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CDC

    HEALTH

    With Case Counts Growing, Provincetown Gets MPV Vaccines

    Large allocation of doses will help protect working people, says Cyr

    By

    PROVINCETOWN — Nationwide, the news about monkeypox continues to get worse. Case counts are still doubling every 10 days or so: 42 in Massachusetts, 156 in New York, and 9,647 globally as of July 11, according to the CDC.

    Workers at Outer Cape Health Services in Provincetown administered hundreds of vaccinations against monkeypox on Friday, July 8. From left: Chris Casale, Joe Kennedy, Lakia Norwood, and Jeff Schaffer. (Photo by Paul Benson)

    Testing is limited, the vaccine supply is still constrained, and, while no one in the outbreak countries (now including most of Europe and the Americas) has died, the disease is painful, with reports emerging of people being hospitalized for pain management.

    Against this backdrop, Provincetown received a major dose of good news — 900 doses, to be exact. The Biden Administration’s release of 56,000 doses of the Jynneos vaccine resulted in 1,800 doses coming to Massachusetts. Half of that allotment came directly to Outer Cape Health Services in Provincetown, said state Sen. Julian Cyr, and public health workers launched a campaign to get eligible people vaccinated.

    According to the CDC, “presumed contacts” eligibility includes “presumed contacts,” which is currently defined as a man who has sex with men, has had multiple partners in the last few weeks, and is in an area where the virus is spreading.

    Because there have been cases in Provincetown, any gay man here with multiple recent partners meets that threshold.

    The town’s health workers aimed their vaccine campaign at those men, especially those who work in hospitality for the short summer season.

    “We were able to vaccinate so many of the people in our community who could be at highest risk from this,” said Cyr. “Monkeypox is unlikely to be fatal, but it could be devastating to your livelihood. Given the isolation and recovery period, you could lose three or more weeks of work.”

    Provincetown’s health dept. alerted business owners about the vaccination campaign, while the AIDS Support Group of Cape Cod and other groups used their networks of service industry workers to get the word out. The health dept. also posted the news on social media. Hundreds of people were vaccinated at OCHS Provincetown on July 7, 8, and 9, and the organization is now keeping a waiting list for the arrival of the next batch of the Jynneos vaccine, expected later this week.

    “We’re encouraging all eligible individuals to call Outer Cape Health and make an appointment,” said Cyr.

    Eligibility criteria could change, but for the time being, the focus remains on men who have sex with men. Though there is a possibility of monkeypox transmission in intimate nonsexual settings — to roommates, health-care providers, housekeepers, or family members — actual case data in this year’s outbreak have not yet shown significant transmission along those lines.

    According to a July 6 World Health Organization report, 99.5 percent of the cases for which data exist are in males; only 25 out of thousands of cases are in health-care workers; and only six out of 5,584 cases are in minors. The fact that women, children, and health-care workers have not been getting the virus — during this outbreak, at least — helps explain why the vaccination campaign has been tightly focused so far.

    That global transmission pattern has been playing out locally, Cyr confirmed.

    “The town has been very deliberate in all the information it’s put out,” said Cyr. “This is truly playing out like a sexually transmitted infection. That’s still the case — there’s no new evidence there.”

    COVID-19 UPDATE

    Outer Cape Kids and Parents Feel Relief About Pediatric Vaccine

    Gatherings, family vacations, and going back to school

    By

    PROVINCETOWN — With crayons and pages of coloring books scattered over the floor around them, Alaina and Kacey Vida sit in the waiting area of a Walgreens Pharmacy. It’s the Tuesday before Thanksgiving, and they are about to get their first Covid-19 vaccinations.

    “I’m excited to get the shot because I want to be safe, and I’m nervous because I don’t really like shots,” says nine-year-old Alaina, clutching “Pandy,” a plush panda head. Her sister, seven-year-old Kacey, holds a toy Ariel a few feet away. “It’s important in order to stay healthy,” she adds.

