Some laboratory professionals refuse to draw blood from monkeypox patients, raising concerns about stigma and delays in testing.

Labcorp and Quest do not dispute that in many cases their phlebotomists do not draw blood from monkeypox patients. After the company’s statements and CNN’s observations, it remains unclear whether phlebotomists are refusing to draw blood on their own or if company policy is preventing them. The two testing giants said they are reviewing their security policies and procedures for their employees.

Infectious disease experts who treat cases of monkeypox say the refusals are based on stigma and slow efforts to identify and isolate cases of monkeypox, and the country’s health officials have been criticized for struggling to contain the outbreak. According to the US Centers for Disease Control and Prevention, there were 6,326 cases of monkeypox as of Tuesday, an 81% increase from a week earlier.

“It’s absolutely inexcusable. It’s a serious abdication of responsibility,” said David Harvey, executive director of the National Coalition of STD Directors, which represents 1,600 U.S. sexual health clinics, some of which include 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 a variety of clinics and physician offices and patient care centers across the country.

Although monkeypox can be treated with swabs, blood tests are needed to distinguish the virus from other types of infection, infectious disease experts say. Harvey said doctors at sexual health clinics were forced to find workarounds when phlebotomists refused to draw blood from patients with suspected monkeypox.

“We cannot afford delays in diagnostic testing because commercial labs are wrong,” he said.

Harvey adds that rejections are “a modern example of coding” – the perspective of others.

“It reminds me of the old days when people didn’t want to care for people with HIV,” said Arthur Kaplan, a bioethicist at New York University.

In the US, monkeypox was mostly among men who had sex with men, and if the technician didn’t take blood, it would “perpetuate more stigma, fear and anxiety” for the already stigmatized virus, added Dr. Peter Chin-Hong, member of the California Department of Public Health’s Monkeypox Virus Scientific Advisory Committee, Care of Monkeypox Patients.

According to Chin-Hong, an infectious disease specialist at UCSF Health, men avoid getting tested for the virus for fear of stigmatization.

“The fact that phlebotomists are afraid to take samples makes it even more unpleasant for someone to ask for a monkeypox test,” he said. “So that makes it worse.”

Phlebotomists regularly draw blood from people with a variety of infections, and monkeypox is nothing new: The U.S. has already seen two cases, including two last year and dozens in 2003. The number of smallpox virus in the blood is “low”. CDC instructs healthcare workers to use standard precautions to avoid transmission when handling specimens from patients with suspected or confirmed monkeypox.

“Some of our phlebotomists are freaking out.”

Blood tests are needed not only to distinguish between monkeypox and other infections, but also to check for other sexually transmitted infections, such as syphilis, because people with monkeypox sometimes have STDs.

If blood is not drawn from patients with suspected monkeypox, “the standard of care is not maintained,” said Harvey, director of the Association of Sexual Health Clinics.

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In an email to CNN on Monday morning, a spokesperson for Quest wrote that “we follow CDC guidelines that state that patients with confirmed or suspected monkeypox infection should be isolated. Once the person is released from isolation, we will provide them with services.”

Spokeswoman Kim Gorode sent a link to these CDC guidelines in support of Quest’s policy. However, these guidelines do not say that health services should be delayed until isolation is completed. In fact, the CDC says its isolation recommendations “do not apply in healthcare settings.”
CDC spokeswoman Kristen Nordlund said, “CDC isolation guidelines for monkeypox state that people should remain isolated in addition to receiving medical care. Taking a sample for testing is medical care that leads to diagnosis or treatment.”
Since the first U.S. case was identified in May, the CDC has issued guidelines for health care workers to monitor monkeypox infections. The page provides detailed guidance on how to safely treat these patients and notes that transmission in health care settings is “rarely” reported.
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“We are evaluating our guidance based on the updates posted on the CDC website today,” Gorod wrote in an email to CNN. He did not specify what those updates were. CDC spokesman Jason MacDonald said Monday that the only update was that the ruling that isolation guidelines did not apply to health care facilities had been moved to the top of the page.

Gorode added, “we want to ensure that every patient gets the testing they need, while creating a safe environment for our staff and all of our patients.”

Executive Director of Labcorp Dr. Brian Caveney told CNN last week that “so far we have not received blood from patients with suspected monkeypox,” but that the company is reviewing its policy and that “may change.”

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Caveney, the company’s president of diagnostics, said Labcorp is “trying to make sure our workforce is safe, but we’re also trying to make sure we’re taking care of our customers when we develop appropriate health and safety regulations and policies.”

“(Monkey pox) is new — nobody knew what it was — some nurses and doctors were afraid of it. Some of our phlebotomists were afraid of it,” he said.

But the head of a group of phlebotomists said they need not fear as long as they take standard precautions.

Diane Crawford, CEO of the National Phlebotomy Association, said she is “dismayed” that labs are allowing phlebotomists to refuse to draw blood from patients with suspected or confirmed monkeypox.

“It’s a problem. It’s like a doctor refusing to take care of a patient,” he says.

CDC calls for more education

Kaplan, the bioethicist, questioned why Quest and Labcorp were working on guidelines for their phlebotomists more than two months ago when the first case of monkeypox appeared in the United States.

“It should have been done long ago,” he said.

Kaplan said the CDC needs to do more to educate phlebotomists beyond pages on its website.

“They need an education program (for phlebotomists) and not just instruction. That’s very important,” he said.

He said education about standard safety precautions should help phlebotomists feel more comfortable collecting samples from these patients.

“I don’t want you to get sick, leave or start a new job, which would compromise the availability of these services,” he said. “And we’re committed to making their work as safe and risk-free as possible, and that goes beyond information on websites.”

But Kaplan added, eventually, phlebotomists must draw blood from people who have or have had monkeypox.

“We want you to do it, it’s important to help control the epidemic, and it’s a risk factor that you’re signing up for,” he said.

CNN’s Nadia Kounang contributed to this report.

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