Monkeypox is spreading as college students return to campuses. Some universities are still preparing.

For the last two years, college and university administrators have welcomed the start of the fall semester with a mix of excitement and trepidation about the coronavirus pandemic.

This year, even as COVID-19 continues to spread, colleges are confronting another public health threat: monkeypox, which so far has predominantly afflicted men who have sex with men but can spread through skin-to-skin contact to anyone, regardless of sexual orientation or gender identity.

It’s unclear whether the college social scene will hasten monkeypox’s spread. Yet on several college campuses in Pennsylvania, New Jersey, and Delaware, specific guidance and policies about monkeypox are still being refined, with a couple of schools having yet to release updated information even as students prepare for move-in.

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It raises questions not only about universities’ preparedness but also what role they can play when national messaging has been muddled and the federal vaccine supply is limited. Without enough vaccine, education is key to mitigating the spread and combating misinformation — as colleges wait to see whether monkeypox will spread more quickly on their campuses than it has in the general population.

Needless to say, 18-to-22-year-olds living on their own can be known to partake in intimate physical activities. Not only do they have sex but they also make out, dance shoulder-to-shoulder at house parties and bars, share vapes and red Solo cups, and live with roommates in tight quarters.

“I know that we’re going to see some cases at Temple, because college students do share things and they are who they are,” said Thomas Trojian, assistant clinical director at Temple University Student Health Services. But he said he believes the virus will not spread more rapidly than it has anywhere else.

Over the course of the two-month outbreak, there have been 362 reported cases in Pennsylvania, 367 in New Jersey, and 10 in Delaware as of Wednesday, according to the CDC.

There is no public database of cases among college students. But even before the fall semester begins, cases have been confirmed at several colleges nationwide, including Penn State, West Chester, Bucknell, George Washington University, American University, and the University of Texas at Austin.

While no one in the United States has died from the virus, it causes painful and infectious lesions, requires isolation for up to 30 days, and threatens to exacerbate existing stigma and discrimination against members of LGBTQ communities, something that several student leaders said they were more worried about than getting sick themselves.

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“I think a lot of the concern is less so about the virus itself and more about the homophobic moral panic that is beginning,” said Eitan Runyan, president of the Temple Queer Student Union.

Muggs Leone, a student employee of Penn State’s Center for Sexual and Gender Diversity, said he, too, has heard his peers voice concern about stigma.

“In regards to the physical safety, I haven’t heard a whole lot,” he said.

Student leaders said they want their universities to address the virus head on, similar to how they responded to COVID, while acknowledging the viruses are vastly different. This, they say, can also help reduce stigma.

So far, some universities have communicated through online bulletins and emails; others have not provided information or guidance on monkeypox since early summer.

Some said they hope to eventually offer the vaccine. But for now, doses are extremely limited, with even the Philadelphia Public Health Department receiving fewer vials than they would like.

When a West Chester University commuter student contracted monkeypox in July, spokesperson Nancy Gainer said the experience spurred the university to start circulating information to students about the virus and how it’s spread.

The student is doing well, Gainer said, and finished summer class remotely. A health department investigation determined that they had no close contacts in Chester County, she said, and there have been no other confirmed cases at the university.

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Penn State announced Wednesday that a main campus student, who lives off campus, tested positive for monkeypox last week.

No other local or state university would say if there had been cases among students or staff.

At Penn State, where more than 40,000 undergraduate students are returning to its main campus this weekend and classes start Monday, its monkeypox guidance was also released Wednesday.

Students who develop symptoms should make an appointment with University Health Services, said Rebecca Simcik, the center’s medical director. The health center is working with the state Department of Health to offer testing and vaccines, she said.

At the University of Pennsylvania, where first-year students move in starting Monday, spokesperson Ron Ozio told The Inquirer that “any information we have for students will be posted online when it is ready.”

In Newark, the University of Delaware launched a web page with monkeypox information on Thursday, about a week before move-in.

Drexel University, which is on a quarter system, doesn’t start classes until Sept. 19. Spokesperson Niki Gianakaris pointed a reporter to a FAQ the university released in late July.

Drexel officials said that the health center can test for monkeypox and get an antiviral drug for severe cases. It will work to get the vaccine if it becomes more available.

“We anticipate seeing cases among students and have already begun testing,” Marla Gold, chief wellness officer and senior vice provost for community health, said in a statement. “It’s in Philadelphia and the region. We’re ready for it.”

Temple is able to test for monkeypox, Trojian said, but would direct students to the city health department if they may be eligible for vaccination.

West Chester is also able to test, Gainer said, and has told the Chester County Health Department that it’s willing to offer the vaccine if it becomes more available.

In New Jersey, where Rutgers starts classes after Labor Day, university spokesperson Kevin Lorincz said a monkeypox advisory was sent out this week, advising students to consult their physicians about suspected illness or exposure.

“The university does not have access to monkeypox vaccine and will not be offering treatment,” Antonio M. Calcado, executive vice president and chief operating officer, said in the statement.

A reason for the communication delays may be that colleges are waiting for the most up-to-date guidance from public health officials, said Jennifer Horney, the founding director of the University of Delaware’s epidemiology program who has worked with the university on its response.

“I think the challenge has been since we started working on our messaging a week ago, the guidance has already changed,” she said.

University leaders want to ensure, too, that communications don’t stigmatize members of LGBTQ communities, she said.

“We want to focus on high-risk populations,” Horney said, “but not at the expense of letting everyone know this is not just a risk for men who have sex with men but it’s a broader risk.”

Monkeypox also poses tricky logistical questions, such as what to do about the 30-day isolation time — whether to offer isolation housing or trust students to self-isolate, and how to ensure students can continue attending classes virtually.

At Temple, Trojian said the school will advise students to go home. If they can’t, and also can’t isolate from roommates, the university will work to make isolation housing available, much as they do for students who test positive for COVID-19.

Similar strategies are in place elsewhere.

“Since the isolation period can be up to four weeks, on-campus students should expect to make arrangements to complete their isolation at home,” Penn State officials say in their guidance, noting staff will work with anyone who is “unable to travel.”

At West Chester, Gainer said the university will put students up in a hotel if isolating off campus is not possible.

Some student leaders said they worried about the mental health and well-being of students, especially those in LGBTQ communities, who might have to return home to environments where they are not as accepted as they are on their campuses.

Drexel, meanwhile, is in the process of designating isolation spaces, Gianakaris said.

College administrators said they also want to stress that monkeypox is not sexually transmitted and can be contracted by anyone.

Toward that goal, West Chester University is planning in-person educational programs for all students, Gainer said, and training for health center employees.

In central Pennsylvania, “the majority of people at Penn State, I don’t think they know about this virus,” said Carter Gangl, who chairs the Committee on Justice & Equity for Penn State’s student government, noting that their fellow LGBTQ peers know more “because they almost feel like they have to.”

“Without that education piece” for the broad population, they added, “I think it’s going to be really, really difficult to mitigate the spread.”