    While Covid-19 vaccines have been available for all adults since April, and for children 12 years or older since May, kids between 5 and 11 were not eligible for the shots until early November. The long-awaited authorization has provided relief for many Outer Cape families, opening up the opportunity for gatherings, vacations, and, in some cases, school.

    “I’ll allow them to do more things once everybody’s protected,” says the girls’ mom, Tracy Kachtick-Anders. The family’s 12 kids (five of whom no longer live at home) have been getting vaccinated in batches, depending on their age and eligibility.

    Kachtick-Anders was reluctant to put her son Wyatt, who has Down syndrome and is immunocompromised, back in the classroom. “My fear was that he can’t tell me where the cases are coming from, like if the cases were just the football team or people coming from Bourne,” she says. “He’s at risk, so I haven’t sent him to school.”

    Now she’s feeling a sense of relief. She is planning a trip to Disney World, the first that the whole family would be able to take since the pandemic started almost two years ago. “I’m excited to sleep in the hotel,” says Kacey, smiling, “to go on the airplane, and to see Mickey Mouse, Minnie, Daisy Duck, Donald Duck, Goofy, Pluto, Ariel, Elsa, and Anna.”

    Tracy Kachtick-Anders holds nine-year-old daughter Alaina Vida’s hand as she receives her first Covid-19 vaccination. [Photo Michaela Chesin]
    Trial data for the pediatric vaccine was collected, vetted, and authorized for emergency use by the Food and Drug Administration. The Centers for Disease Control and Prevention released a statement on Nov. 2 recommending that children between ages 5 and 11 get the Pfizer pediatric vaccine, which has the same active ingredients as the adult and adolescent vaccine but a third of the dosage (10 micrograms). Like the adult vaccine, the pediatric version requires two injections given three weeks apart.

    The adolescent (or adult) and pediatric vaccines are not to be used interchangeably, according to the CDC. Pfizer is the only pharmaceutical or biotechnology company to have an approved pediatric vaccine, and no vaccine has yet been authorized for children younger than five. The pediatric vaccine is 91 percent effective in preventing Covid-19, according to a Mayo Clinic webpage.

    “I felt very happy to get the vaccine,” says 10-year-old Sally Hay. “I soon won’t have to wear a mask as much as before.” She got her first dose with her seven-year-old sister, Nora, on Nov.18. They were both  taken out of Wellfleet Elementary School and home-schooled for part of the pandemic when the family found remote learning to be too challenging. Since their full-time return to the classroom in April, “there’s been a lurking uneasiness,” says their mother, Elspeth Hay. “It’s nice to have the opportunity for them to get vaccinated after so long.”

    Since the start of the pandemic, about 1.9 million children between 5 and 11 have been infected with the coronavirus. More than 8,300 have been hospitalized and 94 have died, according to data released by the CDC in November.

    The death toll in the past year put Covid as one of the top 10 causes of death for this age group, says Outer Cape Health physician assistant Gretchen Eckel. In November, cases among children jumped 32 percent in a two-week period, according to a statement released by the American Academy of Pediatrics and the Children’s Hospital Association.

    Eckel says she recommends that kids in the 5 to 11 age group get vaccinated, because, while the virus is milder in children, vaccinating more of the population will reduce transmission within the community and suppress the continued evolution of the virus into more dangerous variants.

    Eckel also warns of post-Covid conditions that have been identified in children, such as long-term headaches and fatigue, and, in rarer cases, multisystem inflammatory syndrome, affecting different parts of the body, including vital organs. The condition is serious and, in some cases, deadly, Eckel says.

    Effects at School

    There are no active Covid cases at Wellfleet Elementary School, Truro Central School, or Provincetown Schools, according to school officials. So far this school year, there have been 15 cases at Wellfleet Elementary, four cases at Truro Central, and two cases in the Provincetown Schools.

    A mask order from the Dept. of Elementary and Secondary Education remains in place “until a school has an 80-percent vaccination rate,” says Wellfleet Elementary School nurse Claudia Cope. She notes that vaccination status changes the conditions and protocols under which a student would be considered a close contact.

