The outbreak of monkeypox should have been easy to eradicate. Even before the current outbreak, tests and vaccines were at hand because the virus doesn't spread efficiently.
The response in the United States has been slow and timid, reminiscent of the early days of the Covid epidemic, raising troubling questions about the nation's readiness for a potential Pandemic.
The first cases of monkeypox were reported in May, but tests won't be available for a while. There will be a shortage of vaccines for a long time. The official case counts are likely to be underestimated.
At least 700 cases have been reported in the United States, but experts think the real number is much higher. If it can't be controlled at this point, there will be many more infections.
Anne Rimoin, an epidemiologist at the University of California, Los Angeles, was the first to warn of a monkeypox outbreak. We have to go through this many times.
New diseases will emerge more frequently with increased travel and trade. It is time to wake up.
The experts said that the obstacles to readiness are systemic at every level of government.
The public health system in the United States is still hamstrung despite the fact that the coronaviruses have been around for three years. Its weaknesses have persisted for a long time.
The United States estimated in 2010 that in the event of a bioterrorist attack, 132 million doses of a vaccine would be required for people who can't take an older- generation vaccine. After the current outbreak began, the national stockpile held just 64,000 doses.
The situation shows that the US does not take public health seriously. Do we ever run out of jet fighters?
Monkeypox is what it is. In parts of Central and West Africa, there is a disease called monkeypox. It is not as bad as smallpox. According to the Centers for Disease Control and Prevention, it was discovered in the 50's.
The symptoms are what they are. People who have been bitten by the Monkeypox will have a rash that starts with red marks and grows into a large lump of flesh. Symptoms can take as long as three weeks after exposure to show and can last as long as four weeks. Vaccines and other treatments can be used to stop an outbreak.
What is it that makes it infectious? Some experts think that the virus could occasionally be airborne. It has spread in unusual ways this year and among populations that have not been at risk in the past.
What is happening in the US? The rapid spread of monkeypox across the country and the government's slow response raises questions about the nation's ability to deal with a Pandemic threat. Vaccines will be in short supply for a long time due to the unavailability of tests. The official case counts are likely to be underestimated.
It can be difficult to know which agency is responsible for a particular part of the response. The strategic national stockpile used to be under the control of the CDC. The C.D.C. still makes decisions about who should get the vaccine despite the fact that it was handed to a different agency.
State and county health departments have their own rules and priorities. An activist and epidemiologist at the Yale School of Public Health said that the machine is ossified. Everything is moving at normal speed as the house is on fire.
The global monkeypox toll has surpassed 8,100 cases, mostly men who have sex with men, and about as many possible cases are under investigation. Many of the patients can't identify the source of their infections.
The C.D.C. has found at least two different versions of the virus in the US.
Jay Varma is the director of the Cornell Center for Pandemic Prevention and Response.
The first mistakes in the US response to monkeypox were made. It can take days for samples from monkeys to be sent to the C.D.C. for final diagnosis. Only recently has a test been shipped to a commercial lab.
There is a network of public health labs that can identify orthopoxviruses. The same process used in early 2020 to identify coronaviruses can be used to clear local doctors.
The local health departments trace contacts only after a confirmed diagnosis.
Covid was able to get its footprint in the U.S. and spread undetected for a month, without any of us knowing.
We are doing the same thing all over again because that is how it is done.
She said: "Our failure to do that has almost certainly allowed the outbreak to become much larger than it could have been, and now I have serious doubts about whether it can even be stopped."
B, a 43-year-old medical writer who asked that his name be kept out of the public eye for privacy reasons, was in San Francisco on June 14, eight days after he had sex at a bathhouse in Chicago.
He suspected monkeypox when he saw a blisters on B's wrist. After the Juneteenth holiday, the city's health department won't be able to pick up his sample.
No one reached out to him to inquire about his contacts or give him a vaccine. It was Friday, a week later, before the sample was picked up, and the next day he was told he had tested positive for an orthopoxviruses.
He no longer needed to be isolated. He said that the irony of this happening on the same day as a test result is not lost on him.
He was told by the health department that it would take another week for the C.D.C. to confirm he had monkeypox.
B said that there were two blisters and a rash on his butt. He doesn't think we're prepared for another epidemic that's serious.
A senior Biden administration official, who spoke on condition of anonymity to discuss internal matters, acknowledged that implementation of monkeypox testing had not been as easy as it needed to be.
The first cases were identified in the third week of May and that's when the negotiations began. It took time to set up contracts, scale up test supplies and train personnel.
The C.D.C. published test procedures in June and the F.D.A. authorized additional test supplies. He said that the wait time for test results has dropped from 15 days to 9 days from the start of symptoms.
A lack of sexual health clinics is one of the barriers toContaining a disease like monkeypox.
In the current outbreak, the majority of patients have only a few pox, mostly in the genital area. Patients with genital symptoms are more likely to seek care at sexual health clinics because they tend to offer confidentiality, convenience and free or low cost care.
The funding for these clinics has gone down after accounting for inflation. According to a C.D.C. report, there was a decline in sexually transmitted infections in the US in the last year.
Men who have sex with men are more likely to be affected by monkeypox if it can't be contained. It is feared that this will become entrenched as an S.T.I. or H.I.V. for that reason.
He said that without a lot of high quality sexual health services, you won't be able to control it.
The National Coalition of STD Directors wants at least $30 million to strengthen sexual health clinics. David Harvey, the organization's director, said that states and cities are largely on their own.
Where is the money, the resources, the training that is needed at the nation's S.T.D. clinics to respond to an out-of-control outbreak?
Janet Hamilton is the executive director of the Council of State and Territorial Epidemiologists.
Public health funds can't be used for anything other than Covid. She thinks that the public needs and expects us to function at the level that we cannot. We don't learn this lesson for the first time.
The message to men who have sex with men, which encourages caution while recognizing people's needs, was praised by the experts.
The C.D.C. doesn't stigmatize them for wanting to have sex and enjoy themselves. It is one of the best harms reduction advice I have seen.
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