Now that students have returned to university, it is important to reduce the risk of disease outbreaks, including monkeypox.
During the Covid-19 pandemic the higher education community demonstrated its ability to adapt to changing public health concerns, balancing the needs of students and staff.
We can use this learning to respond to potential outbreaks of monkeypox (and of other communicable diseases).
Monkeypox is a rare viral infection and is spread through close contact including through physical contact, touching clothing, bedding or towels of someone with monkeypox, or through coughs and/or sneezes of someone with monkeypox.
When a person contracts it, they may notice unusual rashes, blisters or lesions develop on their body – and a range of other symptoms.
The UK Health Security Agency (UKHSA) have published lots of helpful information about monkeypox, but one thing that needs reiterating is that it can affect everyone. We’ve sadly seen articles that suggest monkeypox is strictly linked to the activities of gay, bisexual and other men who have sex with men (GBMSM), but this isn’t the case.
Despite there being a disproportionately high prevalence of monkeypox within the GBMSM community in the UK, the risk of infection remains for all, regardless of sexual orientation.
Not another one
For many of us, recent years have led to health being thrown to the forefront of our work. Yet the prolonged and often uncertain conversations about restrictions and our own responsibility to reduce the spread of diseases has led to “pandemic fatigue” – the scale of which shouldn’t be underestimated when talking about monkeypox with students and staff.
We need to continue to be aware of existing health risks, but universities also need to be pragmatic and realistic about how the challenges of the last few years may impact students’ and staff’s willingness to take the necessary precautions to stop the spread of infectious diseases.
Self-isolation and FOMO
As most courses have begun, students are now in an intense period of in-person relationship building. Crowded venues, welcome week events and high levels of close social contact could increase the risk of transmission of monkeypox. With this comes concern for periods of self-isolation. The UKHSA has issued guidance for self-isolation which may last for 2-4 weeks.
We know that many students faced serious challenges to their mental health and academic performance during periods of self-isolation during the pandemic. As many universities return to in-person teaching and social activities reopen for students, universities need to be aware of these impacts and make sure students are properly supported.
Self-isolation guidance for monkeypox is similar to that for Covid, with those self-isolating advised not to share communal areas with others. Given the pressure for students to make friends and settle into university life – and potential pandemic fatigue – the risk is that “suggested” self-isolation is completely ignored in favour of socialising.
If students live in accommodation with shared facilities such as bathrooms or kitchens, self-isolation becomes near impossible. We will also need to consider the potential concerns and reactions of those sharing accommodation with someone with monkeypox and be prepared to listen to individual concerns without reinforcing prejudice and stigma.
One hundred and eighty
At no point should monkeypox and the groups who are more at risk of infection be stigmatised. We’ve seen how destructive stigma is to the groups who are particularly affected by diseases – and the diseases themselves – and it’s critical that all students feel confident and empowered to seek out care if they’re affected by monkeypox.
Communication from universities can play a huge part in this. Targeting the most at-risk groups is a helpful starting point – offering advice about dealing with the symptoms of monkeypox, guidance on isolating and protecting others in university accommodation, and information about reaching out to local sexual health services are crucial to reducing further cases. Most importantly, communications should reiterate the message that monkeypox affects everyone.
For students and staff who are considered at risk including healthcare workers in contact with confirmed monkeypox patients, GBMSM communities, and people who have had close contact with a monkeypox patient, are eligible to receive a vaccine to protect them from infection. However, whether there will be adequate supplies of the vaccine remains uncertain given that the government has not purchased the additional stocks recommended by the UKHSA.
Diagnosis, treatment and care
Monkeypox is not a sexually transmitted infection, however testing, treatment and vaccination are being delivered through sexual health clinics. This may be a pragmatic choice for the NHS given the current profile of those infected with monkeypox in the UK, but it also risks students and others not accessing treatment that they need.
For new – and indeed returning – students, many have not connected with their local sexual health service and may not have any information about how they do this. Universities should therefore ensure that all students have the necessary information about where their local sexual health clinic is, and how to access treatment and care for monkeypox as early into the academic year as possible.
A briefing is out
Universities UK (UUK), in partnership with the UKHSA, the University Safety and Health Association (USHA), AMOSSHE and the Student Health Association (SHA), has put together a detailed briefing on the principles for preventing and managing cases of monkeypox infections in higher education settings.
The briefing sets out the requirements for dealing with confirmed cases of monkeypox in accommodation settings, including managing communal environments, waste and cleaning and disinfection. UUK calls on universities to adopt the principles – developed in part using the lessons learned from the Covid-19 pandemic – to create accessible and safe environments where the risk of an outbreak is reduced.
A timely and relevant article. The challenge of shared facilities is somewhat understated as this is the norm for students and for many workers too. Practical solutions are needed for isolation when facilities are shared. You’ve mentioned cleaning here but who would be responsible for frequent bathroom and kitchen cleaning when someone is unwell? Is someone able to add to this discussion to address the challenge of sharing with practical strangers whilst ill.