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August 19, 2022
Monkeypox Requirements for California Employers, Tips for All Employers

Q: Regarding monkeypox, what do employers need to provide and do regarding this new state of emergency declared in California? 

A: California declared a state of emergency regarding monkeypox on Monday, August 1, but the proclamation does not have any specific provisions addressing employers or requiring employers to do anything. The proclamation primarily appears to allow the state to take action to mobilize state resources to combat monkeypox in the state. 

California has confirmed over 1,000 monkeypox cases, making it a hotspot for the disease, with the majority of cases found in San Francisco and Los Angeles.  According to Governor Newsom’s statements addressing the proclamation of emergency, “The proclamation supports the work underway by the California Department of Public Health and others in the administration to coordinate a whole-of-government response to monkeypox, seek additional vaccines and lead outreach and education efforts on accessing vaccines and treatment.”

Additionally, President Biden declared monkeypox a national health emergency to ensure that federal funding may be quickly directed toward developing and evaluating vaccines and drugs as well as towards the hiring of additional federal agency workers to help manage the outbreak. As with the California proclamation, the federal declaration does not include any specific employer responsibilities. 

While these declarations of emergency for monkeypox do not address employer responsibilities, employers in California, and every state, should be familiar with how monkeypox is spread and be prepared to address employee absences related to monkeypox and even the potential for outbreaks in the workplace, though transmission in the workplace is less likely for most employers because of the way monkeypox is transmitted.  

According to the Centers for Disease Control and Prevention (CDC), monkeypox generally is spread through close, personal, often skin-to-skin contact, including direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox; touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox; and prolonged contact with respiratory secretions, such as kissing. It is not transmitted through casual contact as COVID-19 can be. So, most office and warehouse employees likely are not at risk for transmission in the workplace, while health care workers, hotel housekeepers, and workers in laundries and dry cleaners may be more at risk (to name a few potentially more risky occupations). Employers should consider their workplace job requirements and conditions to assess potential risks. 

The CDC also recommends that people who have symptoms of the disease should isolate at home or at another location for the duration of illness, generally until any accompanying rash has fully resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.

According to the CDC, symptoms of monkeypox can include fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion, respiratory symptoms (e.g. sore throat, nasal congestion, or cough), a rash that may be located on or near the genitals or anus but could also be on other areas like the hands, feet, chest, face, or mouth. The rash will go through several stages, including scabs, before healing and can look like pimples or blisters and may be painful or itchy. Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.  

Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts between 2 and 4 weeks. 

Because of the way monkeypox is transmitted, it likely will not become as widespread a problem as COVID-19 has been, particularly in the workplace. As noted above, California has recorded over 1,000 cases, and nationally the number is about 6,600 cases, with almost 50% of the cases reported in California, New York, and Illinois. In addition, according to a recent online article in the New York Times, more than 99% of monkeypox cases reported in the United States have been by men who have sex with other men, though the disease may be passed to anyone who comes into close personal contact with an infected person or their clothing or bedding that has touched open sores. According to the CDC, monkeypox infection can be painful and extremely unpleasant, but it is seldom deadly, though those who are elderly, immunocompromised, and under the age of 8 may be at risk for more severe infections. And, there is a vaccine available for monkeypox, though supply is scarce at this time.    

Accordingly, employers should educate themselves on the monkeypox virus and begin to implement policies and procedures based on their risk analysis to ensure they are not caught by surprise by this new communicable disease. Many of the steps you may have taken to address COVID-19 in the workplace may be applied to this new transmittable illness. Here are several steps you should consider taking: 

  1. Have a plan to address potential monkeypox outbreaks. Review your leave, paid time off, compensation, and attendance policies to determine how they will be implemented if any of your employees report a case of monkeypox.
  2. Provide a work environment that promotes personal hygiene. For example, provide tissues, no-touch trash cans with plastic liners, hand soap, hand sanitizer, disinfectants, and disposable disinfecting towels for workers to clean their work surfaces.
  3. Regularly clean work spaces and surfaces. Bathrooms and break areas are obvious places that should be scrubbed, but do not forget to clean phones, computer keyboards, desk tops, and doorknobs. Encourage employees to wipe down their personal workspaces at the end of each day. These precautions also will help prevent the transmission of colds and the flu, communicable diseases that you very likely will see in your workplace.
  4. Ask symptomatic employees to stay home. Encourage employees to follow the suggestions from the CDC, including going to their healthcare provider and self-quarantine if they are diagnosed with monkeypox.

    California’s paid sick leave law also will cover employee absences related to monkeypox, as will the paid sick leave laws in cities such as San Francisco, San Diego, Berkeley, and Santa Monica, to name a few cities. You should allow the use of paid leave if available and do not penalize employees who take the time off for this reason.

    Note that monkeypox cases also may meet the serious health condition definition for coverage under the Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA) depending on the severity of the infection. Generally, if an employee requires three consecutive days of sick leave and more than two visits to a health care provider and continuing treatment related to monkeypox, the employee may be protected by the FMLA and the CFRA. And, any inpatient care related to monkeypox also is covered under these leave laws.  

  5. Send employees home who become ill at work. Do this regardless of whether you think it is monkeypox, COVID-19, the flu, or simply a bad cold. Try to minimize their contact with other employees until they can go home to limit the potential spread of the virus. Encourage them to seek medical treatment from their health care providers and self-quarantine if they think this is monkeypox or COVID-19.  
  6. Keep medical information confidential. Remember, the Americans with Disabilities Act (ADA), FMLA, and CFRA require you to keep medical information about employees confidential, including information about monkeypox.  
  7. Keep up to date with the latest information on monkeypox from the CDC and local health authorities. Monitor outbreaks in your community and check the CDC’s monkeypox website on a regular basis, online at https://www.cdc.gov/poxvirus/monkeypox/index.html, for new recommendations for responding to any outbreak.  

Because of the public emergency declarations at both the state and federal level and the uncertainty surrounding monkeypox, you should discuss this matter with an attorney to ensure compliance.

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