As monkeypox cases continue rising across the U.S. and worldwide, university students may have questions about their risk of infection and how to protect themselves while on campus. Amid the ongoing COVID-19 pandemic, this new public health emergency can also be a source of stress for students in their daily lives.
Emory University continues to provide educational resources and supportive care for members of the campus community who may be affected by the monkeypox outbreak.
In a video for the Emory community, Jodie Guest, PhD, professor and senior vice chair of the department of epidemiology at Emory’s Rollins School of Public Health, is joined by Sharon Rabinovitz, MD, executive director of Student Health Services at Emory and assistant professor in the School of Medicine, and Keilan Rickard, PhD, executive director of Emory Counseling and Psychological Services, to discuss preparations for potential cases of monkeypox at Emory, efforts to educate the community and the resources available to Emory students.
Their conversation is part of an online video series hosted by Guest, who is also a public health advisor for the City of Atlanta’s monkeypox outbreak response and leader of the Emory COVID-19 Outbreak Response Team, answering questions related to the ongoing COVID-19 pandemic and other public health topics.
Q: What are the latest developments with the monkeypox outbreak?
A: In July, the World Health Organization declared the monkeypox outbreak a global health emergency, and the U.S. declared a public health emergency in August.
“These are important markers when we think about epidemics,” says Guest. As of Sept. 26, more than 65,000 cases of monkeypox have been reported worldwide, including more than 25,000 cases in the U.S. Georgia continues to have the second highest rate of cases and fifth highest case count. Most cases in the current outbreak have been among men who have sex with men, but the virus has also spread beyond sexual networks.
Q: How is monkeypox spreading?
A: “Monkeypox is not spread easily,” says Rabinovitz. “Spread generally requires close and sustained contact — direct or indirect — through skin-to-skin contact with scabs or bodily fluids, and usually this is during intimate sexual contact.”
Monkeypox may also spread through shared towels or bedding, or through respiratory droplets during prolonged face-to-face contact like kissing, Rabinovitz adds.
“We want to highlight that it’s not COVID,” she emphasizes. “Monkeypox can be spread through respiratory droplets, but that's not the primary way. It really needs direct, intimate, skin-to-skin contact for transmission.”
Q: Is monkeypox considered a sexually transmitted infection?
A: While monkeypox is primarily spreading through sexual networks during the current outbreak, it is not considered a sexually transmitted infection, Rabinovitz says.
Q: What are the symptoms of monkeypox?
A: “There are two different phases of monkeypox,” Rabinovitz explains. “The first is the prodromal phase, which has the fever, headache, sore throat, body aches, exhaustion and can also have swollen lymph nodes in the groin, neck or armpits. This is all before the rash.”
“The second part is identified by the rash, which can go through an evolution starting with red bumps,” she continues. “It can go into blisters or pimples, and it can be anywhere from the face to the hands and even genital areas.”
Monkeypox lesions can be painful and can last around two to four weeks — “a long period of time to wait for symptoms to go away,” Guest says.
Q: When should a student seek testing for monkeypox?
A: It can be difficult to distinguish between the first symptoms of monkeypox and other illnesses such as COVID-19 or strep throat. Rabinovitz notes it is important to rule out other diagnoses first.
“I would ask, ‘Did you take a COVID antigen test at home? Have you been exposed to anyone with COVID? Have you had any other symptoms that might lead me in a different direction, or to a different diagnosis?’ And then we would get into the more intimate questions about contact — knowing anyone who has been exposed, if they've exposed themselves to someone with monkeypox or someone that they have been with has an undiagnosed rash,” she says.
Individuals who have a fever or feel sick should isolate, even if they do not have a particular diagnosis. “Be mindful of the fact that you're sick and have some type of illness, and should then stay away from others,” Rabinovitz says.
If the person develops a rash within one to four days of flu-like symptoms, they should seek monkeypox testing. “Once the rash starts, that's the trigger to reach out to Student Health for monkeypox testing,” Rabinovitz says.
Students on Emory’s Atlanta campus can use the Student Health Portal to make an urgent care appointment, during which a provider can assess symptoms and determine if monkeypox testing is needed.
Q: Is monkeypox testing available at Student Health Services?
A: “Yes. We knew that was very important to have available for our students, especially when they came back [after the summer],” Rabinovitz says.
Q: Where else can members of the campus community seek monkeypox testing?
A: Many primary care providers are offering monkeypox testing, along with community services such as Viral Solutions and Peachtree Immediate Care, Rabinovitz says. Student Health regularly updates its website with the latest resources.
“Atlanta Strong also has some really good resources on their website about both how to find testing across the broad version of metro Atlanta, as well as vaccination opportunities for the entire state of Georgia,” Guest adds.
Q: What should a student do if they test positive for monkeypox?
A: “The first thing if someone is diagnosed with monkeypox: we want them to isolate. We also want them to reach out for support, because one of the things that is important to us is that they know that they have support within Student Health,” Rabinovitz says. “That is the most important thing: that people are not alone. We have a lot of resources and expertise on campus for people to reach out to if they are positive.”
