seventy-eight days And the More than 7000 documented cases in the United States 2022 monkeypox outbreak, federal officials have declared the disease a nationwide public health emergency. With COVID-19 (you know, another ongoing viral public health emergency) still so raging, the US is officially in the throes of two Infectious disease crises must now, with limited funding, be argued simultaneously.
The two viruses and diseases are starkly different, as are the demographics of the populations most at risk. But simultaneous outbreaks will compete for overlapping groups of resources, and put a subset of people at high risk of contracting. Both Maybe even in some cases simultaneously. They will also demand distinct responses, from the nation’s leaders and the public alike. For most Americans, today’s announcement doesn’t change much: Eating home can be “no panic,” says Tyson Bell, MD, a critical care and infectious disease physician at UVA Health. Avoid stigmatizing men who have sex with men who stay greatest Risk, but “be aware that everyone is at risk.” In a press call today, HHS Secretary Xavier Becerra urged every American to “take monkeypox seriously and take responsibility for helping us tackle this virus.”
The trick is to do this while ensuring that resources are allocated to those who need them most. Although federal officials have Frequently assured the public that the state has all the resources it needs to control the outbreak, The nation is clearly not living up to its containment potential. Many experts have criticized the country’s timid steps toward action in the early days of the outbreak, when eradication of the virus was, in fact, relatively possible. Now, with tests, treatments and vaccines still in short supply and hard to reach, allowing case numbers to swell, the chance of beating the virus again looks narrower than ever.
Today’s announcement will mobilize more resources to contain the outbreak, allow federal leaders to distribute vaccines and treatments more quickly, and source more data from state and local governments. But this step may already be overdue. At the press conference, CDC Director Rochelle Walinsky noted that about 1.6 million to 1.7 million people in the United States — including men who have sex with men living with HIV — were classified as “at highest risk of developing chickenpox.” monkeys at the moment”, and priority should be given to vaccination. This number is much higher 600,000 doses or so of the Jynneos bivalent vaccine rolled out across the country; It will take months to get more and ship the US, It extends into the fall and beyond. Meanwhile, federal officials are Think whether they can Divide Jynneos doses into fiveand administer them intradermal rather than subcutaneously – a ‘dose-sparing’ approach.
I met with Greg Gonsalves, an epidemiologist and AIDS activist at Yale University, and a consultant to the World Health Organization on the monkeypox outbreak, to understand today’s announcement, and the diagnostics for an epidemic in the United States. Gonçalves has been a vocal critic of the United States’ approach to the coronavirus. In this new outbreak, he and others have already seen a resurgence of the failures of the past. Today, Demeter Daskalakis, deputy coordinator of the national monkeypox response at the White House, described the American response to monkeypox as “aggressive, responsive, and persistent from day one.” There is little to suggest that this is true.
Our conversation has been edited for clarity and length.
Catherine J. Woo: How would you describe the current situation of the monkeypox outbreak in the United States?
Greg Gonsalves: We are not in a good place. We’ve heard refrain, COVID-style, about having all the tools we need to deal with this — enough for all US jurisdictions, which is clearly not true. We keep seeing increasing cases. We are probably being tested. And we definitely have a shortage of vaccines, Despite what the secretary says. And so we’re not in a good position to contain this, which gives us the sad distinction from the possibility that there have been two endemic viruses in the United States for the past three years.
Wu: And that’s been clear for some time now – that the outbreak has been ballooning, and that resources are scarce. Should we declare a public health emergency sooner? Will that help?
Gonsalves: Declaring a public health emergency gives us some ability to do certain things we wouldn’t normally be able to do. But what helps me is that we did it It was A public health emergency for COVID. And two covid czars! And we were Leaders in per capita COVID mortality among the G7And we are now the pioneers in the absolute numbers of monkeypox cases. So hiring leaders and making announcements is one thing.
But when you have leaders who say this was an aggressive reaction from day one, and that’s where we are? This does not make you feel confident in our nation’s response to this new and emerging outbreak. It would be more useful to say, We’re out of the gate slow, but now we’re bringing in all the relevant federal authorities. We’re talking with local and state health departments. We are talking with community organizations. We will use all government resources in a strategic operational campaign to deal with this. At the moment, I’m still not sure of their plan. We’re going to cut the vaccine doses into five pieces? We need research to evaluate or think about it ACAM2000 [an older smallpox vaccine with more side effects] As a precaution.
