A swab that tested positive for monkeypox virus is shown at the University of Washington Medicine Virology Laboratory on July 12 in Seattle, Washington. (Karen Ducey | Getty Images)
WASHINGTON — College students are heading back to campus following more than two years of a pandemic that led many schools to empty out for full semesters and later move to hybrid schedules in a struggle to curb the spread of COVID-19.
But the attempt by colleges and universities to return to something resembling normal could be truncated by monkeypox, the virus that has steadily increased throughout the summer, challenging both the federal government and state and local public health officials.
Higher education plans for dealing with monkeypox appear opaque or nonexistent. Schools have begun sending students information about monkeypox through websites and newsletters, but large public colleges contacted by States Newsroom were unable to explain how they’ll help students isolate or keep up with their classes during the two to four weeks they’ll be contagious if they contract monkeypox.
In New Hampshire, few colleges and universities have posted public information about monkeypox. The University of New Hampshire currently has no guidance on its website for students that contract the virus, though a spokeswoman for the university said that information is coming soon.
“UNH Health & Wellness is using social media to share information and is creating an FAQ on monkeypox and prevention for its website,” the spokeswoman, Erika Mantz, said in a statement Tuesday. Mantz said the university plans to make educational outreach efforts around prevention and would train medical staff on how to deal with students who have it.
Other colleges and universities, including Plymouth State University, Keene State College, and Colby-Sawyer College, do not provide public information on monkeypox.
A spokeswoman for Dartmouth College pointed to an Aug. 11 email sent out to faculty, students, and staff that said the college was “preparing accordingly” for monkeypox outbreaks and would provide more information “as the situation evolves.”
Plymouth State Interim Vice President Marlin Collingwood said in a statement Tuesday that the university would be “sharing detailed information and recommended guidelines” to students and staff “before the new semester begins.”
Case counts throughout the United States began increasing after a Massachusetts man was diagnosed on May 17 and have since risen to more than 14,100 people in every state except Wyoming. The White House has declared this outbreak a national public health emergency.
American Public Health Association Executive Director Georges C. Benjamin said colleges should be preparing for the year by assuming they’ll have monkeypox cases on campus.
“My advice to universities is that, while we’re all trying to rapidly return to normal, the truth of the matter is they ought to have contingencies to provide support to students in a hybrid manner,” such as providing options for online study, he said in an interview. “Anybody who’s not making plans for that is going to find themselves deeply disappointed.”
Student health centers and health care providers that regularly treat college students should become extremely familiar with how the rashes and lesions are presenting in this monkeypox outbreak, he said.
“Rashes are high on the list of what people see in the student health centers,” Benjamin said. “The vast majority of those will be rashes for a range of other relatively benign conditions, but they want to make sure they’re really up to speed on the early phases of monkeypox.”
Preparation is key, he said. “There’s nothing to say they’ll have big outbreaks, but all schools should assume that they’re going to have somebody on their campus that has monkeypox,” Benjamin said. “The outbreak is just too widespread for that not to be the case.”
College responses vary
The virus, which is a cousin of smallpox, is characterized by a rash or lesions that can look like acne or mosquito bites. The virus can come with flu-like symptoms and painful muscle aches, though sometimes it can present with just the rash. No one in the United States has died in this monkeypox outbreak.
Unlike COVID-19, which is a respiratory virus that can spread somewhat easily from person to person, monkeypox is spread by direct physical contact with someone who has been infected. It can also spread by touching fabrics, such as bedding or towels, or surfaces an infected person has touched.
The current outbreak in the United States has spread predominantly among gay, bisexual, and men who have sex with men, though cases have been diagnosed outside that population as well.
Among colleges and universities reviewed by States Newsroom, there’s no guidance about how students should address missed lectures, exams, labs, or work-study programs that might be critical for students’ financial aid. Colleges don’t offer insight on how students on academic or athletic scholarships might be affected if they miss a month of instruction, or practices due to monkeypox.
The university guidance also lacks information about how administrators will respond if several cases crop up in a dorm, or other on-campus housing.
In New Jersey, Rutgers University’s online guidance details what monkeypox is and how it spreads before telling students that “at this time, there is no need to take special precautions to avoid monkeypox unless you experience symptoms.”
Rutgers then directs students to the state health department and U.S. Centers for Disease Control and Prevention websites for more information.
A University of Maryland spokesperson shared websites run by the state health department, but said in a statement, “We don’t have any particular university’s plan. This is all general information that is provided for use by all Marylanders.”
In New Hampshire, colleges and universities have continued to publish guidelines for handling COVID-19, including recommendations by the Centers for Disease Control and Prevention to quarantine for five days if positive. Dartmouth College requires all students to take a rapid antigen test and test negative for COVID-19 “before their first in-person gathering” on campus, according to the Aug 11 guidance. Those who test positive are directed to wear a face mask, isolate immediately, and notify close contacts. The school has separate reporting systems for students and staff who test positive, allowing the school to facilitate information sharing.
But when it comes to monkeypox, the college said that its leadership “is monitoring the global outbreak”
“We expect that cases may occur over the course of the year and are preparing accordingly,” the Dartmouth guidance states. “We will provide updates as the situation evolves on campus.”
Dartmouth hosted an Aug. 17 webinar from Dr. Elizabeth Talbot, a professor of medicine at the college, during which administrators highlighted the possibility that students would need to isolate for two to four weeks.
“This could be a longer isolation,” said Ann Bracken, director of clinical medical services for Dartmouth, speaking during the webinar. “We’re going to work with students related to providing the services they need, but also working with their deans and providing academic accommodations as possible, as we would with any prolonged illness that a student might have.”
Bracken said the college would also participate in state contact tracing efforts should any students test positive.
