When an outbreak of monkeypox was first detected in the United States, it seemed to be in terms of epidemics of infectious diseases, such as those that this country should be able to deal with. Tests and antiviral drugs are already in place; The government had stockpiled the vaccines. In contrast to SARS-CoV-2, monkeypox has been a well-known entity, a relative softball in the pathogen domain. It was not overly transmissible, moving mainly through intimate contact during illness Symptoms stage; Previous epidemics, with few interventions, Soon they set themselves on fire. The game’s guide was clear: Marshall’s American resources and making sure they went to the people most at risk, sending aid abroad, and getting them out of the park. “If there was one virus that could be contained,” says Bogoma Kapisin Tetangi, a virologist and infectious disease physician at Emory University, “this should have been the case.”
Two months later, global numbers have crossed 21,000 confirmed cases, nearly the fourth ones in the United States, which It is now ranked first among the countries Keep track. infections, Most men who have sex with men, has been documented in 46 states, DC, and Puerto Rico; New York and San Francisco have Declare the outbreak of a health emergencyas such It has the WHO, on a global scale. Jay Varma, director of the Cornell Center for Epidemic Prevention and Response, says control of the virus is not far off. But as the outbreak grows, so does the challenge of combating it. “It didn’t have to be that difficult,” Varma told me.
Years of similar footage surrounding SARS-CoV-2 – a much harder virus to combat – should have taught the United States something about its vulnerabilities. Instead, the lackluster response to monkeypox demonstrates that the state’s ability to deal with infectious disease may be equal. worst than at the beginning of 2020. Monkeypox, the country’s second infectious crisis in three years, is not just an unfortunate flop. It’s an affirmation of that, though the United States might It once seemed one of the best-equipped countries to stop and prevent an outbreakIndeed, it is one of the best at squandering its potential instead.
For years, there have been warning signs of monkeypox. Decades of sporadic outbreaks in Central and West Africa have illustrated the virus’s toll: It can cause a painful, debilitating illness, with bouts of fever and rashes, and in many cases it leaves behind permanent scars; Sometimes, it can kill certain strains of the pathogen. And while the virus has infected many places at random, it has infected communities close to wildlife, which is 2017 Disease outbreak among young people in Nigeria He hinted that sex could pose a particular danger.
So when the numbers of cases started It erupts in several parts of Europe in MayWhich indicates that the epidemic It was already popularPharma told me, “It should have been obvious” that the pandemic has huge potential for expansion. Multiple countries have already participated; The upcoming summer travel season poses high risks. Infection has also been concentrated in communities of men who have sex with men — networks that sexual health experts know are “thick, and where infectious diseases spread very quickly,” he said. “The United States has not reacted,” Varma said repeatedly, amid alarm bells ringing.
During most of May and June, monkeypox was tested It remained isolated within the Centers for Disease Control and its network of public health laboratories, already stretched by the epidemiological response. Healthcare providers had to transport samples to these centers for diagnosis, leaving patients in a state of intense anxiety for days, up to weeksDelaying treatment, vaccination and tracing of contacts. So far, after the ability to test has risen With the help of commercial laboratoriesresponse times for typical results are stretch for a long time. In Missouri, for example, “they still tell us three to four days” at best, Hilary Reno, MD, medical director of the St. Louis County Sexual Health Clinic, tells me.
Shots were also alarmingly rare. He owns the strategic national stockpile of America Millions of doses of smallpox vaccine (which also works against monkeypox), but most of it is ACAM2000, a vaccination associated with rare but serious side effects and should not be taken by certain vulnerable groups, including people with HIV. Another shot, labeled Jynneos in the US, is safer, although a two dosesCan more difficult to me Management after exposure. Since spring, manufacturers of this shot have been shifting the cranks on assembly lines to boost supply. But US officials hung around and hesitated for weeks before flying in much-needed doses from abroad.and then only in spurts.
The issue at hand is certainly not about a vaccine the demand. Stephen Thrasher, journalist and author of viral underclass, which studies the intersection of infectious diseases and social inequality. despite of More doses of the vaccine be headedHowever, with cases ballooning, the country may not have enough. And as the test stress continues, it won’t necessarily be Send potions to the right places. Reno told me that in Missouri, for example, only a handful of cases have been reported so far. But with much transmission likely not detected, the state’s original order of shots may not cover its true needs. The country slowed so long at the starting line that even the relatively slow monkeypox took its chance to move forward – making the gap even more difficult to close.
