Clinics that treat sexually transmitted diseases – which are already struggling to contain an explosive rise in infections such as syphilis and gonorrhea – now find themselves on the front line in the nationwide fight to control the rapidly growing monkeypox epidemic.
After decades of underfunding and a 2.5-year pandemic that severely disrupted care, clinic staff and public health officials say clinics are ill-equipped for a new outbreak.
“America doesn’t have what it needs to adequately and comprehensively fight monkeypox,” said David Harvey, executive director of the National Coalition of STD Directors. “We are already at full capacity.”
Monkeypox – a cousin of smallpox – is not technically considered a sexually transmitted infection. But it spreads through close contact and is now transmitted largely through networks of men who have sex with men.
Since the current outbreak of monkeypox causes genital blisters or pimples, many patients seek care for what appears to be herpes, syphilis, or another sexually transmitted infection. Patients often prefer to seek care anonymously at public clinics, rather than see their GP, due to the stigma of sexually transmitted infections.
Although most people with monkeypox recover on their own in two to four weeks, about 10% need hospital care, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College. of Medicine.
The degree of complications from monkeypox “has been much higher than expected,” said Dr. Mary Foote, an infectious disease expert with the New York City Department of Health and Mental Hygiene, who spoke. on July 14 during a webinar presented by the American Society for Infectious Diseases. In addition to severe pain, some people with monkeypox risk permanent scarring. Foote said the pain can be excruciating, making it difficult for patients to swallow, urinate or have a bowel movement.
Sexual health clinics have been so overstretched that many are understaffed to perform such basic tasks as contacting and treating the partners of infected patients.
These clinics are among the most neglected safety nets in the country’s tattered public health system, which has less authority and flexibility to fight outbreaks today than before the covid-19 pandemic.
With 1,971 cases of monkeypox reported since May in the United States – and around 13,340 worldwide – doctors are warning that the outbreak may have become too large and diffuse for them to contain.
Dr. Shira Heisler, medical director of the Detroit Public Health STD Clinic, said she was proud of the quality of care she provided, but she just didn’t have time to see all the patients who needed care. “We just don’t have the bodies,” she said. “It’s a total collapse of the infrastructure.”
Funding for the Centers for Disease Control and Prevention to prevent sexually transmitted infections has fallen nearly 10% since 2003, to $152.5 million this year, even as syphilis cases alone have more than quadrupled during this period. Adjusted for inflation, this funding has dropped 41% since 2003, according to an analysis by the National Coalition of MST Directors.
Meanwhile, hundreds of local and state health professionals who trace the origins, track the trajectory and stop the spread of cases reported by sexual health clinics have resigned or been replaced since the start of the pandemic. Some left due to burnout, and others were driven from their jobs by critics protesting unpopular policies on masks and closures. Some federal grants to strengthen the public health workforce have just been rolled out.
Data reporting systems have not been updated during the pandemic, despite the glaring inadequacies it has helped expose. Public health workers are still using fax machines to handle monkeypox cases in Florida and Missouri, public health officials told KHN.
“Even with the benefits of having a test and a vaccine, we still haven’t invested enough in the public health system to be able to respond quickly enough,” said state chief science officer Dr Tao Kwan-Gett. from Washington. Many people “will tell you that we have the best health care system in the world. But I think the covid-19 pandemic, as well as [the monkeypox] epidemic, shows that the system is broken and needs to be repaired.
The White House is currently distributing hundreds of thousands of monkeypox vaccines, releasing additional doses as they become available, for a total of nearly 7 million doses over the next year.
But Hotez said those vaccine shipments “may not be enough.”
Some cities run out of doses soon after opening their doors. In New York, where monkeypox cases tripled last week, the vaccine rollout has been plagued with technical issues; the vaccine website crashed at least twice. San Francisco officials said their city was also running out of vaccine supplies.
Monkeypox vaccines can effectively prevent infection in people before they are exposed to the virus.
Experts believe vaccines can also help prevent infection after exposure. But they are most effective if given within four days of close contact with a patient with monkeypox, said Dr. Trini Mathew, medical director of antimicrobial stewardship and infection prevention and control at the Beaumont Hospital in Taylor, Michigan. Vaccines given between four and 14 days of exposure can reduce symptoms but not prevent disease.
Yet the battered public health system is not built for speed.
Although monkeypox testing has become easier to access in recent days, some public health systems do not have enough staff to quickly locate and test patients’ partners. And because most healthcare professionals have never seen a case of monkeypox, patients often have to make multiple visits before they are accurately diagnosed.
Contacting those exposed becomes more complicated if they live on the other side of the county or state, which may require coordinating an outbreak response with other health departments, Shawn Kiernan said. , chief of the Communicable Disease Section of the Fairfax County Health Department in Virginia.
Decades of budget cuts have led many sexual health clinics to limit their hours of operation, making it harder for patients to receive care.
Public health departments have lost key members of their teams in recent years, including highly trained nurses and outreach specialists.
A 2020 KHN-AP analysis found that at least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a workforce in tatters to meet public health needs across the country. America – and that was before covid hit. This survey found that only 28% of local public health departments have statisticians or epidemiologists, the disease detectives who investigate the source and trajectory of infectious outbreaks.
More than 2.4 million sexually transmitted infections were reported in 2020, according to the CDC.
“I don’t think any health department in America can handle all the STIs that come to them,” Kiernan said.
The federal government has spent billions of dollars to fight the covid pandemic, and some covid-related grants will be used to expand the overall public health workforce.
But the CDC and Congress often designate funds for specific purposes, said Lori Tremmel Freeman, head of the National Association of County and City Health Officials. “If you have someone working on covid, you can’t just reassign them to monkeypox using the same bucket of money,” Freeman said.
And in some states, that money has yet to reach public health departments or sexual health clinics.
The CDC gave Michigan millions of dollars to bolster its public health workforce, but Michigan’s legislature earmarked only a portion of the money. Heisler wrote to several state lawmakers begging them to release the remaining funds. None answered him.
Public health officials say they hope monkeypox will be a wake-up call.
“I hope this drives home the need for more investment in public health infrastructure,” said Kwan-Gett of the Washington State Department of Health, “because without that investment, this is going to happen again. and even”.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.