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The coronavirus exposed flaws in the nation’s pandemic plans. The spread of monkeypox shows that the problems remain deep-rooted.

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Ms Mandavilli has covered both the Covid pandemic and the monkeypox outbreak. She spoke to more than a dozen public health experts about flaws in the national response that need to be fixed.

If it wasn’t clear enough during the Covid-19 pandemic, it’s become apparent during the monkeypox outbreak: The United States, one of the world’s wealthiest and most advanced nations, remains woefully unprepared to combat emerging pathogens.

The coronavirus was a cunning, unexpected adversary. Monkeypox was a known enemy, and tests, vaccines, and treatments were already available. But the response to both threats stuttered and stumbled at every step.

“It’s like watching the tape play, except some of the excuses we relied on to rationalize what happened in 2020 don’t apply here,” said Sam Scarpino, who oversees pathogen surveillance at Rockefeller Foundation Pandemic Heads Prevention Institute.

No single agency or administration is to blame, more than a dozen experts said in interviews, although the Centers for Disease Control and Prevention have acknowledged they botched the coronavirus response.

The price of failure is high. Covid has so far killed more than a million Americans and caused untold misery. Cases, hospitalizations and deaths are all declining, but Covid was the third leading cause of death in the United States in 2021 and will likely continue to kill Americans for years to come.

Monkeypox is now spreading more slowly and has never been a challenge of Covid’s proportions. But the United States has reported more cases of monkeypox than any other country — 25,000, about 40 percent of the world total — and the virus is likely to persist as a constant, low-level threat.

Both outbreaks have revealed deep fissures in the national epidemic containment framework. Add to this falling public confidence, rampant misinformation and deep divisions — between health officials and patients treating patients, and between the federal and state governments. A confused reaction to future outbreaks seems almost inevitable.

“We’re really ill, ill prepared,” said Larry O. Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University.

New threats of infection are certainly on the way, largely due to the double increase in global reluctance to travel and vaccinate, and the growing proximity of humans and animals. For example, from 2012 to 2022, Africa saw a 63 percent increase in animal-to-human outbreaks compared to 2001-2011.

“Perhaps in people’s minds is the idea that this Covid thing was such a freak of nature, a crisis that only happens once in a century, and we’re good for the next 99 years,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

“It’s the new normal,” she added. “It’s like the levees are built for the crisis of one in 100 years, but then there’s flooding every three years.”

Chronic Underfunding

Ideally, the national response to an outbreak might be like this: Reports from a clinic somewhere in the country would signal the arrival of a new pathogen. Alternatively, ongoing wastewater monitoring could alert on known threats, as was recently the case with polio in upstate New York.

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What to Know About the Monkeypox Virus

What is monkeypox? Monkeypox is a virus similar to smallpox, but the symptoms are less severe. It was discovered in 1958 after outbreaks occurred in monkeys kept for research. This may interest you : Former Hawk County Recorder named state real estate chief. The virus has been found mostly in parts of central and west Africa, but recently it has spread to dozens of countries and infected tens of thousands of people, mostly men who have sex with men.

How is it spreading? The monkeypox virus can spread from person to person through close physical contact with infectious lesions or pustules, by touching objects such as clothing or bedding that have previously been in contact with the rash, or via the respiratory droplets produced by coughing or sneezing. Monkeypox can also be transmitted from mother to fetus via the placenta or through close contact during and after birth.

I’m afraid I might have monkeypox. What should I do? There is no way to test for monkeypox if you only have flu-like symptoms. But if you start noticing red lesions, you should contact an emergency center or your GP, who can order a monkeypox test. Isolate at home as soon as you develop symptoms and wear quality masks if you need to come into contact with others to receive medical care.

I live in New York. Can I get the vaccine? Adult men who have sex with men and have had multiple sex partners in the past 14 days are eligible for a vaccination in New York City and close contact with infected individuals. Eligible individuals with diseases that weaken the immune system or have a history of dermatitis or eczema are also urged to be vaccinated. People can book an appointment through this website.

Information would flow from local health departments to state and federal agencies. Federal officials would quickly allow the development of tests, vaccines and treatments, and would offer guidance on development and make them fairly available to all residents.

Neither of these steps has worked smoothly in the two recent outbreaks.

“I’m very familiar with outbreak response and pandemic preparedness, and none of it looks like it,” said Kristian Andersen, a virologist at Scripps Research Institute in San Diego who has spent years studying epidemics.

dr Andersen said he assumed the shortcomings revealed by the coronavirus would be addressed as soon as they became apparent. Instead, “we are less prepared now than when the pandemic started,” he said.

Public health in the United States has always worked with a minimum. The C.D.C. and other federal agencies are ridiculously outdated. Many public health workers have been abused and assaulted during the pandemic and have fled or are planning to flee their jobs.

More money won’t solve all problems, several experts said. But additional funding could help public health departments hire and train staff, update their outdated data systems, and invest in robust surveillance networks.

But in Congress, preparing for a pandemic remains a tough sell.

Mr. Biden’s fiscal 2023 budget request is $88 billion over five years, but Congress has shown no inclination to approve it.

