A SECOND OPINION
( continued from page 27 ) from Nigeria . It was felt to be travel-related ; contacts were followed up ; warnings were emphasized to travelers returning from central or western Africa . Prior to that , on July 15 , 2021 , a Texan also returning from Nigeria , taking two flights , was monitored along with over 200 potential contacts . No cases were identified by September . Nigeria , by contrast , had reported over 450 cases since its 2021 reemergence there .
The first known U . S . case of 2022 was confirmed in Boston on May 18th in a man returning from Canada ; Britain had confirmed nine and cases had been reported from multiple European countries . Once again , the contact tracers swung into action . As of mid-August we had racked up around 15,000 cases “ felt to be an undercount ” because of the time-consuming difficulty of getting tested . Full PPE required , mostly done in selected urgent care centers after thorough screening – not something you can nip up to your nearest pharmacy for , at all . I had immediate flashbacks to the first batches of flawed Covid tests released by the CDC and shipped out in trickles . People who were negative on these tests in fact had Covid and could infect others in that very dark winter and spring of 2020 . Just searching out a Covid test for months was an exercise in frustration for thousands upon thousands . Finding out your test was unreliable did not build confidence in your doctor or anyone else .
As it turns out , and not something the CDC could have known at the outset , casual skin contact is less a source of getting monkeypox than is intimate contact with semen . A study in Spain found that 92 % of the 181 enrolled men had sex with men ( MSM ) and 40 % were HIV positive . All had skin lesions , 78 % in the anogenital area and 43 % oral / perioral lesions . Other scientists have since proven the virus is present in semen and saliva . Viral load was higher in lesion swabs than in pharyngeal specimens . Tonsillitis was found in 95 % of the men who had oral sex . Later , the WHO reported that 96.9 % of 9,100 cases were in men who have sex with men . doses by using the intradermal technique is brilliant – this was validated in a two dose 2015 study . Having that decision anger the prime manufacturer of that vaccine , Bavarian NordicA / S , cannot be helped : let them think of eventual and not immediate profits , for heaven ’ s sake .
But I do fault the CDC for not overseeing our strategic stockpile of all vaccines with a lot more urgency and efficiency . Didn ’ t they read The First Shots ? Didn ’ t their brass learn , in the hardest way possible , the terrible consequences of being unprepared for a viral pandemic ? This – this is the sticking point . The CDC needs a czar or two to reduce the many-headed administrative monster to a set of smoothly interlocking cubes – and fast .
Too many people – too many nurses and aides and doctors and EMS – have died of Covid to even count . Monkeypox has a case fatality rate of 3-6 %, and treatment other than vaccination is not commercially available outside of potential studies . At least it is not as severe ; the specter of mutations can always raise its ugly head .
I am certain , at least in Louisville , that every one of us who knows how to give an intradermal dose properly – and is licensed to do so – will sign straight up for any version of LouVax needed . Sadly , we won ’ t have Dr . SarahBeth Hartlage to lead us , but we are ready to help always .
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .
The CDC has been careful not to come across as targeting a group of people who already face discrimination for a different identity . On the other hand , rushing available tests and vaccines to such groups makes perfect sense and getting the word out in a polite and sensitive ( and speedy !) way is imperative . The CDC eventually flagged MSM , then removed the reference , then restored it mid-August . I understand their caution ( closeted men and youth might be afraid to seek care ) and the hostility from groups who disapprove of being gay is , in this day and time , a danger to those groups .
The Biden administration has now set aside 50,000 smallpox vaccine doses for use in upcoming LGBTQ events : that ’ s real progress . Additionally , the CDC is depleting our national stockpile of smallpox vaccines at a rapid rate , while hoping to boost manufacturing . On the other hand , the FDA ’ s splitting each dose into five
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