The U.S. continued to see monkeypox cases rise across the country as health agencies struggled with their response to the growing health issue amid the COVID-19 pandemic.

Aside from COVID, America’s ragged health system appeared ravaged by years of underfunding and messy bureaucracy. Because of these, the “tired” and “overworked” health agencies scrambled to contain the situation before it got worse, The Guardian reported.

“Unfortunately, delayed actions mean monkeypox has spread within the gay community and among other men who have sex with men,” the executive director of the National Coalition of STD Directors David Harvey told the outlet.

“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,” he continued.

After the World Health Organization (WHO) declared monkeypox a global health emergency, the U.S. is anticipated to follow suit and declare it a national public health emergency. The country already has 5,811 confirmed monkeypox cases, per the latest case count update from the U.S. Centers for Disease Control and Prevention (CDC).

Official data released on Monday showed New York recorded the highest number of cases with 1,390, followed by California with 827 and Illinois with 520.

“The system is tired, it’s overworked, it’s underpaid, it’s understaffed. All the same issues that plagued us during the pandemic are still with us and haven’t gone away,” said Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials.

Freeman added, “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.”

With the growing number of transmissions, it may be too late to stop the monkeypox outbreak from becoming endemic and a permanent threat in the U.S. and Europe, as per The Daily Beast.

James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told the outlet that this seems inevitable at this point because the rate of transmissions is en route to outpacing authorities’ efforts to trace and vaccinate at-risk individuals.

In May, the CDC issued a warning, saying members of the LGBTQ community should take precautionary measures as they seem to be at a higher risk amid the outbreak. Preliminary data showed the transmissions were most common in men who have sex with men.

Although monkeypox is technically not a sexually transmitted disease, the virus can be passed through contact with body fluids and sores during sexual intercourse and intimate contact.