The early lack of testing and care also made it difficult to estimate or communicate the scale of the US outbreak – another parallel to the failed response to COVID. The lack of testing means that there are no exact numbers, which can make a devastating pandemic look deceptively content. “This amplifies the cycle of neglect,” Varma told me, a pattern to which the United States has been particularly prone. pile on the problem he is Persistent shortage of funds for US sexual health services, coinciding with the recent rise in sexually transmitted diseases. People with genital symptoms struggled to reach providers, and they opened more encrypted channels for the virus to spread.
Monkeypox is also a very challenging disease in the United States, where the sex It’s still a polarizing taboo, and men who have sex with men remain a marginalized society. This is a particularly fraught time for discussion of the LGBTQ community in America, where the recent rollback of abortion protections has raised alarm Other federal civil liberties may be on the verge of collapse. “We are in this deep anti-gay and transgender moment,” Thrasher told me, at a time when these societies need more protection, not less.
experts They praised some of the Centers for Disease Control and Prevention’s (CDC) efforts to avoid stigmatizing at-risk groups, which are still necessary at this point. Monkeypox definitely not need to Sex spreads, Ina Park, a sexual health expert at the University of California, San Francisco, told me. Kissing, cuddling and other situations that Placing the corpses in close proximity for long periods It can also transmit the virus. So can contact with clothes or bed linen, because monkeypox can happen Lasts on unsanitary surfaces for several days. Which means that men who have sex with men are certainly not the only ones at risk. At the same time, some people very scary Whoever described monkeypox as a “gay disease” was almost exclusively sex censorship Of the discussions, “giving people a misperception of the different risks the population is currently facing,” Thrasher said. Especially while supplies remain very limited, we need to “vaccinate people in places where the virus is transmitted”. Which means “we need to send both messages at once,” Park said, “that’s not something that only affects gay men” while referring to the fact that monkeypox still does.In the first class affect certain communities,” a trend that should influence the distribution of the shots. Titanji told me that calls for mass vaccination of “children or suburban mothers” are not where you will get the most impact.
For the MSM communities, the way the Biden administration is behaving at this moment reveals unspoken priorities and values. says Kelitsu Makovani, an epidemiologist at the Harvard School of Public Health, who has been Trace the evolution of the outbreak via a survey led by the LGBTQ community. “But when is it time to give us the resources? To prevent what some people describe as the worst pain they have ever felt in their lives? They chose not to.” Now, some experts even swamp lowest In discussions about whether monkeypox should be described as a sexually transmitted infection. Behind the controversy, McCovani told me, is the most important question, the allocation of resources. This is really a conversation about, Do these people deserve mercy and care?Continuing to pull vital tools and resources away from vulnerable populations, he said, would suggest that the nation believes the answer is no.
Varma told me that as long as the virus continues to move mostly through networks of MSM, the United States still has a chance to intervene quickly, trace transmission, and allocate resources in a targeted manner. But the current pattern of monkeypox may not hold. Already, the virus has begun to be transmitted across races and age groups, taking advantage of other, non-sexual forms of close contact. infections in young childrenwho are likely to have contracted the infection in their homes, and among imprisoned persons in prisons, where the infection is especially difficult to eradicate, began to appear. Across geographies, there are familiar disparities in access to tests, vaccines and treatments began to appear.
The interaction of monkeypox possession with SARS-CoV-2 also made matters worse. “This virus could not have chosen a worse time for its great entry into the world arena,” said Titanji. Thrasher told me that people are still suffering from one outbreak, are exhausted, and have “too little appetite for another.” Numbed up by the ongoing toll of COVID, the public has also indulged in reassuring comparisons that, though grounded in a kernel of truth, have been skewed into misleading extremes: monkeypox might be less portable And the less lethal Corona virus, but it is not a nuisance that cannot be ignored and is guaranteed to dissipate. Titanji told me that the more segments of society affected, the more difficult it would be for an outbreak to break out.
Experts tell me that the top priority now should be to direct money toward distributing vaccines and expanding testing. Health workers and patients need ongoing guidance about the often subtle symptoms of illness and Silent transmission capability, plus resources to administer express care. Paid sick leave and housing support will also help lighten the burden Isolation of monkeypox, which can last for weeks, given the length of symptoms. If these efforts fail, as happened with SARS-CoV-2, monkeypox could become the second virus to establish permanent residence in the United States within three years — giving it more opportunities to find new ways to spread, transform and spread the disease. Preventing this means acting decisively now, to make up for the time we’ve already lost.