More monkeypox testing is needed to understand how far it has spread

A lack of testing keeps public health officials in the dark about the extent of monkeypox in the United States and poses new uncertainties for the medical system.

Why is this important: The lack of robust disease tracking is reminiscent of the troubled early response to COVID-19 and could bode ill for local health systems still grappling with the virus, its legacies, and the impending flu season.

  • It falls to primary care providers, including sexual health clinics, to track an unknown disease that manifests in different ways.

By the numbers: The CDC says 556 samples have been sent to labs for monkeypox testing as of June 13, and as of last week, 2% of national lab capacity is dedicated to the outbreak, according to the Association of Health Laboratories. public.

  • “We need to increase testing for those with a characteristic rash, looking like pimples or blisters, so we can make quick diagnoses,” CDC Director Rochelle Walensky said Friday.
  • Experts say the actual number of cases in the United States is significantly higher than the 49 confirmed so far and wonder why the federal government isn’t doing more.
  • “The sheer geographic spread of cases means this is a bigger outbreak than what we’re currently capturing,” David Harvey, executive director of the National Coalition for STD Directors, told Axios. “So we’re very concerned about that; we’re concerned about the lack of an effective federal response, and we think we need to step up a gear to deal with that.”

How it works: The Laboratory Response Network’s 69 public health labs in the United States have the capacity to test 6,000 to 8,000 samples per week for orthopoxvirus, the family of viruses to which monkeypox belongs.

  • But in a two-step process, samples must be sent to one of those labs for confirmatory testing before being sent to the CDC, STAT reports.
  • This process takes time and can delay the response at the local level, where contact tracing is used to find high-risk contacts and offer them vaccines in some cases.
  • Some companies are already rushing to develop PCR tests for monkeypox, although there is not yet a need for hundreds of thousands of tests, which was the case when COVID emerged, Reuters reports.

Yes, but: Some believe a wave of demand for testing is heading our way, pointing to the experience in England, where more than 300 cases have been confirmed and contact tracing has already become a challenge.

  • “We’re still learning a lot about monkeypox; we’ve never seen anything like it with this particular virus in the United States,” Sarah Turbett, an infectious disease physician and microbiologist at Massachusetts General Hospital, told Axios.
  • Monkeypox presents differently than it usually does in parts of Africa where it is endemic, with a rash confined to certain areas of the body and mild symptoms in people infected so far.
  • In Africa, monkeypox can be fatal, but the current outbreak has so far resulted in no deaths.

Between the lines: Because the disease spreads through intimate contact, finding new cases falls on front-line clinicians, as well as patients who report telltale rashes.

  • The San Francisco Health Department began receiving inquiries about the virus and testing last week, and local health officials expect that demand to increase in the coming weeks.
  • “We need to step up and help sexual health clinics across the United States prepare for what we believe will be an onslaught of patients seeking testing,” said Harvey of the National Coalition of STD Directors.
  • While public health labs can currently handle the current amount of testing for monkeypox, the CDC is working with the FDA and CMS to explore how commercial labs could help expand testing capacity.

Go further: The virus has a longer incubation period than the virus that causes COVID-19, giving public health officials up to three weeks to ask people to isolate and identify close contacts.

  • The majority of people who test positive so far identify as men who have sex with men, but the virus is not unique to this group – anyone can test positive if they come into close contact with someone who has it.

Threat level: The majority of confirmed cases have been attributed to international travel or direct contact with someone who has a confirmed case. But a few cases have no connection to a confirmed case, implying there is some community spread.

  • “We don’t have an area where we feel like there’s community transmission,” Jennifer McQuiston, the CDC’s deputy director of pathology, told reporters on Friday.

What we are looking at: As local health departments say they are ready to respond, the outbreak could overwhelm their capacity, said Lori Tremmel Freeman, CEO of the National Association of City and County Health Officials.

“If you have a larger type of outbreak, then it becomes less manageable,” Freeman said. “While the health services know how to get it, whether or not they have the funding and the money to do it and can do it quickly is another question.”

Editor’s Note: This story has been updated to reflect new test numbers the CDC provided to Axios after the deadline.

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