Some lab technicians refuse to draw blood from potential monkeypox patients, raising concerns about stigma and testing delays.



CNN

Many technicians at Labcorp and Quest Diagnostics, two of the largest commercial laboratories in the US, have refused to draw blood from patients who might have monkeypox, CNN has learned.

Labcorp and Quest do not dispute that, in many cases, their phlebotomists fail to draw blood from potential monkeypox patients. What remains unclear, after company statements and CNN coverage, is whether the phlebotomists are refusing to draw blood on their own or whether it is company policy that prevents them from doing so. The two testing giants say they are reviewing their security policies and procedures for their employees.

Infectious disease experts treating monkeypox patients say the denials are based on stigma and slow efforts to identify and isolate monkeypox patients at a time when health officials of the nation are under pressure. criticism for fighting to control the outbreak. As of Tuesday, 6,326 cases of monkeypox were reported, an increase of 81 percent from the previous week, according to data from the US Centers for Disease Control and Prevention.

“This is absolutely inexcusable. It is a serious dereliction of duty,” said David Harvey, executive director of the National Coalition of STD Directors, which represents 1,600 sexual health clinics in the US, some of which have phlebotomists from commercial laboratories, including Labcorp. and Quest, in their offices. Commercial laboratories employ tens of thousands of phlebotomists (health professionals who draw blood) in various types of clinics and doctors’ offices across the country, as well as in their own patient care centers.

Although monkeypox is diagnosed using samples of lesions, blood tests are needed to differentiate the virus from other types of infections, infectious disease experts say. Harvey said doctors at sexual health clinics have had to find workarounds when phlebotomists have refused to draw blood from suspected monkeypox patients.

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

Harvey added that it appears the denials are “a modern example of discrimination,” a view shared by others.

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

Cases of monkeypox in the US have been primarily among men who have sex with men, and when a technician fails to draw blood, “it perpetuates more stigma, fear and anxiety” about a virus that is already stigmatized, added the Dr. Peter Chin-Hong, a member of the California Department of Public Health’s Monkeypox Virus Scientific Advisory Committee who cares for monkeypox patients.

Chin-Hong, an infectious disease specialist at UCSF Health, said men avoid getting tested for the virus for fear of being stigmatized.

“The fact that phlebotomists are afraid to take samples makes it even less attractive for someone to ask for a monkeypox test,” he said. “So this will make it even worse.”

Phlebotomists regularly draw blood from people with many types of infections and monkey pox is not new: The US has seen cases before, including two last year and dozens in 2003. The amount of smallpox virus in the blood is “low,” according to the Centers for Disease Control and Preventionthat instructs health workers to use standard precautions to prevent transmission when handling specimens from suspected or confirmed monkeypox patients.

Blood tests are necessary not only to differentiate between monkeypox and other infections, but also to detect other sexually transmitted infections, such as syphilis, since people with monkeypox sometimes have STIs.

If suspected monkeypox patients don’t have their blood drawn, “the standard of care is not followed,” said Harvey, director of the association of sexual health clinics.

In an email to CNN Monday morning, a Quest spokeswoman wrote that “we follow CDC guidelines that patients with confirmed or suspected monkeypox infection should be isolated. Once a person comes out of isolation, we will provide service to them.”

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

CDC spokeswoman Kristen Nordlund said “the monkeypox isolation guide specifically states that people must remain isolated, except to receive medical care. Obtaining a sample for testing is medical care that could lead to a diagnosis or treatment if warranted.”

Since the first US case was identified in May, the Centers for Disease Control and Prevention has provided guidelines for the control of monkeypox infection to healthcare providers. That page offers detailed instructions on how to treat these patients safely, noting that transmission in healthcare settings has been “rarely” reported.

Later Monday, Gorode wrote in an email to CNN that “we are now evaluating our guidance in light of the updates posted today on the CDC site.” She did not specify what those updates were. CDC spokesman Jason McDonald said the only update on Monday was that the sentence about isolation guidelines that don’t apply to health care settings was moved higher on the page.

Gorode added that “we want to make sure all patients have access to the tests they need while also fostering a safe environment for our employees and all of our patients.”

Dr. Brian Caveney, an executive at Labcorp, told CNN last week that “so far, we haven’t normally been doing” blood draws from suspected monkeypox patients, but that the company was reviewing its policies and that this “probably change”.

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

“(Monkey pox) is new, no one knew what it was, some nurses and doctors are afraid of it. Some of our phlebotomists have been afraid, appropriately, of that,” she said.

But the head of a group of phlebotomists said they shouldn’t be afraid, as long as they take standard precautions.

Diane Crawford, executive director of the National Phlebotomy Association, said she is “disappointed” that labs allow phlebotomists to refuse to draw blood from suspected or confirmed monkeypox patients.

“It’s a problem. It’s like a doctor refusing to treat a patient,” he said.

Caplan, the bioethicist, questioned why Quest and Labcorp are now working on guidelines for their phlebotomists when the first case of monkeypox appeared in the US more than two months ago.

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

Caplan said the CDC needed to do more to educate phlebotomists beyond the pages of its website.

“They need an educational implementation (for phlebotomists) and not just provide guidance. That is very, very important,” she said.

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

“I don’t want him to get sick, leave or take a new job, which would hurt 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 information on websites.”

But Caplan added that, at the end of the day, phlebotomists need to draw blood from people who have, or might have, monkeypox.

“We want you to do it, it’s important to help control outbreaks, and this is the kind of risk factor you signed up for,” he said.

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