Alicia: good afternoon. We will get started in a couple of minutes.
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Alicia: Good afternoon, and welcome to a Columbia student's
guide to Monkeypox. What it is and how to manage.
My name is Alicia Czachowski. I'm the director for health
promotion. Welcome. There have been many questions
and concerns about Monkeypox among members of the Columbia
community. So we wanted to bring together a group of experts from
across campus to really talk through what it Columbia's
response is going to be and is currently.
And to answer frequently asked questions we have been
receiving. At this point I will turn it over to the presenters
to introduce themselves.
Wafaa, would you like to start?
Wafaa: yes and apologies for the
delay. I am a professor of
medicine at Columbia, University. I am also the
Executive Vice President for Columbia global
joining me today -- and thank you for letting me join you
Hello, I am Daniel Chiarilli.
I'm director of the gay health project.
And also a sometime adjunct assistant professor in the music
Katherine: My name is Katherine McAvoy and I work closely with
our contact tracing program and am located within health
Rick: Hi, I'm Rick O'Keefe.
And I have cared for a number
of students diagnosed with Monkeypox.
I am one of the members of the behavioral health team that
collaborates within medical services and I am very glad to
be here today.
Colleen: Good afternoon. My name is Colleen Lewis and
I'm the senior executive of health here at Columbia.
Alicia: Before we get started, there is a question feature.
If you have a question, please heal free to post the question
and we will answer at the conclusion of the webinar.
Closed captioning is available.
Just go to the bottom of your
screen and click the closed captioning button and you will
be able to see a live transcript. For the core
section, we are going to talk a little bit
about the current state of Monkeypox and provide a bit of
background information. So I am going to turn it over
to Professor El-Sadr. Wafaa:
Thank you very much. I will
share my screen.
Sorry about this.
Sometimes there are Snafus. It will take a minute.
I'm sorry area can you see my screen?
-- I'm sorry, can you see my screen?
>> We see Monkeypox testing and diagnosis.
Wafaa: Hold on. I'm not sure why this is happening since we
tested it before.
How about now? Do you see it now?
Are you able to see the screen?
>> We are not seeing the screen.
Alicia: Would it be helpful for
us to share the slides?
Wafaa: I think that will be necessary. Apologies.
>> One second.
Wafaa: Thank you. I apologize.
OK. Thank you very much. Again, apologies for the delay.
I will provide the Monkeypox update for all of you today and
I eagerly await your questions. Next slide, please.
To hear an outline of my presentation, I'm going to touch
a little bit on the Monkeypox virus itself, its history.
And talk about the epidemiology of the current 2022 outbreak.
We will describe the key clinical features of this
outbreak, touch on vaccination and treatment and end with a
brief summary and conclusions.
So let's talk about the Monkeypox virus itself. This is
what we call a viral zoo gnosis which means it is transmitted
from animals to humans. It causes very similar symptoms
to those that we have seen in the past with smallpox.
However, it's important to remind everyone that the
symptoms caused by the
Monkeypox virus are much less severe than those reported with
This virus belongs to what we call the orthopod genus and it
was discovered in 1958 when there were two outbreaks of a
disease that occurred in monkeys that were kept for research
The first human case was identified in 1970.
Prior to the 2022 outbreak, essentially cases of Monkeypox
were reported from several West African and central African
countries. That is why we call these the countries where
historically Monkeypox is been reported
previously or where this virus has been endemic. There are two
different kinds of the virus.
One is played -- Clade 1 which is more severe and this outbreak
is Clade 2. Which is typically less severe.
What are the modes of transmission? We will touch on
the modes and the symptoms. Importantly, you
will see the main route of transmission is through direct
pronounced skin to skin contact with an individual who has a
rash or sores caused by this virus.
Skin to skin contact and transmission can occur during
sex or other intimate activities.
There are less routes of transmission, but the most
important is what I talk to you about already and through
contact with clothing, bedding, and other items used by someone
with Monkeypox. And possibly through
respiratory secretions. If somebody sneezes or coughs
that can be passed on through prolonged face-to-face contact.
It is really important to remind everyone that this virus is very
different from COVID-19, from SARS-CoV-2 virus.
With SARS-CoV-2 coronavirus, we know that it can be transmitted
very easily and can be transmitted to someone without
any symptoms and can be transmitted through casual
contact. This is not the case with Monkeypox.
