Last week, after what felt like the 20th meeting I had been to with the word monkeypox in it, I finally had the opportunity to actually swab a patient for monkeypox.
Two things actually ran through my head as I was performing the test, doing the swab on the patient. Number One: Don't you think we should come up with a better name for this disease? Number Two: Here we go again.
It seems to me that just about 2.5 years ago, we in the healthcare world, as well as the rest of humanity, had this little experience called the COVID-19 pandemic -- remember that? This new disease, with a terrible and terrifying learning curve, incredibly sick patients, fear and anger, and more missteps than we care to imagine -- as well as incredible heroics and tales of tenacity, survival, and grit that revealed the incredible strength that lies at the core of human nature.
And quite importantly, this disease and how it played out amongst us laid bare the failings of our public health system, of what happens when you don't have a nimble, intelligent system in place to manage these threats on a local, regional, national, and global level. We had experts in healthcare, as well as politicians and the press, saying that this would "just blow over" in a matter of days or weeks. We've had all sorts of strange and scary ideas about how to treat the disease, and at times it felt like the message around who was doing what was more important than the science and the healthcare that we needed to give to our patients.
Right now, despite being in the middle of yet another wave, another variant, we seem to at least be in a better place, with treatment options, a vastly vaccinated and protected population, a better system for communication about what works and what doesn't, and speedier paths to getting things done. And we once again (or maybe truly for the first time) recognized how our failure as a society and a healthcare system to provide equitable and just access to care exposed the many biases that are the underpinning of so much of what happens in the world today.
Then along came monkeypox. I remember my disbelief when I got an email entitled "Monkeypox Briefing". Images of what I had learned in medical school about smallpox, chickenpox, and cowpox ran through my head, but nowhere could I find mental reference to monkeypox. Our administration and infectious disease teams have done an incredible job of keeping us updated, tracking the creeping but accelerating spread of the disease, starting to recognize the multiple clinical presentations that we are seeing, and rapidly instituting protocols for treatment, as well as connection to potential vaccines.
But as we've seen in the news, it feels like things are already spreading too fast, like it's a wildfire that's getting ready to burn out of control. And despite our best efforts, the systems aren't in place to alert us that these things are happening, and to rapidly institute measures to put out the flames.
If we're ever going to get to a place where we can recognize these things before they start to take off, we need a system of surveillance, laboratory testing, and interconnectivity that is just missing right now in what we call a healthcare system. We will need, and should demand, a global and unified syndromic monitoring system that checks for all sorts of things that could be clues to what's coming around the bend next. Far too often, as it did for COVID-19, it feels like we are being reactive, like we are playing catch up, like we are looking back at a burning house and saying we probably shouldn't have been playing with matches in the living room, and once we smelled smoke, we probably should have done something about it.
It's great that in a matter of weeks our laboratory and infectious disease colleagues have been able to rapidly ramp up our ability to test for monkeypox, and from the other direction we are getting more and more protocols for treatment. Even vaccines seem like they are coming down the pike at some point in numbers that we hope will match the need equitably. But if we are going to survive as a society, we need to do this on a massive scale, we need to be smarter, and we need to use the tools we have. We need to get lessons from other industries about how to do this better, how to do this right, how not to make the same mistakes, how to smell the smoke and know that somewhere there's got to be fire.
If not, then a pox on us all.