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

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 who treat monkeypox patients say the denials are based on stigma and the slow pace of efforts to identify and isolate monkeypox patients at a time when state health officials the nation are being criticized for struggling to control the outbreak. As of Tuesday, 6,326 cases of monkeypox had been reported, an 81% increase from the previous week, according to data from the US Centers for Disease Control and Prevention.

“This is absolutely inexcusable. This 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 (healthcare professionals who draw blood) in various types of clinics and doctor’s 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 can’t 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.

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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 is going to make it even worse.”

Phlebotomists draw blood from people with many kinds of infections on a regular basis, and monkeypox isn’t new: The US has seen cases before, including two last year and dozens in 2003. healthcare workers to use standard precautions to prevent transmission when handling specimens from suspected or confirmed monkeypox patients.

‘Some of our phlebotomists have freaked out’

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.

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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 leaves the isolation, we will serve you.

Spokesperson Kim Gorode sent a link to these CDC guidelines to support Quest’s 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 CDC’s monkeypox isolation guidance specifically states that people should 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 case was identified in the US in May, the CDC has provided guidelines for the control of monkeypox infection to health care providers. That page offers detailed instructions on how to treat these patients safely, noting that transmission in healthcare settings has been “rarely” reported.
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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.”

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

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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.”

“(Monkeypox) is new, no one knew what it was, some nurses and doctors are afraid of it. Some of our phlebotomists have appropriately been afraid of it,” he 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.

Ask the CDC to do more education

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 already have 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’s very, very important,” he 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.

CNN’s Nadia Kounang contributed to this report.

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