The major route of transmission is direct prolonged skin to skin
contact. The symptoms after somebody
gets infected, they appear within three weeks of exposure
and the illness itself lasts between two weeks to four weeks.
In most people, the symptoms are self-limiting.
They will go away by themselves without the need for any
But a quarter of the people may
have more severe symptoms. How do we diagnose monkey pox itself?
This is diagnosed by a health care provider that will take a
specimen from an individual who comes in with suggested symptoms
of Monkeypox and the provider will send the specimen
to the laboratory for testing using a very highly accurate PCR
tests. They will take a swab in the
upper right hand corners and they will run the swab across
the lesions, the rash, or the sores on the body to collect
enough material to be able to detect the virus if it is
present. It is also possible as well to
send this gap from a skin lesion to the lab for detection of
A PCR tests is conducted to detect the family of these
viruses. And usually the result is
obtained and available within a few hours within a few days
after it is sent to the laboratory. However, it's
important to keep in mind that while you are
waiting the results of the test itself, it's important to take
all the precautions to prevent the spread of Monkeypox to
others while awaiting the results of the lab testing.
What is going on now in terms of the Monkeypox outbreak?
You can see on this figure that as of October 5, there have
been a total of about 70,000 or more than 70,000 cases reported
More than 69,000 of those cases have occurred in countries that
have not historically reported Monkeypox in the past. During
this outbreak, only about 700 or so cases have been ordered in
countries that have historically reported Monkeypox.
Those are the countries in blue on the map.
I need to caution, though, that this number that has been
reported in terms of what we know about the occurrence of
cases may be an underestimation because this is not widely
available in those countries.
In all likelihood, that is an underestimation of the current
burden of Monkeypox cases in those countries.
As you can see, there have been more than 26,000 cases of
Monkeypox that have been detected and reported. And you
can see again from the map of the U.S.
and the different colors of blue that they reflect the
burden within those countries and it has been reported from
almost all of the U.S. states.
On the right-hand side of the slide, it appears that this
outbreak in the U.S. has peaked and we are seeing a decrease in
the daily numbers of cases being reported.
Why is this happening? It could be for a lot of different
factors. It could be that people are more aware of Monkeypox.
They are going to their provider and their provider is sending a
specimen to the laboratory.
Earlier detection of infection and isolation of cases prevent
There have also been access to vaccination in this country
which may also have had an impact in decreasing
transmission. And we have evidence to suggest
there have been changes in
certain behaviors, decreasing the risk of transmission
particularly among the most affected populations.
It's important to take a look at who is being reported with
Monkeypox in the United States.
You will note that early on, about half of the cases were
reported among white individuals and the other half were reported
among black or African-American. Over time, you notice the
change and you see a majority of cases in September are in this
magenta color. The majority of cases are being
reported among black or African-American individuals
while the smaller proportion of
Hispanic or Latinx with the smallest among whites.
The most severely impacted subsets of our population have
been African-American, black men in particular in this country.
What has been happening in New York City, today there have been
more than 3000 600 cases of Monkeypox reported in our city.
But you will see again reassuring data from the figure
on the right. We also peaked in August or so
and there has been a rapid decline in terms of the daily
number of reported cases.
The right-hand side is good news, indicating that we are
seeing a decrease in numbers of cases in New York City and in
Now what are the clinical demographic and clinical
features of a person with Monkeypox? These are results
across 16 countries that included more than 500 cases.
You can see some of the lesions, some of the sores, the rashes
that occur on the skin. And you can see as well that
there could be sores around the mouth, the throat, and the
So what is distinguishing this outbreak is not only are there
skin sores and skin rash, but there is a rash and ulcers that
have been noted in the mouth as well as in the perianal area.
But what we know from the
series of cases is 90% of the persons were gay or bisexual
men. About 40% were individuals
living with HIV and transmission has largely occurred among
individuals through sexual activity.
Also note 95% of individuals presented with a rash and some
of the common symptoms have included fever, enlargement of
the lymph glands, weakness, muscle aches, as well as
Also from infection to manifestation of symptoms, it
ranges from three days to 20 days.
13% of persons were hospitalized but no deaths were reported in
this series. Most were because of severe
symptoms, especially when the sores were in the mouth,
limiting the ability to eat or drink or they were in the
perianal area or in the rectum. Or among people that have
underlying medical conditions.
