Labcorp and Quest do not dispute that their phlebotomists do not draw blood from possible monkeypox patients in many cases. What remains unclear after corporate statements and follow-ups from CNN is whether the phlebotomists refuse to take the blood of their own accord or whether it is corporate policy that is preventing them. The two testing giants say they are reviewing their safety policies and procedures for their employees.
Infectious disease experts who treat patients with monkeypox say the denials are based on stigma and slow efforts to identify and isolate patients with monkeypox at a time when the country’s health officials are criticized for struggling to contain the outbreak. to gain control. On Tuesday, there were 6,326 reported cases of monkeypox, an 81% increase from a week earlier, according to data from the U.S. Centers for Disease Control and Prevention.
“This is absolutely inexcusable. It’s 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 labs, including Labcorp and Quest in their portfolio. offices. The commercial labs employ tens of thousands of phlebotomists — health professionals who draw blood — in various types of clinics and doctor’s offices across the country and their own patient service centers.
Although monkeypox is diagnosed by smears, blood tests are needed to distinguish the virus from other types of infections, infectious disease experts say. Harvey said doctors at sexual health clinics have had to find a solution when phlebotomists have refused to draw blood from suspected monkeypox patients.
“We can’t afford delays in diagnostic testing because commercial labs aren’t doing the right thing,” he said.
Harvey added that it feels like the denials are “a contemporary 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.
Monkeypox cases in the U.S. were primarily among men who have sex with men, and when a technician doesn’t draw blood, it “perpetuates more stigma and fear and concern” for a virus that’s already stigmatized, added Dr. Peter Chin-Hong to it. a member of the California Department of Public Health’s Scientific Advisory Committee on Monkeypox Virus that deals with patients with monkeypox.
The initial strategy to vaccinate only known monkeypox contacts was “doomed to failure” in the US, experts said Chin-Hong, an infectious disease specialist at UCSF Health, said men avoid being tested for the virus for fear of being stigmatized.
“The fact that phlebotomists are afraid to take samples makes it even more unappealing for someone to ask for a monkeypox test,” he said. “So this is going to make it worse.”
Phlebotomists regularly draw blood from people with many types of infections, and monkeypox is not new: The U.S. 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 CDC, instructing health professionals to take standard precautions to prevent transmission when handling samples from suspected or confirmed monkeypox patients.
‘Some of our phlebotomists are afraid’
Blood tests are not only necessary to distinguish between monkeypox and other infections but also to test for other sexually transmitted diseases, such as syphilis, as people with monkeypox sometimes have STDs.
If blood samples are not taken from suspected monkeypox patients, “the standard of care is not being followed,” said Harvey, the Association of Sexual Health Clinics director.
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In an email to CNN Monday morning, a spokeswoman for Quest wrote, “We are following CDC guidelines that patients with confirmed or suspected monkeypox infection should be isolated. Once a person is out of isolation, we will provide service for them. ”
The spokeswoman, Kim Gorode, sent a link to these CDC guidelines to support Quest’s policies. However, those guidelines do not say that health care services should be delayed until after an isolation period. In fact, the CDC says its isolation recommendations “do not apply in healthcare facilities.”
CDC spokeswoman Kristen Nordlund said, “CDC’s guidelines for isolating monkeypox specifically state that people should remain isolated except to receive medical care. Obtaining a sample for testing is medical care that can lead to diagnosis or treatment if warranted. ”
Since the first case was identified in the US in May, the CDC has issued monkeypox infection control guidelines to health care providers. That page provides detailed instructions on how to safely treat these patients, noting that transmission in health care settings has been “rarely” reported.
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Later Monday, Gorode wrote in an email to CNN that “we are now evaluating our guidelines in light of the updates posted to the CDC site today.” She did not specify what those updates were. CDC spokesman Jason McDonald said the only update Monday was that the sentence about the isolation guidelines that don’t apply to health care facilities has moved higher up the page.
Gorode added, “we want to ensure that every patient has access to the tests they need while also promoting a safe environment for our employees and all of our patients.”
Labcorp Director Dr. Brian Caveney told CNN last week that “usually no” blood draws were taken from suspected monkeypox patients, but that the company was reviewing its policy and that this would “probably change.”
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Caveney, the company’s president of diagnostics, said Labcorp “tried to make sure our workforce is safe, but also to make sure we’re taking care of our customers while figuring out appropriate occupational safety regulations and policies.”
“(Monkeypox) is new — nobody knew what it was — some nurses and doctors are afraid of it. Some of our phlebotomists have — rightly so — been afraid of it,” he said.
But the head of a group of phlebotomists said there’s no need to worry as long as they take standard precautions.
Diane Crawford, CEO 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 care for a patient,” she said.
Calls on CDC to provide more education
Caplan, the bioethicist, wondered 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 happened already,” he said.
Caplan said the CDC needed to do more to educate phlebotomists beyond the pages on its website.
“They need an educational rollout (for phlebotomists), not just providing guidance. That’s very, very important,” he said.
He said education about standard safety precautions should help phlebotomists feel comfortable taking samples from these patients.
“I don’t want you to get sick or leave or take a new job, which would hurt the availability of these services,” he said. “And we have a duty to make their work as safe and risk-free as possible, and that goes beyond just information on websites.”
But Caplan added that eventually, phlebotomists do need to draw blood from people who have or may have monkeypox.
“We want you to do it. It’s important to help manage the outbreaks, and this is the kind of risk factor you signed up for,” he said.
