Clinics that treat sexually transmitted diseases — already experiencing an explosive increase in diseases such as syphilis and gonorrhea — are now on the front lines of the fight to control the rapidly growing monkeypox outbreak.
With decades of funding shortfalls and a two-and-a-half-year pandemic that has increased their workload and severely hampered care, health professionals and public health officials say the clinics are ill-equipped for another pandemic.
“The United States does not have what it takes to adequately combat monkeypox,” said David Harvey, executive director of the National Coalition of Directors of Sexually Transmitted Diseases (STDs). “We are already at the limit of our capacity.”
Monkeypox – related to the smallpox virus – is not technically considered a sexually transmitted infection. But it spreads through intimate contact and is now transmitted primarily through networks of men who have sex with men.
The current outbreak of monkeypox causes genital blisters or pimples, so many patients seek care for herpes, syphilis or other sexually transmitted infections. Because of the stigma of sexually transmitted infections, patients often prefer to seek care anonymously in public clinics rather than their usual GP.
According to Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, most people with monkeypox recover on their own within two to four weeks, but 10% require hospital care.
Although monkeypox is traditionally considered a mild illness, the rate of complications is “much higher than any of us expected,” said Dr. Mary Foote, an infectious disease specialist at the New York City Department of Health and Mental Health, speaking July 14 in a webinar presented by the Infectious Diseases Society of America. Keeping In addition to severe pain, some people with monkeypox are at risk of permanent scarring.
Sexual health clinics are so overwhelmed that many lack the staff to perform basic tasks such as contacting and treating the partners of infected patients.
Sexual health clinics are one of the most neglected safety nets in the country’s ailing public health system, with less authority and flexibility to combat outbreaks today than before the Covid-19 pandemic.
With 1,052 cases of monkeypox reported in the United States since May — and more than 10,800 worldwide — doctors say the epidemic has grown too large and widespread to contain.
Dr. Shira Heisler, medical director of the Detroit Public Health STD Clinic, said she’s proud of the care they provide, but doesn’t have time to see every patient who needs care.
“We just don’t have the staff,” Heisler explained. “It’s a total collapse of the infrastructure.
Centers for Disease Control and Prevention (CDC) funding for sexually transmitted infections has fallen by $16 million to $152.5 million since 2003, although it has quadrupled in that time for syphilis. Adjusted for inflation, that funding has dropped 41% since 2003, according to an analysis by the National Coalition of HTA Directors.
Meanwhile, hundreds of state and local health professionals who tracked, traced and stopped the spread of cases reported by sexual health clinics have resigned or been replaced since the epidemic began. Some quit due to exhaustion and others were fired from their jobs due to criticism of the unpopular mask and lockdown policy. Federal grants announced to strengthen public health workforce.
Data reporting systems have not been updated despite the obvious flaws revealed by the pandemic. Public health workers from Florida to Missouri continue to use fax machines to treat monkeypox, public health officials told KHN.
“Despite the benefits of testing and having a vaccine, we still haven’t invested enough in the public health system to be able to respond quickly,” said Dr. Tao Kwan-get, Washington state’s chief scientific officer. Many “will tell you that we have the best health care system in the world. But I think the Covid-19 pandemic, as well as outbreaks [de viruela del simio]They show that the system is broken and needs to be fixed.”
It’s not built for speed
The White House is distributing tens of thousands of monkeypox vaccines, totaling 1.9 million doses this year and another 2.5 million doses next year.
But Hotez assured that that vaccine shipment “may not be enough.”
Some cities ran out of doses soon after they opened their doors. In New York City, where monkeypox cases tripled last week, the rollout of the vaccine has been plagued by technical glitches; The vaccine website has been down at least twice. San Francisco authorities said their city is also running out of vaccines.
The monkeypox vaccine can effectively prevent infection in humans before exposure to the virus.
Experts believe vaccines can help prevent infections after exposure. But they are most effective if given within four days of close contact with a monkeypox patient, said Dr. Trini Mathieu, an epidemiologist at Beaumont Hospital in Taylor, Michigan. Vaccines given four to 14 days after exposure can reduce symptoms but do not prevent disease.
However, battered public health systems are not built to act quickly.
Although access to monkeypox testing is easy, some public health systems do not have sufficient staff to rapidly identify and test partners of patients. And since most health professionals have never handled a case of monkeypox, patients often have to undergo multiple visits before being properly diagnosed.
Contacting them is more complicated if they live across the county or across the state, according to Sean Kiernan, chief of the infectious disease division.
Decades of budget cuts have limited many sexual health clinics to their operating hours, making it difficult to care for patients.
The Department of Public Health has lost key members of its team in recent years, including highly trained nurses and community outreach specialists.
A 2020 KHN analysis revealed that at least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a workforce stranded to address America’s public health needs, and that was before Covid hit.
“The system is over,” said Dr. Louise Ostrowski, an infectious disease specialist at UTHealth Houston/Memorial Hermann Hospital.
A 2020 KHN/AP investigation found that only 28% of local public health departments have statisticians or epidemiologists, disease detectives who investigate the source and trajectory of infectious outbreaks.
“What if only 28% of emergency rooms have doctors?” asked Brian Castrucci, president and CEO of the Beaumont Foundation, a nonprofit organization that works to strengthen public health.
Staffing shortages often lead high-skilled health providers to take on tasks that could be performed by people at much lower wages. When Heisler’s clinic is full, professional nurses have to clean exam rooms between patients.
And while a case manager usually works with newly diagnosed HIV patients and reminds them of appointments, Heisler now has to make those calls herself; The case manager now has to deal with monkeypox.
According to the CDC, in 2020, more than 2.4 million sexually transmitted infections were recorded.
“I don’t think any health department in the United States can handle all the infections that are reported to them,” Kiernan said.
The federal government has spent billions fighting the pandemic, and some of the Covid-related grants will be used to expand public health workers across the board.
But the CDC and Congress often earmark funding for specific purposes, said Lori Tremmel Freeman, director of the National Association of County and City Health Officers. “If you have someone working on Covid, you can’t reassign them to Monkeypox using the same money,” Freeman added.
And in some states, that money still hasn’t reached public health departments or sexual health clinics.
The CDC has given Michigan millions of dollars to improve its public health workforce, but part of the money was appropriated by the state legislature. Heisler wrote to several state legislators asking for the remaining funds to be released. No one answered. KHN reached out to the same lawmakers, but they also did not receive a response.
Public health workers say they hope monkeypox is a wake-up call.
“I hope this points to the need for more investment in public health infrastructure,” said Quan-Gate of the Washington State Department of Health, “because without that investment this is going to happen again and again.”
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