Even though hundreds are still dying from COVID every day and several thousand are hospitalized in the U.S., the pandemic has receded into the mid-summer background hum of American life. Variants come and go, and whatever residual risks exist for essential workers in healthcare or congregant care we expect them to just suck it up.
Just like the ever present risk of workplace violence, including the potential for a random assault rifle attack, it's all part of the implicit 21st century take-it-or-leave-it social contract imposed on the essential workforce. Hazard pay? What hazard?
Now, freshly mixed into the risk-threat matrix for nurses and other front line workers, exposure to the monkeypox virus — which the New York Times reported was "a virus similar to smallpox" but with symptoms that were "less severe." The virus, which originated in Africa and was first seen in the late 1950s, is primarily spread through close physical contact, like sex, but does pose some occupational health risk for healthcare and other frontline workers in congregant care or hospitality settings.
The first case in New York City was flagged May 20. According to an internal) occupational health guidance from the New York City Fire Department Bureau of Emergency Medical Services (FDNY EMS) issued in May and obtained by Salon, the strain of monkeypox identified was "not capable of causing permanent disability of life threatening/fatal disease in healthy humans" but could manifest in lesions as well as other nasty symptoms.
"Incubation periods after potential contact with an infected person is 5-21 days and a patient is considered infectious from 5 days prior to the onset of rash until the lesions have crusted over with new skin," according to the FDNY's EMS 911 fact sheet. "Symptoms usually start within 5 days of exposure and can include fever/chills, headache, muscle aches, fatigue, and lymphadenopathy of swollen lymph nodes in the neck, jaw, and inguinal area (genital area) and usually start before a rash appears. The distinct rash which may appear 1-3 days after initial symptoms, usually begins on the face then spreads to the palms, soles, extremities, and trunk. Classically, they appear as fluid filled vesicles but not all patients with monkeypox develop a rash."
Back on July 23, the World Health Organization (WHO) declared a global public health emergency due to the proliferation of the monkeypox virus. When WHO's panel met a month earlier to evaluate the status of the contagious virus there were 3,040 cases in 47 countries. In just a month it had exponentially expanded to 75 countries and was observed in more than 16,000 people.
Public health experts and union officials warn they are seeing the same plodding response to the monkeypox virus that was so evident during the onset of COVID — when the lack of testing and contact tracing gave the virus a running head start.
In New York City and New York State, now the epicenter for the monkeypox outbreak, officials were suddenly scrambling for a vaccine that remained in short supply. City officials reported 1,300 confirmed cases and that potentially as many as 150,000 New Yorkers had been exposed to the virus. Both Mayor Eric Adams and Gov. Kathy Hochul declared a public health emergency as the local news showed clips of long lines of people hoping to get the shot that was in short supply. President Joe Biden followed suit Aug. 4, declaring a public health emergency as the U.S. confirmed over 6,000 cases, the highest caseload in the world.
Public health experts and union officials warn they are seeing the same plodding response to the monkeypox virus that was so evident during the onset of COVID — when the lack of testing and contact tracing gave the virus a running head start. And as with COVID, the failure to contain and limit the occupational health exposure to the virus put the broader society at risk as healthcare workers inadvertently spread COVID.
"Monkeypox is much different from COVID as far as the way that you get it," said Dr. Edward Zuroweste, the founding director of the Migrant Clinicians Network, an international non-profit that serves migrant and immigrant workers. "It has to be close contact like either with a person that has it, or bed, clothing, or other articles that a person slept on — or used, like towels. So people who are cleaning, for example, in a hotel room or a setting like that, really have to be cognizant of that so that they don't come into skin contact with the virus."
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That means wearing gloves and frequently washing your hands throughout the workday. "The good news is monkeypox does not like soap and water," said Zuroweste.
And while monkeypox has yet to yield a death in the U.S., it's likely a bellwether of things to come as the climate continues to heat up and tropical infectious diseases migrate, Zuroweste believes. "There's no question that we have to find a way to protect essential workers from these infectious diseases because it's going to continue to be an issue so that people have to be aware of the new viruses coming down the pike and what to look out for," he said.
Zuroweste says that in the current risk climate, union representation for essential workers is more vital than ever and that the best countermeasure to the proliferation of pandemics and public health emergencies is the establishment of universal health care that would promote "rapid public health investigations of infectious diseases and contact tracing."
"Morale is at its lowest in EMS. We need parity with police and fire now."
Gloria Middleton is president of CWA 1180 which represents several thousand administrative managers, many of whom work at Health + Hospitals Corp, New York City's municipal hospital system. She lost members to COVID including Priscilla Carrow, who worked at Elmhurst Hospital and was responsible for handing out PPE masks to the clinical staff but because they were in short supply did not wear one.
She says management has been slow so far to communicate with the union about monkeypox. "I have not heard anything from H+H as far as the additional risk to my members," Middleton said. "The city agencies have not yet set policies as to what healthcare workers are to do regarding this. Everybody is still wearing masks but we just don't have enough information out there to make sure our members are protected."
A spokesperson with Health+Hospitals did not respond to a request for comment.
