Unheeded lessons: Torpid U.S. and state monkeypox responses evoke dark early months of COVID

July 25, 2022 12:02 am

In this Centers for Disease Control and Prevention handout graphic, symptoms of one of the first known cases of the monkeypox virus are shown on a patient?s hand June 5, 2003. (Photo Courtesy of CDC/Getty Images)

Why is it that when a new transmissible pathogen arrives in Virginia, it seems as though governmental agencies responsible for coordinating the response are mired knee-deep in wet cement? Did COVID-19 teach us nothing?

Last week, the Mercury’s Kate Masters revealed that Virginia was behind the curve in responding to monkeypox, a viral infection growing across the nation. The state, she reported, lacked sufficient vaccines, testing and other forms of treatment, raising the specter that the outbreak will become harder for officials to contain.

Sound familiar?

Let’s set the dial on Professor Peabody’s Wayback Machine to early 2020 when the commonwealth was making its first tentative acknowledgements that an emerging contagion that had ravaged Asia, Europe and parts of the United States was actually present within its borders.

In early March, having just begun her work as the Mercury’s health care reporter, Masters wrote that then-Gov. Ralph Northam, a doctor, and other leading state health officials were insisting there was no community spread in Virginia, that somehow the risk was low from a freakishly contagious disease spread merely by inhaling where an infected person had breathed. It was a rosy assessment that, at the time, had been extrapolated from just 17 tests statewide. And it proved tragically wrong.

It wasn’t clear then, the story said, how the state would respond as the demand grew exponentially for hard-to-find tests that took a long time to deliver results. And prospects then for a vaccine or effective treatment laid many months – perhaps years – in the future.

The Northam administration’s initial response to the deadly novel coronavirus to which humans had no immunity was halting, and within a month the gravity of the pandemic in Virginia had become sobering. With severe illnesses, hospitalizations and deaths mounting, the state scrambled for protective gear for hospital staff and other medical professionals. A dearth of tests led officials to recommend that Virginians turn to private labs for testing. By the second week of April, a New York Times analysis had identified a nursing home in far western Henrico County as having the highest death toll of any long-term care facility in the United States.

As the breadth and apocalyptic gravity of the disease became indisputable, Northam finally lowered the boom, ordering wholesale closings and quarantining. By then, the disease was rampant. Remarkably, that didn’t keep voices from the far-right fringe from assailing the governor for the lifesaving steps he belatedly took.

But you get the idea. The state was tardy in summoning all hands to battle stations at the dawn of the pandemic, and you can see early signs that a similar pattern may be playing out now.

First, some context.

The virus that causes monkeypox is a member of the family of viruses that causes smallpox. Unlike the coronavirus, it is spread by physical contact with an infected person or animal, not by mere proximity. Its symptoms include fever, headaches, chills and blistering rashes and lesions. The disease was once almost unheard of and outbreaks were largely confined to Africa. But the 2022 outbreak has seen cases spring up worldwide.

As of Friday, the Centers for Disease Control and Prevention had confirmed 2,891 cases in the United States, or about 17 percent of the 16,538 cases worldwide. Only Spain, with 3,125 reported cases, had more. The Virginia Department of Health as of Friday listed 64 cases statewide, with the bulk of them, 50, in Northern Virginia. That places the commonwealth well behind the No. 1 state, New York, with 830 reported cases Friday, or even neighboring Washington, D.C., with 110, according to the CDC.

But the reported cases are only as good as the extent of the testing, and, as Masters reported, that’s not going so well. Case counts have taken off since the first Virginia diagnosis in May, but because of limitations on testing and widespread unawareness of the presence of the previously rare virus, many infections likely aren’t getting diagnosed or reported.

Unlike COVID-19, monkeypox has been around since the Beatles broke up, so there are vaccines already developed to keep it at bay. But, like tests, vaccines are frustratingly hard to find.

If the Virginia Department of Health seems slow out of the blocks, it’s only mirroring an asleep-at-the-switch federal response that, as with the start of COVID-19, fails to inspire confidence. At the beginning of June, there were just a dozen monkeypox cases in the United States. Shortly before that, the White House’s coronavirus response czar, Ashish Jha, gave a facile assessment of those cases: “It is not as contagious as COVID. So, I am confident we’re going to be able to keep our arms around it.”

Thus the feds dawdled and did not marshal America’s peerless research and manufacturing might behind the effort to produce more tests, vaccines and therapeutics to help those who already have symptoms.

Now, scientists fear the genie has escaped Aladdin’s lamp and isn’t going back. This weekend, the World Health Organization declared the outbreak a global health emergency, the highest alert it can issue. 

Advocates for LGBTQ communities wonder aloud – and with good reason – whether the response would have been more robust if monkeypox were not disproportionately afflicting those who identify as gay or bisexual.

The dominant vaccine, Danish-manufactured JYNNEOS, is distributed by the U.S. Department of Health and Human Services to states. As of July 19, HHS’s Administration for Strategic Preparedness and Response had dispensed 191,372 doses, according to the ASPR website. Virginia, as of last Wednesday, had been allotted 4,051 of those doses.

The feds allot doses based on case counts and likelihood of spread. That’s why Uncle Sam has sent only a dozen doses to Alabama and eight to Montana, yet California and Florida were sent more than 26,000 doses apiece and the cities of New York and Los Angeles were sent about 22,000 and 24,000, respectively. Virginia follows a similar template for dispensing its doses, meaning the lion’s share will go north of the Occoquan.

While monkeypox is nowhere near the threat to life or the resilience of the health care system that COVID has been, it’s worth remembering that Virginia once took a carefree, wait-and-see attitude toward a new virus, purportedly of Chinese origin, that emerged in the deep winter weeks of 2020, dismissing the first cases as merely come-heres that hitched a ride to the commonwealth in overseas travelers and denying that the killer respiratory disease was already spreading in our communities.

Nor is monkeypox likely to reach pandemic proportions and shut down the economy as the coronavirus did. We’re not going to see restaurants limited to takeout, cinemas shuttered, basketball seasons halted and pro football games played in empty stadiums.

But this certainly would have been a good time for a country emerging from those privations to see its federal and state health agencies a little more ahead of the game for a change.

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Bob Lewis
Bob Lewis

Bob Lewis covered Virginia government and politics for 20 years for The Associated Press. Now retired from a public relations career at McGuireWoods, he is a columnist for the Virginia Mercury. He can be reached at [email protected]