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Slow response to monkeypox exposes ‘tired, overworked’ US health agencies | Monkeypox
A “slow and bureaucratic” response that has seen monkeypox spread rapidly across the US – with more than a thousand cases in New York City alone – reveals just how badly battered local health agencies have been since the Covid pandemic, advocates have said.
Once a rare African virus, monkeypox has taken hold amid the ragged patchwork of city, county, state and federal agencies that make up the US public health infrastructure.
“Unfortunately, delayed actions mean monkeypox has spread within the gay community and among other men who have sex with men,” said David Harvey, executive director of the National Coalition of STD Directors.
“This outbreak has grown to be a public health crisis in America. We are still in a very chaotic situation at the state and local level with an organized response.”
As an explanation for the chaos, many observers point to how Covid reshaped the landscape for public health officials. Once considered neutral arbiters of information, many health officials were politically attacked following unpopular mask and vaccination policies.
Across the country, public health officials were harassed, threatened, fired or simply felt burned out and quit. The situation was not helped as resources that had once been devoted to things like tracking communicable diseases, such as tuberculosis, or running routine vaccination clinics, were suddenly diverted to Covid-19.
Sexual health clinics have struggled, too, as testing and staff resources were devoted to Covid-19, hurting organizations that had already suffered years of underfunding.
The result has been worse health outcomes for many basic public health services: routine vaccinations for children have fallen; overdose deaths have exploded; and the US has posted a record-high rate of sexually transmitted infections for the sixth year running.
As monkeypox has spread, the Biden administration has attempted to respond by releasing about 1.1m vaccines and ramping up testing capacity, which has grown from about 6,000 to 80,000 per week. The World Health Organization declared monkeypox a global health emergency this week, and the US could follow suit by declaring monkeypox a national public health emergency, which would release more resources to local agencies.
“The system is tired, it’s overworked, it’s underpaid, it’s understaffed,” said Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials. “All the same issues that plagued us during the pandemic are still with us and haven’t gone away.
“What’s added to it, with monkeypox and beyond, is that we also have a workforce that has documented mental health trauma after the pandemic.”
Public health advocates want the president and Congress to allocate more funds to respond to the outbreak, and for sexual health clinics in general. Public facilities have proven to be the first line of defense with monkeypox, even as federal prevention funding for such work has fallen 41% since 2003.
“Local sexual health providers are being asked to respond to monkeypox on top of an already out-of-control STI epidemic in America,” said Harvey. “We are at the breaking point: we need the Biden administration and Congress to immediately fund STI public health programs and clinical services.”
Although anyone can catch monkeypox, the virus has primarily affected men who have sex with men. Sexual health clinics have often been frontline responders to the outbreak because of how monkeypox can present its symptoms, with lesions around the genitals and the anus – though sex is just one way monkeypox can spread. Any close contact with an infected person can spread the disease, including touching, kissing and cuddling, as well as sharing glasses, utensils, bedding and towels.
Although the virus, which belongs to the same family as smallpox, is rarely fatal, symptoms can be excruciating, with painful lesions and flu-like symptoms, according to the Centers for Disease Control and Prevention. Up to 10% of people are reportedly requiring hospitalization, , and many are showing up in emergency departments because of severe pain, said Freeman.
The situation is exacerbated because testing for monkeypox is limited. There is no home test and results can take days. There is, however, a vaccine, for which people at heightened risk may be eligible; they may also qualify for treatment with the drug tecovirimat, sold as TPOXX. But the barriers are significant, obtaining it can be tricky, and tecovirimat – usually reserved for people with severe symptoms – must be requested by doctors from the government’s national strategic national stockpile, which involves significant paperwork.
Moreover, people without insurance probably lack access to both vaccine and drug, said Freeman; about 12.7% of the LGBTQ+ community lacks health insurance compared with 11.4% of the general population, according to an analysis by federal officials. Even if you do have insurance, there are hurdles baked into the US healthcare system, such as trying to navigate between urgent care clinics, primary care providers and state health departments.
Freeman recounted a story she about a local health department that asked its state for information about a monkeypox outbreak. The state replied to check with the CDC; the CDC then redirected local officials back to the state.
“There’s a lot of finger-pointing going on here,” she said. “We should have learned. We should know more now than we knew three years ago from our Covid response [about] what we need to do here.”