There is still no real clarification of how we will continue to ramp up diagnoses until we can figure out where the outstanding cases are. Commercial sellers are testing now, but we are still mostly in passive monitoring [phase], where people come to sexual health clinics, primary care physicians. How much active testing is being done in the community, working with the organizations that fund it Ryan White HIV/AIDS Program [which provides resources to low-income people living with HIV], for example? To go out to gay bars, sex clubs, gay parties, and introduce people who may have suspicious lesions, blisters or bumps to the privacy of a mobile health vehicle for testing, or a referral for testing nearby? Also, you have to be in [isolation] For 21 days with this infection. Many people cannot do this. Some of the men who get this are either uninsured or uninsured. There are still problems with accessing [the antiviral] Tpoxx.
And there is no new money spent on the shaft. Management brought up the idea they needed $7 billion for monkeypox response. But for some strange reason, they didn’t officially tell Congress this before they left for recess. This is an emergency without a budget. So this does not give you the feeling of having an aggressive reaction from the start. We don’t need to be spoiled. Some honest talk would be nice.
Wu: How should the audience react at this point? The nation has been asked to respond. Monkeypox has been modeled on COVID, on the one hand. However, levels of risk vary between populations. What does that mean for us?
Gonsalves: For all the people telling the gay community they should get the ball rolling, my friend Joe Osmondson, a microbiologist, said the gay community was responding valiantly. And the article is that Kai Kupferschedmt wrote today in New York times He has a really important message: This is not a homosexual disease, but it happens to MSM [MSM]And we have to start thinking about how to tackle the epidemic ourselves.
This is what happened during the AIDS epidemic. Gay men have understood the collective threat facing them, and they have changed sexual behavior. Kay was saying that maybe we need to reduce the number of partners, give up certain types of sexual activities or events until we’re vaccinated, and think about restricting our sexual partners to capsules, sort of like the early days of COVID social contact. So I think the gay community is responding really well, and they understand the risks.
For the general community at the moment, the prospect of another endemic virus emerging in the United States should worry them. But out of solidarity and sympathy with the people in the LGBT community who are facing this, and bearing the brunt of it now. Could you jump to other populations where there is close physical contact? prisonsHomeless shelters, university dormitories, sports facilities? potentially. But for now, they just have to keep an eye on it.
What should worry people is the government’s response. Don’t tip the burden on the American people again, as we did with COVID – a do-it-yourself version of the pandemic. We need the government to implement, and they haven’t. This response was a squawk, stammering, stiff. Now they have put two people in charge, declared a public health emergency – they have no money – and say everything is fine.
Wu: Do you think monkeypox has a high probability of spreading to groups of non-men who have sex with men or becoming endemic here in the United States?
Gonsalves: This has been pretty prevalent among MSM, we haven’t seen much jumping into home contacts, etc. But the longer this continues, the higher the chances of sporadic cases outside the context of MSM.
And there is a concern that this will also begin to trace the divisions in our social geography. For someone who’s followed the AIDS epidemic for 40 years…even when some people have access to the interventions they need, many people don’t. You can easily see that kind of ends up exactly where HIV is – in the southern countryside, in the communities Black men who have sex with menthose who have Some of the highest rates of HIV in the world. We can see monkeypox becoming a disease of marginalized marginalized populations, like everything else in the United States
This is the biggest long-term concern. That we’re going to have to deal with this for a long time, that it’s going to places where there’s less robust public health or healthcare infrastructure, and people have much less access to resources. And so it remains.
Wu: What is a future like this that reflects America’s approach to public health?
Gonsalves: I wrote piece in Nation which spoke of the decline we see in the response to AIDS after 40 years. and again, We have the highest excess COVID-19 death rate per capita in G7A quarter of monkeypox cases worldwide. This tells us that we are hopelessly unprepared and not very serious about the threat of infectious disease. It tells us that we are not ready to invest in what we need to keep our neighbors safe, to keep our families safe in the long run. What amazing things have you seen over the past few weeks? report in scalpel About life expectancy in America [being set to drop in world rankings over the next couple of decades]. There is this phenomenon that represents something much more profound and structurally wrong with the American way of life. And that doesn’t give you a good feeling about our odds of something that might be around the corner that is much more lethal, and much more contagious than what we’ve seen so far.