A “slow and bureaucratic” response that saw monkeypox spread rapidly across the United States, with more than a thousand cases in New York City alone, reveals how mistreated local health agencies have been since the pandemic Covid, the defenders have said.
Once a rare African virus, monkeypox has implanted itself amid the patchy patchwork of city, county, state and federal agencies that make up the US public health infrastructure.
“Unfortunately, delayed actions mean that monkeypox has spread to the gay community and among other men who have sex with men,” said David Harvey, executive director of the National Coalition of STD Directors.
“This outbreak has become a public health crisis in the United States. We are still in a very chaotic situation at the state and local level with an organized response.”
As an explanation for the chaos, many observers point to how Covid reshaped the landscape of public health officials. Once considered neutral arbiters of information, many health officials came under political attack after unpopular mask and vaccination policies.
Across the country, public health officials were harassed, threatened, fired, or simply burned out and quit. The situation was not helped, as resources that had previously been devoted to things like monitoring communicable diseases, such as tuberculosis, or running routine vaccination clinics, were suddenly diverted to Covid-19 .
Sexual health clinics have also struggled as testing and staffing resources were devoted to Covid-19, hurting organizations that had already suffered years of underfunding.
The result has been worse health outcomes for many basic public health services: routine vaccinations for children have fallen; overdose deaths have exploded; and the US has recorded a record rate of sexually transmitted infections for the sixth year in a row.
As monkeypox has spread, the Biden administration has tried to respond by releasing about 1.1 million vaccines and increasing testing capacity, which has grown from about 6,000 to 80,000 per week. The World Health Organization declared monkeypox a global health emergency this week, and the US could follow suit by declaring monkeypox a national public health emergency, which would free up more resources for agencies locals
“The system is tired, it’s overburdened, it’s underpaid, it’s understaffed,” said Lori Tremmel Freeman, executive director of the National Association of County and City Health Officials. “All the same problems that affected us during the pandemic are still with us and have not gone away.
“What’s added to that, with monkeypox and beyond, is that we also have a workforce that has documented post-pandemic mental health trauma.”
Public health advocates want the president and Congress to allocate more funds to respond to the outbreak and to sexual health clinics in general. Public facilities have proven to be the first line of defense against monkeypox, although federal prevention funding for this work has fallen 41% since 2003.
“Local sexual health providers are being asked to respond to monkeypox on top of an STI epidemic that is already out of control in the United States,” Harvey said. “We are at breaking point: We need the Biden administration and Congress to immediately fund public health programs and STI clinical services.”
Although anyone can get monkeypox, the virus has mostly affected men who have sex with men. Sexual health clinics have often been the first responders to outbreaks because of how monkeypox can present its symptoms, with lesions around the genitals and anus, although sex is only one way how monkey pox can be spread. Any close contact with an infected person can spread the disease, including touching, kissing and hugging, as well as sharing glasses, utensils, bedding and towels.
Although the virus, which belongs to the same family as smallpox, is rarely fatal, the symptoms can be excruciating, with painful lesions and flu-like symptoms, according to the Centers for Disease Control and Prevention. Up to 10 percent of people reportedly require hospitalization, and many present to emergency departments because of severe pain, Freeman said.
The situation is compounded by the fact that testing for monkeypox is limited. There is no at-home test and results can take days. There is, however, a vaccine for which people at high risk may be eligible; they can also opt for treatment with the drug tecovirimat, sold as TPOXX. But the barriers are significant, obtaining it can be complicated, and tecovirimat, normally reserved for people with severe symptoms, must be ordered by doctors from the government’s national strategic national stockpile, which involves a important paperwork
Also, people without insurance likely lack access to both the vaccine and the drugs, Freeman said; about 12.7 percent of the LGBTQ+ community lacks health insurance compared to 11.4 percent of the general population, according to an analysis by federal officials. Even if you have insurance, there are obstacles in the U.S. health care system, such as trying to navigate between urgent care clinics, primary care providers, and state health departments.
Freeman told a story about a local health department that asked their state for information about a monkeypox outbreak. The state responded to consult with CDC; then the CDC redirected local officials to the state.
“There’s a lot of finger-pointing here,” he said. “We should have learned. We should know more now than we did three years ago about our response to Covid [about] what we have to do here”.