Waukesha parade: DA who released suspect ahead of tragedy says it was the result of human error by an overworked staffer
An assistant prosecutor who was assigned to a domestic violence case against Brooks was handing a jury trial and almost two dozen felony cases when she reviewed Brooks’ most recently posted bail, which was $500, related to a reckless endangerment charge, Chisholm said. The unidentified assistant district attorney, who was overloaded with cases, decided to double the bail amount to $1,000, he added.
The mistake by the assistant district attorney was due to her not having access to a critical risk assessment for Brooks because it had not yet been uploaded to the office’s case management system, he said.
Chisholm, who has been a longtime champion of efforts to reduce mass incarceration by using the discretion afforded to prosecutors, said that higher cash bail should have been recommended for Brooks and the error “set in motion a chain of events that resulted in a tragedy.”
“I put the finger on myself and that’s my obligation, that’s my responsibility,” Chisholm said. He added that his office will employ a process called sentinel event review to learn from the errors in the case through an ongoing practice that examines the causes, successes and failures of an incident.
When he ran for office in 2006, the district attorney committed to a program that seeks to connect individuals charged with low-level offenses to services that matched their assessed risk and divert people determined to be high-risk, such as violent offenders. Chisholm said Thursday that this system was in place when Brooks was released and “should have been followed.”
“There was a public safety assessment that was done that characterized this situation as a high-risk situation. Our default position in this case because of the laws in Wisconsin is that we recommend higher amounts of cash,” he said, in describing what should have happened in Brooks’ case.
Suspect was out on bail for two allegations of violence
Brooks, who is the lone suspect in the Waukesha tragedy, was out on bail for two separate allegations of violence, including using a car to run over a woman while she was walking through a gas station parking lot, according to a criminal complaint. The woman told authorities she was the mother of his child, according to the criminal complaint.
Brooks faced five charges related to the incident, including domestic abuse, and was also charged with bail jumping because he was already out on bail in connection with a separate incident in July 2020, court documents say. In the 2020 incident, Brooks was accused of firing a handgun during an argument and was charged with two counts of second-degree recklessly endangering safety while using a dangerous weapon and one count of possession of a firearm by a felon.
Bail had initially been set at $10,000 in that case, but because Brooks had asked for a speedy jury trial — which could not be met — bail was reduced to $500. He was then released on bail in that case on February 21, the district attorney’s office said.
Separately, Brooks pleaded guilty in Nevada to statutory sexual seduction in November 2006, according to court records, and is a registered sex offender in that state.
Hours before Brooks drove his SUV through the Waukesha parade, he was involved in a domestic disturbance and left the scene, according to Waukesha Police Chief Dan Thompson.
Chisholm previously said his office was conducting an “internal review of the decision to make the recent bail recommendation,” related to the domestic violence incident in early November.
DA said his office is ‘overwhelmed’ with cases
Chisholm, who took office in 2007, has said his office should focus on keeping violent people in the system and non-violent people out — an approach notably in line with national “bail reform” efforts.
Bail reform aims to curb or eliminate cash bail for people who are in jail awaiting trial if they are charged with misdemeanors or nonviolent offenses. The purpose is to make the system more equitable for those who cannot afford to pay their bonds.
Law enforcement leaders have targeted bail reform efforts as a contributing factor to the surge in violent crime rates, however, data shows that only a small percentage of defendants released on bail are committing violent crimes.
A 2020 Loyola University Chicago study found that 97% of defendants released pretrial in Cook County were not charged with a new violent offense, based on court data from 2017 to 2019.
“You can’t pin cash bail to the spike in violent crime because, for one thing, cash bail affects mainly low-level non-violent offenders,” Jody Armour, a professor of law at the University of Southern California, told CNN in the summer.
Moving forward, Chisholm said on Thursday, there should be an “honest assessment” of the purpose of bail. The district attorney said he is opposed to cash bail because it “doesn’t do a good job of assessing risk.”
“That doesn’t mean I don’t think that some people need to stay in custody until their case is tried. That’s called the preventative detention framework. We have a statute that allows for that, it’s simply unworkable,” he added.
Nationwide, prosecutors have been challenged to navigate a criminal justice system that has been largely disrupted by the pandemic and tasked with mitigating the risk of exposure to Covid-19 that comes with defendants going to court and jail.
Chisholm said during Thursday’s meeting that his office and the system are “overwhelmed” and has lost six assistant district attorneys since 2018, including two in the domestic violence unit, due to a cut in federal funding.
“We generally try about 500 matters to a jury or court trial every year. Because of the pandemic, we’ve had to constrain some of that, and that, in turn, affects other parts of the system,” Chisholm said.