This is a series looking from Europe and we can see similarly
that again, the majority have been amongst males. You can see
most of the transmission occurred during
sex about 38% to 40% that have occurred among people living
with HIV and thankfully, the majority of cases have been
Let's move on to vaccination and treatment.
We have a vaccine that seems to work quite well.
This vaccine contains a nonreplicating virus which means
the virus itself can't replicate in the body.
You can't get Monkeypox from getting vaccinated and that's
important to keep highlighting this. It is the preferred
vaccine and recommended to be given into doses, four weeks
It is administered in the skin or right under the top layers of
the skin and you can see eligibility in New York City
includes people that had multiple
-- gender conforming and gender non-binary individuals
as well as individuals that had transactional sex or sex at
certain venues. Also importantly, individuals
that have been the close contact of someone with Monkeypox.
And we have data that tell us that this vaccine works which is
very important. And you can see on the
left-hand side of this figure that they were -- in this case,
there were 14 that did not receive the vaccine and only one
in terms of a person who got the vaccine.
These are people that are eligible and should have been
vaccinated as quickly as possible. This is good news that
early evidence of the vaccine works.
What we have noted is a disparity in the distribution.
This is data from New York City and I want you to focus in the
middle of the slide and you
will see if you look at the
white population, for example, it's about 45% eligible for
vaccine and about 48% of the vaccine doses administered for
The disparity is quite evident
and you can see about 13% were eligible. 31% were eligible for
vaccine and only about 13% or so of the
doses were administered who are eligible for the vaccine.
We have a disconnect, more
people reported with Monkeypox and fewer of the population are
getting vaccinated. New York City is doing a good
job in terms of trying to reach the diversity of individuals who
should get vaccinated with the establishment of
vaccination science in the highly infected communities,
where some may be having a concerted effort to reach those
with the highest risk.
The good news is that we have treatment and it should be
considered in individuals with severe symptoms and severe
Those that have high risk of progression including people who
are immunocompromised are living with HIV as well as individuals
who may be pregnant or breast-feeding.
In general, the treatment is not recommended for the majority of
people. This is recommended for a
subset of people. What this outbreak has
highlighted is the importance of paying attention to stigma and
discrimination. That means a negative association with a
person or group of people and this is
often fueled by fear and anxiety and can result in
We know from many experiences,
that it is well documented that often stigmatizing and
discriminating can lead to creating barriers to
So it is really important when talking about Monkeypox that we
are sensitive to this issue and we do not stigmatize the
population bearing the brunt of Monkeypox infections.
So I think a few conclusions are that the current Monkeypox
outbreak has resulted in an unprecedented number of cases
There are unique characteristics and in the U.S.
and New York City, this may be due to a variety of different
factors that I mentioned before.
We have disparities that are evident in terms of who has
access to vaccine and treatment and these are not only within
our own communities, that there
are access -- there is access, or limited access to testing and
no access to vaccines.
And it is critically important to combat discrimination for the
health and well-being of
our communities and to achieve optimal outcomes.
Thank you very much and I will stop here.
Alicia: Now we will turn it over to Dr.Chiarilli –
Dr. Chiarilli to talk about the stigmatization.
Daniel: I wanted to talk about de-stigmatizing.
The Columbia community and students are really sensitive
people and they consciously work to avoid stigmatizing people.
But we are all susceptible to fear and we are all capable of
perpetuating stigma even when unintended. There are some
harmful consequences of stigma.
And to review a few of these, there is the possibility of
There are concerns and responses from the government that it
won't be robust. And when the health issue or the
community is affected, there is fear of overt discrimination,
concern about bias or violence against people with Monkeypox or
people at risk of contracting.
And finally, a stigma can really discourage people from seeking
testing or treatment,
thereby jeopardizing keeping the virus in circulation.
What I would like to spend a few minutes talking about today
is the connection in this particular instance of the
stigma around Monkeypox and the focus on sex. Right?
It is a wellspring there are connections between Monkeypox
and sex. They are definitely contributing to both real
stigma and the potential for increased stigma.
When sex is associated with an
infection, the way that stigma can change.
We usually don't feel ashamed or guilty if we catch a cold or
come down with the flu. In fact, people sympathize with us.