The United States spends 300 to 500 times more on its military defenses than on its health care systems, and yet “no war has killed a million Americans,” noted Dr. Thomas R. Frieden, who created the C.D.C. under ex-President Barack Obama.

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Renewed Urgency

The United States should be best at handling outbreaks. See the article : Cases of COVID-19 are on the rise in Cumberland County, the health director says. A global health security assessment in 2019, a year before the arrival of the coronavirus, ranked the nation first among everyone else – best at preventing and detecting outbreaks, most adept at communicating risk and second only to the United kingdom regarding the speed of their eruption response.

All of this assumed, however, that leaders would act quickly and decisively when confronted with a new pathogen, and that the public would follow directions. The analyzes failed to take into account a government that downplayed and politicized every aspect of the Covid response, from tests and masks to the use of vaccines.

Too often, when government officials face a crisis, they look for simple solutions with dramatic and immediate repercussions. But there are none for dealing with pandemics.

“A pandemic is, by definition, a problem from hell. It’s very unlikely that you can eliminate all of the negative consequences,” said Bill Hanage, an epidemiologist at Harvard T.H. Chan School of Public Health.

Instead, he added, officials should rely on combinations of imperfect strategies, with an emphasis on speed rather than accuracy.

In both the coronavirus pandemic and the monkeypox outbreak, for example, the C.D.C. first tried to keep testing in control instead of spreading responsibility as much as possible. The move led to limited testing and left health officials blind to the spread of the virus.

The Food and Drug Administration has been slow to help academic laboratories develop test alternatives and promote the highest quality of diagnosis. It may be reasonable for officials to ask which test is faster or which produces the fewest errors, said Dr. Hanage, but “anything is better than doing nothing.”

Georgetown University’s Mr. Gostin holds a C.D.C. for most of his career and was among his staunchest defenders at the start of the pandemic.

But he became increasingly disillusioned when the United States was forced to rely on other countries for crucial information: How effective are boosters? Is the virus in the air? Do masks work?

“In virtually every case, we have received and acted on our information from foreign health authorities, from the UK, from Israel, from South Africa,” Mr Gostin said. The CDC “Always seemed to be the last and the weakest,” he said.

Many at the C.D.C. and other health officials appeared paralyzed for fear of being held accountable if something goes wrong, he added: “They cover their rear ends and try to follow procedure. It all boils down to a lack of fire in their bellies.”

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Divided Responsibilities

The most difficult hurdle to a coordinated national response comes from the division of responsibility and resources between federal, state, and local governments, as well as communication gaps between the health authorities who are coordinating the response and the doctors and nurses who are actually treating patients.

The complex laws that govern healthcare in the United States are designed to protect confidentiality and patient rights. “But they are not optimized to work with the public health system and give the public health system the data it needs,” said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response.

In principle, federal states are not obliged to pass on health data such as the number of cases of infection or demographic data of vaccinated people to federal authorities.

Some state laws actually prohibit officials from sharing the information. Smaller states like Alaska may not want to give out details that make patients identifiable. Hospitals in small jurisdictions are often reluctant to release patient data for similar reasons.

Healthcare systems in countries like the UK and Israel rely on nationalized systems, which make it much easier to collect and analyze information about cases, said Dr. Anthony S. Fauci, the Biden administration’s chief medical adviser.

“Our system isn’t that interconnected,” said Dr. fauci “It’s not uniform — it’s a patchwork quilt.”

A CDC official said the agency understands states’ perspective, but current rules on data sharing have created “limitations and hurdles.”

“I don’t think it’s about scapegoating states,” said Kevin Griffis, a spokesman for the agency. “It’s simply a statement that we don’t have access to the information we need to optimize an answer.”

Legislation introduced in Congress could help remove these obstacles, he added. The measure would require healthcare providers, pharmacies, and state and local health authorities to submit health records to the C.D.C.

Epidemics are managed by public health agencies, but it is clinicians – doctors, nurses and others – who diagnose and care for patients. An efficient response to an outbreak relies on mutual understanding and information sharing between the two groups.

The sides have not communicated effectively during either the Covid pandemic or the monkeypox outbreak. The split has led to absurdly complicated procedures.

The CDC, for example, has not yet included monkeypox in its computerized disease reporting system. This means state officials have to manually enter data from case reports, rather than simply uploading the files. An application for testing often has to be faxed to the state laboratory; Results are often relayed through a government epidemiologist, then to the provider, and then to the patient.

Few public health officials understand how health care is delivered on the ground, some experts said. “Most people in the C.D.C. don’t know what the inside of a hospital looks like,” said Dr. James Lawler, co-director of the University of Nebraska’s Global Center for Health Security.

dr Frieden, who once ran the New York City Department of Health, suggested C.D.C. Local health officials could help officials understand the obstacles faced in responding to an outbreak.

dr Frieden has also proposed what he calls a “7-1-7” accountability metric loosely modeled on a strategy used to combat H.I.V. Epidemic. Any new disease should be identified within seven days of onset, reported to public health authorities within one day, and treated within seven days.

The strategy could give the government a clearer sense of the issues hampering the response, he said.

In the United States, “we have repeated cycles of panic and neglect,” said Dr. Peace. “The most important thing we have to do is break this cycle.”

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