The county’s chief judge, Mary Triggiano, said during the meeting that the county has a backlog of 1,600 felony and 3,100 misdemeanor cases, which is what caused Brooks’ bail to be lowered to $500 earlier this year in relation to the 2020 incident.
Chisholm said while it does not excuse Brooks’ low cash bail, the assistant district attorney assigned to his case did not have ample time to make a decision.
“It puts it in context that when you’re dealing with high-volume triage and trying to sort what the most serious offense is, get the case in the system and move on to the next one, sometimes errors can occur,” he added.
The district attorney’s office previously said in a statement that the state’s bail recommendation in Brooks’ case was “inappropriately low in light of the nature of the recent charges and the pending charges” against him.
“The bail recommendation in this case is not consistent with the approach of the Milwaukee County District Attorney’s Office toward matters involving violent crime, nor was it consistent with the risk assessment of the defendant prior to the setting of bail,” the office’s statement reads.
Activision Blizzard QA and customer service employees say they’re underpaid and overworked
“Use, dispose, repeat.”
Activision Blizzard has a problem keeping its quality assurance (QA) testers and customer service representatives around. That’s partly by design; workers are contracted on a temporary basis. But the work that QA and customer service workers at Activision Blizzard do, in offices in California, Texas, and Minnesota, is very demanding, employees said, especially considering the low pay, intense crunch, and mistreatment by customers.
Current and former employees who spoke to Polygon described feeling defeated by their time at Activision Blizzard, due to a combination of the brutal crunch and devaluation of their positions.
“I cried when I got the job,” one current employee told Polygon. “I was so excited to be a part of the process, and to be in this industry. It’s always been my dream to work in video games. And now I feel crushed.”
“The company took a lot from me,” another former QA employee, Sami King, told Polygon.
A large portion of Activision Blizzard’s QA department, working on game franchises like Call of Duty, are contract workers employed in offices far away from the publisher’s California headquarters, in places like Austin, Texas and Eden Prairie, Minnesota. Hundreds of contract workers work under a few full-time, salaried employees that lead the QA process of identifying and reporting game bugs. (The Blizzard employees Polygon spoke to said they were employed by the company itself as salaried workers, while the Activision side houses most of the company’s contract workers.)
Fifteen current and former employees in both QA and customer service told Polygon that the structure of Activision Blizzard’s QA and customer service programs, specifically in its Texas and Minnesota offices, makes workers feel undervalued and exploited. (A dozen additional Activision Blizzard employees corroborated these reports in statements sent to the press, including Polygon, through the ABK Workers’ Alliance.) These employees described a constant rotation of QA workers, with people working under contracts studded between three-month long unpaid breaks between new contracts. Contracts work in cycles; workers said company policy specifies a certain amount of time on a contract before a worker has to be off-contract again, also for a designated amount of time. Then the cycle repeats. This creates a system where it’s challenging to actually advance in a career at QA; workers can’t afford to not have a job for three months, and many often just find something new and never return to Activision Blizzard.
Workers pointed to the company culture outlined in the California Department of Fair Employment and Housing lawsuit filed last month as the root of a company-wide problem. In the lawsuit, employees alleged widespread sexism and workplace misconduct perpetuated by leadership that trickled down to all levels of the company. Activision Blizzard workers told Polygon that leadership in Texas and Minnesota have been positioning the lawsuit and its alleged toxic culture as a problem specific only to Blizzard Entertainment, which is cited frequently in the court documents. But workers from other studios told Polygon that’s not true: The problems are in all facets of the company, and contracted workers in both QA and customer service say they feel vulnerable due to the lack of job stability.
All 15 current and former employees Polygon spoke to, as well as the majority of workers that emailed statements through a representative, said that pay is exceptionally low, with rates as low as $12 an hour. During crunch periods, some people said they worked up to seven days a week for at least 10 hours a day. Some workers said they struggled with their mental and physical health during these times, yet felt compelled to work anyway, simply because they otherwise were not paid enough to survive.
Activision Blizzard has not responded to Polygon’s request for comment. Current workers said that leadership has not yet addressed the demands laid out in July.
Image: Raven Software/Activision
In the lead-up to the release of 2020’s Call of Duty: Black Ops Cold War, workers said they’d get one day off every three weeks to a month. “That was their gift to you during crunch,” one current employee said. “I know some people who had […] worked 28 days in a row. Twelve-hour shifts. That was probably the most chaotic time.”
