The news has been filled with stories about the latest viral epidemic to blight humanity—a highly contagious illness called monkeypox. Fortunately, as far as we are aware of at this point, unlike COVID-19 it does not kill its victims, although it does inflict on them an ugly and uncomfortable rash similar to smallpox that can last for weeks.
For employers who want to know how to deal with this illness, one problem is that at this point the state of our knowledge about how it spreads is fairly rudimentary, and the sources of information sometimes contradict themselves. Some say it can only be spread through skin-to-skin contact, while public health and medical authorities in this country contend it can be picked up from objects, including infected clothing, bed linens and towels.
Another issue that makes it difficult to deal with is social stigma attached to it because so far it has been mostly found in men who have sex with men, though monkeypox is not a "gay disease." Public health officials emphasize that anyone can catch the disease.
Fiona W. Ong, an employment attorney with the law firm of Shawe Rosenthal, notes that the World Health Organization has declared monkeypox to be a global health emergency—a designation that also is currently held only by COVID-19 and polio. Unlike those diseases, as far as we know no one has died or been rendered permanently disabled by monkeypox from the most recent version.
In spite of that, the numbers of people infected are climbing every day around the world, with a total of 26,200 cases worldwide and 6,616 cases in the United States as of Aug. 4. Those numbers rose from zero very quickly, which is of growing concern to public health authorities.
“Our recent experience with COVID-19 is a lesson for employers to be proactive in preparing for yet another infectious outbreak,” Ong stressed on July 29. “Many of the workplace considerations learned from COVID-19 are equally helpful in helping employers protect the workplace from monkeypox.”
The Centers for Disease Control and Prevention (CDC) says that monkeypox can spread to anyone through close, personal, often skin-to-skin contact, including direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox. The CDC adds it also can be transmitted by touching objects, fabrics (clothing, bedding or towels), and surfaces that have been used by someone with monkeypox and through contact with respiratory secretions as well.
Although a vaccine exists that is supposed to prevent contracting the disease, limited supplies and availability have sparked accusations of racial and ethnic discrimination. In the U.S., it has led to its distribution being largely confined to the LGBTQ community in certain localities.
Workplace Policies Vary
As is the case with COVID-19, there is no one-size-fits-all answer for employers, Ong explains. The right choices depend on the type of workplace setting, the kind of job a particular employee performs and the employer’s tolerance for legal risks (to name a few of the considerations she says an employer normally would take into account).
In spite of all of the media coverage, the CDC asserts that the risk to the general public is low. However, the agency issued a Level 2 travel alert, recommending enhanced precautions be taken during all international travel, given that monkeypox has been found in countries all around the world—and not just in those central or west African countries where it had occurred in the past.
The Occupational Safety and Health Administration (OSHA) has not yet issued any guidance on monkeypox, but general OSHA standards would apply, including the General Duty Clause that requires employers to provide a safe and healthy working environment. Employers in general are required to maintain a place of employment free from recognized hazards that may cause injury or endanger health, Ong says.
If the monkeypox outbreak becomes more widespread within your community or if a case arises in your workplace, she recommends that an employer then conduct a workplace hazard assessment and engage in appropriate control measures similar to those set forth in OSHA’s COVID-19 guidance.
Healthcare employers especially need to ensure that their workers are complying with OSHA requirements on personal protective equipment as well as the CDC’s Infection Prevention and Control of Monkeypox in Healthcare Settings.
For employers in general, Ong specifically suggests taking these actions:
Engage in employee education. As with past outbreaks, there likely will be some misunderstanding about how monkeypox is transmitted, and where the outbreaks are occurring. Employees should be educated about the facts, which should calm some of their fears.
Reiterate non-discrimination policies. In the context of the COVID pandemic, there was significant and widespread anti-Asian discrimination, Ong points out. “Given that the monkeypox is typically found in central and west Africa, and is commonly spread during male-male sex, there is the possibility of discrimination on the basis of race and national origin, as well as sexual orientation. Employers must be vigilant to ensure this does not occur in the workplace, by emphasizing non-discrimination policies and responding promptly to complaints of discrimination.”
Prevent infection in the workplace. Employees should take appropriate preventive steps in the workplace that are designed to avoid spreading monkeypox and other infections, like COVID-19, the flu or even a cold. Encourage frequent handwashing/sanitizing, allowing employees to use protective gear such as masks/face coverings and gloves, perform regular cleaning and disinfection of the workplace, and instruct employees to seek medical treatment immediately when symptoms appear following exposure to monkeypox.
If a Worker Gets Monkeypox
What should an employer do if an employee contracts monkeypox? Encourage them to seek treatment right away, and the CDC suggests calling ahead to a medical center or doctor’s office before a monkeypox patient arrives, to allow the staff to prepare for minimizing contact with other patients.
It would seem that to contract the disease, exposure to monkeypox must be more significant than under COVID—involving more direct and prolonged contact with an infected individual or materials, Ong observes. “Employers may require employees who have that level of exposure to remain out of work for the incubation period, either with or without pay.”
Ong also says employers could also permit employees to return to work, subject to self-monitoring and with appropriate protective measures—such as wearing a mask and taking enhanced sanitary/cleaning precautions.
Another approach would be to require employees exposed to monkeypox to be assessed by their doctor, in consultation with public health authorities, to determine what their risk level is and what actions are appropriate to take. In this scenario, whether the employee would be permitted to return to work with self-monitoring would depend on the doctor’s assessment.
Keep in mind that any information received from employees having to do with monkeypox exposure, symptoms and medical examinations must be treated as a confidential medical record (which means that it is kept in a secure file separate from the employee’s personnel file).
Also, it is not appropriate for an employer to discuss the individual employee’s exposure, symptoms or results of medical examinations with the co-workers, or even managers who do not have a business need to know. What employers can and should communicate to workers is that they have implemented monkeypox policies and that those policies are being followed with regard to all employees to ensure a safe workplace, Ong adds.
This communication can include reminding employees about your company’s sick leave and any employee assistance policies. In addition, you might want to identify a company representative to assist employees who are exposed or become ill. In addition, don’t forget that employers also may require employees who have contracted monkeypox (and other infectious illnesses) to be cleared by a doctor before returning to work.
Because we are currently in uncharted legal territory, Ong also says employers should talk to an attorney before developing or changing your policies and protocols.
