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Employer Strategies For Managing Monkeypox Risks In The Workplace – Health & Safety

After having managed through COVID-19, employers are rightly
thinking, “another pandemic?“. Employers have
built an internal resiliency from COVID-19 and can apply many of
the lessons learned to monkeypox. As we saw from COVID-19,
practical steps taken early on by employers in a pandemic can be
beneficial for all stakeholders and employers often bear the brunt
of the hard decisions.

Current status of the monkeypox outbreak

On July 23, 2022, the World Health Organization (WHO) Director General declared that the global
monkeypox outbreak represents a public health emergency of
international concern (PHEIC). A PHEIC is defined in the WHO
International Health Regulations as an extraordinary event, which
is determined as provided in those regulations, to constitute a
public health risk to other states through the international spread
of disease and to potentially require a coordinated international
response. The WHO assesses that the risk of monkeypox is
moderate globally and in all regions, except in
the European region where the WHO assesses the risk as

On the same day, the Public Health Agency of Canada (PHAC)
correspondingly issued an update on monkeypox in Canada. PHAC
noted that monkeypox cases are “expected to continue to rise
[in Canada] as the outbreak evolves”, with 681 confirmed cases
across five provinces as of July 23. PHAC also noted that it has
seen a doubling of cases since July 1, the first case in a female
and the first cases in Saskatchewan.

What is Monkeypox, how does it spread & how long can it

The WHO notes that monkeypox is a viral zoonosis (a virus
transmitted to human from animals) with symptoms similar to those
seen in the past in smallpox patients, although it is clinically
less severe.

The Centers for Disease Control and Prevention (CDC) summarizes
that monkeypox spreads in different ways and can spread from
person-to-person through:

  • direct contact with the infectious rash, scabs, or body

  • respiratory secretions during prolonged, face-to-face contact,
    or during intimate physical contact, such as kissing, cuddling, or

  • touching items (such as clothing or linens) that previously
    touched the infectious rash or body fluids; and

  • pregnant people can spread the virus to their fetus through the

The CDC also notes that it is possible for people to get
monkeypox from infected animals, either by being scratched or
bitten by the animal or by preparing or eating meat or using
products from an infected animal.

The CDC points out that monkeypox can spread from the time
symptoms start until the rash has fully healed and a fresh layer of
skin has formed, with the illness typically lasting 2-4 weeks. The
WHO notes that symptoms usually start to show between 6-13 days
after contact but it can take up to 21 days. PHAC advises that
symptoms include a rash that can be painful and could affect any
part of the body (including mouth, genitals, perianal, face, arms
and legs, feet and hands), with the rash usually lasting between 14
to 28 days and finally forming scabs that later fall off. The rash
can be accompanied by general symptoms such as fever, chills,
swollen lymph notes, headache, muscle pain, joint pain, back pain
and exhaustion. PHAC warns that a person is contagious from the
onset of first symptoms until the scabs have fallen off on their
own and the skin is healed. The WHO notes that the extent to which
asymptomatic infection may occur is unknown.

The WHO notes that groups at the highest risk of severe disease
from monkeypox include pregnant women, young children, and
individuals who are immunocompromised. The WHO also advises that
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

The WHO indicates that the case fatality ratio of monkeypox has
historically ranged from zero to 11 per cent in the general
population and has been higher among young children and that, in
recent times, the case fatality ratio has been around 3–6 per

It is important not to stigmatize any group with respect to
monkeypox. It is not a disease that is limited to
any group or setting.


For employers, the limited supply of vaccines and likely limited
supply of therapeutics, at least for the near term, may very well
mean that it will have to manage situations where employees are
dealing with monkeypox, either themselves or someone in their
household. Employers are not new to this as they have managed
through COVID-19, but monkeypox is not the same and will have some
unique considerations.

Unlike the beginning of the COVID-19 pandemic, at this early
point in time there is at least one Health-Canada approved vaccine
that the National Advisory on Immunization has released
recommendations for immunization against monkeypox. The Government
of Canada has deployed over 70,000 doses of the vaccine, is
providing treatments for case management and is working to secure
future national supplies of both vaccines and therapeutics.

