Editor’s note: This article has been updated with the latest information from local and county public health officials as of Saturday, July 24. We will continue to update as new information is reported to us.
PROVINCETOWN — The number of confirmed cases of Covid-19 in the so-called Provincetown cluster “officially reported” to the Mass. Dept. of Public Health was 430 as of Friday, July 23, town and county officials reported on Saturday morning.
“Of these cases,” the press release said, “342 are Massachusetts residents, 153 of which reside in Provincetown. The remainder of individuals who tested positive reside in other states.”
The press release was issued by Town Manager Alex Morse under the imprimatur of the select board, board of health, and Barnstable County Dept. of Health and Environment. It said that 69 percent of the Mass. residents who tested positive were reported to be fully vaccinated, and that three people in the cluster had been hospitalized, two of them in state. The other 427 cases, apparently, “are known to be mild and without complication.”
The select board and board of health have called an emergency meeting for 5 p.m. Sunday, July 25 in the Judge Welsh Room at Town Hall to “discuss further actions to contain the spread of Covid-19.” A representative of the Mass. Dept. of Public Health will be there. There will be no public comment period at the meeting.
At a previous emergency joint meeting of the board of health and select board on Monday, on Facebook, in restaurants, workplaces, and everywhere people talk and gather, Provincetown debated a new question this week: what do lots of Covid cases in vaccinated people mean?
As of Tuesday, the number in the Provincetown Covid cluster was reported to be 132. That number included 38 residents of Provincetown, one other resident of Cape Cod, 32 residents of Boston, and 43 people living out of state. “Overwhelmingly, the affected individuals have been fully vaccinated for Covid,” according to a statement issued by county and town leaders on Tuesday.
“It’s important to recognize the symptoms have been mild among the vaccinated,” said Sean O’Brien, Barnstable County’s director of health and environment at the Monday joint meeting. “The vaccine works.”
“A year and a half ago, we knew very little about this virus, we had no vaccine, we didn’t know how to treat it,” said Town Manager Alex Morse on Monday. “If we saw this number of cases with highly ill individuals, not mild symptoms — if hospitalizations started to spike — then we could throw around words like emergency. But that’s not the conversation we are having this morning.”
Instead, the select and health boards adopted a public health advisory with several components. It calls for people to get tested, get vaccinated, and stay home from work if they feel sick. It “strongly advises” venues with high social density to require proof of vaccination for admission. It says that “masks are advised indoors where social distancing cannot be achieved.” And it says that “individuals are encouraged to take steps to manage their personal risk appropriately.”
Both testing and vaccination continue to be available at a mobile testing site at the Veterans Memorial Community Center through Friday, July 30, and possibly beyond. The mobile site offers both the Pfizer and Johnson & Johnson vaccines, and “vaccination is free, easy, and no appointment, I.D., or insurance is required,” according to the advisory.
“We’re testing about 250 to 275 people a day at the mobile testing site,” said Morse. “We’re constantly monitoring the data — every day, what’s the percent positivity?
“Over the last week, more business owners have decided to require proof of vaccination” from customers, said Morse. “Employers have the right to require masks and vaccination of employees.”
In addition, the advisory highlights the state’s Temporary Emergency Paid Sick Leave program. Starting on May 28 and continuing until Sept. 30, the state will reimburse employers for up to a week of sick pay for employees who contract Covid, need to recover from the vaccine, need to quarantine, or need to care for a family member with Covid.
The advisory was not met with universal acclaim. Select board member Bobby Anthony and board of health member Dr. Janet Whelan both argued for an indoor mask mandate. The other four members of each board preferred to wait for more information, however, noting that the new cases are among the vaccinated.
“I struggled with where we would end up on this,” said board of health chair Steve Katsurinis. “I have been convinced that we’re not in an emergency, in large part because the vaccines keep people from becoming extremely ill. There is a spike, people are getting sick, and it is a shift in my view. I felt like we were done with Covid, and we’re not done.”
How Many Cases?
Monday’s joint meeting heard from Vaira Harik of the county Dept. of Human Services and from Sean O’Brien of the Dept. of Health and Environment. The state epidemiologist, Dr. Catherine Brown, also spoke briefly.
First came the state’s definition of a Covid cluster: “Two or more confirmed or probable cases of Covid that are linked by the same location of exposure.” From then on, however, only confirmed cases were discussed or described. Probable cases were never mentioned again — despite being included in the state’s definition of a cluster, and despite the fact that there are almost certainly dozens of probable cases in Provincetown.
That is because from Dec. 23 to July 14, almost all testing on the Outer Cape was done in the state-supported rapid testing program at Outer Cape Health Services (OCHS). Because rapid tests, also called antigen tests, were at one point prone to false positives and negatives, the results of rapid tests are still called “probable cases.” Rapid tests are also vastly outnumbered by molecular PCR tests in the state. Partly because of these factors, the state does not report “probable cases” at the town or county level — only a statewide daily total.
There are clear indications, however, that there are a lot of probable cases here.
One is the sheer number of people, including Provincetown residents, who posted their positive results to Facebook before the state-supported mobile PCR testing began on July 15.
Another is that Sen. Cyr told the Independent on July 13 that “several cases per day” were being discovered at OCHS since just before the July 10 weekend. He would not elaborate, but those were almost certainly found through the rapid testing program.
Another data point comes from Truro. Health Agent Emily Beebe still posts “active cases,” which includes both confirmed and probable cases, on the town website. (This used to be Provincetown’s practice as well, but was discontinued after the vaccine rollout.) On Saturday, July 17, Beebe updated the site to reflect 10 active cases among Truro residents.
Meanwhile, Harik stated that, as of Friday afternoon, July 16, there was only one “confirmed case” outside of Provincetown, but on Cape Cod, that was linked to the Provincetown cluster. That one case may or may not be in Truro — but there are definitely nine other cases in Truro, and the odds are they’re mostly “probable cases” discovered through rapid testing and linked to the Provincetown cluster.
The Independent has filed records requests with the state and county health departments to find out how many probable cases are in the cluster, and how many reside here, but it’s not clear the agencies will have to release that information.
“Public health surveillance, for any disease, is about getting the information right,” said Cyr in a phone call with the Independent on Tuesday. “The process to confirm these cases is always going to require due diligence and science. What’s most important is to get right whatever information is shared publicly, so people can take the appropriate protective measures.”