But it's really a different story for other kinds of
infections. For her piece, for HPV.
And the differences these other kind of infections are sexually
transmitted. It could even be argued that
flu is much more likely to put someone out of commission then
a chlamydia infection especially in a world where chlamydia can
be treated easily with antibiotics and not lead
to serious health problems. But the flu isn't understood as a
consequence or something that has a stigma around it.
We don't say to somebody or to ourselves, I can't believe you
held onto that subway pole and wiped your nose after.
This is not the way we think about infections.
So I think it's important to keep in mind a little bit when
we are thinking about infections and the way that
they collect ideas in guilt and shame.
I think a concern that I've found voiced in the sensitive
way from a lot of people is around the messaging.
Messaging around vaccine eligibility, transmission risk,
and testing. Especially the targeting.
I think it's very important that Monkeypox is not a gay
disease in the way that HIV is not a gay infection.
There is nothing about being
queer or gay that makes it more or less susceptible.
As we are working to destigmatize Monkeypox, we
really ought to be mindful that the stigma reduction we do
needs to go with honesty and the best medical practices.
In the 2022 outbreak, about 98% of infections have been among
men who have sex with men.
That is a reality that would be silly to ignore.
Of course, messaging that targets specific communities
could definitely use language that's stigmatizing or
destigmatizing but it can be a mistake if we are thinking that
the targeting message itself is itself stigmatizing.
And as a result, there is no identification for communities
who might be more at risk or might be personally affected.
No sort of recognition of a hierarchy among different
In some ways it's another consequence for us.
It could be argued that effort to avoid stigmatizing language
results in omission of information that can be useful
to people at risk and be assuring to people who are not
We do a lot of HIV work, and I think it can feel complicated.
But not all modes of transmission of HIV are equal.
If we don't have a very clear hierarchy , it is significantly
more likely to lead to transmission
to HIV then oral sex, we don't really know how to behave
properly. We don't know what kind of message to give.
There still is a lot of uncertainty about certain
I think it is important to recognize that it is a
Physical contact in the form of rashes or sores is far more
likely to transmit the virus then being in proximity to
This is important.
So that people can make reasonable and effective efforts
at contracting or transmitting the virus.
It reassures people that the day-to-day activities are not
leading to infections.
And another sort of truth is that while certain behaviors it
is definitely necessary there is the absence of the
prevalence of the virus.
The chances of contracting the virus are automatically lower.
We don't want to say things that are stigmatizing,
homophobic, or anti-queer. Luckily, we are able to
reassure people and we are seeing a lot of success with
that messaging and with people changing their behavior, which
It is a situation changing all the time.
So we are moving to a state of relative scarcity.
To one where we are becoming more accessible.
And the scope of the focus, they can stand away from the most
vulnerable people to all vulnerable people.
Thank you for letting me share my thoughts.
Alicia: I'm going to turn it over to Rick and Katherine to
talk a little bit about medical services and the contact tracing
Rick: Thank you.
What I want to do is talk about what would happen if we have any
questions, concerns, or exposure to Monkeypox. Medical services
is one of the divisions of Columbia health. We are your
medical home when you're on campus.
It is organized into clinical teams and each student has
chosen on their own a primary care provider.
If you think you might have Monkeypox or think you might
have been exposed or simple have questions, we are available to
The first is to send a secure message to your primary care
provider through the portal.
Often, your physician or nurse practitioner can answer your
questions in that message.
If you need to speak to somebody more urgently, call
medical services at 212-854-7426. And a nurse or
clinician will return your call.
Please answer the phone and keep your phone on.
During the phone call when the nurse or the clinician calls
you back, they will determine your risk and your need for help
at that point.
the nurse will refer you to the New York City Department of
Public health. Medical services does not have the vaccine.
Once you arrive for your visit, the clinician will ask you
questions to help determine the risk and will likely do an
If you have a sensitive area, there will be a chaperone.
If a rash or characteristic history of Monkeypox, they will
take a sample to test for Monkeypox as outlined in the
slide. If there are many sites of the
rash, many samples may be done. People wanted me to show you
that it is just a cotton swab. That is just rolled on the
lesion. If there were lesions on your
genitals or your buttocks or your abdomen or arm, all of
those sites would be sampled. It is important to note that this
test is covered by the student health insurance so there is no
cost to the student. It's also important to
understand that the clinician will be wearing gloves, goggles,
or face shield and a mask which is standard protocol just so you
know that that would be the case.
