STD clinics, already struggling to contain an explosive rise in infections such as syphilis and gonorrhea, are now on the front lines of the nation’s fight to control the rapidly growing outbreak of monkeypox.
After decades of underfunding and two and a half years of a pandemic that severely disrupted care, clinic staff and public health officials say clinics are ill-equipped for another epidemic.
“The United States does not have what it takes to adequately and fully combat monkeypox,” said David Harvey, executive director of the National Coalition of STD Directors. “We are already at the limit of our capacity.”
Monkeypox, a cousin of smallpox, is not technically considered a sexually transmitted infection. But it spreads through close contact and is now mainly transmitted through networks of men who have sex with men.
Because the current outbreak of monkeypox causes blisters or pimples on the genitals, many patients seek care for what appears to be herpes, syphilis, or another sexually transmitted infection. Patients often prefer to seek care anonymously at public clinics, rather than visit their primary care doctors, due to the stigma of sexually transmitted infections.
Although most people with monkeypox recover on their own in two to four weeks, about 10 percent need hospital care, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
The level of complications from monkeypox “has been much higher than any of us expected,” said Mary Foote, an infectious disease expert with the New York City Department of Health and Mental Hygiene, who spoke Tuesday. July during a webinar presented by the Department of Infectious Diseases. Society of America. In addition to severe pain, some people with monkeypox are at risk of permanent scarring. Foote said the pain can be excruciating, making it hard for patients to swallow, urinate or have a bowel movement.
“We just don’t have the bodies,” Shira Heisler said. “It is a total collapse of the infrastructure.”
Sexual health clinics have become so small that many lack the staff to perform tasks as basic as contacting and treating the partners of infected patients.
These clinics are some of the most neglected safety nets in the country’s broken public health system, which has less authority and flexibility to fight outbreaks today than it did before the Covid-19 pandemic.
With 1,971 cases of monkeypox reported since May in the United States, and about 13,340 worldwide, doctors warn the epidemic may have grown too large and too diffuse to contain.
Shira Heisler, medical director of the Detroit Public Health STD Clinic, said she’s proud of the quality of care she provides, but she just doesn’t have time to see every patient who needs care. “We just don’t have the bodies,” he said. “It is a total collapse of the infrastructure.”
Funding from the Centers for Disease Control and Prevention to prevent sexually transmitted infections has dropped by nearly 10 percent since 2003, to $152.5 million this year, even as syphilis cases have more than quadrupled in that time. Factoring in inflation, that funding has fallen 41 percent since 2003, according to an analysis by the National Coalition of STD Directors.
Meanwhile, hundreds of state and local health professionals who trace the origins, trace the trajectory and stop the spread of cases reported by sexual health clinics have resigned or been replaced since the pandemic began. Some left due to exhaustion and others were pushed out of their jobs by critics protesting unpopular policies on masks and lockdowns. Some federal grants to strengthen the public health workforce are just being implemented.
Data reporting systems have not been updated during the pandemic, despite the glaring shortcomings it helped reveal. Public health workers still use fax machines to treat monkeypox cases in Florida and Missouri, public health officials told KHN.
“Even with the advantages of having a test and a vaccine, we still haven’t invested enough in the public health system for us to be able to respond quickly enough,” said Tao Kwan-Gett, chief scientific officer for Washington state. Many people “will tell you that we have the best healthcare system in the world. But I think the Covid-19 pandemic, as well as the [monkeypox] outbreak, show that the system is broken and needs to be fixed.”
The White House is distributing hundreds of thousands of monkeypox vaccines now, releasing additional doses as they become available, for a total of nearly 7 million doses within the next year.
But Hotez said those vaccine shipments “may not be enough.”
Some cities are running out of doses soon after opening their doors. In New York City, where monkeypox cases tripled last week, the vaccine rollout was plagued by technical glitches; the vaccine website has been blocked at least twice. San Francisco officials said their city is also running low on vaccine supplies.
Monkeypox vaccines can effectively prevent infection in people before they are exposed to the virus.
“I don’t think any health department in the United States can handle all the STIs that are reported to them,” Kiernan said.
Experts believe that vaccines can also help prevent infection after exposure. But they are most effective if given within four days of close contact with a monkeypox patient, said Trini Mathew, medical director of antimicrobial stewardship and infection prevention and control at Beaumont Hospital in Taylor, Michigan. Vaccines given between four and 14 days of exposure can reduce symptoms but not prevent disease.
However, the broken public health system is not designed for speed.
Although monkeypox testing has become more accessible in recent days, some public health systems are understaffed to quickly locate and test partners of patients. And because most health professionals have never handled a case of monkeypox, patients often must make multiple visits before receiving an accurate diagnosis.
Contacting exposed people becomes more complicated if they live across the county or across the state, which may require coordinating an outbreak response with additional health departments, said Shawn Kiernan, chief of the communicable diseases section. Fairfax County Virginia Department of Health.
Decades of budget cuts have led many sexual health clinics to limit their hours of operation, making it difficult for patients to receive care.
Public health departments have lost key members of their teams in recent years, including highly trained nurses and outreach specialists.
A 2020 KHN-AP analysis found that at least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a workforce tattered to meet America’s public health needs, and that was before that the covid arrived. That research found that only 28 percent of local public health departments have statisticians or epidemiologists, the disease detectives who investigate the source and trajectory of infectious outbreaks.
According to the CDC, more than 2.4 million sexually transmitted infections were reported in 2020.
“I don’t think any health department in the United States can handle all the STIs that are reported to them,” Kiernan said.
Public health workers say they hope monkeypox is a wake-up call.
The federal government has spent billions of dollars fighting the COVID pandemic, and some COVID-related grants will be used to expand the broader public health workforce.
But the CDC and Congress often earmark funds for specific purposes, said Lori Tremmel Freeman, director of the National Association of County and City Health Officials. “If you have someone working on covid, you can’t just reassign them to monkeypox using the same amount of money,” Freeman said.
And in some states, that money has yet to reach public health departments or sexual health clinics.
The CDC gave Michigan millions of dollars to strengthen its public health workforce, but the Michigan Legislature appropriated only a portion of the money. Heisler wrote to several state legislators begging them to release the remaining funds. None answered him.
Public health workers say they hope monkeypox is a wake-up call.
“I hope this drives home the need for more investment in public health infrastructure,” said Kwan-Gett, of the Washington state health department, “because without that investment, this is going to happen over and over again.”
KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.
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