Monkeypox, COVID responses share central obstacle

Red tape, red tape, red tape.

That was the refrain that popped up repeatedly on Tuesday, when California lawmakers convened for two separate hearings on the two viruses for which Gov. Gavin Newsom has declared a public health state of emergency: COVID-19 and monkeypox.

The key takeaway from the two hearings — which, ironically, took place at the exact same time in the exact same building — was that although California’s monkeypox response has been aided and accelerated by lessons learned from the COVID pandemic, some frustrating problems continue to repeat themselves, CalMatters’ Kristen Hwang reports.

“We have shot ourselves in the foot,” state Sen. Scott Wiener, who leads the Senate Select Committee on Monkeypox, said at the start of the hearing, referring to “severe public health failures” at the federal level to procure doses of the vaccines used for monkeypox and to set up robust testing and treatment programs.

Officials ran through the ways in which red tape has hampered California’s monkeypox response, including:

• Difficulty in prescribing a drug known as TPOXX as an antiviral treatment for severe cases of monkeypox. Because the drug — federally approved to treat smallpox — hasn’t been cleared by the U.S. Food and Drug Administration to treat monkeypox, it requires hours of paperwork for each patient, along with an ethics review. (Anecdotally, monkeypox patients report TPOXX alleviates symptoms, which can include severe pain.) This “lengthy process has inhibited many medical centers and clinics from being able to offer the drug to many people,” said Dr. Vivek Jain, an associate professor of medicine at San Francisco General Hospital. To state Sen. John Laird, a Monterey Democrat, that signaled “another troubling parallel to the HIV crisis, where potentially life-saving drugs were being held up by the FDA because of bureaucratic red tape.”
• Difficulty in ramping up testing. “We know right now the only test that the FDA has approved is swabbing the lesions from monkeypox,” Wiener said. “So if someone doesn’t have lesions, or the test is done incorrectly, their tests may be falsely negative. There are new tests coming out, and we need a sense of urgency from the FDA in evaluating and approving those tests.” Dr. Erica Pan, California’s state epidemiologist, said the state is exploring with “academic partners” other methods of testing for monkeypox, including “antibody testing and testing for people who don’t have symptoms.”
• Difficulty in reallocating public health funds earmarked for COVID to monkeypox, a move that requires both state and federal approval. Some California lawmakers have already asked the feds to allow the state to authorize some of the $1.5 billion in COVID-19 response funds for monkeypox.

“What we learned from COVID is that speed is everything. When we look at the response of monkeypox later on, we’ll see speed is the main thing we take issue with,” Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco and a member of the state’s scientific advisory committee for monkeypox, told Kristen.

A similar point was raised during the hearing on the state’s COVID response, led by state Sen. Josh Newman of Fullerton, CalMatters health reporter Ana B. Ibarra notes.

• Dr. Aimee Sisson, Yolo County’s health officer: “During a public health emergency the government needs to get out of its own way so we can act fast. … Our pandemic response went well when we suspended the usual rules and imported masks from overseas despite the high costs and without (federal) approval, and when we expanded the types of health care providers who could administer vaccines. Our response went poorly when we created a duplicative mechanism to allocate vaccines to providers and when we refused to allow labs to develop their own COVID tests.”

California’s monkeypox response may also take a page out of its coronavirus playbook when it comes to isolation and paid sick leave policies — which could signal a repeat of past legislative battles between business and labor groups. 

• Wiener: “We need to make sure we are protecting people who have monkeypox and making sure that they do not lose their homes because of an inability to work. …You might have to isolate for three or four weeks if you get monkeypox, and for people who can’t work from home, they need to have paid sick leave.”

The coronavirus bottom line: As of Monday, California had 10,071,958 confirmed cases (+0.5% from previous day) and 93,193 deaths (+0.1% from previous day), according to state data now updated just twice a week on Tuesdays and Fridays. CalMatters is also tracking coronavirus hospitalizations by county.

California has administered 78,998,017 vaccine doses, and 71.8% of eligible Californians are fully vaccinated.