If the test is recommended and done, they will refer you to
contact tracing management team and they will reach out later
If on campus they will help you with housing for the short term.
The clinician will follow up by secure message and/or phone
calls to make sure you are OK and answer any of your
questions. You're always welcome to reach
out to that clinician so that you can make sure you're doing
OK. I will hand it over to Katherine.
As Dr. O'Keefe mentioned, we step in to help support you
while you're pending that result. If they do get a
positive test result once that comes a couple of days later.
Our contact tracing team is really focused on providing
individualized support services to support you through
isolation. That isolation could be a couple of days until your
test result comes back and hopefully comes back negative.
You can go back out, do your life, and go forward from there.
If it comes back positive, you are looking at a couple of
isolation until your lesion is fully healed. The team will be
working really closely with those dudes to figure out what
sort of supportive services do they need for that time?
For some of our students who
live in on-campus housing, general studies or graduate
students living in Morningside residential parchments or CIC
students living in uptown campus, we will work with them
to figure out what sort of housing support they need. Will
they be able to stay where they currently are? If so, we can
talk through how to reduce the risk to other household members
or if they will be eligible in need of an isolation unit.
If students live on campus we will give them information
around protecting or preventing exposure. We will also talk to
things like food. Do you have enough of your prescription and
over-the-counter medications to last you through that time? Are
you going to be able to attend classes?
Columbia does have policies.
When they take certain risk reduction protocols.
Some of the classes are not eligible for in person
attendance at which point we
refer those students to the disability services for some
pretty individualized academic accommodations.
We also work with other clinicians over at medical
services to make sure students get all of the appropriate
medical care that they need throughout their isolation
process and connect students with any other things that they
might need support around. Do they need a mental health
support whether it is counseling or otherwise?
Do they need assistance communicating with their coach?
Do they need to navigate remote work or take sick time?
They will work with students to provide that support.
And I will turn it back over to Alicia.
Alicia: Just a quick reminder that if you have any questions,
type those into the question and answer feature below.
I'm going to turn it over to Eduvigis and Colleen.
Eduvigis: Good afternoon. I am one of the psychologists at CPS.
They have long known how difficult isolation can be for
people in treatment and recovering from a multitude of
illnesses including Monkeypox.
Those that have experienced those students, or what is
reasonable to them, we will likely have a strong reaction
to have to go into any length of isolation.
The good news is that there are simple steps that we can take to
make the discomfort more bearable. Speaking with someone
who can support and guide the student to this temporary
postponement of their lives is crucial.
Our staff at CPS is committed to doing just so.
Students can call us.
To schedule a telehealth consultation because even though
we have a variety of services that include individual
counseling, supportive groups and the like,
you can access those in person so we can contact you by phone
or by video chat. In addition, there are support
spaces that are targeting some of the common difficulties that
people have such as time management, management of
stress, and the multitude of effects of borderline connection
difficulties and we are sick with medical conditions that
requires you to stay by yourself through extended periods of
time. There are other resources available.
For the sake of time, I will
refer you to our website under the Columbia health CPS section
and get more information there.
Beyond CPS, how you are able to access 24/7 free confidential
services through New York City and New York City well is one of
It is important to remind yourself if you have been
exposed and you are required to be in isolation to give yourself
permission to ask for help even if you are not sure that you
needed from many of us at CPS.
In addition to that, good sleep and an attempt to eat regularly.
If your body allows it, move around the room.
And reach out to the people in your life who have been a
source of support in the past. Research tells us that people
who have friends and connections with others do
better and recover better from any medical conditions.
Reach out and remain open to making new connections.
In the student organizations that will support you through
In the service of time, I will pass this onto my colleague for
Colleen: My name is Colleen Lewis.
I'm from Disability Services. We work with students who have
permanent disabilities. In addition to working with
students with permanent disabilities, we work with
students have temporary injuries or who have a temporary illness
lasting a few weeks.
In thinking about supporting students who may need
accommodations and disability services who have Monkeypox, we
have streamlined the registration process. We will
work closely with our colleagues and medical services and contact
tracing to expedite the registration process and to
think about accommodations and support services for students on
an individual basis. There are so many variables and
we think about accommodations. They are course-dependent.
