PROVINCETOWN — For four weeks now, Provincetown has detected zero new cases of coronavirus.
Memorial Day weekend came and went. Phase two of the statewide reopening was announced; lodgings, retail shops, and restaurants cautiously opened. Owners and renters returned for the season, and every weekend there were more visitors. All of this arriving and circulating humanity — and Provincetown has not detected one new case.
No new confirmed cases of Covid-19 have been reported in Truro, Wellfleet, or Eastham for at least the last two weeks, either.
All good news, probably, but it raises lots of questions.
Dr. Randall Sell, a professor of public health at Drexel University and a part-time resident of Provincetown, offered the town’s health dept. some pro-bono assistance with developing models of potential case importation back in early May. With no new cases, Sell said, “To me, that’s the interesting discussion. We looked at the case rate for the rest of the state, and we projected that as more people arrived, we would become more like that statewide number.
“One of the first possible answers is that the people coming here aren’t the same, in terms of the virus, as the statewide population,” Dr. Sell continued.
This could be more complex than just pointing out that Provincetown is expensive.
“It could be anecdote, but I hear a lot of visitors say they’ve been totally isolated in their cities,” said Dr. Sell. “It could be that the people who spend money now are the people who worked from home, who could afford masks and health care, who could afford to stay home, and were cooped up enough to decide to travel.” People could be motivated to come here specifically because they have been so alone, and those people could have a correspondingly low incidence of virus.
“Alternately, people could be coming here and they don’t know where to get tested,” he said. “They don’t get tested. Or if they’re here for a short time, their physician is back home and they say they’ll get tested when they go home.” In that scenario, Sell explained, “They’re here, they’re walking around, but we don’t find them.”
Even looking only at local residents, our testing could be slanted towards the “worried well.”
“There are always health-care access issues,” said Dr. Sell. “People don’t have a physician, or they don’t have insurance, or they don’t have the time or the money. Or they don’t know how to get a test. I don’t know what the test costs out-of-pocket. Most people don’t know.”
The answer to the cost question is complicated. At present, Outer Cape Health Services offers free tests to people who are symptomatic or have been exposed to someone who is. The related office visit costs $200, but could be covered, depending on a patient’s insurance.
People whose work puts them at higher risk could be the least likely to get a test. Also, a test could be scary if the consequences are scary.
“One of the public health concerns is, how do you protect the most vulnerable without further traumatizing them,” said Dr. Sell. “Closing down workplaces when people need to work. Traumatizing the traumatized.
“I don’t need to be told that poor people are more likely to get sick,” he added. “I need to be told ways to help them.”
Where’s the Limit?
Provincetown’s models are meant to predict how many cases will exist among those who are living here. People who are here for a short time will go back home. The active management of resident cases, on the other hand, puts a variety of burdens on the health dept., including contact tracing and quarantine support.
“With the social behavior we have in the Northeast, it’s not about 50 cases exploding into 250,” said Steve Katsurinis, chair of the Provincetown Board of Health. “That kind of exponential growth isn’t happening here. It’s more about what it means to care for 50 cases.
“We already fell to zero,” Katsurinis continued. “If there’s a slow angle of ascent, because of all these restrictions, then it’s about our capacity to care for people. We have to keep the DPW staff healthy, the ambulance crews, the health dept. staff. And if the number of people sick starts to outstrip our ability to care for them, that’s when you’ll start to hear that we need to go backwards.”