    “One of the main reasons there are school nurses is to monitor the spread of contagious diseases, and to reduce the impact of things like this pandemic,” Provincetown Schools Nurse Mary-Beth Maloney says. “I’m finding a lot of parents are pro-vaccination in terms of how many people are calling me enthused, finding out they can get one close to home.”

    Where to Go

    “The main question I am getting from families is where to go,” Cope says.

    Kachtick-Anders says she was not able to get local appointments for her children in time for their upcoming trip, so she drove them from Provincetown to Mashpee for their vaccinations.

    Kacey Vida watches a nurse apply a Band-Aid after getting her first Covid vaccination. “That wasn’t bad,” she shrugged moments later. [Photo Michaela Chesin]
    Wellfleet resident Sarah Hill has an upcoming vaccine appointment booked for her fifth-grader, Eli, with a friend’s private pediatrician. “It’s hard to get vaccines otherwise,” she says,

    Outer Cape Health Services CEO Patricia Nadle says there have been no shortages of vaccines or people manning the phones. “OCHS has been giving vaccines to the 5-to-11-year-olds since the second week of November, by appointment only, at all of our three health centers,” she says. So far, 40 to 50 pediatric vaccine doses have been given weekly across the three sites.

    Eckel says that OCHS can’t offer vaccinations on demand, but they are available at weekly clinics that may vary by week. “There is a limited amount of vials that we’re not prepared to waste,” she says. Sally and Nora were two of the children who received vaccinations at one of those clinics.

    Meanwhile, the schools are organizing their own clinics. The Provincetown Schools are having a vaccination clinic on Monday, Dec. 6, while Truro is in the process of planning one. “We’re hoping to announce a date for families very soon, whether it be at the school or the community center,” says Truro Central School Principal Patrick Riley.

    Eli says a lot of his friends have gotten vaccinated, which has been exciting. “It also just makes me feel a little bit safer,” he adds.

    WATER SAFETY

    Swimming in the Pandemic: Fear and Reality

    Coronavirus hell isn’t in the water — it’s other people

    By

    Kids on the beach in Truro
    Playing in the water is safe — the issue is keeping a safe distance from other humans. Left to right, Kai Vera, Spencer Cavanaugh, Greyson Vera, and Lucca Swain test the waters in Truro. (Photo Nancy Bloom)

    Scientists have reassuring news for Outer Cape residents and visitors who are worried about contracting coronavirus from swimming in ponds and in the ocean and Cape Cod Bay. There is no evidence, they say, that the virus is transmitted through the water. The danger at our swimming spots isn’t the water — it’s the crowds.

    Henrietta Reilly, a college student from Louisville, Ky., has been coming to Truro with her family for over 20 years. This year, they wondered if they would be able to swim in the two ponds near their home in the Cape Cod National Seashore.

    “We usually think of the ponds as so clean,” she said, “but now we’re worried.”

    This same concern was voiced at a recent Wellfleet Select Board meeting. Afterwards, Suzanne Grout Thomas, Wellfleet’s beach director, said she would rely on the advice of Hillary Greenberg-Lemos, the town’s health and conservation agent — namely, that there is no science that supports the idea that Covid-19 makes swimming dangerous.

    Among many other examples of similar advice, authorities at the University of Colorado schools of medicine and public health report, “The water in lakes and the ocean should be safe since the virus that causes Covid-19 is not transmitted in water. The same concerns about social distancing and hand hygiene apply at lakes and beaches, just like they do at pools or other places where people gather.”

    Still, Grout Thomas wondered if there could be a problem in swimming pools, because of their smaller size. But scientists across the country agree that concern has no basis in fact.

    The Centers for Disease Control and Prevention reports that there is “no evidence that Covid-19 can spread to people through the water used in pools, hot tubs or water playgrounds. Proper operation and disinfection of pools, hot tubs, and water playgrounds should kill the virus that causes Covid-19.”

    Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, said in a recent interview with National Public Radio, “I don’t believe that bodies of water — swimming pools, lakes or ponds, or the ocean — are major ways that people can contract the virus.”

    Dr. Paula Cannon, a professor of molecular microbiology and immunology at the University of Southern California, told the Los Angeles Times, “It would never cross my mind to get Covid-19 from a swimming pool or the ocean.” According to Cannon, it is more important to think about staying away from others at the beach than to fear the water.

    That’s why social distancing will remain the rule this summer. “Remember, it’s a respiratory virus that spreads through coughs and sneezes and common-touch surfaces,” Dr. Adalja said.

     

    PLAYBOOK

    Masks Must Be Worn Downtown

    Select board makes rule that health officials say isn’t needed

    By

    PROVINCETOWN — The select board has ordered the wearing of face masks starting Friday, May 1, in all Provincetown businesses and by everyone outdoors on Commercial Street between Bangs and Pleasant streets.

    The order, which passed by a 3-2 vote on Monday, went against the advice of the town’s health director and of both the chair and the vice chair of the health board. As of the Independent’s deadline, the order did not include enforcement provisions, such as fines, though that may come later.

    “There is no right or wrong answer, but I want to err on the side of the community being safe,” said member Bobby Anthony, who voted for the order.

    The mask question was not on the board’s agenda, but came up in response to several public comments, letters, and a Facebook back-and-forth.

    Herbie Hintze told the select board it’s not realistic to expect people to stay six feet from one another on Commercial Street. In his view, creating a regulation takes away the ambiguity that has spawned vigilante social media behavior, including postings of photographs of people without masks.

    “It’s a way to stop the hate on social media,” Hintze said. “You can stop it right now by voting that everyone should be wearing masks.”

    The U.S. Centers for Disease Control and Prevention recommends masks in situations where it’s not possible to stay six feet away from others. Based on that recommendation, the Provincetown Board of Health has issued a similar advisory.

    That advisory has done its job, said Dr. Susan Troyan, vice chair of the health board and a surgeon at Brigham & Women’s Hospital in Boston. She argued that further regulations were unnecessary.

    Provincetown had only two current confirmed active cases of the coronavirus as of April 27. There has been one death and 25 recoveries since testing began in March.

    “We are doing a good job; the community has pulled together,” Troyan said. “I disagree that mandatory rules on mask wearing will improve relationships in our community.”

    Morgan Clark, the town’s health director, told the select board, “You should be making good policy and not responding to fear.”

    But board member Louise Venden said, “Your arguments are not winning here. We’re clearly going to vote for this tonight. We need to make this statement. It’s about public education.”

    Venden ultimately voted against the mask rule, however, saying that the process was flawed, since the item was not on the meeting agenda. David Abramson, the chair, also voted no. Anthony, Lise King, and John Golden made up the majority.

    The next day, business owners had many questions.

    Rob Anderson, co-owner of the Canteen restaurant, which has been serving take-out since March, said he agrees with the mask order, though he was concerned that the policy came out of a single discussion.

    “It seems like they are making regulations on the fly,” Anderson said.

    His questions included should his staff wear masks though they have no contact with the public and stay six feet from each other? And how should a restaurant employee deal with someone who isn’t wearing a mask? Should the customer to be kicked out? Should staff call the cops?

    Similar mask orders have been implemented in Connecticut, New Jersey, Maryland, and New York, as well as in several towns in Massachusetts, including Brookline and Northampton.

    Enforcement in these areas is not always clear or doesn’t exist, and businesses themselves are in charge of enforcement. That’s also the case in Provincetown. Businesses must post signs and police their customers.

    The select board did not set an end date for the rule.

    “People want certainty and we cannot provide certainty,” board of health chair Stephen Katsurinis said on Tuesday. Katsurinis, a Provincetown guest house owner and former chief of staff at the White House Office of National Drug Control Policy, added that, in his view, “Cooperation and a joint sense of purpose has worked and is the most effective thing.”

