Some lab techs refuse to draw blood from possible monkeypox patients, raising concerns about stigma and testing delays

Labcorp and Quest do not dispute that in many cases their phlebotomists do not draw blood from possible monkeypox patients. What remains unclear, after company statements and CNN follow-ups, is whether phlebotomists are refusing to draw blood on their own or whether company policy prevents them from doing so. Both 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 the country’s health officials are being criticized for having struggled to control the epidemic. 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.

“It’s 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 across the United States, some of which have phlebotomists. commercial labs, including Labcorp and Quest. in their offices. Commercial labs employ tens of thousands of phlebotomists — medical professionals who draw blood — in various types of clinics and doctor’s offices across the country, as well as in their own patient service centers.

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

“We can’t afford to delay diagnostic testing because commercial labs aren’t doing the right thing,” he said.

Harvey added that he felt the refusals were “a modern example of discrimination” – a view shared by others.

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

In the United States, cases of monkeypox are mostly in men who have sex with men, and when a technician does not draw blood, it “perpetuates further stigma, fear and anxiety” for a virus already stigmatized, added Dr. Peter Chin-Hong, a member of the California Department of Public Health’s monkeypox virus scientific advisory committee that 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 more unpleasant for someone to ask for a monkeypox test,” he said. “Then it will make things worse.”

Phlebotomists routinely draw blood from people with many types of infections, and monkeypox is nothing new: the United States 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, which instructs health care workers to use standard precautions to prevent transmission when handling specimens from patients with suspected or confirmed monkeypox.

“Some of our phlebotomists were scared”

Blood tests are needed not only to differentiate monkeypox from other infections, but also to look for other sexually transmitted infections, such as syphilis, because people with monkeypox sometimes have STIs.

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

In an email to CNN Monday morning, a Quest spokeswoman wrote that “we are following CDC guidelines which state that patients with confirmed or suspected monkeypox infection should be isolated. Once a individual is released from solitary confinement, we will provide a service to him”.

Spokesperson Kim Gorode sent a link to these CDC guidelines to support Quest’s policy. However, these guidelines do not say that health care services should be delayed until the end of a period of isolation. In fact, the CDC says its isolation recommendations “do not apply in healthcare settings.”
CDC spokeswoman Kristen Nordlund said “The CDC’s monkeypox isolation guidelines specifically state that people should remain in isolation except to seek medical attention. Obtaining a sample for testing is medical care that could lead to a diagnosis or treatment if necessary”.
Since the first US case was identified in May, the CDC has issued monkeypox infection control guidelines for healthcare providers. This page offers detailed instructions on how to treat these patients safely and notes 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 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 isolation guidelines not applying to health care facilities had been moved higher on the page.

Gorode added that “we want to ensure that every patient has access to the tests they need while promoting a safe environment for our employees and all of our patients.”

Labcorp director Dr. Brian Caveney told CNN last week that “so far we have generally not taken” blood samples from suspected monkeypox patients, but that the company was reviewing its policies and that this “should change”.

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Caveney, president of corporate diagnostics, said Labcorp is “trying to make sure our workforce is safe, but also making sure we’re taking care of our customers as we work out the regulations. and appropriate workplace safety policies”.

“(Monkeypox) is new – nobody knew what it was – some nurses and some doctors are afraid of it. Some of our phlebotomists were afraid of it – rightly so -,” he said.

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

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

“It’s a problem. It’s like a doctor refusing to take care of a patient,” she said.

Calls on the CDC to do more education

Caplan, the bioethicist, asked why Quest and Labcorp were now working on guidelines for their phlebotomists when the first case of monkeypox emerged in the United States more than two months ago.

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

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

“They need educational deployment (for phlebotomists) and not just counseling. 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 you to get sick, quit or take a new job, which would affect 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 ultimately phlebotomists have to draw blood from people who have or may have monkeypox.

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

CNN’s Nadia Kounang contributed to this report.

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