The “slow and bureaucratic” response to the rapid spread of monkeypox in the US – with more than a thousand cases in New York alone – shows how badly local health facilities have been hit since the Covid pandemic, advocates say.
Monkeypox, a once-rare African virus, gained momentum amid the ragged efforts of the cities, counties, states and federal agencies that make up the U.S. public health infrastructure.
“Unfortunately, the delayed action means monkeypox has spread in 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 epidemic has become a public health crisis in America. We are still very confused at the state and local level with an organized response.”
As an explanation for the confusion, many observers point to how Covid has changed the landscape for public health workers. Many health officials, who are considered impartial arbiters of information, have come under political attack following the unpopular mask and vaccination policies.
Across the country, public health workers have been harassed, intimidated, fired, or simply burned out and quit. The situation has not been helped by resources once devoted to things like tracking infectious diseases like tuberculosis or running routine vaccination clinics, suddenly laughing at Covid-19.
Sexual health clinics have also been hit hard as testing and staffing resources have been diverted to Covid-19 and organizations that have been underfunded for years have been hit.
As a result, the health of many key public health services has deteriorated: routine vaccinations for children have declined; overdose deaths exploded; and the U.S. reported a record number of sexually transmitted infections for the sixth straight year.
As monkeypox spread, the Biden administration tried to respond by releasing 1.1 million vaccines and increasing testing capacity, which has grown from about 6,000 to 80,000 per week. The World Health Organization this week declared monkeypox a global health emergency, and the U.S. declared monkeypox a national public health emergency, freeing up more resources for local agencies.
“The system is tired, it’s overworked, it’s underpaid, it’s underfunded,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Employees. “All the problems that plagued us during the pandemic are still here and have not gone away.
“Added to that monkeypox and beyond that, we have a post-pandemic traumatized mental health workforce.”
Public health advocates want the president and Congress to allocate more funds to the epidemic and to sexual health clinics in general. Public facilities have proven to be the first line of defense against monkeypox, even as federal prevention funding has been cut by 41% since 2003.
“Local sexual health providers are being asked to respond to monkeypox because there is no control of the STD epidemic in America,” Harvey said. “We’re at a crossroads: We need the Biden administration and Congress to immediately fund STI public health programs and clinical services.”
Although anyone can get monkeypox, the virus primarily affects men who have sex with men. Sexual health clinics have often fought outbreaks because monkeypox can show symptoms, such as sores around the genitals and anus, but sex is only one way monkeypox spreads. Close contact with an infected person, including touching dishes, kissing, caressing, and sharing glasses, sheets, and towels, can spread the disease.
According to the Centers for Disease Control and Prevention, a virus from the same family as smallpox is rarely fatal, but symptoms can be excruciating, with painful sores and flu-like symptoms. About 10% of people reportedly require emergency care, and most end up in wards because of severe pain, Freeman said.
The situation is exacerbated because monkeypox testing is limited. There is no at-home test and results may take several days. However, there is a vaccine for which high-risk individuals may be eligible; they may also be eligible for treatment with the drug tecoxiramit, sold as TPOXX. But the hurdles are significant, it can be difficult to obtain, and the certificate – often for people with severe symptoms – must be requested by doctors in the government’s national strategic warehouse, which requires significant paperwork.
In addition, people without insurance have less access to vaccines and medications, Freeman said; According to an analysis by federal officials, about 12.7% of the LGBTQ+ community lacks health insurance, compared to 11.4% of the general population. Even if you have insurance, the US health care system has hurdles like trying to navigate between emergency clinics, primary care and state health departments.
Freeman told the story of a local health department that asked his state for information about an outbreak of monkeypox. The state responded to an inspection with the CDC; The CDC then sent local officials back to the state.
“There’s a lot of finger-pointing going on here,” he said. “We had to learn. We need to know more about our response to Covid now than we did three years ago [about] what should we do here.’