Why monkeypox is a repeat of the data mistakes made with Covid-19
“the roots of this deadly problem long predate monkeypox outbreaks or the Covid-19 pandemic. The US has always had a fragmented health care system, with widely disparate experiences for patients based on state, insurance company, or hospital chain. Without systems to reliably record and share population-level data between decision-makers, health care workers can’t focus on helping the patients who need it most. The consequences are worse for marginalized people — such as Indigenous people, people with disabilities, or youth at risk for teen pregnancy — who were already facing inadequate care before the pandemic.
It doesn’t have to be this way. The US has an opportunity to learn from the tough lessons of the last few years and build on work to improve transparency and data sharing. With monkeypox already a global public health emergency, it’s vital for the data to be available, promptly and accurately, to coordinate an effective public health response.”
“Data comes in from over 900 health systems, or chains of hospitals under shared management; the largest include about 200 hospitals. But that’s just a fraction of the over 6,000 hospitals across the country. So when, for example, positive test results for Covid-19 or monkeypox, or cases of workplace exposure to pesticides, have to be reported to the state, public health boards in every state must coordinate with hundreds of different organizations and aggregate their data before they can share it with federal agencies. Except during an officially declared public health emergency — which, for monkeypox, is only a week old — the CDC has limited legal power to mandate reporting.
Data also isn’t collected the same way everywhere. There is a large number of different electronic health record systems currently in use in the US. They allow medical professionals to document a patient’s diagnosis and treatment, and in theory, share them more efficiently than in the days of paper-based records. But the software systems aren’t designed to be compatible with each other, so they cannot easily exchange data.”
“Undertesting doesn’t just affect the case numbers reported, but hurts patients’ access to treatment. Tecovirimat, or TPOXX, an antiviral drug that is most effective for treating monkeypox if started early, can’t be prescribed until a test comes back positive, and since it’s not officially approved by the FDA for monkeypox treatment, doctors need to jump through bureaucratic hoops to prescribe it. This leaves many patients suffering from untreated painful lesions for days or weeks.”
“With monkeypox, the US can lean on the systems and infrastructure built during the Covid-19 pandemic, but some programs, like those that reimburse providers for treating uninsured patients or provide free Covid-19 tests, vaccines, and antiviral drugs to community health centers, were already scaled down after funding was decreased. In order to pull together a national response, the US needs straightforward, transparent data reporting that can be compared and combined on a national level.
The final difficulty will be in keeping this momentum going. The declaration of a new public health emergency for monkeypox will help keep federal funding flowing toward projects like the new NCATS OpenData portal for monkeypox, but the need for better health care infrastructure won’t end when the emergency does. In a chronically underfunded public health system, short-term efforts may not be enough.”
A worldwide monkeypox outbreak
“The worldwide monkeypox outbreak began in early May 2022. Since then, more than 15,000 cases of monkeypox have been identified across more than 60 countries. Disease caused by the monkeypox virus typically involves a few days of fever and lymph node swelling followed by a rash, which can leave scars. Most cases in the current outbreak have resolved without hospitalization or the need for medication. As of July 20, there have been five deaths, all of them in Africa.
Monkeypox is related to the smallpox virus, and immunity to smallpox is protective against monkeypox. But as of 1980, smallpox has been eradicated in humans, and vaccinations against smallpox have grown rare — and human cases of monkeypox have been on the rise.
With monkeypox, the world faces a very different situation than in the early days of Covid-19. Monkeypox, unlike SARS-CoV-2, is a known quantity. We have more tools to prevent and treat it — far more than we did for Covid-19 at the outset of the pandemic — and both public health and the general public have had a lot of practice taking measures to prevent infections from spreading.”
Biden administration authorizes emergency monkeypox vaccine strategy
What Puts Someone at Risk of Catching Monkeypox?
