Once a rare African virus, monkeypox has taken hold in the tattered patchwork of cities, counties, states and federal agencies that make up the US public health infrastructure. “Unfortunately, delayed action means that monkeypox has spread to the gay community and among other men who have sex with men,” said David Harvey, executive director of the National Coalition of STD Directors. “This outbreak has become a public health crisis in America. We’re still in a very chaotic situation at the state and local level with an organized response.” As an explanation for the chaos, many observers point to how Covid has reshaped the landscape for public health officials. Once considered neutral arbiters of information, many health officials have come under political attack following unpopular mask and vaccination policies. Across the country, public health officials have been harassed, threatened, fired, or simply felt burned out and resigned. The situation was not helped as resources that had once been devoted to things like monitoring infectious diseases such as tuberculosis or running routine vaccination clinics were suddenly diverted to Covid-19. Sexual health clinics have also struggled as testing and staffing resources were devoted to Covid-19, hurting organizations that had already suffered years of underfunding. The result has been worse health outcomes for many key public health services: routine vaccinations for children have declined. Overdose deaths have exploded. and the US has seen a record high rate of sexually transmitted infections for the sixth year in a row. As monkeypox has spread, the Biden administration has tried to respond by releasing about 1.1 million vaccines and increasing testing capacity, which has increased from about 6,000 to 80,000 a week. The World Health Organization declared monkeypox a global health emergency this week, and the US could follow suit by declaring monkeypox a national public health emergency, which would free up more resources for local agencies. “The system is tired, it’s overburdened, it’s underpaid, it’s understaffed,” said Lori Tremmel Freeman, executive director of the National Association of County and City Health Officials. “All the same issues that plagued us during the pandemic are still with us and have not gone away. “What’s added to that, with monkeypox and beyond, is that we also have a workforce that has documented post-pandemic mental health trauma.” Public health advocates want the president and Congress to allocate more funding to the epidemic and to sexual health clinics in general. Public facilities have proven to be the first line of defense against monkeypox, even though federal prevention funding for such work has fallen 41% since 2003. “Local sexual health providers are being asked to respond to monkeypox on top of an already out-of-control STD epidemic in America,” Harvey said. “We are at a tipping point: we need the Biden administration and Congress to immediately fund public health STD programs and clinical services.” Although anyone can get monkeypox, the virus has mostly affected men who have sex with men. Sexual health clinics were often frontline responders in the outbreak because of the way monkeypox can present its symptoms, with lesions around the genitals and anus – although sex is only one way it can be transmitted. monkey pox. Any close contact with an infected person can spread the disease, including touching, kissing and hugging, as well as sharing glasses, utensils, bedding and towels. Although the virus, which is in the same family as smallpox, is rarely fatal, symptoms can be excruciating, with painful lesions and flu-like symptoms, according to the Centers for Disease Control and Prevention. Up to 10 percent of people reportedly need hospitalization, and many show up in emergency departments because of severe pain, Freeman said. The situation is exacerbated because control of monkeypox is limited. There is no at-home test and results can take days. There is, however, a vaccine for which people at increased risk may be eligible. they may also be eligible for treatment with the drug tecovirimat, sold as TPOXX. But the hurdles are significant, obtaining it can be difficult and tecovirimat – usually reserved for people with severe symptoms – must be requested by doctors from the government’s national strategic national stockpile, which involves significant red tape. In addition, people without insurance likely lack access to both vaccine and medication, Freeman said. about 12.7 percent of the LGBTQ+ community lacks health insurance compared to 11.4 percent of the general population, according to an analysis by federal officials. Even if you have insurance, there are hurdles in the US health care system, such as trying to navigate between urgent care clinics, primary care providers and government health services. Freeman told a story about a local health department that asked his state for information about a monkeypox outbreak. The state responded to check with the CDC. the CDC then redirected local officials back to the state. “There’s a lot of finger pointing going on here,” he said. “We should have known. We should know more now than we did three years ago from our response to Covid [about] what should we do here?’
