Health

When smallpox reached rural communities, it collided with strained public health systems


When a case of monkeypox was reported in Nevada’s Humboldt County in August, it was the first time the state had detected the virus in a rural area. Before long, cases were found in other rural districts – Nye, Lyon and Elko – posing another hurdle for a public health system already eroded by the covid-19 pandemic.

Experts say the response to the monkeypox virus in rural America could be influenced by patchy resources and the acrimonious politics that are legacy of the pandemic, challenges that some Worried people could allow sporadic infections to gain a foothold.

“Your embers turn into wildfires really quickly,” said Brian Castrucci, president and chief executive officer of the Foundation de Beaumont, a national nonprofit focused on public health policy. . “The challenge is: Do we have the infrastructure in place in rural America to adequately respond to monkeypox, for whatever follows in the future?”

In Humboldt County, local officials quickly began work after monkeypox was reported. The local health board has issued a New information posted encourages residents to exercise caution when it comes to physical contact and to outline what symptoms to look for – painful or itchy rash, fever, and headache, among others.

“I don’t think this is something we should be afraid of,” said Dr. Charles Stringham, county health officer, in the press release, “but instead each of us can be avoided by taking some relatively simple precautions. “

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Local health officials play a “primary prevention” role, Stringham said in an interview. It’s a role that includes educating the community about the virus, tracking people who test positive, and checking in with local doctors.

State and local public health officials in Nevada said the response in Humboldt County, home to nearly 18,000 people, and similar efforts in other rural communities followed the guidelines set by the Center released by the Centers for Disease Control and Prevention. State and local health leaders meet monthly to discuss public health issues, which of late include monkeypox virus. They said they trust local feedback.

However, some residents in rural Nevada said they were confused about where to find the vaccine or if it was available in their county.

Stevie Noyes, a resident of Winnemucca, Humboldt County’s largest city, who has been identified as a common illness, said she wouldn’t know where to go to get the monkeypox vaccine. She called a retail pharmacy near her home, where her family usually receives vaccines, in early September and was told that the pharmacy did not have a monkeypox vaccine. The pharmacist has no idea where she can find one in town.

Noyes, a 34-year-old hairdresser, said she’s not too worried about monkeypox because no other cases have been detected in the county. However, should the virus begin to spread, she said, members of the local LGBTQ+ community would rely on each other, rather than local county or health officials.

Noyes said health and county officials are “very interested in the town” about the politics of responding to public health issues. “What I see a lot is the political influence on where it’s done restricts what gets released and it prevents steps from being taken.”

Although Noyes has witnessed speeches about venom, Stringham said that in his experience, monkeypox virus is not difficult to respond to politically, especially compared to covid.

CDC data showed that non-Hispanic and Hispanic black men who have sex with other men accounted for representation of infections nationwide. LGBTQ+ Supporters said they were concerned that the government response was not reaching their communities even though they were disproportionately affected.

In larger cities, such as Las Vegas, officials have partnering with LGBTQ+ community centers to raise awareness and distribute educational materials and vaccines. But there is no similar center in Humboldt County, where 57% of voters oppose a polling question in 2020 overturned a provision in the state’s constitution that banned same-sex marriage. Statewide, the ballot measure was approved by 62% of voters.

Noyes said she’s more worried about prejudice than the virus and fears that because the virus has been linked to men who have sex with men, it could have retribution for those who identify. is LGBTQ+ in Humboldt County. “A lot of these people, the more you come into contact with them, the more encouraged and, I mean, they end up being dangerous,” she said.

Some in Winnemucca have been outspoken in calling smallpox the “gay virus” and making fun of it on Facebook, she said.

In late September, Noyes helped organize Winnemucca’s second Pride festival. Immunize Nevada, a nonprofit focused on providing vaccines statewide, was there to provide information on covid-19 and monkeypox.

“We’re hoping to counter it that way,” Noyes said.

Kristy Zigenis, director of the state’s immunization program, said responding to the monkeypox virus in rural areas requires nuance. “If we held a clinic in a rural area, not all of those people might be willing to share with the world that they engaged in this behavior,” says Zigenis.

She added that public health officials have encountered affected people in Clark County, home to Las Vegas, who are unwilling to share the names of their sexual partners during contact tra or unable to identify their sexual partners. “I think that might go into the countryside a little bit compared to what is happening with the number of cases,” she said.

As of October 26, there were 28,087 confirmed cases of monkeypox virus nationwide, According to CDC, and 298 in Nevada, putting the state in the second-highest tier in terms of transmission. Most of the state’s cases are in Clark County, where more than two-thirds of the state’s residents live, but cases have been reported in four rural counties.

Since it’s unclear whether monkeypox is spreading beyond the case detected in Humboldt County, Stringham said he’s trying to deliver enough message to inform residents, but not so much to devastate strength.

He said he thought resources would be directed towards better prevention of covid, adding that the situation could change.

To make matters more difficult, the public health nurse, who was responsible for distributing vaccines from a state clinic in Winnemucca, retired a few months ago, and her replacement, a nurse from Carson City, didn’t arrive until October.

“We’re working with a bit of a deficit in that respect,” Stringham said.

In the interim, Zigenis said, Humboldt County residents who are eligible to receive the monkeypox vaccine should meet with an administrative assistant at the Winnemucca Community Health Nursing Services office, where 100 doses are available. Jynneos vaccine. The state agency will then send people to Humboldt County to administer the vaccine.

Experts say that gap is symbolic of the kinds of difficulties officials in rural communities across the country face when dealing with public health issues.

“The challenge is that there may be people who are not seeking primary care, so cases will not be admitted,” says Castrucci. He added that concentrating resources on smallpox or monkeypox could put other health problems in shambles, especially when considering the lack of investment in public health departments. local communities in rural America compared with departments in larger cities.

KHN (Kaiser Health News) is a national newsroom specializing in the production of in-depth coverage of health issues. Along with Policy Analysis and Exploration, KHN is one of the three main activities in KFF (Kaiser Family Foundation). The KFF is an advocated non-profit organization that provides information on health issues to the nation.

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