    COVID & HEALTH

    Giving Birth During Crisis Adds to Risks

    Home birth isn’t for everyone and isolation is a challenge

    By

    Covid-19 is a brand-new disease with many unknowns. The Centers for Disease Control and Prevention cites a lack of data on special risks for pregnant women and infants, but with other viral respiratory infections, pregnant women have been more likely than others to suffer serious complications.

    With care providers everywhere scrambling to keep up with continually changing guidelines and concerns about overburdened hospitals, Outer Cape families are learning about the limitations of home birth options and facing the challenges of keeping supportive loved ones at a distance.

    Andrea Aldana of Eastham is expecting her first baby around July 21. She hopes to give birth at home rather than in a hospital — a choice more women are considering now than they have since the mid-20th century, when hospital birth became the norm throughout the U.S.

    Andrea Aldana and Scott Sebastian deploy their own blood-pressure cuff; their midwife has them monitor vitals and do checkups by phone. (Photo Jorge Aldana)

    “I have gotten more calls in the past two weeks than I get in a whole year,” said Nicole Cisneros Pegher, a certified professional midwife who attended her first home birth in Truro in 2016, followed by a second in Provincetown two years ago. “This is really different. There are home-birth midwives who have come out of retirement to help,” she said.

    As much as she would like to help all women now seeking her services, Pegher said, not everyone is a candidate for home birth.

    Only women with low-risk pregnancies are eligible. Preparing for home birth means out-of-pocket expenses of $4,000 to $6,000, not covered by insurance in Massachusetts. Home-birth midwives provide prenatal care throughout pregnancy, monitoring clients carefully for risks like pre-eclampsia or gestational diabetes, conditions that necessitate a hospital delivery.

    Pegher is receiving calls from women in late pregnancy who were planning a hospital delivery, but are now afraid of giving birth in facilities where Covid-19 patients are being treated.

    “There is a lot of education that needs to happen if you get a call from a woman at 35 weeks,” she explained. “There is an additional risk to that.”

    Aldana and her fiancé, Scott Sebastian, decided to hire Pegher before the extent of the Covid-19 crisis became apparent, because they were looking for a more personal and intimate birth experience. Now Aldana says she feels fortunate.

    “I wouldn’t have been able to do that if I had waited another week,” she said, “because home-birth midwives are booking out so fast right now.”

    Minimizing Exposure

    Like hospitals and other care providers, Pegher has made adjustments, including conducting all non-milestone appointments via telephone to minimize possible exposure to the virus.

    Meredith Goff, a certified nurse midwife, who on March 1 came out of retirement to offer services to patients at Outer Cape Health Services, said, “We are quite capable of giving safe care during this difficult time.” Like Pegher, Goff is carrying out most of her prenatal appointments via telephone.

    “We want to keep pregnant women safe and, for the most part, if we can keep them out of the office,” Goff said, “then it’s safer for the patient.”

    As a former home-birth midwife herself, Goff is aware of the draw of home birth at a time like this. “Women are understandably feeling reluctant to go into the hospital because of the possible risk of exposure to Covid-19,” she said. “I am very sympathetic.”

    The Independent asked officials at Cape Cod Hospital to comment on the situation. Christina Peaslee, executive director of marketing communications and content strategy, declined.

    But Goff encourages women to feel safe about giving birth at the hospital. “I am in touch with the hospitals,” she said. “I have not yet heard of any pregnant women who have tested positive, and a maternity unit is quite separate from other parts of the hospital.”

    Families and their newborns face another set of challenges: being isolated just when they need support. Women attending prenatal appointments at hospitals are leaving their partners in the parking lot to minimize possible Covid-19 transmission. Chris Milewski, a Wellfleet fisherman, will not be able to join his wife for her milestone 14-week ultrasound at Beth Israel hospital in Plymouth.

    “It’s a big appointment, so that’s hard,” Milewski said. “She really wanted me to be there for her, and to see the baby. She is pretty upset about it.”

    Nora Corrigan, a current Fine Arts Work Center fellow in Provincetown, is due to give birth to her first baby on April 26 at Cape Cod Hospital. Her husband has not been allowed to attend recent appointments either.

