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In article <t2fsn4$3jeoj$162@news.freedyn.de>
bks@panix.com (Bradley K. Sherman) wrote:

On June 13, a man in New York began to feel ill.

"He starts to experience swollen lymph nodes and rectal
discomfort," says epidemiologist Keletso Makofane, who's at
Harvard University.

The man suspects he might have monkeypox. He's a scientist, and
knowledgeable about the signs and symptoms, Makofane says. So
the man goes to his doctor and asks for a monkeypox test. The
doctor decides, instead, to test the man for common sexually
transmitted diseases. All those come back negative.

"A few days later, the pain worsens," Makofane says. So he goes
to the urgent care and again asks for a monkeypox test. This
time, the provider prescribes him antibiotics for a bacterial
infection.

"The pain becomes so bad, and starts to interfere with his
sleep," Makofane says. "So this past Sunday, he goes to the
emergency room of a big academic hospital in New York."

At this point the man has a growth inside his rectum, which is a
symptom of monkeypox. At the hospital, he sees both an ER doctor
and an infectious disease specialist. Again, the man asks for a
monkeypox test. But the specialist rebuffs the request and says
"a monkeypox test isn't indicated," Makofane says. Instead, the
doctor speculates that the man might have colon cancer.

A few days later, he develops skin lesions — another key sign of
monkeypox.

A misleading case count
On the surface, the monkeypox outbreak in the U.S. doesn't look
that bad, especially compared with other countries. Since the
international epidemic began in May, the U.S. has recorded 201
cases of monkeypox. In contrast, the U.K. has nearly 800 cases.
Spain and Germany both have more than 500.

But in the U.S., the official case count is misleading, Makofane
and other scientists tell NPR. The outbreak is bigger — perhaps
much bigger — than the case count suggests.

For many of the confirmed cases, health officials don't know how
the person caught the virus. Those infected haven't traveled or
come into contact with another infected person. That means the
virus is spreading in some communities and cities, cryptically.

"The fact that we can't reconstruct the transmission chain means
that we are likely missing a lot of links in that chain,"
Jennifer Nuzzo, an epidemiologist at Brown University, says.
"And that means that those infected people haven't had the
opportunity to receive medicines to help them recover faster and
not develop severe symptoms.

"But it also means that they're possibly spreading the virus
without knowledge of the fact that they're infected," she adds.

In other words: "We have no concept of the scale of the
monkeypox outbreak in the U.S.," says biologist Joseph Osmundson
at New York University. "

Why are so few cases getting detected? Testing. In many ways,
the U.S. has dropped the ball on monkeypox testing.

Across the nation, public health agencies are running too few
tests — way too few, Osmundson says. "State officials are
denying people testing because they're using a narrow definition
of monkeypox to decide who receives a test. They're testing in
only a very restrictive number of cases."

Take for instance the man Makofane knows. Eventually, after
seeing more than four doctors, the man finally finds an activist
who's trying to expand testing. The activist connects the man
with a doctor who orders a test through a private company
(that's working to produce a commercial test.) The result: He's
positive. He has monkeypox.

Makofane says the testing situation right now is so "abysmal" in
the U.S. that he launched his own study, called RESPND-MI, to
figure out the prevalence of monkeypox in New York City and to
help friends share information about monkepox.

The CDC would not divulge to NPR how many tests have been
performed across the country, nor will the agency say where
community transmission is likely occurring in the U.S. (NPR
emailed the agency multiple times about these questions but the
press person declined to comment or provide an interview.)

On Thursday, the CDC told the New York Times, it has performed
1,058 monkeypox tests. However, it's not clear how many of these
tests are duplications for the same person. And several sources
involved with monkeypox testing doubt the agency has tested that
many cases. One source told NPR that, as of last Friday, the CDC
had tested about 300 cases. At that time, about 100 of those
tests were positive, giving a positivity rate of more than 30%.

When the outbreak first began last month, the CDC quickly helped
to set up testing in about 70 state and local labs across the
country. Unlike with COVID, the agency already had a test
developed and ready to send to labs.

"We should celebrate that prior investment," Nuzzo says. "That's
what preparedness means.

An ineffective testing system
But as the need for testing grew — and the disease became more
common than officials initially predicted — the testing system
set up by the CDC stopped functioning well, because it actually
deters doctors from ordering a monkeypox test.

Providers have to go out of their way to order a test. They have
to receive permission and instructions from local or state labs,
Nuzzo says. The process is cumbersome and often time-consuming.
Sometimes a doctor has to sit on the phone for hours.

"That's really the bottleneck that we're worried about," she
says. "We need to cast a wider net with testing to find
infections that we're missing. And that's really hard to do if
we make it cumbersome and difficult for health care providers to
request a test in the course of their busy days."

Nuzzo says the CDC and local health departments need to remove
the barriers to testing. "I also want to make testing easier and
more widespread so that all clinicians feel that they can test a
patient. Any patient with a suspicious rash."

And doctors and nurses need to have a better understanding of
what monkeypox actually looks like in patients. It's different
from what's in medical textbooks. It can present like many other
diseases, including herpes, syphilis and colon cancer.

"Infections have been largely found in men who have sex with
men, who may typically seek care at a sexual health clinic,"
Nuzzo explains. "Those providers may be particularly well-
educated now about monkeypox and may be more willing to send a
specimen out for testing. But we may not be seeing that level of
education and willingness to test with other health care
providers, who see different kinds of patients. And that means
we may be missing infections in different patient groups."

On Thursday afternoon, the CDC announced they were working to
ramp up testing at the main labs that health providers normally
use. And the agency is aiming to make testing easier sometime in
July.

But Nuzzo says changes to testing need to happen right away. It
needs to be easier, right now, for doctors to submit samples to
the labs already doing this testing.

"Time is not on our side here," she says. "Every day we delay,
we are missing links in the transmission chain and are allowing
this outbreak to grow possibly beyond control."

And monkeypox, just like COVID, may become a long-term — perhaps
even permanent — problem here in the U.S.

Black and gay, you will pay.

https://www.npr.org/sections/health- shots/2022/06/25/1107416457/monkeypox-outbreak-in-us

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