- Wastewater data from a few major cities suggests monkeypox may have already peaked in some areas of the US.
- Outbreaks in New York City and San Francisco have stopped growing, though there are still many new cases.
There are some early signals that monkeypox may be slowing down in areas of the US, after infecting more than 18,900 people across the US in barely three months.
Wastewater data, case counts, and reported sexual activity patterns all suggest this outbreak may be turning a corner.
Cristin Young, an epidemiologist who's studying monkeypox for the private wastewater company Biobot, says it's a little too early to say for sure that cases are declining across the entire US. Disease rates will likely continue to "vary widely" based on local availability of tests, vaccines, and education, she told Insider.
Some cities are showing promising signs of turning a corner
There are promising signs popping up in San Francisco, New York, San Diego, and other hard-hit areas of the country showing that both case numbers and wastewater levels of the virus are plateauing, and in some cases, declining.
(Monkeypox case rates are also slowing down in other hard-hit countries around the world, including France, Germany, Spain, Portugal and the UK, leading the World Health Organization to argue that elimination of the virus is still possible across Europe.)
In Los Angeles, Dr. Rita Singhal, who directs disease control, told reporters last week that there's been a "leveling" in new cases in her county, which could be an "early indication that transmission is beginning to slow."
Singhal said she's "cautiously optimistic" that the level off "is real and that it will hold," but the wastewater in LA still has record-high levels of monkeypox in it:
This sewage data suggests the worst of LA's outbreak may not be over. Some monkeypox cases may be being missed by providers, while other patients manage their own care at home, without getting an official diagnosis. But even those more hidden positive cases will show up in raw sewage.
"Your poop will know that you're sick before you know you're sick," chemist Stephan Baumann, an infectious disease expert at the lab supply company Agilent Technologies told Insider.
Baumann explained that wastewater, unlike case numbers and hospital admission rates, throws up clues before people feel ill. It's "a good tool in the sense that it doesn't lie, it's anonymous, and no one's privacy is being invaded," he said.
Three big reasons why the monkeypox outbreak may be slowing down
1. The way it spreads
Monkeypox requires close and prolonged contact to spread, and is chiefly being passed around in this outbreak through sexual contact. That is "probably one of the reasons that we are going to start seeing a slowing down," Singhal said.
Baumann described the monkeypox outbreak like a "fuse" which burns at a moderate pace through a community, before eventually leveling off and extinguishing itself — unlike COVID.
2. Vaccines
In the US, the free, nationwide monkeypox vaccine campaign is also finally underway in a meaningful sense, with thousands of new Jynneos doses being distributed to pride events and pharmacies in different areas, and a new intradermal vaccination strategy stretching supplies to more people across the country.
3. Behavior
Finally, people in affected communities have been shifting their behaviors — and there are some clear indications that those lifestyle adjustments are making a big difference.
An astonishing shift in behavior that has impressed public health experts
Surveying more than 800 men who have sex with men, the CDC found around 48% reported reducing their number of sexual partners this summer, and 50% said they've slowed down on one off "sexual encounters."
Grindr's Head of Communications Patrick Lenihan told Insider users are still active (because "we're not just a sex app," but also a social network, he said).
Still, there's no doubt that "people are changing their approach to sex" during this outbreak, Lenihan said. "I've been out for 20 years, I live in a very heavily GLBT community, and I can tell you that people are being really responsible, by and large, and taking it seriously."
The coming months will be crucial
It remains to be seen exactly how effective these vaccines are at stamping out transmission during sex, how long mitigation measures will last before fatigue sets in, and whether public health departments and STI clinics will receive enough funding to continue any meaningful response to this outbreak.
If it turns out that monkeypox can spread asymptomatically, that will add another complicating factor to the elimination efforts. Health experts expect that even if containment is possible, it could take years.
Dr. Demetre Daskalakis, the White House's Deputy Monkeypox Coordinator, said on a recent Instagram live with Grindr that, of course, behavioral changes aren't the solution — and they are "not forever." But they do help control the outbreak until more vaccines, testing, and treatments are available for those who need it.
"Edit what you're doing based on where you're at," Daskalakis, a longtime LGBGQIA+ health advocate, said. "Pick your own adventure, but pick one that may reduce your likelihood of being exposed to monkeypox."