Experts: Team Biden blows on monkeypox outbreak

On a slow news day like today, why not check out a topic we haven’t covered in a while?

Tell me if this sounds familiar. A deadly virus begins to spread undetected across the United States, threatening to erupt beyond quarantine and therapeutics to stop it. But the Feds are slow to act. They cannot pull themselves together during testing; the CDC is spreading misleading information; commercial labs are underutilized in early case detection efforts. America ends up flying blind for months on the extent of community transmission until the virus becomes so widespread it cannot be contained.

It happened with COVID. It recurs with monkeypox, experts tell WaPo. Except that this time, the person responsible is the one who got himself elected by promising to “close” this other virus (which he did not do). The professionals were supposed to take over the controls in Washington from January 2021.

Yet many of the mistakes of 2020 are being repeated now, albeit on a thankfully much smaller scale.

Biden doesn’t even have Trump’s excuse of having to deal with a new virus that we knew nothing about. Scientists know everything about monkeypox: they know how it spreads, they know how to stop it. They even have a ready-to-use vaccine. In such circumstances, one would expect a germ to be stopped short.

But it is still spreading among Americans. Experts are sounding the alarm, hoping to wake up the powers that be:

Communication about who to test, when to test them and what monkeypox symptoms look like has been dismal, said Sauer, a public health expert at the University of Nebraska Medical Center…

Clinicians, patients and some administration officials have criticized the Centers for Disease Control and Prevention for having the testing criteria which they say are too narrow and have resulted in long waits – sometimes days – to identify positive cases. Under the current framework, doctors who want a test for someone suspected of having monkeypox must first consult with a state epidemiologist. State public health officials say the protocol helps identify those most at risk so doctors can recommend isolation and take other steps to prevent community spread…

And just like in early 2020, when the coronavirus first threatened the United States, federal authorities initially limited monkeypox testing to a network of dozens of public health labs — and also failed to authorize thousands of commercial labs and hospitals to conduct their own tests

The response has also been hampered by American doctors’ lack of familiarity with the disease. The CDC initially released decades-old photos of more severe outbreaks in Africa, instead of the more subtle rashes detected in the recent global outbreak. The United States has been much slower than Britain and Canada to distribute updated teaching materialsrecently sharing photos showing what rashes look like on fair skin, said David Harvey, executive director of the National Coalition of STD Directors.

A New York patient presented to a clinic this month with flu-like symptoms and swollen lymph nodes after returning from Portugal after having sex with other men there. If you’ve been following the news of the monkeypox outbreak in Europe, you know it should have set off alarm bells for her doctor. The virus is mainly spreading among gay and bisexual men and a festival in the Canary Islands, off the coast of Portugal, appears to have been a widespread event. The patient also developed abnormal lesions, but he had to see four different providers before one of his doctors finally came up with the idea of ​​testing him for monkeypox. A city-based virologist told WaPo that “he was aware of about a dozen similar cases in which people with possible symptoms of monkeypox were repelled.”

Not a big effort from the CDC to get the word out if even doctors in America’s largest city don’t know what to look for and can’t easily test.

The upshot is that the small number of confirmed monkeypox cases in America compared to Europe is almost certainly an undercount due to poor surveillance, not less spread. Known cases in Britain rose by almost 40% in the space of five days last week and the WHO is considering declaring a global emergency. Since there is a vaccine for the virus, it is extremely important to quickly identify patients and then rush the vaccine to their close contacts to stop the spread, i.e. “ring vaccination”. But the longer the virus goes undetected, the more contacts there are to trace, and suddenly it becomes logistically impossible to track down everyone who might have been exposed. You know how this story unfolds as well as I do.

In fact, no one can guess whether the virus has already spread enough in the population to make ring vaccination temporarily impossible. The United States has stockpiled 36,000 doses of the main monkeypox vaccine; if there are, say, 6,000 people infected right now and each has six close contacts, that’s every last dose counted – if we can find those contacts and forward them to them immediately. Every day they have to wait means the number of people infected grows.

Another thing that you know as well as I do is that the more people a virus infects, the more likely it is to mutate into something more contagious or more virulent or both. We have lived with this reality for two years with COVID. We are now also experiencing it with monkeypox:

In the latest study, the researchers found about 50 genetic variations in the viruses they studied compared to those in 2018 and 2019. This, they said, “is much more than one would expect given previous estimates” the mutation rate of orthopoxviruses of which monkeypox is a type – between six and 12 times higher…

“Considering that this 2022 monkeypox virus is likely a descendant of that of the 2017 outbreak in Nigeria, no more than five to 10 additional mutations would be expected instead of the approximately 50 mutations observed. We hope that now specialized groups will carry out experiments in the laboratory in order to understand whether this 2022 virus has increased its transmissibility. »

Monkeypox may have been spreading quietly in western countries for some time, after stumbling upon a key mutation at some point that made it more transmissible, and the result was the global epidemic we know currently. In fact, the CDC announced earlier this month that it had discovered a case in the United States that *predated* the first cases in Europe in May. Which makes it all the more important to shut this thing down yesterday.

The good news is that the feds are getting their act together, belatedly. Another 300,000 doses of the vaccine are now on order, and they just authorized five commercial labs to start testing for monkeypox in July. There’s also good news in the way the virus spreads (for now): despite its many mutations, it looks like you need skin-to-skin contact or something very close to contract it. . It is “airborne” in the sense that it appears in large respiratory droplets but not in coronavirus aerosols, the key to the spread of COVID. I hope it’s not too late to slam the brakes here. We will know soon.

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