OHA addresses back-to-school COVID protocols, first pediatric hMPXD case

Aug. 22, 2022 — With the return to schools approaching, State Health Officer and epidemiologist Dr. Dean Sidelinger and Oregon Department of Education (ODE) Director Colt Gill discussed the coming school year during a press conference on Aug 17.

Currently, state-level intervention, such as mask mandates in school settings, are looking unlikely. Decisions will be left to local school leaders, who can base those decisions off “what is happening in individual classrooms, grade levels, schools or across a district,” Sidelinger said.

If an individual is high risk, or lives with someone who is high risk, Sidelinger still highly encouraged mask wearing in indoor settings, such as schools.

School districts, and now schools, have been required for this coming school year to have a “communicable disease plan,” which goes beyond COVID-19 and covers a plan of action for potential outbreaks, according to the ODE.

Oregon schools were able to stay open during the Omicron surge, aside from a few outliers that needed to close for one to three days.

Gill said that the schools “did well,” using mitigation strategies such as ventilation controls, access to testing and emphasizing vaccinations, and will continue to have these tools.

Since the spring, contract tracing and case investigation has been peeled back, and there is no plan to bring it back. This is in accordance to CDC guidelines.

“I'm really confident in our local school leadership and our local public health authority leadership, to manage and help maintain the in person instruction for our students,” Gill said.

The OHA reinforced the message that individuals who are sick or experiencing symptoms, particularly a rash, should stay home. Parents are also encouraged to schedule COVID-19 vaccinations for their children, as well as routine immunizations, as they prepare to return to the classroom.

Discussions of monkeypox (hMPXD) in schools came after Oregon reported its first pediatric case of the virus on Aug. 17. A pediatric case is defined as any case in an individual below the age of 18. The OHA did not give any information on the child to protect patient confidentiality.

“We have a known connection to a previously diagnosed case,” Sidelinger said. “This child did not get the virus at school, childcare or another community setting.”

As of Aug. 17, there are 116 cases of monkeypox in Oregon, although Sidelinger said that the number of reported cases is “likely an undercount.”

The cases were in seven counties: four in Clackamas, one in Columbia, one in Coos, 20 in Lane, one in Marion, 73 in Multnomah and 16 in Washington. About 27.6% of cases identify as Hispanic/Latino.

“​​We continue to work with our healthcare partners about early identification of monkeypox,” Sidelinger said. “The rash can be subtle. The rash may not be covering the face or the limbs as we've seen in some earlier pictures.”

While transmission in schools is lower risk, the OHA is asking schools to plan in case of an outbreak, particularly with how to support students and staff who may need to quarantine at home for long periods of time while they recover. Schools should also plan to protect the confidentiality of sick community members and to address monkeypox in a non-stigmatizing manner.

Despite monkeypox spreading primarily through communities of “gay, bisexual or queer men who report recent sexual activity with other men,” anyone can contract the disease, Sidelinger said.

The primary form of spread comes from skin to skin contact with the lesions of an active monkeypox case. While, during this outbreak, this has primarily been seen during intimate or sexual contact among men who have sex with men, it can also be seen through caregiving from a parent to a child, from an adult to another adult or in some household settings where transmission could occur during prolonged close contact.

“Monkeypox is not COVID-19,” Sidelinger said. “This virus is not easily spread unless you have that prolonged, close, skin-to-skin contact with an infected person.”

Symptoms of the virus can include fever, swollen lymph nodes, chills, headache, muscle aches and fatigue. Not everyone will have these symptoms, but everyone will experience a rash or sores. The rash can affect the skin of the face, arms, legs and torso, as well as the genitals, in and/or around the anus (butthole), or in the mouth.

Initially, the rash can look like a pimple with an area of red skin underneath it. From there, the pimples can get a little bigger, form indentations, and fill with fluid or pus. Typically, they then scab. It usually takes two to four weeks to heal over with fresh skin.

OHA recommends people who test positive for monkeypox or who are awaiting test results isolate at home to avoid spread of infection to others. There are additional precautions they and household members can take to further reduce transmission risk that can be found at www.oregon.gov/oha/ph/monkeypox/.

The full recording of the press conference can be accessed at https://www.youtube.com/watch?v=4n9AYcUEjAc or on the OHA website.