Other Stories You Should Know

1 Newsom unveils last-minute climate goals

Newsom is pushing state lawmakers to pursue a series of beefed-up measures to combat climate change, which he outlined in a memo sent to legislative leaders in the past week, CalMatters’ Rachel Becker and Julie Cart report. But behind the ambitious goals — unveiled soon after the governor urged state regulators to add teeth to California’s climate strategy — lurk large logistical hurdles, including:

• Timing. Lawmakers have little time left to accomplish what Newsom spokesperson Alex Stack described as an “ambitious climate agenda for this session”: The session ends in three weeks.
• Frustration. Assemblymember Al Muratsuchi, a Torrance Democrat, has sponsored bills related to three of Newsom’s five major proposals — but the governor didn’t appear to support the bills, and none made it past the state Senate. “We need him to not only to nudge the Legislature, which has been working on these issues for years, we need his leadership, we need his willingness to push back against big oil and its allies,” Muratsuchi said. “The Legislature cannot do it on its own.”
• Confusion. Newsom wants lawmakers to establish a buffer of at least 3,200 feet between new oil and gas production wells and homes, schools and parks — but a state agency is already in the midst of a rulemaking process to do the same thing.
• Feasibility. Newsom wants to significantly accelerate California’s pace of greenhouse gas cuts — even though the state isn’t on track to meet its existing goal. “I don’t think we lack for ambitious targets. What’s missing is a key strategy, a firm strategy to implement our existing targets,” said Danny Cullenward, policy director at CarbonPlan. (Meanwhile, California’s electric grid, which is already producing below ideal capacity, is on track to fall 1,800 to 2,000 megawatts short of demand by 2025, Mark Rothleder, chief operating officer at the California Independent System Operator, said during a Tuesday legislative hearing.)

Other environmental news you should know:

• In the latest sign of California’s dire drought, the state denied a request from some Southern California water agencies for additional water to irrigate dry vegetation in areas of high wildfire risk, noting that “providing supplemental water … increases the likelihood that the State will have to make even more difficult tradeoffs over water supplies in 2023,” the Los Angeles Times reports. Meanwhile, Angelenos in July slashed their water use 11% compared to the same time in 2020, more than any other July on record.
• On the other end of the spectrum, flash flood watches were posted Tuesday for some Southern California deserts and mountains, according to the Associated Press.
• The McKinney Fire raging through the Klamath National Forest in Siskiyou County had burned more than 60,000 acres and was 55% contained as of Tuesday morning. Meanwhile, the lightning-sparked Six Rivers Complex had blazed through nearly 9,000 acres in Humboldt and Trinity counties and was 0% contained.

2 State investigating SF housing policies

In the latest indication that California is serious about cracking down on local governments that it concludes aren’t building enough housing, the state Department of Housing and Community Development announced Tuesday that it’s launching a first-of-its-kind “housing policy and practice review” of San Francisco. The housing department said that according to San Francisco’s self-reported data, it has the longest timeline in the state for advancing housing projects to construction — and California’s housing accountability unit has received more complaints about San Francisco than any other local jurisdiction.

• Gustavo Velasquez, the the department’s director, said in a statement: “We are deeply concerned about processes and political decision-making in San Francisco that delay and impede the creation of housing and want to understand why this is the case.”
• San Francisco Planning Director Rich Hillis told the San Francisco Chronicle: “They are elevating this issue and wanting to shine more of a light on it, and we get it. We recognize that our process is not geared toward getting housing built quickly and with certainty.”
• Hillis added that the state’s review could help ensure San Francisco’s final housing element — a document cities are required to produce every eight years outlining their plans for building the number of homes the state projects they’ll need — complies with state law. California’s housing department on Monday sent back San Francisco’s first draft for revisions, a fate that also befell the vast majority of Southern California cities earlier this year.

As if illustrating San Francisco’s challenges in building housing, the city is now facing a lawsuit over one of the two affordable housing measures slated for its November ballot. The group behind one measure — which is aligned with Mayor London Breed — sued the city late Monday night over a competing measure put forward by the San Francisco Board of Supervisors, alleging that it didn’t go through a required environmental review before being placed on the ballot, the San Francisco Chronicle reports.

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