We Have Learned Nothing from the COVID Pandemic

A few weeks ago, some asshole with a blog asked, “Will we learn anything from COVID testing: The monkeypox edition?” Tragically, the answer appears to be nope (boldface mine):

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.

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…

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%…

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.”

Monkeypox won’t be another COVID pandemic, but we are going to have a lot of unnecessary illness that could have and should have been prevented. Give providers at the point of care the ability to easily order tests. Yes, reporting (both positive and negative results) must be required, but don’t let that delay administering the test.

This is so frustrating, and this time, we can’t blame Ron Atlas or Donald Trump.

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