“As monkeypox spreads across the United States, it may be giving people flashbacks to the days of wiping down counters and groceries to get rid of the coronavirus. But for most people, the risk of getting monkeypox remains low. Almost all cases in the current outbreak — 98% — have been in adult men who have sex with men.
So how is the virus spreading? Studies of previous outbreaks suggest that the monkeypox virus is transmitted in three main ways: through direct contact with an infected person’s rash, by touching contaminated objects and fabrics or by respiratory droplets produced when an infected person coughs or sneezes. There is also evidence that a pregnant woman can spread the virus to her fetus through the placenta.
Scientists are still trying to understand if the virus can spread through semen, vaginal fluids, urine or feces and if people can be contagious before they develop visible symptoms.”
“The activities that put a person at highest risk of catching the virus involve close, intimate contact with another infected individual. This includes the kind of skin-to-skin contact that occurs during sex as well as when cuddling, hugging, massaging or kissing another person. Condoms probably add a layer of protection during sex, but they are unlikely to prevent contact with lesions on an infected person’s groin, thighs, buttocks or on other parts of their body.
Roommates and family members in the same house are also at significantly higher risk of getting monkeypox compared to any other individuals a patient may come into close contact with, said Dr. Bernard Camins, the medical director for infection prevention at the Mount Sinai Health System.
Household contacts can catch monkeypox through contaminated clothes, towels and bedding. Shared utensils that may carry an infected person’s saliva should also be considered high risk, said Saskia Popescu, an infectious disease epidemiologist at George Mason University.”
We Don’t Need a White House Monkeypox ‘Coordinator.’ We Just Need the Vaccines.
“We’re up to about 3,600 known cases of monkeypox in the United States, according to the Centers for Disease Control and Prevention (CDC). That’s more than double the number of cases from just two weeks ago.
As the federal government struggles to distribute vaccines where they’re needed, The Washington Post reports that the White House is thinking of declaring a public health emergency and naming a “White House coordinator” to oversee the response.
The public response should be: Please don’t. Please just get the vaccines to local public health agencies and let them deal with it. Because right now, that’s about half the problem that’s causing monkeypox to spread.
Red tape from the Food and Drug Administration (FDA) and the CDC left more than a million monkeypox vaccine doses stuck in storage in Denmark, and then another roll of red tape made it incredibly difficult for doctors to prescribe an alternative monkeypox treatment because it’s still in clinical trials.
As a result, local health agencies have had to carefully portion out vaccines to the highest-risk citizens—and they’re still running out. In Los Angeles, the county Public Health Department will only administer to people who are infected, people who have had high-risk contact (typically sex) with somebody who is infected, and then gay or bisexual men or trans people who fit in one of the [certain] categories”
“Fortunately, monkeypox’s spread has still remained pretty limited even as it has grown. The percentage of growth seems huge because we’re dealing with a fairly low baseline. And though monkeypox is not technically a sexually transmitted disease—it is spread through contact with the rashes and lesions created by the virus as well as through saliva—this particular version of monkeypox has been pretty resistant so far to being spread through methods other than sexual contact.”
Yes, monkeypox is a real threat — but risk level varies
Don’t Panic Over Monkeypox
“in the past 10 days, cases have been reported in the United States, as well as in Australia, Belgium, Canada, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, and the U.K. Typically, monkeypox is rare outside West and Central Africa.
In total, there were 92 confirmed cases and 28 suspected cases as of yesterday, the World Health Organization (WHO) reports.
On the upside, there’s little reason to think monkeypox will wreak the kind of havoc that COVID-19 did. It does not spread as easily or cause severe symptoms in most people. And it’s not novel—we already know what monkeypox is and how to fight against it.”
“In addition, we already have a vaccine that provides some protection against monkeypox: the smallpox vaccine. And the U.S. has “enough to deal with the likelihood of a problem,” said President Joe Biden in Tokyo this week.
“I just don’t think it rises to the level of the kind of concern that existed with COVID-19,” said Biden. He says he does not expect quarantine requirements even for people infected.”