    “There is no one in the waiting room, no other mothers even, and all the staff wear masks,” Corrigan said.

    She hopes that her husband will be able to attend the birth. That is their plan, but they know it could change. “We’re taking our cues from the midwives and doctors at the hospital,” she said, “and it seems like things on their end are changing every day in terms of best practice and what people understand about the virus and pregnancy and newborns.”

    Alexandra Foley gave birth to her first child, a boy, at Cape Cod Hospital on March 15. She said that her husband was the only support person allowed to attend the birth, and he was told not to leave the maternity unit for the duration of their stay. Foley’s parents and in-laws were not permitted to visit their new grandson in the hospital, and more than two weeks later have still not yet met him in person.

    Foley, her husband, and baby are now at home, but remain in isolation to protect the newborn from potential exposure to Covid-19.

    “I’m sad that I can’t share our son with the people we love,” Foley said. “I can’t hug my mom or my mother-in-law, and I can’t get their support when my husband goes back to work. I’m going to have to figure it out solo, which is not what I thought it would be like.”

    Goff is concerned about the vulnerability of new families during the postpartum period: “I think about women not having easy access to their families and the support that they need with a brand-new baby,” she said.

    Liz Libby, a lactation consultant who works with women throughout the Lower Cape, agreed. She is offering assistance: a free virtual postpartum support group, as well as free online breastfeeding group meetings, through her website: risingtidewomen.com.

    “Breastfeeding is the best immune protection for a baby,” Libby added. “When parents reach out to me, often what they need most is parameters on what is normal. Do I need to worry? A lot of that we absolutely can still do, virtually. We can provide emotional support and just say, yes, this is really hard and you’re doing a great job.”

    CORONAVIRUS

    In Oldest County in State, Gray Areas of Elder Care

    Residents of independent living centers have few protections in pandemic

    By

    PROVINCETOWN — Last Friday, March 20, Seashore Point condominium owner Bruce Mason had just returned from a meditation class with other residents. At the same time in Yarmouth Port, Fran Turgeon was packing up to leave her apartment at Heatherwood, a senior independent living community, after receiving notice from management that the first case of coronavirus had been confirmed there.

    Both 84-year-olds own their condominiums in multi-unit complexes filled mostly by elderly occupants — those at greatest risk from the highly contagious virus.

    Yet management’s approaches to that risk were very different at the two complexes. The reasons for those differences, and the lack of consistent policies to protect vulnerable people from an epidemic, have many older residents of the Outer Cape and their loved ones worried.

    At Heatherwood, residents have been instructed to self-isolate since March 15, said Turgeon, formerly of Eastham. They’ve been told not to walk the hallways for exercise, which normally happens frequently, or to congregate in groups. Heatherwood stopped serving meals in its dining room on March 15 and began delivering them to residents’ doors. After lunch on March 20, the kitchen was shut down completely, with management citing a lack of staff.

    At Seashore Point, groups led by outside teachers have been canceled, Mason said. But the condominium owners still had use of a coffee bar and could gather in the mail area and use the gym, said Barbara “Mae Bush” Stevens. Seashore Point stopped service in the dining room only on March 19, but meal delivery continues there.

    Despite what seem to be stricter precautions, it was the Heatherwood residents who got the memo: “We regret to inform you there is a confirmed case of the coronavirus at Heatherwood.”

    The memo, from Director Scott McClellan, described the patient only as someone “at Heatherwood” without specifying whether the person was a resident or a staff member or how management might proceed with determining specific contact risks or related protocols. McClellan advised residents to “stay in your home to help all of us stay safe. This is a good time to reach out to your family and let them know there is a confirmed case at Heatherwood. Your family may choose to have you stay with them until this crisis passes.”

    Management then informed the 190 or so homeowners that meal service would end that day. Many Heatherwood residents are over 80 years old and some require significant help, including prepared meals.

