We had been so careful, keeping our distance, and doing all the right containment measures. Then came an explosive Delta-variant Covid outbreak in Provincetown. For a while, case counts doubled every few days, with numbers that were orders of magnitude greater than we experienced even early in the pandemic — over 1,000 cases as of Aug. 3.
It’s troubling that this happened in a community that has been vaccinated at rates far higher than other Cape towns or the national average, and that about three-fourths of the new cases are breakthrough infections in vaccinated people.
How do we understand this? What needs to happen now?
July brought people from across the country, packed together indoors on rainy, cold weekends, having the exuberant good times that have been missing for so long, enjoying our restaurants, arts, and entertainments. We know that only just over half of Americans are fully vaccinated. So, tens of thousands of people crowded downtown Provincetown, creating lots of possible close exposures.
A person carrying the earlier Alpha variant of Covid would infect an average of two or three others. But the now-dominant Delta strain will infect six or eight people, because the viral load appears to be more than 1,000 times greater. Also, the Delta-carrying person becomes contagious within three days, compared with five days with the earlier variant — again, related to faster replication, even in those fully immunized — and sheds virus for more days.
These characteristics explain how our case numbers exploded so quickly here, as all sequenced viral samples so far are of the Delta type.
It is sobering to learn that vaccination protection is not absolute. Even fully vaxxed people can be infected and can transmit the virus. But they are very unlikely to need hospital care or to die of Covid.
It is also like a bucket of ice water on our heads to realize that we are not now, we cannot be, “back to normal,” no matter how much we might want to be.
This outbreak has revealed the deep conflict between individual autonomy, or “freedom,” and community solidarity.
The essence of quarantine — a long-established public health policy — is to isolate infected people while they are likely to be contagious. The infectious agent is cleared, or the person succumbs, and the chain of transmission is thereby broken. The patient’s contacts and activities are markedly restricted; personal autonomy is sacrificed for the purpose of reducing the burden of disease in the community.
What we have all seen in the past few weeks reflects the social stresses of our long confinement. We want to socialize again. And so, even when we saw tightly packed crowds, we did not worry.
Clearly, what we want to be able to do does not equal what we need to be doing right now. About a quarter of the cases in this outbreak are local — we have had over 200 cases in current Provincetown residents. That translates to well over 1,000 potential contact infections, given the much higher infectiousness of the Delta variant. That means we are in regular contact with potential illness as we go about town. Some workers are experiencing symptoms but not getting tested for fear of missing work days. And we know that not everyone who is infected has significant symptoms. Their viral shedding is thus unwitting.
In Provincetown, we have a proud tradition of caring for our neighbors. But we are also a very open tourist destination. In this case, some of our visitors had more interest in partying than concern for their own health or the health of others.
We are not at all unique. The individual freedom versus collective responsibility drama is playing out across the nation. It has both pragmatic and political aspects. Some reluctance is simply denial of risk, or procrastination, or anxiety caused by nonsense about vaccine safety. More disturbingly, anti-vax campaigning and mask resistance have also taken on the “Don’t Tread on Me” hostility to the social functions performed by governments at every level.
I sometimes lean toward anger at such behavior, but I am aware of its futility. Instead, I am channeling my energy into maintaining social distancing and masking when I’m around anyone outside the house. Because it beats getting myself and those around me avoidably sick.
Getting vaccinated is extremely effective prevention for your own health, while constant mask use largely protects those around you. And that, dear neighbors, is what we need to be doing now about Covid in our community.
Brian O’Malley, M.D., is Provincetown’s elected delegate to the Barnstable County Assembly. Write him at [email protected].