Colleges have spent more than two years grappling with a public health crisis, the coronavirus, which disrupted the fabric of their operations and stretched their finances.
Now they face another: the spread of monkeypox.
The virus will almost assuredly not reach the same infection levels as COVID-19, as it’s not as transmissible. But the public is exhausted and disease-wary amid the lingering effects of the pandemic, and some campuses have already confirmed monkeypox diagnoses. Institutions will need to prepare for more potential cases as the fall term gets underway.
We spoke with health experts about how colleges should plan for the coming academic year, message around monkeypox and understand the risk factors for their campuses.
What is monkeypox and how is it transmitted?
Monkeypox is a rare disease, generally concentrated in several central and western African countries prior to this year.
It’s in the same family of viruses as smallpox, which the World Health Organization declared eradicated through vaccinations in 1980. Its symptoms are much milder than smallpox. They generally present as a rash that appears near the genitals, as well as other parts of the body, including the face, chest, feet and hands.
The Centers for Disease Control and Prevention says the rash can “initially look like pimples or blisters” that will often scab over before healing.
Other flu-like symptoms — fever, chills, swollen lymph nodes — are also common. These can usually last two weeks to a month. The virus in the current outbreak is rarely fatal.
It spreads through means like skin-to-skin contact or touching objects used by someone with monkeypox, such as bedding, clothes or towels. It can also spread through respiratory secretions with close contact, although scientists are studying how frequently this occurs.
How is monkeypox spreading now and is it likely to do so on college campuses?
Monkeypox as of now is primarily circulating among men who have sex with men, and is most often being contracted during sexual encounters. A New England Journal of Medicine study found that of more than 500 confirmed infections in 16 countries between late April and June, 98% were among gay and bisexual men. Nearly all of them were suspected to have contracted monkeypox through sexual activity.
Because colleges often place individuals in close contact with each other, institutions should plan for monkeypox to be a potentially disruptive force, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
Colleges have been hotbeds for other diseases that can wind through their populations quickly, like the flu or meningitis, or most recently, the coronavirus. Students are in proximity to one another in residence halls and classrooms, creating ripe conditions for diseases to disseminate.
However, an illness like the coronavirus is much more transmissible than monkeypox, Adalja said.
How should colleges prepare for monkeypox?
While it’s unlikely monkeypox will burn through a campus the way the coronavirus did, colleges should still identify an area to isolate those who are infected, Adalja said. The isolation period for monkeypox is different from COVID-19 too, – monkeypox can last up to a month, while generally those who contract coronavirus need to stay home for at least five days, 10 days at most.
Because colleges have contended with the coronavirus for years, and other diseases before that, they likely will have ideas of where to house infected students, Adalja said.
The most key element of a monkeypox plan right now, however, is proper messaging, said Dr. Sarah Van Orman, chief health officer of University of Southern California Student Health and past president of the American College Health Association.
It’s a complex message to deliver on the heels of COVID-19, Van Orman said. Public awareness of disease is at a high, but colleges need to make explicit that the coronavirus and monkeypox differ drastically.
And while monkeypox has frequently passed on through sexual contact, it is neither a sexually transmitted infection, nor is it exclusively confined to gay or queer men, Van Orman said. Colleges should acknowledge that, she said.
What are the best ways to message and avoid stigmatizing monkeypox?
Colleges should practice “universal messaging,” Van Orman said. Her institution, USC, has posted information to its website on monkeypox. The university also sent out a message preceding the fall term about coronavirus but broadened it to include monkeypox.
Social media can also be a tool, though a supplemental one, Van Orman said. It’s more important to have an institutional message, she said.
Institutions should also urge students and employees to get tested if they experience signs or symptoms of monkeypox, because early detection can help prevent spread. And vaccinating against the disease after it’s been contracted can also potentially minimize sickness, Van Orman said.
She also said colleges should work with organizations that cater to the demographic most affected by monkeypox right now — LGBTQ individuals. Van Orman suggested reaching out to campus centers or outside local groups that focus on LGBTQ students to increase awareness.
Colleges should communicate that monkeypox does not solely affect men who have sex with men. It has found its way into that social network, but it could easily have spread through other demographic groups, Van Orman said.
The Human Rights Campaign, one of the nation’s top LGBTQ lobbying organizations, stresses that monkeypox is “not a 'gay disease.'” And framing it as such can hinder efforts to stem outbreaks. The organization said that gay men are more proactive about their sexual health compared to other communities, and so they are quick to recognize and sound alarm bells about a disease.
It advises, however, to limit sexual encounters if an individual is feeling ill.
Do colleges play a role in vaccine uptake?
Colleges can help connect students to monkeypox vaccines but likely not in the same way as they did for the coronavirus.
Campuses often served as COVID-19 vaccination sites as governments at all levels worked to get the public inoculated. However, the supply of monkeypox vaccines are much more limited. The U.S. Food and Drug Administration has approved two for use, but they’re tightly controlled by the federal government.
Colleges can link students to health agencies providing the vaccines, even if they won’t be administering the shots themselves, Van Orman said.
One of the vaccines, Jynneos, is newer, and is a typical shot in the arm. The other, ACAM2000, is older, and is unsafe for those with compromised immune systems, skin conditions like eczema or who are pregnant. While both contain a live virus, ACAM2000 is able to replicate in a person’s cells and those who receive it develop a form of “pox,” Van Orman said, though this is much milder than had they contracted the disease.
Which campuses have identified monkeypox?
The following institutions have confirmed monkeypox cases on their campuses, and more are likely as students return for the fall: University of Texas at Austin, Bucknell and West Chester universities, both in Pennsylvania, and Georgetown and George Washington universities, both in Washington, D.C.
What are colleges saying publicly about monkeypox?
Colleges across the country have urged students and employees to be vigilant about monkeypox symptoms. Higher Ed Dive reached out to several institutions in states with high shares of monkeypox compared to their population to ask for details about their prevention and messaging plans.
A City University of New York system spokesperson said in a statement that “as it has been throughout the COVID-19 pandemic, CUNY is committed to providing the members of our community with the most reliable and up-to-date guidance so they can best protect themselves and their families.” The system is working with local and state health officials, the spokesperson added.
The State University of New York system said it’s closely monitoring developments around monkeypox and reviewing CDC guidelines.
“Our campuses are fully prepared to quickly put in place the necessary health and safety protocols, and we will remain in close communication with leadership across the system to provide accurate data and dispel misinformation,” spokesperson Holly Liapis said in an email.
Georgetown University told Higher Ed Dive as of a week ago it had identified two monkeypox cases, and both individuals were out of isolation and “doing well.”
“The university’s Public Health team will continue to work closely with the Student Health Center and the Infectious Diseases Department at MedStar Georgetown University Hospital to identify, test and manage suspected and confirmed cases,” spokesperson Jason Shevrin said in an email.
Can colleges expect new guidance on monkeypox soon?
The American College Health Association has not issued guidance but is “moving to provide something soon,” said spokesperson Rachel Mack. She did not provide a more specific timeline.
ACHA has met with the CDC to assess current outbreaks and to discuss what guidelines colleges might need, Mack said.