Provincial and territorial public health authorities have
started vaccinating populations currently deemed to be at higher
risk, although vaccination is not available to the broader public
yet. Supplies of the vaccine are limited at the moment and
governments are appropriately prioritizing who can get the

Situation management steps for Canadian employers

Here are three steps for employers before there are more
monkeypox cases in Canada as warned by PHAC, including potentially
in employees or employees’ family members. Many of these build
upon steps that employers took to manage through COVID-19.

1. Consider potential employment issues (including
business continuity) that may arise and legal
Employment-related business issues to
consider include:

  1. Implement preventative steps now. Employers can take a
    number of preventative steps, including:

    1. reminding 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;

    2. encouraging sick employees to stay home, and special
      consideration should be given to the lengthy timelines related to
      monkeypox symptoms and infectiousness;

    3. encouraging employees to avoid close physical contact with
      someone who is infected with or may have been exposed to

    4. perform routine environmental cleaning, including cleaning and
      disinfecting high-touch surfaces and objects;

    5. advise employees before travelling to take steps such as
      reporting their travel locations to their employer;

    6. consider limiting business travel to certain countries or

    7. encourage employees to inform employers if they are undergoing
      testing for monkeypox, particularly if there has been contact with
      others at the workplace;

    8. encourage employees to inform employers if they have a sick
      family member at home with monkeypox;

    9. inform employees that some people may be at higher risk for
      severe illness;

    10. cross-train employees to perform essential functions in case of
      workplace absences;

    11. remind employees of cyber risk related to monkeypox, including
      not becoming a victim of monkeypox phishing email attacks;

    12. consider whether flexible work hours (e.g., staggered
      start times and/or shifts), remote work or other off-site
      arrangements would be acceptable to the business;

    13. reach out to key suppliers to ensure that the business will
      have uninterrupted goods and services during any outbreak;

    14. create or update human resources policies, including statutory
      and non-statutory leaves of absence policies and legal
      requirements, vaccination policies, business continuity plans and
      pandemic response plans, including who in the chain of command can
      make a decision to close business locations; and

    15. assess whether the business has and will have sufficient
      inventory and supplies, including from a health and safety
      perspective (e.g., tissues, no-touch disposal receptacles,
      soap and water, surface cleaning supplies, disposal wipes and hand

  2. 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

  3. If an employee refuses to work for safety reasons and/or
    employee informs employer that s/he or a family member at home is
    undergoing testing for monkeypox
    . 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.

  4. Significant absences in the workforce. Businesses
    should consider how they would deal with a significant number of
    absences, including for reasons of voluntary self-isolation or
    mandatory quarantine. Options include asking employees to work
    overtime, hiring temporary employees with appropriate employment
    contracts to mitigate risk, and engaging temporary help agencies
    for temporary workers.

2. Assess the nature of the business. It is
important to have an objective assessment of the business and any
unique risk factors that may be present in the environment. For
example, retail businesses with a large amount of touch surfaces
and face-to-face contact with members of the public will have
somewhat different considerations than businesses that only employ
workers that work remotely. Long-term care homes, retirement homes
and airlines will also have unique considerations. Depending on the
nature of one’s business, certain steps will be necessary
and/or appropriate to take that may not necessarily be necessary or
appropriate to take for a business in a different sector. Again,
context matters. Depending on the nature of the business, the
monkeypox situation can have broader business impacts, including
business transactions, contracts with other parties and supply

3. Locate reputable sources for information and
. As we saw with COVID-19, it is essential to base
actions on evidence and facts. Employers should be cautious before
relying on non-government sources, as misinformation abounds on the
internet. Reputable sources include medical expert organizations
such as:

Leaders including executives, legal and human resources heads,
should consider taking these concrete steps now. As we saw with
COVID-19, it is better to be overprepared than underprepared.

About BLG

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

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