Dr. Emily Druiega, of the University of Illinois Health System, and Maggie Butler, a registered nurse, prepare monkeypox vaccines at the nonprofit Test Positive Aware Network clinic in Chicago, Illinois, July 25, 2022.
Eric Cox | Reuters
Dr. Ward Carpenter, co-director of health services at the Los Angeles LGBT Center, said the monkeypox outbreak in the US is worse than expected.
“We are just as busy, just as stressed and living in the same chaos as we were at the start of Covid,” he said.
The Los Angeles LGBT Center has had to replace so much of its staff to respond to the outbreak that it no longer has the capacity to provide emergency care for its patients, Carpenter said. The center provides monkeypox vaccinations, testing and treatment in addition to its usual services, which include primary care, HIV care, sexual health, women’s health and mental health.
“We have people who have nothing to do with this kind of work who have stopped doing their normal work and started working on this answer,” Carpenter said.
US health officials declared monkeypox a national health emergency on Thursday as cases surged and clinics struggled. STD clinics in major cities across the country are serving as the first line of defense in efforts to contain the virus in the US, offering care and guidance to gay and bisexual men who currently face the greatest threat from the disease.
Clinics are struggling
The surge in patients needing vaccines, tests and treatments for the disease as infections rise is putting pressure on a system already strapped for resources after years of underfunding, doctors say.
Monkeypox is primarily spread through skin-to-skin contact during sex. Since the UK first alerted the world to the virus in May, sexual health clinics around the world have been the eyes and ears of national public health systems, identifying unusual symptoms that diverge from the usual description of the disease in the medical literature.
Doctors at clinics in Los Angeles and Chicago, major centers of the current outbreak in the US, say they are struggling to meet demand for vaccines, tests and treatment from the communities they serve and need financial support to respond to the outbreak .
The U.S. has reported more than 7,000 cases of monkeypox in 48 states, Washington, D.C. and Puerto Rico, according to the Centers for Disease Control and Prevention. The outbreak has spread rapidly since health officials in Boston confirmed the first US case in May.
Monkeypox is rarely fatal and no deaths have been reported in the US, but some patients experience such excruciating pain from the rash, which often develops on the genitals or anus, that they require hospitalization.
“Pain for weeks”
“Unless you’ve potentially experienced pain in those sensitive areas, it might be hard to conceptualize what it is, but it’s not something that clears up with some antibiotics in a few days.” People live with this pain for weeks,” said Dr. Anu Hazra, a physician and infectious disease expert at Howard Brown Health in Chicago.
Although gay and bisexual men are currently at greatest risk, public health officials have repeatedly stressed that anyone can contract monkeypox through physical contact with someone infected with the virus or through contaminated materials such as towels and sheets .
“Monkey pox doesn’t care if you’re gay. He doesn’t care what gender you are,” Hazra said. “Monkeypox only cares if you’ve been in close contact with another person who has monkeypox.”
Carpenter said the U.S. has an opportunity to contain the epidemic while it is still largely confined to a close-knit community of gay and bisexual men, but as infections rise, the risk that the virus will begin to spread more widely increases.
“We’ve now had two outbreaks in a row that have not been managed in a way that allows them to be contained,” Carpenter said. “It will take a co-ordinated, committed and comprehensive public health strategy that goes from the top down and treats it as seriously as Covid,” he said.
An influx of patients
The Los Angeles LGBT Center learned in early May that monkeypox would become a major health concern for the communities it serves after cases reported in Europe showed transmission taking place through sexual networks of gay and bisexual men. according to Carpenter.
Staff at the center had never encountered monkeypox before, so they began educating themselves about the virus. But the patients had symptoms not described in the medical literature, such as single lesions in the genital and anal areas. They didn’t know their first patient had monkeypox until the results came back because the symptoms didn’t match the textbook description.
“We knew very early on that this wasn’t going to behave like the book,” Carpenter said. “We’re not just learning from the books, but as we go and see clients, we’re actually learning what this new epidemic looks like and how it differs.”
