A latest CNN investigation discovered that within the midst of rising case numbers, some phlebotomists within the US have refused to attract blood from sufferers with suspected monkeypox, stopping these sufferers from acquiring medically essential and physician-ordered checks.
But the definition of “suspected monkeypox” and the opposite particulars round these circumstances stay murky at greatest. As CNN famous in its reporting, it’s unclear if the phlebotomists refused to carry out blood attracts, or whether or not firm coverage prohibited it. Are these encounters wherein homosexual males are being denied bloodwork just because they’re homosexual and monkeypox is now related to this demographic? Or are these conditions wherein sufferers with seen and infectious pustules are presenting to diagnostic testing websites the place phlebotomists are fearful about whether or not correct security insurance policies and procedures are in place?
Within the first encounter, homophobia is the driving issue; within the second, any affordable well being care supplier would equally have reservations about placing themselves in danger. (Although the US Facilities for Illness Management and Prevention means that virus ranges in contaminated folks’s blood are low, non-bloodborne transmission routes akin to straight touching lesions might enhance a well being care employee’s attainable danger of getting contaminated with out sufficient PPE.)
We’re homosexual males, and seeing these in our group denied medical care echoes the early days of the HIV/AIDS epidemic. Initially known as GRID (homosexual associated immunodeficiency), the outbreak resulted in discrimination and stigmatization of LGBTQ+ people throughout society no matter infectious standing.
It’s discriminatory to imagine that an identification is itself a danger issue for illness and that avoidance of full segments of society is an applicable security mechanism. But these defective assumptions stay the cornerstone of homophobia in modern-day medication and account for a lot of the distrust that LGBTQ+ folks have towards the well being care system.
However as medical professionals, we additionally perceive the concern that comes with encountering sufferers who’ve extremely infectious illnesses. Eric has been a frontline doctor since day one of many Covid-19 pandemic and is now a doctor working with sufferers with monkeypox. Tom has labored with sufferers within the intensive care unit through the Delta Covid-19 surge. We perceive the actual concern of contracting viruses at work, and — as a married couple — we acknowledge the priority about bringing illness dwelling to family members.
With the Covid-19 pandemic, we watched as tips on PPE modified out of comfort moderately than out of scientific knowledge and noticed our coworkers — fellow medical doctors, nurses, phlebotomists, radiology technicians, janitorial workers, safety — contract the virus from their sufferers.
Nobody goes into medication to harm sufferers — everybody in well being care has determined to work in an trade that tries to enhance the lives of others. But, it could be unconscionable to anticipate everybody in well being care to place their very own well being in danger to assist their sufferers. And coming off of the Covid-19 expertise, there’s justified distrust and protracted concern amongst many well being care personnel.
The best way to ameliorate the state of affairs at giant — each to bolster the well being and security of well being care staff and to deal with the stigmas related to monkeypox — is twofold: schooling and correct security insurance policies together with the supply of private protecting tools.
Well being care suppliers in any respect ranges have to be included in trainings about what monkeypox is, how it’s unfold (and the way it is not) and mechanisms to maintain themselves protected whereas caring for all sufferers — each these with monkeypox and people with out. We should make it clear what security procedures are essential and guarantee all suppliers have entry to supplies like PPE always.
We should enable every well being care employee the possibility to ask questions on how monkeypox impacts their job. As a medical group, we’ll greater than possible establish lapses in our insurance policies and methods to enhance them.
Feeling protected is a key motivator for habits change. We have seen the evolution in how we have interacted with, handled and handled HIV via the rise of common precautions, aimed to guard well being care staff. These precautions have been launched by the CDC within the Eighties in response to the HIV epidemic when quite a bit was unknown concerning the virus, and so they embrace protocols for hand hygiene; sporting gloves, goggles and robes; and particular transmission-route based mostly precautions.
If adopted correctly, they’ll stop the transmission of bloodborne pathogens and different infectious supplies. The provision of pre-exposure prophylaxis, post-exposure prophylaxis and HIV therapy have even additional decreased the concern round an infection with HIV amongst well being care suppliers.
Moreover, vaccines to stop monkeypox, like Jynneos, are exhausting to seek out and should first go to sufferers at highest danger of illness. The CDC advises people who find themselves uncovered to monkeypox via their jobs, akin to medical laboratory personnel who carry out diagnostic checks, to get the vaccine as a pre-exposure prophylaxis, and a few well being care staff who have been uncovered to sufferers with monkeypox have gotten the vaccine as a post-exposure prophylaxis to stop sickness or mitigate signs. However provides are nonetheless low, and as soon as the vaccines are extra available, they need to be provided as a pre-exposure prophylaxis to a broader vary of well being care staff, from nurses to hospital workers to technicians — all of whom might encounter sufferers with monkeypox.
Labcorp government Dr. Brian Caveney advised CNN final week that a few of their phlebotomists “have been scared” of monkeypox. With out particular data on what precisely is driving these phlebotomists to refuse blood attracts, shaming well being care staff for being afraid (regardless of probably missing PPE and up to date data on monkeypox) or assuming that it stems completely from homophobia, feels somewhat myopic. As case numbers are projected to climb and the way forward for the monkeypox outbreak stays unsure, cautious messaging, information sharing and destigmatizing must be our collective precedence.
Well being care staff should really feel heard and guarded, as many people are
exhausted, fearful and burnt out from working nonstop via greater than two years of the Covid-19 pandemic. However that can’t imply we overlook the wants of our homosexual, bisexual, queer and transgender sufferers — an already stigmatized group jaded from many years of minority stress. Institutional and public well being methods should make everybody — sufferers and suppliers alike — really feel protected and welcome.