Vincent Variale is the president of DC 37 Local 3621, which represents the FDNY EMS officers. FDNY EMS lost a dozen members to COVID and eight to suicide during the pandemic. "It's good to see the city moving quickly to announce a state of emergency [for monkeypox] but a lot of work still needs to be done to recover from pandemic," he said. "We need to increase staffing for the frontline EMS workforce and morale is at its lowest in EMS. We need parity with police and fire now."
Variale said that because EMS is so short-handed, there's constant pressure to get a rig back into service after a call even though the city's monkeypox outbreak requires ambulances go through a thorough cleaning. "We are so short staffed the Chiefs will yell at crews who go off service to properly clean their vehicles," Variale said.
The risk for EMS from infectious disease made front page news back in 1997 when FDNY EMT Tracy Lee, 34 died from HIV/AIDS she contracted on the job. After only 17 months on the job, Lee's glove tore while she was treating an HIV positive patient. Her spouse's request to have her death classified as a line-of-duty death was denied. Ultimately, the state legislature mandated that HIV on the job infection was a line-of-duty death.
Charlene Obernauer is the executive director of the New York Committee on Occupational Safety & Health, a non-profit supported by labor union and community groups. "Monkeypox has the potential to place a heavy burden on already thinly stretched frontline workers," Obernauer wrote in a text. "We need to do everything we can to support education and access to the vaccine for those who are most vulnerable and who are disproportionately impacted."
Barbara Rosen, the first vice president of Health Professionals and Allied Employees, New Jersey largest nurses union, credited the state of New Jersey with "taking proactive steps on this new public health threat" and that Gov. Phil Murphy had expanded eligibility for the monkeypox vaccine.
"As healthcare workers, we must continue to be vigilant in protecting ourselves," Rosen said in a statement to Salon. "We will continue to advocate for infection disease prevention by ensuring all healthcare workers have access to personal protective equipment, fit testing of such PPE [personal protective equipment] and training on preventative measures and policies. Our members have sacrificed to care for everyone, have become exposed to infectious diseases, have been infected and some of them have died. And the toll is continuing in a staffing crisis that preceded this pandemic and has been greatly exacerbated by it."
The day after the Biden administration declared a national health emergency, Dr. Ashish Jha, the White House's point person on COVID, told MSNBC there had been 6,600 cases in the U.S. but no deaths. Jha explained that the shortfall in vaccines was because there was only "one small Danish company that makes all the vaccines for the world. We have procured more vaccines than the rest of the world combined. So, we have been on this from day one."
Not all the experts agree.
In a New York Times op-ed on Aug. 1 Scott Gottlieb, a former FDA Commissioner said that there had been just 100 cases of monkeypox in Europe in May but that it "wasn't until late June that the Centers for Disease Control and Prevention expanded testing for monkeypox to large commercial labs like Quest Diagnostics and Labcorp for more capacity and access. The CDC had gone through its standard playbook, ticking through its protracted checklist."
"Our country's response to monkeypox has been plagued by the same shortcomings we had with COVID-19," wrote Gottlieb. "Now if monkeypox gains a permanent foothold in the United States and becomes an endemic virus that joins our circulating repertoire of pathogens, it will be one of the worst public health failures in modern times not only because of the pain and peril of the disease but also because it was so avoidable. Our lapses extend beyond political decision making to the agencies tasked with protecting us from these threats. We don't have a federal infrastructure capable of dealing with these emergencies."
Gottlieb closes with a stern warning. "Time is running out. Diseases like Zika, Covid and monkeypox are a dire warning that dangerous pathogens are on the march. The next one could be worse — a deadly strain of flu or something more sinister like Marburg virus. We've now had ample notice that the nation continues to be unprepared and that our vulnerabilities are enormous."
What's clear is that we continue to ignore the data that suggests that protecting our essential workers is foundational to protecting public health.
It might cost more money. And in the U.S. our for profit healthcare system is about the preservation and amassing of wealth — not the well-being of its workforce or the general population.
We know that well over a million people died from COVID here in the U.S. and that tens of millions were infected and millions suffer from so-called long COVID. Yet we have no national registry as to how many people died as result of their workplace exposure and the powers that be are in no hurry to find out.
We know, thanks to reporting by the Guardian and Kaiser Health News that in the first year of the COVID pandemic 3,600 U.S. healthcare workers died due to their workplace exposure. The American Federation of Government Employees, which represents 700,000 federal workers with agencies like the Veterans Administration, lost 600 workers. New York City lost at least 400 civil servants. Its mass transit system lost over 170. We know that nationally several hundred law enforcement officers have lost their lives to COVID.
But by and large we have no idea how many essential workers died as a consequence of the government's mismanagement of the pandemic. That data is essential to knowing which workplaces were the softest targets and where things like ventilation were inadequate. What gets measured is more likely to be managed. So, we avoid the hard question by not creating the data so there's no problem. Just let COVID fade into a blur with the sound of clanging pots and wailing sirens.
Of course, until the next infectious disease officials will say they just didn't see coming.
Editor's note: When this story was originally published, Vincent Variale was quoted as saying that five FDNY EMS employees had died of suicide during the pandemic; on Monday, August 8th, Variale corrected that number to eight, and Salon has revised his quote in turn.