More and more patients started coming in for checkups in late June, when Pride Month ended, Carpenter said. The center tests up to 15 people a day, and patients who have sexually transmitted infections now need a full skin exam to see if they may also have monkeypox.
Hazra said the number of people coming in for monkeypox screenings at Howard Brown Health in Chicago has increased exponentially since May.
Appeals for federal support
Some US lawmakers and local communities criticized the speed of the federal government’s response, but Health Secretary Xavier Becerra said last week that the Biden administration had done everything it could to increase the availability of vaccines, tests and treatment to fight the epidemic.
More than 100 members of Congress told President Joe Biden in a letter late last month that the administration must do more to support frontline sexual health clinics. They called on Biden, Becerra and CDC Director Rochelle Walensky to commit at least $30 million in funding to clinics fighting the outbreak through the CDC’s Division of STD Prevention.
“If we do not provide adequate funding for STI clinics across our country now, it will become significantly more challenging to eradicate monkeypox in the coming months,” Reps. Jerrold Nadler, D-NY, and David Cicilline, D-RI, wrote in the letter in the letter .
Hazra, of Howard Brown in Chicago, said that Covid shows that public health as a whole is chronically underfunded. Sexual health is even more ignored, he said. Federal funding for STD prevention has fallen 41 percent since 2003, adjusted for inflation, according to the National Coalition of STD Directors, a national association of state health officials who work in sexual health.
Although monkeypox is not classified as a sexually transmitted disease, sexual health clinics are the main point of care for many people who have the virus that causes the rash, which can be confused with sexually transmitted infections. A survey of 80 clinics in late July found that 40 percent had unexpected costs for supplies and staff because of the monkeypox outbreak, while 65 percent stopped seeing patients and switched to appointment-only because of capacity issues, according to the coalition.
“There’s absolutely not enough funding,” Carpenter said. “Local health centers like ours play a really important role in responses like this, but we don’t have the capacity to plug in a dime, shift and double our capacity to be able to deal with everyone who needs it.”
Vaccines are still limited
Carpenter said demand for monkeypox vaccines is huge and still outstrips supply. Staff spent all day every day vaccinating people last week, he said. So far, they have administered 1,500 doses of the vaccine.
The center recently told patients to make an appointment for the shots once they get more supplies. Half the appointments were taken in two hours and all slots were booked by the end of the day, Carpenter said. Los Angeles has received about 24,000 doses from the federal government, according to the county health department.
CDC Director Dr. Rochelle Walensky acknowledged the demand last month that the supply of the two-dose Jynneos monkeypox vaccine was limited, leading to lines outside clinics and protests in some cities. The Department of Health and Human Services increased supplies to state and local health departments, with more than 600,000 doses delivered since May.
HHS made 786,000 doses available to state and local health departments last Friday. The city of Chicago received an additional 15,000 doses of the vaccine last weekend in addition to the 7,000 delivered in July. But Hazra said that was still not enough to meet the demand for at-risk men who have sex with men, estimated at between 40,000 and 50,000 people in the city.
“We are currently scheduled three weeks in advance in terms of vaccine appointments,” Hazra said. Howard Brown Health has administered 2,800 doses to date.
The governors of California, Illinois and New York have declared states of emergency in response to the outbreak, in part to support vaccination efforts. But Carpenter said the vaccination campaign needs to be expanded so that anyone who thinks they are at risk of monkeypox can get the vaccine.
In Los Angeles, the vaccination campaign is focused on people taking a drug called PrEP that reduces their chances of contracting HIV and individuals who have had gonorrhea or syphilis in the past year, according to Carpenter. This information is used as a way to identify people who are considered to be at high risk of contracting monkeypox.
Walensky said this week that there are 1.7 million gay and bisexual men in the U.S. who are believed to be at the highest risk of monkeypox because they are either HIV positive or taking PrEP. People with weakened immune systems, such as people with HIV, may suffer more severe symptoms from monkeypox.
The approach is far from perfect, Carpenter said, because there are many people who didn’t catch STDs in the past year who are also…
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