A spokeswoman for the Dartmouth, Diana Lawrence, said the college had identified isolation housing for students on campus that test positive for monkeypox, and that it would recommend that off-campus students who test positive follow CDC isolation guidelines.
At the University of New Hampshire, Mantz said the college was focusing on training.
“Education on monkeypox and prevention will be integrated into both (UNH Health & Wellness’) outreach education programs and clinical interactions, as appropriate, and staff (both clinical and health educators/counselors) will have training on monkeypox,” Mantz said. “Finally, the university is maintaining contact with the New Hampshire Department of Health and Human Services for updates, information, and resources as needed.”
At Plymouth State, Collingwood said the university would work with local, state and national health authorities “to monitor the monkeypox situation” during the beginning of the fall semester, and added that the university was “prepared to adapt to future guidance as needed.”
Still working on plans
Rachel Mack, spokesperson for the American College Health Association, said in a statement that “many colleges are still working on their plans to prevent and manage monkeypox outbreaks.”
At the moment, she said, “there isn’t much guidance specifically for colleges and universities,” including on how to address “unique considerations” like isolating students, making academic accommodations for students who contract the virus, providing extra cleaning, and administering testing.
Colleges are working to come up with the best way to communicate with students effectively, she said.
“Because currently the virus is primarily affecting gay, bisexual, and other men who have sex with men, some students may feel very fearful – or even stigmatized – while other students may mistakenly believe there is no risk to themselves,” Mack said.
Since anyone can contract monkeypox, Mack emphasized that colleges “should communicate it as a public health concern for all. However, campus communications can be tailored to different audiences to be most effective.”
Benjamin said student health centers need to understand how to access the antiviral drug Tpoxx that federal officials are using to treat monkeypox cases. At the moment, the federal government requires an “onerous” amount of paperwork to dispense the prescription medication for monkeypox patients, he said.
Universities, Benjamin said, will need to determine how they’ll isolate students who test positive and how they’ll ensure those students can keep up with their coursework.
Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, said the current monkeypox outbreak has spread “further and wider than it ever had before” because the virus “found itself in a social/sexual network and really exploited those network effects.”
Colleges and universities, he said, should be able to keep cases at bay if they follow some best practices. That includes explaining the virus during orientation, preparing the student health center to test and get test results quickly, planning for the complicated process required to order the antiviral being used to treat monkeypox, providing a bridge between students and the health departments distributing the vaccine, and having a plan in place to isolate students who test positive.
“It’s something that universities have to be proactive about because it’s likely that they’re going to have people that have cases on their campuses,” Adalja said. “And I think if they’re managed swiftly and competently, you won’t have much sustained spread.”
Mark O’Neill, press secretary for the Pennsylvania Department of Health, said in a statement that “while everyone should be aware of the presence of monkeypox, most individuals, including college students, are at low risk of contracting monkeypox as the disease does not spread easily between people.”
The CDC, he writes, “maintains that people who contract monkeypox typically have skin-to-skin contact, direct contact with body fluids, or prolonged face-to-face contact with someone who already has monkeypox.”
Those three things, however, could make up a typical Saturday night for some college students, especially if they don’t realize they have monkeypox.
CDC Director Rochelle Walensky said last week that 98 percent of monkeypox cases are in men and that “among cases with known recent sexual history and gender, 93 percent of cases were among men who reported recent sexual contact with other men.”
Monkeypox is transmissible from the time symptoms begin through when the rash has completely disappeared and a new layer of skin has formed, a trajectory that typically lasts between two and four weeks.
That timeline, much longer than with COVID-19, could create significant problems for students, many of whom don’t have remote classes anymore and would likely miss much of their coursework.
College students also often live in crowded houses and apartments where completely avoiding contact with someone who tests positive or all the fabrics they may have touched could be especially challenging.
The federal government began the outbreak as the only entity allowed to test for monkeypox, but has since opened up testing to commercial laboratories.
Vaccine demand high
The U.S. Department of Health and Human Services began distributing the Jynneos vaccine, which requires two doses, to state health departments earlier this summer.
Guidance for who is eligible has evolved as cases have increased.
At the moment, the CDC recommends vaccination for people who are identified as a close contact of a person diagnosed with monkeypox. People who have had a sexual partner from the past two weeks test positive are eligible, as are people with multiple sexual partners in an area with monkeypox cases. Anyone whose job might expose them to monkeypox, such as a health care or laboratory worker, is also eligible.
But demand has far outpaced supply in many areas, leading the federal government to announce earlier this month that it would approve emergency use for injecting the vaccine just under the skin, or intradermally.
The move away from injecting the vaccine subcutaneously, below the layers of fat in the arm the way most people have experienced, is expected to allow health care providers to get up to five doses out of each vial instead of one.
Benjamin said the United States is behind on distributing the vaccine.
“We have an inadequate number of vaccines, overall. Our pipeline is very thin,” he said, adding that “the manufacturer has already said they’re not sure they can keep up with the demand.”
Adalja was highly critical of the federal government’s response to monkeypox so far, saying “it should have been easier to get a handle on” the virus had there not been “systemic incompetence that you see in the government.”
“The federal response has been dismal from the very beginning, because what you’ve seen is a response that’s very reminiscent of the same mistakes that were made during COVID-19,” he said.
Adalja, however, is optimistic that colleges and universities have learned enough from their COVID-19 experiences as well as from meningitis outbreaks on campus to keep monkeypox from becoming widespread among students.
“I think that there’s a risk on college campuses, that there’s going to be cases and they may see some limited spread,” Adalja said. “But it’s not going to be a disruptive force in the way COVID-19 was on college campuses.”
Ethan DeWitt of the New Hampshire Bulletin contributed to this report.
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