Testing vital for monkeypox control, but ‘shocking’ lack of demand

For example, Mayo Clinic Laboratories has the capacity to process 1,000 monkeypox samples per week, but has received only 45 samples from doctors since monkeypox testing began on July 11. Another of the labs, Aegis Sciences Corp., can do 5,000 tests a week, but has Has received zero samples in the last two weeks. At Labcorp, one of the largest commercial laboratories in the U.S., uptake was high but still “very low,” says Dr. Brian Caveney, the lab’s president of diagnostics.

These numbers are “shocking,” the doctor said. Peter Chin-Hong, member of the California Department of Public Health’s Monkeypox Virus Scientific Advisory Committee.

“It’s really, really disturbing. It’s like Covid PTSD,” he said, referring to the early phase of the pandemic, when testing for the coronavirus was very limited. While the concern is the same, the reasons are different, as testing capacity for Covid-19 has been low, while capacity for monkeypox is high but demand is low.

In this outbreak, the first case of monkeypox in the United States was reported on May 17, and the virus has spread rapidly, reaching 4,639 suspected or confirmed cases, almost all of them in men who have sex with men. Controlling the outbreak has been a challenge for the US Centers for Disease Control and Prevention and the Biden administration, which is expected to name a monkeypox coordinator and is considering declaring the virus a public health emergency.

Dr. Anthony Fauci, President Biden’s chief medical adviser, described the testing as a “pillar” of the government’s monkeypox response. He and other health officials have repeatedly assured Americans that testing capacity is high, with labs capable of processing 80,000 samples a week. Most of this capacity – 70,000 samples – is in private laboratories.

The CDC has recruited five labs to handle the growing number of cases. Two of them, Quest Diagnostics and Sonic Healthcare, declined to tell CNN how many monkeypox samples they received, but “the capacity of the five commercial labs right now far exceeds the demand we’re seeing,” said Susan Van Meter, president of the American Association of Clinical Laboratories.

Testing is a key part of monkeypox containment efforts for two reasons: It’s the first step in identifying and isolating patients, and it gives public health officials an idea of ​​the scale of the outbreak and which geographic areas need the most resources.

“Without testing, you’re flying blind,” the doctor said. William Morris, Chairman of the Board of Directors of the American Association of Clinical Laboratories and President of the Mayo Laboratory. “The biggest concern is that you’re not identifying cases and [monkeypox] It may become an endemic disease in this country. That’s something we should be really concerned about.”

Chin-Hong compared the low lab results to “walking around with Vaseline in your eyes: you’re not seeing the whole picture.”

Dr. Matthew Hardison, senior vice president of Aegis, warns that “if you don’t do enough testing, you won’t find it and it will continue to spread, and we’re seeing significant growth in a number of other areas.” states across the country now.”

A steep learning curve

So far this year, there have been several dozen cases of monkeypox in the United States. As with any emerging pathogen, the CDC has made it a point to educate health care workers on how to identify, test for, and treat the disease.
According to doctors, it is better to look for men who have sex with men who have monkeypox
The agency sent emails through its Health Alert Network, held two calls to more than 17,000 doctors and other clinicians, and set up a phone line for doctors to ask questions. The CDC also sent emails to doctors announcing the availability of testing at five private laboratories.

According to a CDC spokesperson, “monkeypox has been in close contact with clinics and the general public to raise awareness of risk factors, symptoms and testing options.”

JAMA and other medical journals also offered information on how to identify, test, and treat monkeypox.

“The message is definitely getting out,” said a federal health adviser who spoke on condition of anonymity because they are not government employees and do not speak for any federal agency. “Our hope is that every clinical provider in the country knows about monkeypox and when to get tested.”

But even with that knowledge, monkeypox can be difficult to diagnose because the rash isn’t always distinctive, Caveney said.

“It looks like it’s just a pimple or something,” she said.

The head of the World Health Organization has advised men who have sex with men to reduce their risk of monkeypox

Because monkeypox is transmitted through prolonged skin-to-skin contact, the doctor should also take a detailed and thorough history of the patient.

“It’s important for clinicians to get a clear history of contact with someone a week or two ago, and then look at the lesion and say, ‘Oh, this is not just, you know, normal.’ Your skin. This is what I have to try,” he said.

Caveney added that as doctors learn more about monkeypox, he expects the number of tests to increase.

Other barriers to testing

Experts say education is just one reason for the slow adoption of testing.

Second, some people with symptoms of monkeypox may not seek help for fear of stigmatization.

'You don't want it' virus: California man with monkeypox urges others to get vaccinated

“They may think, ‘I think I’m socially unpopular: I have sex with men, I’ve had multiple sex partners, or I haven’t used protection.’ That’s what monkeypox says now, and you can imagine they don’t want to say it all,” said Chin-Hong, an infectious disease specialist at the UCSF School of Medicine who treats people with monkeypox.

Also, many members of the LGBTQ community are accustomed to seeking help from sexual health clinics that now treat monkeypox patients and their ongoing burdens, said David Harvey, executive director of the National Coalition of STD Directors. and private sexual health clinics and programs.

He said about half of the clinics in his organization don’t send samples to private labs because it’s too expensive to hire staff to do the paperwork, which helps explain why the rate of monkeypox tests at private labs is so low.

“In the (sexually transmitted infection) area, it’s very frustrating to hear information from the White House and the CDC about the availability and availability of vaccine trials because implementation issues are not being discussed in your daily clinic.” Harvey said.

A CDC spokeswoman said the agency “encourages anyone who suspects they have monkeypox to contact their clinic for testing because testing is available.”

More than 100 members of Congress wrote a letter to the Biden administration on Monday calling for additional funding for sexual health clinics to improve efforts to combat monkeypox.

“As monkeypox continues to spread, states and communities will rely on the expertise of health clinics and their community outreach efforts in case detection, contact tracing, symptom control, and public education to slow the spread of this virus.” in the letter.

CNN’s Brenda Goodman, Jamie Gumbrecht and Daniel Herman contributed to this report.

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