Guidance on monkeypox and the workplace

August 8, 2022

After two and a half years of dealing with the COVID-19 pandemic I am sure the last thing you want to think about right now is another health issue. However, after speaking with a number of my clients in the public health field, I think it is prudent for you to be aware of the current monkeypox situation and understand that there is a possibility it could be contracted by one of your employees or someone close to them.

Overview
The first thing to know is that this is not a pandemic. Nor has it been declared an epidemic in Canada. On July 23 the World Health Organization (WHO) declared that ‘the global monkeypox outbreak represents a public health emergency of international concern (PHEIC)’.

The WHO defines a PHEIC as ‘an extraordinary event, which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response’. 

Here at home, the Public Health Agency of Canada (PHAC) noted on the same day that there were 681 confirmed cases across five provinces and that monkeypox cases are “expected to continue to rise as the outbreak evolves”. There are now 957 cases across the country with 449 in Ontario.  

For perspective, when the WHO declared COVID-19 a pandemic in March of 2020 there were 113,000 cases outside China – 13 times as many as two weeks before – and the number of affected countries had tripled from 36 to 114 in the same time period. The most recent weekly figures for COVID-19 in Canada show 28,596 cases for the week of July 24 to July 30, 2022 with 11,341 of these in Ontario.

Monkeypox in Canada
While this monkeypox outbreak is not a pandemic, the virus is obviously no longer confined to countries in Central Africa.

The symptoms of monkeypox are similar to but less severe than smallpox. The case fatality ratio of monkeypox in recent times is 3–6 per cent.

Health Canada advises that monkeypox can spread from person to person through

  • contact with an infected person’s lesions or scabs
  • contact with an infected person’s body fluids such as blood, saliva, and semen

An infected pregnant person may also pass on the virus to their developing fetus through the placenta.

The US Center for Disease Control (CDC) adds that infection may also spread through touching items (such as clothing or linens) that previously touched the infectious rash or body fluids.

Information is still being gathered on whether an infected person with no symptoms can spread the virus to others and if the virus can spread through respiratory particles, such as from talking, breathing, coughing or sneezing, during close contact.

People at potentially heightened risk of infection include health-care workers, commercial sex workers, and household members and other close contacts of active cases, such as sexual partners.

While monkeypox is extremely painful, most people recover on their own after a few weeks. There is an existing, approved vaccine as well as therapeutic treatments for monkeypox. Supplies are limited at this time but all levels of government are working to secure further inventory. Because of the current supply situation governments are appropriately prioritizing vaccines for those populations currently deemed to be at higher risk.

More information and updated case figures can be found on the Government of Canada web page: https://www.canada.ca/en/public-health/services/diseases/monkeypox.html

For employers
Since the monkeypox virus may be spread through a variety of activities that are not limited to any particular segment of society, anyone can contract the monkeypox virus.

It is unlikely, but possible, that a case of monkeypox could effect one of your employees or one of their family members or close contacts. 

Under the Occupational Health and Safety Act (“OHSA”) employers have a general duty to take every precaution reasonable in the circumstances for the protection of a worker.

Lessons can be learned form the COVID-19 experience to mitigate the possibility of spread and maintain the safety of everyone in your workplace.

Some appropriate steps would be to:

  • inform employees of the causes of monkeypox and risk of contracting the virus.
  • remind employees of respiratory etiquette and hand hygiene, including covering coughs and sneezes with the bend of one’s arm or wearing a well-fitted mask;
  • perform routine environmental cleaning, including cleaning and disinfecting high-touch surfaces and objects;
  • consider limiting business travel to certain countries or regions;
  • advise employees before travelling to take steps such as reporting their travel locations to their employer;
  • encourage employees who are sick to stay home
    • Swollen lymph nodes are a symptom of monkeypox, but other symptoms may include fever, chills, headache, muscle and joint pain and exhaustion.
    • People usually develop symptoms 5 to 21 days after being exposed to the monkeypox virus 

In the case of monkeypox infection or suspected infection
Unfortunately, there has been some stigmatization of people who have contracted the monkeypox virus and this may result in employees being hesitant to disclose information about themselves or their friends or family members.

To help ensure the safety of your workplace you should:

  • encourage employees to inform you if they are undergoing testing for monkeypox, particularly if there has been contact with others at the workplace and
  • encourage employees to inform you if they have a sick family member at home with monkeypox

As with all disclosures of personal medical information you should also assure employees that all information is confidential.

If an employee shows up ill 
Employees who show up in the workplace appearing to have symptoms should be separated from other employees and/or, if appropriate, sent home without delay.

If employee informs you that s/he or a family member at home is undergoing testing for monkeypox.
You should exercise reasonable precautions to assure the safety of other workers and of the workplace in general. Assessing the risk will include considering whether the employee is in close contact with other workers. 

It may be reasonable to require the employee to undergo testing for monkeypox if this is recommended by public health officials.  You can find your local Public Health Unit on this Government of Ontario web page:
https://www.health.gov.on.ca/en/common/system/services/phu/locations.aspx

If an employee refuses to work because of safety concern 
As with COVID-19, this will be a case-by-case determination. In these cases, key legal considerations for employers will be occupational health and safety legislation, employment standards legislation and public health guidance from reputable sources.

I hope you find this information helpful. Please contact me for assistance working through your staffing matters.