US faces Bottleneck for Monkeypox Testing

US faces Bottleneck for Monkeypox Testing
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To understand the diseases better it is important to have all the data on hand to make an informed decision to control the spread.

The US medical facilities have ramped their capacity for testing the rising monkeypox but the process is time taking and not everyone has the access to these tests.

The US laboratories could run 6000 tests per week before the first case of monkeypox emerged in the country. This capacity was sufficient until the disease broke out in the country and it is spreading at a much faster rate than was expected. There are now at least 5000 confirmed cases in the United States.

Testing is a crucial part of the treatment. This is mainly because a positive result is needed for TPOXX access. It is an antiviral medicine that is currently being used for treating monkeypox. Test results are important tools that guide you in the right direction, especially for diseases that don’t yet have a straightforward cure. They are the key evidence that indicates the disease is there, even when there are no visible symptoms.

Monkeypox Testing in US

Currently, testing has expanded to 80000 per week. This amazing increase has been possible due to five large commercial laboratories that have partnered with the US government to give a much-needed boost to the test capacities. But while the capacity has increased, there are still some barriers that do not allow direct to a large part of the general public.

In the US, states are required to submit reported cases’ data on certain diseases, but so far monkeypox has qualified to be one of them. This is a major reason why it is difficult for health officials to gauge the right magnitude of the outbreak and how-to diseases are spreading, thus making it difficult to break the chain of transmission. The health officials state that they don’t have the exact date of the affected as they do not have the complete information on many tests are being run and what percentage of them are turning out to be positive.

To understand the diseases better it is important to have all the data on hand to make an informed decision to control the spread. Similarly, the government is blindfolded in a way that it doesn’t know if enough testing capacity is accessible to people. Since they are unaware of how much is the actual demand.

Testing Capacity

According to the health department, ramping up the testing capacity was initially slow and it was a challenge to make increase it. The officials were not expecting it to spread as fast as it did. The officials were hoping this on the fact that the transmission of the diseases is very limited to humans. Monkeypox is primarily caused and spread by the rodents like rats and tree squirrels. The biggest outbreak in the Us was back in 2003 when 47 acquired the disease after coming into contact with pet prairie dogs, that were near the imported mammals that were brought in from Ghana. These cases spread over 6 states including, Ohio, Wisconsin, Kansas, Indiana, Illinois, and Missouri.

Monkeypox is quite different from COVID-19, about which we knew nothing and we surely weren’t prepared for it at all. For orthopoxviruses, the US already has a test that can identify viruses including smallpox and monkeypox. CDC didn’t have to start the development of new testing kits for monkeypox. This saved them a considerable amount of time. The time for developing the COVID kits increased the spread of the disease, especially for people who did not have any visible symptoms. While the tests and kits were already there, still each step was required to be done by hand which is time-consuming and reduces the overall speed of completing a test run.

According to the Federal guidelines, testing should only be conducted by swabbing the lesions of the suspected person. The lesions project like big pimples or can be blisters and normally appear on the face, hands, feet, or genital areas. They can be present in the mouth or rectum as well. After taking the swab samples, they undergo a PCR. This test involves the extraction of genetic material and amplifying its magnitude to look if the DNA of monkeypox is present there. While doing it manually, this involves mixing various fluids and reagents to isolate the monkey pox DNA.

Automation of Testing

This entire process makes it a slow one. Labs like the Mayo Lab are working to make these tests more automated. Other commercial labs are working on similar lines. The capacity was to run 20 or 30 tests a day, using the manual protocol. But until recently, these tests will become more and more automated which will increase the capacity to run hundreds of tests each day. Such tests can create some other issues as well. Currently, these tests require a swab test of a lesion. But for people who have internal lesions, these might not be a very good idea as they become too painful.

This creates a limitation to performing such tests only on people who have external lesions that are more visible. Still, it can take several days for the rashes to appear. In other cases, some people might have very subtle lesions and it does not become very clear if they have the symptoms at the start when there are less visible symptoms, thus making early detection next to impossible. Catching the infection early on increases the chances of treating it much more effectively and getting the vaccination early on. CDC says that it is better if the affected gets the vaccination four days from the first exposure.

Similar to the COVID-19 test, the requirement for a monkeypox test must come from a certified physician. The problem arises, as the disease and its symptoms are still very new and not many doctors are aware of them, it becomes a bit difficult for the doctors to even know if the patient needs one. Many of the current cases are in homosexual men. In the state of Indiana, nearly 20% of the reported cases are of women and the remaining two are identified in children.

Monkeypox and the Financial Crisis

Another barrier to the testing lies on the financial side. Lack of finances along with lack of medical insurance or even availability of transportation to the testing sites are also becoming an issue. Also, there is this stigma that surrounds, if you test positive that stops people from going through the process of testing.  FDA says that monkeypox testing should be done only on the lesions but in Spain, there are other ways for testing the presence of the virus. The DNA of the virus is also present in the semen and saliva. 12 tests came out positive by using this testing technique.

Flow Health, a company in California, is already using this technique. The company has been offering COVID-19 testing services. The company is working on preparing a spitting test to test if the monkeypox virus is there in a person.

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But the FDA released a statement stating that there are good chances that the tests performed other than the swab test of the lesion, might not be accurate. It is understandable, that lesion tests are painful and invasive but they ensure accuracy. However, the saliva tests could save people from embarrassment and pain and they would be easier to perform even at home.

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