Monkeypox in the Workplace: A Practical Guide for Employers

The World Health Organization has declared monkeypox to be a global health emergency – a designation currently held only by COVID-19 and polio. In the U.S., cases are rapidly rising, and the federal Centers for Disease Control and Prevention (CDC) has created a monkeypox website.. Although the total number of U.S. cases is currently less than 3000, our recent experience with COVID-19 is a lesson for employers to be proactive in preparing for yet another infectious outbreak. Many of the workplace considerations learned from COVID-19 are equally helpful in helping employers protect the workplace from monkeypox.

Just as with COVID, there is no one size fits all answer. The right choices will depend on the type of workplace, the job the employee performs, and the employer’s tolerance for legal risks (to name a few of the considerations an employer would take into account).

What is Monkeypox and How Does it Spread? Monkeypox is a viral infection that is related to smallpox, although typically less severe and rarely fatal. The symptoms of monkeypox can include fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion, and a rash that can look like pimples or blisters on the face, inside the mouth or elsewhere on the body, including the hands, feet, chest, genitals, or anus. It typically lasts 2-4 weeks. The incubation period lasts between 6-13 days.

Monkeypox spreads person-to-person, from the time symptoms start until the rash has fully healed, through:

• direct contact with the infection rash, scabs or body fluids
• respiratory secretions during prolonged face-to-face contact or intimate physical contact
• touching contaminated items.

Cases have been reported among household members, as well as sexual partners. It seems that monkeypox is less transmissible than COVID-19, however, meaning that precautions need not be as stringent.

What U.S. Government Agencies Are Saying. In the U.S., the Center for Disease Control is simply monitoring the situation, asserting that the risk to general public is low. It has issued a Level 2 travel alert, recommending enhanced precautions during 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 normally occurs.

It does not appear that OSHA has yet issued any guidance on monkeypox. Nonetheless, the general OSHA standards would apply, including the General Duty Clause that requires employers to provide a safe and healthy working environment. Employers must furnish a place of employment free from recognized hazards that may cause death or serious physical harm.

Employer Actions. If the monkeypox outbreak becomes more widespread within the community or if there is a case in the workplace, employers should then conduct a workplace hazard assessment and take control measures similar to that set forth in OSHA’s COVID-19 guidance. Of note, OSHA offers a free and confidential on-site consultation program to small and medium businesses, with priority given to workplaces at high risk for infection (e.g. healthcare or congregate settings). To locate the OSHA On-site Consultation Program nearest you, call 1-800-321-OSHA (6742) or visit https://www.osha.gov/consultation.

The following suggestions are generally based on the CDC’s and OSHA’s COVID-19 guidance:

• Employee Education. Just as with past outbreaks, there will likely be some misunderstanding of how monkeypox is transmitted, and where the outbreaks are occurring.  Employees should be educated as to the facts, which should calm some of the fears in the workplace.
• Reiterate Non-discrimination Policies. In the context of the COVID pandemic, there was significant and widespread anti-Asian discrimination. 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 be trained or reminded to take preventive steps in the workplace to avoid spreading monkeypox as well as other infections, like COVID-19, the flu or a cold. These steps include: encouraging frequent handwashing/sanitizing, providing or allowing employees to use protective gear such as masks/face coverings and gloves, perform regular cleaning and disinfection of the workplace, and instructing employees to seek medical treatment immediately if symptoms appear following exposure to monkeypox. The CDC suggests calling ahead to the medical center or doctor’s office before arriving, to allow them to prepare to minimize contact with other patients.

 

Healthcare employers 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.

• Business Travel. Certainly, employers should continue to monitor the CDC’s travel advisories, but no restrictions are currently recommended.
• Exposures and Quarantine. It would seem that the exposure to monkeypox must be more significant than under COVID – involving more direct and prolonged contact with an infected individual or materials. Employers may require employees who have that level of exposure to monkeypox to remain out of work for the incubation period, either with or without pay. They could also permit employees to return to work, subject to self-monitoring, and with appropriate protective measures – such as wearing a mask and enhanced sanitary/cleaning precautions.

 

Another approach, in keeping with past CDC guidelines, is to require employees who have been exposed to monkeypox to be assessed by their doctor, in consultation with public health authorities, in order to determine their risk level and what actions are appropriate.  Whether the employee would be permitted to return to work, with self-monitoring, would depend on the doctor’s assessment.

• Confidentiality. Any information received from employees with regard to monkeypox exposure, symptoms, and medical examinations should be treated as a confidential medical record (meaning that it is kept in a secure file separate from the employee’s personnel file).  It is not appropriate for the 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. Employers may and should communicate that they have implemented monkeypox policies and that the policies are being followed with regard to all employees to ensure a safe workplace.
• Review and Remind Employees About Sick Leave Policies. Given the increasing proliferation of sick leave laws at the state and local level, employers should ensure that their sick leave policies are compliant with any applicable law. In addition, employees should be kept informed of such policies and any employee assistance policies. In addition, employers may wish to identify a company representative to assist employees who are exposed or become ill. And employers may require employees who have contracted monkeypox (and other infectious illnesses) to be cleared by a doctor before returning to work.
• Telecommuting. If an employee is required to remain home for the incubation period or if they are out because of actual illness, telecommuting may or may not be an option, depending on the type of work performed by the employee. Because of COVID, many of the logistical issues regarding remote work have already been addressed.
• Consult with Your Attorney. In developing a written policy or protocol, we suggest that you consult with counsel to ensure that, before the proposed policy/protocol is implemented, legal risks have been identified and assessed, and that the policy/protocol is appropriate for your specific workplace.  In addition, what the policy/protocol actually contains may need to be modified as the monkeypox situation further develops.