Monkeypox epidemic grows in the United States, the country enters a public health emergency

Inadequate smallpox vaccines are causing lines like this at a San Francisco hospital. (David Paul Morris/Bloomberg)

“After repeating early mistakes in the face of COVID, the United States is now experiencing the largest smallpox outbreak in the world,” USA Today reports.

The US Department of Health and Human Services (HHS) declared monkeypox a public health emergency on Thursday. Since the first case of smallpox in the United States was identified in mid-May, more than 6,600 infections have been detected nationwide, in 48 of 50 states, making it the epicenter of the outbreak in the world. With 5% of the world’s population, the United States already has 25% of those infected.

The decision follows last month’s announcement by the World Health Organization (WHO) of the disease as a public health emergency of international concern. Rarely seen outside Africa, the virus, a less deadly cousin of smallpox, has now sparked a global emergency of 26,000 people, hitting 83 countries, 76 of which have historically not seen the disease.

Due to the limited number of tests, the number of infections is believed to be greatly underestimated. The Biden administration had been sharply criticized by public health experts for not acting faster to deal with the crisis. A week earlier, Europe was considered the epicenter of the contagion.

“Smallpox is on the verge of becoming the next public health failure,” Scott Gottlieb, former commissioner of the US health agency FDA and current head of Pfizer, told The New York Times on Saturday. “Our country’s response to monkeypox has been plagued by the same shortcomings we had with Covid-19,” he added, noting the failure to detect the virus in a timely manner.


An assessment that USA Today, another major US newspaper, agrees with, noting that the story of the spread of monkeypox “seems frustrating to experts as a repeat of the early months of the Covid-19 pandemic in 2020.”

According to the publication, “Tests have been slow to get going. The data did not reveal the full extent of the outbreak. The spread was not stopped quickly enough.

With monkeypox – he adds – “it should be different, because it is much more difficult to transmit, treatments and vaccines were already available, a lot was known about a virus first described in 1958, and so many lessons would have been learned from Covid19″.

“No one knows the full extent of the epidemic in America,” said USA Today, which in its board diagnosis notes that “states don’t need to tell the federal government when they have a patient, and testing difficulties have left many people undiagnosed.” Communication was “so scattered” that many people and doctors “do not consider the virus a possible cause of symptoms such as fever, swollen glands, body aches and the telltale rash” .

“Opportunities have been missed to stop the spread of a virus that rarely kills but can cause severe pain and scarring.”

“It’s deja vu again,” said Lawrence Gostin, a university professor and global health law expert at Georgetown University in Washington. “We really fly in the dark.”

“It’s been a challenge to look at what’s happened over the past two and a half months,” said Dr. Megan Ranney, an emergency physician and academic dean of the School of Public Health at Brown University in Rhode. Island. “I am puzzled as to why we are here today.”

For Ranney, a number of factors likely contributed to the slow initial response, “including competing priorities of federal agencies,” “the decentralization of America’s public health system, with many decisions left to the 50 states,” and “the exhaustion that many public health officials feel after more than two years of battling Covid-19.


Another underlying reason is the intense privatization of health care in the United States and the lack of resources for public health. “If you fund something with a tiny fraction of what it takes to do the job and then criticize it for not doing the job, that doesn’t make sense,” said Dr. Thomas Frieden, former director of the United States Centers for Disease Control and Prevention (CDC). “We are really underfunding public health.”

Frieden said he remembers traveling to the Democratic Republic of the Congo, Africa, when he was director of the CDC in early 2010 and hearing from officials concerned that smallpox and other infectious diseases could eventually spread around the world. But “there were no resources to fight these diseases,” he added. Meanwhile, a few days ago, the US Congress approved a budget for the Pentagon of over $800 billion.

“Who knows why we don’t act more aggressively, as we should? asked Jared Auclair, an analytical chemist and associate dean at Northeastern University in Boston. “Not only should we have learned from the coronavirus pandemic, it’s like a replay of HIV/AIDS from the late 1980s.” The virus is mainly spread through close physical contact, such as skin-to-skin contact.


An article in the Chinese newspaper Global Times referred to another fundamental problem in American society, facing a crisis and, based on the statement of the former CDC official, said that the diagnosis “points in a direction – the dysfunctional political system. Because of such a system, whenever a crisis arises, when American politicians have to unite and face their common enemy, they are simply busy fighting each other .

In this way, the publication adds, “no one can mobilize the resources of the country to achieve an agreed goal”. Which is a huge difference with the Chinese experience of solidarity and coordinated mobilization and action.

“The smallpox epidemic in the United States, in some ways, seems to be repeating the experience of Covid-19. Less than a week ago, Europe was the epicenter of the virus, but now the United States USA has the highest number of monkeypox cases in the world,” some US experts said.


Once the door is broken, the order is to go after the lock. On Tuesday, Biden named Robert Fenton the White House national smallpox response coordinator. Fenton — a Federal Emergency Management Agency (FEMA) regional administrator with no public health background — will coordinate the federal government’s response to the outbreak. As deputy coordinator, Demetre Daskalakis, director of the CDC’s Division of HIV/AIDS Prevention.

Some cities and states, including New York, San Francisco, California, Illinois and New York, had previously declared monkeypox an emergency, a decision that freed up funds and resources for their responses to the new epidemic. The insufficient number of vaccines leads to huge queues, for example in San Francisco.


Historically, the infection fatality rate of the monkeypox strain has been estimated at around one percent, similar to that of Covid-19. A recent study estimated the current global reproduction number (R-value) at around 1.29 [cada contagiado infecta outros 1,29 indivíduos]. In the United States, this rate is 1.55, the highest value among all non-endemic countries.

Monkeypox has similar but less severe symptoms than smallpox, which was eradicated in 1980. About 10% of cases have required hospitalization, mainly because of the suffering it causes. The virus causes lesions in any part of the body, the progression of which is often very painful.

The infected individual must be isolated for about a month and transmission can occur even before the lesions appear. The main modes of transmission are thought to be skin-to-skin contact and respiratory droplets.

Although the media has widely portrayed monkeypox as only affecting “men who have sex with men”, it is actually an infectious disease that threatens all of society. A 2016 monkeypox study found that men accounted for just 57% of all infections.

Specialized publications warn that, although it is a fact that the disease is currently spreading mainly among this public, admitting that the rhetoric of a “new gay plague”, as happened in the 1980s with regard to the AIDS, prevails, in addition to being stupid and discriminatory, from a strictly health point of view, is disastrous.

According to the BBC, doctors were surprised that the most common symptoms of monkeypox were different from what was described in previous outbreaks, when the most common manifestations of the infection were fever, malaise, lymph nodes swollen lymphatics, headaches, sweating and the appearance of various skin lesions, mainly on the face, palms and soles of the feet.

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