    Turgeon said she was leaving immediately because she no longer felt comfortable there, not knowing whom to avoid contact with.

    Chris Hannon, chief operating officer of Pointe Group Care, which bought Seashore Point last year, said, “We are doing everything we can to prevent coronavirus at this property and we take it very seriously.” Management has provided training and information on social distancing, he said, but, “the independent living residences are not specifically covered by any state or federal guidance beyond that issued for society at large.”

    Home Alone

    Barnstable County has the oldest population in the state, with the number of people over 65 at least double the state average. According to the U.S. Census, seniors make up 32 percent of the population in Provincetown, 41 percent in Truro, 34 percent in Wellfleet, and 38 percent in Eastham.

    Care for seniors has never been more important. The U.S. Centers for Disease Control and Prevention report that 8 out of 10 coronavirus deaths in the U.S. have been people over age 65.

    The gray areas of elder care for those who remain in their own homes are pronounced. Caregivers (often elderly spouses) are in as much danger as the frailest member of the family, and yet they feel most obligated to keep up with their normal activities, said Molly Perdue, co-founder of the nonprofit Alzheimer’s Family Support Center.

    All 50 monthly self-help groups of the support enter have now been canceled, she said. She and her staff of 22 part-timers are instead calling group members and other clients frequently.

    “If anyone is sick, we call them every day,” said co-founder Melanie Braverman.

    Under unprecedented circumstances, the nonprofit is trying to be practical, Braverman said. The most important step is to create contingency plans in case a caregiver gets ill. Compiling  medication lists and arranging food and medication deliveries so someone else can step in is critical.

    Many seniors depend on home health aides, and asking them to stay away is not practical, Braverman said. Rather, she advised, ask the agency providing the aides what their policies are: do they take employees’ temperatures and otherwise screen them, and do they provide protective gear? The state Dept. of Public Health (D.P.H.) has issued guidance and a checklist for in-home care providers, including restrictions on nonessential visitors, temperature taking, and use of personal protective equipment.

    Nursing Homes and Assisted Living Rules

    Coronavirus rules are much clearer at nursing homes and assisted living facilities. On March 15, the D.P.H. banned all nonessential visitors and advised staff and visitors who are not restricted — those necessary for medical assistance or people coming to visit a dying relative — to be screened. Anyone with a fever is not to be allowed into nursing facilities.

    The same rules apply at assisted living communities, which generally offer help to residents for all non-medical living needs — dressing, cleaning, cooking, and medication — though the residents still live alone in separate apartments.

    At Chatham’s Victorian Assisted Living, all residents’ temperatures are checked daily, said Celeste Fox, the executive director. Also, staff and visitors must wear masks, she said.

    “The mailman won’t let us take his temperature, so we have him leave the mail between the first door and the second door,” Fox said. “We have two sets of doors at the main entrance to our facility, and he leaves them in the little room in between.”

    Residents can leave only for essential medical appointments and are driven by family members.

    Elder Wisdom

    Gladys Johnstone, who lives at the recently renamed AdviniaCare nursing facility at Provincetown’s Seashore Point, turned 98 on March 18. Her birthday celebration was going to be a huge family affair involving relatives from all over the country. Instead, it was scaled down to just her and her son, Doug Johnstone of Provincetown. He visits with her through her first-floor window.

    Though everyone is worried about older residents, Gladys herself said she’s just slightly bored.

    Gladys is Provincetown’s oldest registered voter and holder of the Boston Post Cane. At her age, she said, “You realize you cannot control it and you never could.”

    Provincetown resident Ilona Royce Smithkin, who turns 100 on March 27, said nearly the same thing. Living alone on Commercial Street, Royce Smithkin has hired help five days a week, and friends who don’t hug or kiss. She is not stressed out.

    “Life goes on, the world is pretty crazy, but we have to make the best of it,” she said. “Each day it’s a surprise. Every day when I wake up, I move my hips and I move my lips and I say, ‘Wow. I’m still here.’ ”

    Devin Sean Martin contributed reporting for this article.

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