“On the medical side, [they should] reach out to make sure that they have what they need as far as medication or pain control,” she continues. “And people should be isolating to make sure that they do not spread monkeypox, but also be careful not to share drinks or towels or anything else, especially if they're in a setting where there's other people.”
If students do need to isolate for monkeypox, Student Health will provide isolation spaces, prepared meals, towels, linens, basic medications and other necessities. They will also connect the student to a case manager and the medical team who will monitor their needs during the two- to four-week isolation and recovery period.
“We're here for the students, so we’re preparing for what could be,” Rabinovitz says.
Q: Are university students at higher risk for monkeypox infection than other communities?
A: “We know that university students are social beings, and they do a lot of social activities like attending very packed parties, or sharing drinks, or sharing towels, and sexual activity,” Rabinovitz says.
“Monkeypox transmission is by direct, close contact, and it happens to be that university students engage in a lot more of those activities, whether this occurs intentionally or not intentionally. Just by being in a residence hall, you're around other people. You might pick up a towel by accident, so we just want to be very mindful of not sharing drinks, not sharing towels, not sharing bedding or anything like that that can lead to any transmission,” she emphasizes.
Q: Will the monkeypox vaccine be available at Student Health?
A: “Vaccination is a very important tool for any virus,” Rabinovitz says. “At this time at Student Health, we do not offer monkeypox vaccines, but we will refer and make sure that people understand where they can access monkeypox vaccine. As more opportunities to access the vaccine come about, we'll keep people updated on our website with more information.”
Q: How else can the campus community prevent monkeypox?
A: “This is a community response,” Rabinovitz says. “Everybody has to know how monkeypox is spread and what it looks like, but individuals have to understand their own risk and get support, be vaccinated and ask questions.”
“The most important thing is to identify your own risk, and whether that changes your own sexual behavior or intimate behavior, that is obviously a personal decision. There are a lot of resources to help people walk through this,” she adds.
“We've been trying to talk about community responsibility since the onset of COVID, and how important my risk is to someone else, and this community compact: we're better together than we are individually, when we care about those who are around us,” Guest says.
Q: Can students safely participate in campus activities during the monkeypox epidemic?
A: “Absolutely,” Rabinovitz says. “We want to make sure that people are aware and are mindful, but not restricting their activity in an impactful way.”
“The thing that we've said with COVID-19 is we want to keep our community vibrant and active and focused on our educational mission and social mission, and we don't want that to impact it,” she continues. “So, education and communication amongst ourselves is really, really important to make sure that everybody has the resources and understanding to keep themselves safe and do what they love and what adds to their university experience.”
Q: What resources are available through Counseling and Psychological Services (CAPS)?
A: “CAPS provides individual, group and couples counseling for enrolled students,” says Rickard. “We also offer some stress management classes and community outreach to provide support for students on the Atlanta campus. The Oxford campus has its own counseling center, as well, so we can assist them in negotiating emotional and interpersonal difficulties, and we have on-call counselors throughout the day.”
On-call counselors are available for students on the Atlanta Campus from 8:30 A.M. to 3:30 P.M. They can be reached at 404-727-7450.
Counselors are also available for Emory Oxford campus students from 8:30 A.M. to 12:00 P.M. and 1:00 P.M. to 5:00 P.M. They can be reached at 770-784-8394.
Q: What additional support can CAPS provide if a student is dealing with monkeypox?
A: “We understand that being exposed to or contracting monkeypox can be super distressing, especially if you have some pre-existing conditions or if you belong to a vulnerable population, so we want to make sure that students are aware not only of CAPS resources, but other Emory resources,” Rickard says.
For example, TimelyCare is a telehealth service that is available 24/7 for Emory students.
“For folks in isolation, this is perfect,” Rickard explains. “We already have the infrastructure set up for folks to be able to engage in virtual services, so students can engage from almost anywhere. They can sign up using their Emory email address, and once they are there, they can choose a therapist, maybe who matches some identities that they hold.”
TimelyCare also offers a TalkNow service. “Let's say that you’re experiencing some immediate distress — you can use the TalkNow feature to talk to a supportive person right away, and we urge students to use that if they're feeling distressed,” Rickard says.
“Two to four weeks is a long time to isolate, so please be in touch with CAPS and we will offer additional support, if that's what students need,” he adds.
Q: What are some other resources available on campus?
A: Student Case Management and Intervention Services (SCMIS) is another resource for students that offers judgement-free guidance.
“If you as a community member are concerned about a student, you can submit a Student of Concern form and SCMIS will reach out and follow up with the student,” Rickard says.
Case managers will also be assigned to students who are in isolation for monkeypox to assure their needs are met throughout their isolation period.
“We assume that there are going to be some academic concerns that arise because of isolation, so the SCMIS office is going to be crucial in helping students navigate those academic concerns,” Rickard continues.
The Office of Spiritual and Religious Life also supports students through worship, meditation, education, service, social justice and interfaith engagement.