critics protesting unpopular policies on masks and blockades. Some federal grants to strengthen the public health workforce are being put in place.
Data information systems have not been updated during the pandemic, despite the glaring inadequacies it helped reveal. Public health workers still use fax machines to treat monkeypox cases in Florida and Missouri, public health officials told KHN.
“Even with the benefits of having a test and a vaccine, we haven’t yet invested enough in the public health system so we can respond quickly enough,” said Dr. Tao Kwan-Gett, the state’s scientific director. Washington. Many people “will tell you that we have the best health care system in the world. But I think the COVID-19 pandemic, as well as [the monkeypox] outbreak, shows that the system is broken and needs to be fixed “.
The White House is distributing hundreds of thousands of monkeypox vaccines now, releasing additional doses as they become available, for a total of about 7 million doses over the next year.
But Hotez said those vaccine shipments “may not be enough.”
Some cities are running out of doses shortly after they open their doors. In New York City, where cases of monkeypox have tripled last week, the deployment of the vaccine has been affected by technical errors; the vaccine website has crashed at least twice. San Francisco officials said their city is also running out of vaccine supplies.
Monkeypox vaccines can effectively prevent infection in people before they are exposed to the virus.
Experts believe that vaccines can also help prevent infection after exposure. But they are more effective if administered within four days of close contact with a monkeypox patient, said Dr. Trini Mathew, medical director of antimicrobial management and infection prevention and control in the world. Beaumont Hospital of Taylor, Michigan. Vaccines given between four and 14 days of exposure may reduce symptoms but not prevent the disease.
I don’t think any U.S. health department can handle all the STIs that are reported to them.
However, the battered public health system is not built for speed.
Although smallpox testing has become easier to access in recent days, some public health systems do not have enough staff to quickly locate and test patients’ pairs. And because most health professionals have never managed a case of monkeypox, patients often have to make several visits before being accurately diagnosed.
Contact with exposed people becomes more complicated if they live on the county or state line, which may require coordinating a response to the outbreak with additional health departments, said Shawn Kiernan, head of the Department’s communicable diseases section. of Fairfax County, Virginia.
Decades of budget cuts have led many sexual health clinics to limit their operating hours, making it more difficult for patients to receive care.
Public health departments have lost key members of their teams in recent years, including highly trained nurses and outreach specialists.
A 2020 KHN-AP analysis found that at least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a manpower splattered to meet states ’public health needs. United, and that was before COVID arrived. This research found that only 28% of local public health departments have statisticians or epidemiologists, disease detectives investigating the origin and trajectory of infectious outbreaks.
In 2020, more than 2.4 million sexually transmitted infections were reported, according to the CDC.
“I don’t think any U.S. health department can handle all the STIs that are reported to them,” Kiernan said.
The federal government has spent billions of dollars fighting the COVID pandemic, and some COVID-related grants will be used to expand the general public health workforce.
But the CDC and Congress often designate funds for specific purposes, said Lori Tremmel Freeman, head of the National Association of County and City Health Officials. “If you have someone working at COVID, you can’t reassign them to monkeypox with the same bucket of money,” Freeman said.
And in some states, that money has not yet reached public health departments or sexual health clinics.
The CDC gave Michigan millions of dollars to strengthen its public health workforce, but the Michigan legislature only appropriated a portion of the money. Heisler wrote to several state lawmakers asking them to release the remaining funds. No one answered him.
Public health workers say they expect the monkey’s smallpox to be a wake-up call.
“I hope this will drive the need to invest more in public health infrastructure,” said Kwan-Gett of the Washington state health department, “because without that investment, this will happen over and over again.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Surveys, KHN is one of the top three KFF (Kaiser Family Foundation) operational programs. KFF is a gifted non-profit organization that provides information on health issues in the nation.