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June 27, 2022
A New York man began feeling ill on June 13.
"He began to experience swollen lymph nodes and rectal discomfort," said Keletso Makofane, an epidemiologist at Harvard University.
The man suspected he had monkeypox. He was a scientist and knew the signs and symptoms like the back of his hand, Makofane said. So the man went to his doctor and asked for a monkeypox test. The doctor decided, instead, to test the man for common sexually transmitted diseases. All of those results were negative.
"A few days later, the pain increased," Makofane says. So he went to the emergency center and again asked for a monkeypox test. This time, the doctor prescribed antibiotics to treat the bacterial infection.
"The pain got so bad and started to affect his sleep," Makofane said. "So this Sunday, he went to the emergency room of a large academic hospital in New York."
At that point, the man had a growth in his rectum, a symptom of monkey pox. At the hospital, he saw an emergency room doctor and an infectious disease specialist. The man again asked to be tested for monkeypox. But the specialist denied the request, saying, "The monkeypox test doesn't mean that," Makofane said. Instead, the doctor speculated that the man might have colon cancer.
A few days later, he developed skin lesions - another key sign of monkeypox.
An Ineffective Testing System
But as the demand for testing grew - the disease was more common than officials initially predicted - the testing system the CDC had set up stopped working properly because it effectively prevented doctors from ordering monkeypox tests.
Providers had to go to great lengths to order the tests. They had to get permission and instructions from local or state labs, Nuzzo said. The process was cumbersome and often time-consuming. Sometimes, doctors have to sit on the phone for hours.
"That's the bottleneck we're really worried about," she says. "We need to cast a bigger net with testing to find the infections we're missing. If we make it cumbersome and difficult for health care providers to request testing on busy days, that's really hard to do."
Nuzzo said the CDC and local health departments need to remove barriers to testing. "I also want to make testing easier and more widespread so that all clinicians feel they can test patients. Any patient who has a suspicious rash."
Doctors and nurses need to better understand what actually happens to patients with monkeypox. It's not like it is in the medical textbooks. It presents like many other diseases, including herpes, syphilis and colon cancer.
Nuzzo explains, "The infection occurs primarily in men who have sex with men, and they often go to sexual health clinics for care." "These providers may now be particularly aware of monkeypox and may be more willing to send out samples for testing. But we may not be seeing the level of education and willingness to test of other providers who are seeing a different type of patient. This means we may be missing infections in different patient populations."
On Thursday afternoon, the Centers for Disease Control and Prevention (CDC) announced that they are working to strengthen testing at major laboratories commonly used by health care providers. The agency's goal is to make testing easier sometime in July.
But Nuzzo said the test needs to be changed immediately. It needs to become easier now for doctors to submit samples to labs that already do such tests.
"We don't have the time," she said. "Every day we delay, we lose a link in the chain of transmission and allow the outbreak to grow to the point where it could get out of control."
And monkeypox, like COVID, could become a long-term, perhaps even permanent, problem in the United States