If a student is able to participate remotely, if a
student is able to engage in academic work throughout the
entire duration of their illness, or if they need some
extended absences, time to catch up on their work. There are a
variety of accommodations that we can put into place to support
students during their illness and the recovery from their
illness. For students who are not
diagnosed with Monkeypox from Columbia health clinicians,
students can contact us
directly by contacting us at [email protected]
member of my intake and registration team will be in
touch immediately to connect with the student to determine
how we can best accommodate them and support them through their
And I'm going to turn it back over to Alicia at this point.
Alicia: Thank you so much. A quick reminder that Q&A is open
at this point. If you have questions, we have two that came
Does the Columbia student health insurance cover the test?
Alicia: Thank you, Dr. O'Keefe. Simple answers to simple
questions. I like it.
Our other question that came in, will we be getting the vaccine
or do we know if we will be getting the vaccine?
Rick: It's not available. I think it's only available
through the New York City Department of Health. So I don't
think it is going to come to Columbia health.
Wafaa: I agree with Rick. I think at this point in time,
there still remains a limited supply of the vaccine in view
of the high demand and limited supply. Because of that, the
Department of Health is the only entity that is providing
vaccination. That may change in the future
of course as the vaccine becomes available.
I'm certain if that happens that there will be an easing of
restrictions and making the vaccine more widely available.
Alicia: Thank you so much.
Not seeing any other questions at this time. One just popped
How can we support our friends?
Eduvigis: I will take that one. I think it is super important
that if you know somebody that has been exposed to Monkeypox,
that you offer support. Don't wait for the person to ask you
for help. A regular check in. How are you doing?
Is there anything I can do for you. That and nothing is
incredibly supportive even if the person replies with Thank
you, I'm OK. Call them again.
Text them. Video chat them.
Just to add a dimension of support is to point them to the
available resources that are remarkable at Columbia health.
If they have symptoms, go and see clinical care.
I think there is so much stigma associated with it that people
are reluctant to speak about it, reluctant to see services. --
seek services. All of us can point people to where they can
Alicia: Another question has come in. Who can I talk to about
getting a test or if I have other questions?
Rick: The first person is to contact your PCP on campus.
If you don't have a PCP, you
can contact me or call the TSL line.
And I believe Alice will be able to help you as well.
Daniel: One thing I would like to add,
to agree with Dr. O'Keefe is that the testing
is for people who are noticing some sort of rash.
Collecting some of the specimen itself.
There is not a blood test or anything looking for evidence of
infection. It's if you notice something on
your body that is unusual, that is when it's a great idea to
contact your PCP and let them know your concerns.
Alicia: Another question is will my information be kept
Katherine: I can take this one. Broadly speaking, yes.
My role at Columbia is to support you through this and
when contact tracing speaks with a student that either has
a confirmed Monkeypox diagnosis or suspected and pending the
test result, we will talk through what sorts of resource
work do they need? And when we set those up, we
are not disclosing it is a Monkeypox diagnosis or
suspicion. Contact tracing might be new to the New York area.
We have been supporting students with COVID and other diseases
for over two years now and we have a host of relationships
with our campus primaries. We can reach out and say the
student needs this support service without indicating why.
We've set up those relationships so that we can get students
support, housing, or other services.
We can facilitate connections with counseling to let them know
this is what the student needs but not disclose the reason.
You may move a dorm room temporarily. We will be
protecting your confidentiality throughout that process.
Colleen: I want to echo everything that Katherine said.
If you see support services, your faculty is not informed of
the reason why but rather the accommodations and the support
that you need.
And we will talk through with students any concerns they have
about confidentiality. The reason why students receive
a particular accommodation can be many and that is never shared
with the faculty member.
Eduvigis: Same here. CPS is fully confidential and private.
Rick: So his medical services.
-- so is medical services.
Alicia: At this point, I would ask for the resource slides to
pop up on the screen.
Thank you so much. I want to quickly go over if you do have
additional information or you would like to eventually share
this webinar with the people that you know who may not have
been able to be here today, you can
go to our website about Monkeypox.
You can also go to the go ask Alice website to get information
and about questions answered about Monkeypox. For information
about where you
can get tested, the vaccine finder dot gov.