“[The pay] is never enough,” another current employee said. “I just really want to be able to afford to live.”
Jessica Gonzalez, a current Blizzard Entertainment employee who’s worked in QA at Activision and Treyarch, told Polygon that the company should be held liable for allegedly creating these working conditions that allow abusers to operate in these systems. She said that the structure creates a “rat race” culture due to the uncertainty of it all.
“Job security is so uncertain that people feel the need to use these avenues to be seen and get in the gaming industry,” Gonzalez said. “The power imbalance created by these actions actively enables harm and psychological abuse towards QA. We believe in the product we work on, we love the games, we love the community. We love what we do. And I feel like that’s used to pay us low wages, to play with our livelihoods by dangling this full-time carrot over our heads for us to do whatever we can — do all the overtime we can — to be seen as the person that’s willing to do anything for the company. And then you get your contract extended.”
Without a clear route for advancement, Activision Blizzard reinforces a misconception, workers said, that QA is unskilled work — “something a monkey could do,” a source told Polygon. In reality, contract workers doing QA for Activision Blizzard are doing crucial, tedious work, yet these workers told Polygon that higher-ups often emphasized to them that “real” developers are more important and that QA workers are easily replaceable. New people are brought in each week, with mass hiring periods alongside busy periods, bringing loads of new testers on during crunch periods that have people working for up to seven days a week.
Photo: David McNew/AFP via Getty Images
“The conditions for [Call of Duty: Black Ops] Cold War were awful, yet that’s their best-selling Call of Duty game today, which reinforces that, ‘Yeah, these methods work. Why would we spend money [for better practices]?’” one current employee told Polygon.
Multiple employees told Polygon about situations in which they alleged a power imbalance between full-time employees and contract workers, which created a toxic environment. Some reported instances of sexual harassment that were allegedly brushed off by HR. The workers described a culture in which QA and customer service departments were siloed off from other parts of the company; most QA workers Polygon spoke to said they were barred from talking directly to developers.
Current and former Activision Blizzard employees have rallied in solidarity over the past few weeks, staging a walkout and demanding leadership take action and responsibility for the culture problem that allegedly disproportionately affects marginalized workers. But contracted workers, while still heavily involved in worker movements, say they feel hesitant to report misconduct or participate in leadership’s proposed “listening sessions,” because the contract structure puts them in such a precarious position in which workers feel they could be fired at any time. Three sources confirmed that, in some cases, contracted QA workers were not even invited to those proposed listening sessions — specifically, workers in the Texas office who were contracted by a third-party agency. Despite working solely on Activision Blizzard products, these workers find themselves even further removed from inclusion at the company.
Workers said these working conditions extend to customer service employees across the company as well. Like QA, customer service is seen as a “low-skilled” job within the development pipeline. The pay is low, and the work is underappreciated and often challenging. One current customer service employee said that managers often make the department feel like a burden — “a cost, not a department that generates revenue.”
Multiple customer service employees described dealing with verbal abuse at the hands of angry players, like threats and slurs. One former customer service employee recalled an instance during World of Warcraft: Battle for Azeroth’s launch, in which there was extended downtime, when a player told customer service they wished the Blizzard office would have burned down in the 2018 California wildfires. Another former customer service employee described instances where angry players would threaten to show up at the company offices. Some workers said it was especially taxing given how they felt perceived by the rest of the company, alongside the low pay.
Multiple workers said that customer service often feels the brunt of anger during controversies, including following the DFEH lawsuit. “While these comments may not be personally directed at me, they take a psychological toll, and we’re told to just remember [that] ‘it’s not us they’re mad at,’” one Blizzard employee said. “It’s kind of hard to help someone who’s telling me to kill myself on a daily basis, all because of a video game.”
Photo: Chesnot/Getty Images
QA testers described having to encounter similar verbal abuse from players during live testing with the public. “It was definitely an issue that I watched take a toll on multiple people,” one current QA worker said. “It was a good time working seven days a week getting to listen to gamers say slurs all day.”
The system of siloing contracted workers away from other parts of the company has enabled bad behavior from the top down, workers said. People felt as if leadership devalued and dehumanized workers in these departments, reducing people to just “bodies on a project.”
“That’s where the formula for abuse comes in,” Gonzalez said. “That’s where I feel Activision Blizzard should be held accountable. There’s definitely a root to the rot. And it’s something that needs to be addressed and fixed.”