Some lab techniques refuse to draw blood from potential monkeypox patients, raising concerns about stigma and delaying tests |  CNN

Some lab techniques refuse to draw blood from potential monkeypox patients, raising concerns about stigma and delaying tests | CNN


CNN has learned that several technicians at Labcorp and Quest Diagnostics, two of the largest commercial labs in the United States, are refusing to draw blood from patients who may have monkeypox.

Labcorp and Quest do not argue that in many cases, phlebotomy specialists do not take blood from potential monkeypox patients. What remains unclear, after the company’s statements and follow-up from CNN, is whether the drawers refuse on their own or whether it is company policy that prevents them. The two testing giants say they are reviewing safety policies and procedures for their employees.

Infectious disease experts who treat monkeypox patients say the refusal is based on stigma and slow efforts to identify and isolate monkeypox patients at a time when the country’s health officials are under fire for their struggle to control the outbreak. As of Tuesday, 6,326 cases of monkeypox were reported, an 81% increase from the previous week, according to data from the US Centers for Disease Control and Prevention.

“This is absolutely indefensible. It’s a serious omission in their offices,” said David Harvey, executive director of the National Coalition of STD Managers, which represents 1,600 sexual health clinics in the United States, some with commercial lab phlebotomists including Labcorp and Quest. In the line of duty.Commercial laboratories employ tens of thousands of phlebotomy specialists—health care professionals who draw blood—in various types of clinics and physicians’ offices across the country, as well as at their own patient service centers.

Although monkeypox is diagnosed by swabbing the lesions, blood tests are necessary to distinguish the virus from other infections, infectious disease experts say. Harvey said doctors in sexual health clinics had to find workarounds when phlebotologists refused to take blood from suspected monkeypox patients.

“We cannot afford to delay in diagnostic tests because commercial labs are not doing the right thing,” he said.

Harvey added that rejection appears to be a “modern example of discrimination” – a view shared by others.

“It reminds me of the old days when people didn’t want to care for AIDS patients,” said Arthur Kaplan, a bioethicist at New York University.

Monkeypox cases in the US have been primarily among men who have sex with men, and when a technician does not draw blood, it “perpetuates more stigma, fear and anxiety” for an already stigmatized virus, added Dr. Peter Chen Hong, a member of the virus’ scientific advisory committee. Monkeypox of the California Department of Public Health that cares for monkeypox patients.

Chen Hong, an infectious disease specialist at UCSF Health, said men avoid being tested for the virus for fear of stigma.

“The fact that poachers are afraid of sampling makes it even more unattractive for someone to ask for a monkeypox test,” he said. “So this will only make it worse.”

Phlebotologists take blood from people with many infections on a regular basis, and monkeypox is not new: the United States has had cases before, including two last year and dozens in 2003. The amount of smallpox virus in the blood is “low,” According to the CDC, which directs health care workers to use standard transmission prevention precautions when handling samples from suspected or confirmed monkeypox patients.

Blood tests are necessary not only to distinguish monkeypox from other infections but to test for other sexually transmitted diseases, such as syphilis, since people with monkeypox sometimes have STDs.

If blood is not drawn from suspected monkeypox patients, “the standard of care will not be followed,” said Harvey, director of the Association of Sexual Health Clinics.

In an email to CNN Monday morning, a Quest spokeswoman wrote: “We are following CDC guidelines that state that patients with confirmed or suspected monkeypox infection should be isolated. Once the individual is out of isolation, we will service them.”

The spokeswoman, Kim Gorode, sent a link to the CDC’s guidance in support of Quest’s policy. However, these guidelines do not state that health care services should be delayed beyond the isolation period. In fact, the CDC says its isolation recommendations “do not apply in healthcare settings.”

CDC spokeswoman Kristen Nordlund said monkeypox isolation guidelines from the CDC specifically state that people should remain isolated, except to get medical care. Obtaining a sample for testing is medical care that can lead to a diagnosis or, if necessary, treatment.”

Since the first US case was identified in May, the CDC has given monkeypox infection control guidelines to health care providers. This page provides detailed instructions on how to treat these patients safely and notes that transmission has been reported “rarely” in healthcare settings.

Later Monday, Gorode wrote in an email to CNN that “we are now evaluating our guidance in light of updates posted on the CDC website today.” It did not specify what those updates are. CDC spokesman Jason MacDonald said the only update Monday is that the award for isolation guidelines that don’t apply to health care settings has been moved up the page.

“We want to ensure that every patient has access to the tests they need while promoting a safe environment for our staff and all of our patients,” Gorod added.

LabCorp CEO Dr. Brian Cavaney told CNN last week that “until now, we haven’t usually” drawn blood from suspected monkeypox patients, but the company has been reviewing its policies, and that “is likely to change.”

Cavaney, the company’s head of diagnostics, said that Labcorp was “trying to make sure our workforce is safe but also to make sure that we take care of our customers while we figure out appropriate occupational safety regulations and policies.”

“(Monkeypox) is new – no one knew what it was – some nurses and doctors were afraid of it. And some of our phlebotologists were – appropriately – afraid of it.”

But the head of the phlebotomy group said they should not be afraid, as long as they take standard precautions.

Diane Crawford, chief executive of the National Phlebotomy Society, said she was “disappointed” that labs were allowing phlebotomists to refuse to draw blood from suspected or confirmed monkeypox patients.

“It’s a problem. It’s like a doctor refusing to take care of a patient,” she said.

Kaplan, the bioethicist, wondered why Quest and Labcorp were now working on guidelines for two phlebotomy classes when the first case of monkeypox appeared in the United States more than two months ago.

“It should have already been done,” he said.

Kaplan said the CDC needs to do more to educate phlebotomists outside the pages on its website.

“They need an educational release (for phlebotomy) and not just a directive release. This is very, very important,” he said.

He said education about standard safety precautions should help phlebotologists feel comfortable taking samples from these patients.

“I don’t want you to move out or leave or take a new job, which hurts the availability of these services,” he said. “And we have an obligation to make their work as safe and risk-free as possible, and that goes beyond just the information on websites.”

But Kaplan added that at the end of the day, phlebotologists need to take blood from people who have or may have had monkeypox.

“We want you to do that, it’s important to help control the outbreak, and that’s the kind of risk factor you’re involved in,” he said.

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