Testing is crucial to getting monkeypox under control, but there’s a ‘shocking’ lack of demand

By Elizabeth Cohen, CNN Senior Medical Correspondent

Testing for monkeypox, a crucial part of containing the growing outbreak, has gotten off to a sluggish start at the five commercial laboratories that have nearly all the US’s monkeypox testing capacity, CNN has learned.

Mayo Clinic Laboratories, for example, has the capacity to process 1,000 monkeypox samples a week but has received only 45 specimens from doctors since starting monkeypox testing July 11. Another of the labs, Aegis Sciences Corp., can do 5,000 tests per week but has received zero samples over the past two weeks. At Labcorp, one of the largest commercial labs in the US, uptake has been higher but still “extremely low,” according to Dr. Brian Caveney, the lab’s president of diagnostics.

Those numbers are “shocking,” said Dr. Peter Chin-Hong, a member of the California Department of Public Health’s Monkeypox Virus Scientific Advisory Committee.

“This is really, really concerning. It’s like Covid PTSD,” he said, referring to the early phase of the pandemic when coronavirus testing was extremely limited. While the anxiety is the same, the reasons are different because for Covid-19, the testing capacity was low, and for monkeypox, the capacity is plentiful but the demand is low.

The first US monkeypox case in this outbreak was reported May 17, and the virus has spread rapidly to reach 4,639 probable or confirmed cases, nearly all of them in men who have sex with men. Getting the outbreak under control has been a challenge for the US Centers for Disease Control and Prevention and the Biden administration, which is expected to name a monkeypox coordinator and has been considering whether to declare the virus a public health emergency.

Dr. Anthony Fauci, President Biden’s chief medical adviser, described testing as a “pillar” of the government’s monkeypox response Tuesday on CNN. He and other health officials have repeatedly assured Americans that there’s high capacity to handle testing, with labs capable of processing 80,000 specimens per week. Most of that capacity — 70,000 specimens — is in the private labs.

The CDC engaged the five labs to handle the growing case numbers. Two of them, Quest Diagnostics and Sonic Healthcare, declined to tell CNN how many monkeypox specimens they’ve received, but “capacity at the five commercial labs at this point far exceeds what we are seeing in demand,” according to Susan Van Meter, president of the American Clinical Laboratory Association.

Testing is a major part of the monkeypox containment effort for two reasons: It’s the first step to identifying and isolating patients, and it gives public health officials an idea of the scope of the outbreak and which geographic areas need the most resources.

“Without testing, you’re flying blind,” said Dr. William Morice, chair of the board of directors of the American Clinical Laboratory Association and president of Mayo’s lab. “The biggest concern is that you’re not going to identify cases and [monkeypox] could become an endemic illness in this country. That’s something we really have to worry about.”

Chin-Hong likened the low lab numbers to “walking around with Vaseline in your eyes: You’re not seeing the whole picture.”

Dr. Matthew Hardison, senior vice president of Aegis, cautions that “if you’re not doing enough testing, you’re not going to find it, and it will continue to spread, and we’re already seeing significant growth in a number of different states around the country right now.”

A steep learning curve

Before this year, there had been just a few dozen cases of monkeypox in the United States. As with any newly emerging pathogen, the CDC has set out to educate health care providers how to detect the disease, order tests for it and treat it.

The agency has sent emails through its Health Alert Network, hosted two calls attended by more than 17,000 doctors and other clinicians, and set up a phone line for physicians to ask questions. The CDC has also sent out emails to physicians announcing the availability of testing at the five private labs.

A CDC spokesperson said there has been “robust outreach to clinicians and the general public to increase awareness of monkeypox risk factors, symptoms and testing options.”

JAMA and other medical journals have also offered information about how to diagnose, test for and treat monkeypox.

“The message is definitely getting out there,” said a federal health adviser who requested anonymity because they’re not a government employee and they don’t speak for any federal agency. “Our hope is that every clinical provider in this country now knows about monkeypox and when to test.”

But even with that education, it can be difficult to detect a case of monkeypox, in part because the rash isn’t always distinctive, Caveney said.

“It just looks like a pimple or something,” he said.

Because monkeypox is spread by prolonged skin-to-skin contact, the doctor also has to get a detailed and thorough history from their patient.

“It’s really hard for clinicians to get an accurate history of someone’s contact maybe a week or two ago and then to look at a lesion and say, ‘Oh, this isn’t just, you know, just a normal thing that would be in your skin. It’s something that I should test,’ ” he said.

Caveney added that as doctors learn more about monkeypox, he expects testing numbers to increase.

Other hurdles to testing

Experts say education is only one reason for the slow adoption of testing.

For another, some people who have monkeypox symptoms may not seek care for fear of being stigmatized.

“They might think, ‘I’m going to identify myself as someone who is frowned on in society: I have sex with men, I have multiple sex partners, or I didn’t use protection.’ That’s what having monkeypox says now, and you can imagine people don’t want to say all that,” said Chin-Hong, an infectious disease expert at UCSF School of Medicine who has treated people with monkeypox.

Also, many members of the LGBTQ community are accustomed to getting care from sexual health clinics, which are now overwhelmed treating monkeypox patients as well as their regular caseloads, according to David Harvey, executive director of the National Coalition of STD Directors, which represents public and private sexual health clinics and programs.

He said that about half of the clinics in his organization don’t send specimens to private labs because it’s too expensive to hire staff to manage the paperwork, which might help explain why the volume of monkeypox tests at private labs has been so low.

“It’s very frustrating to us in the (sexually transmitted infection) field to hear information coming from the White House and the CDC about testing capacity and access to vaccines when what doesn’t get discussed is all the implementation issues within your everyday clinic,” Harvey said.

The CDC spokesperson said the agency “encourages anyone who suspects they have monkeypox to reach out to their clinician to get tested since there is more than enough testing capacity.”

On Monday, more than 100 members of Congress wrote a letter to the Biden administration urging additional funding for sexual health clinics to improve the monkeypox response effort.

“As monkeypox cases continue to rise, states and communities are heavily relying on health clinics’ expertise in disease detection, contact tracing, symptom monitoring, and community education, as well as their community connections, to help slow the spread of this virus,” the letter stated.

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CNN’s Brenda Goodman, Jamie Gumbrecht and Danielle Herman contributed to this report. Clarification: The first paragraph of this story previously mischaracterized private labs’ testing capacity as their testing demand.