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Covid

    PUBLIC HEALTH

    As ‘the Crud’ Hits the Cape, New Covid Shots Are Approved

    A summer affliction that isn’t Covid rears its head

    By

    PROVINCETOWN — For many people on the Outer Cape, summer ended this year as it often has in the past — with a wicked case of “the Crud.”

    Two charts from the Centers for Disease Control show that every variant circulating in the U.S. this summer has been a subvariant of Omicron, a highly contagious strain of Covid that emerged in South Africa in November 2021. (Image courtesy CDC)

    Towns full to the brim and workers stretched past their limits have made the “Cape Crud” a routine seasonal condition. The term is typically used to describe respiratory infections, but it is also just a name for the wide range of problems that afflict a physically taxed population, said Outer Cape Health Services Chief Medical Officer Andy Jorgensen.

    “It’s a colloquialism we use on Cape Cod to refer to a variety of illnesses,” Dr. Jorgensen said, “that can range from stress to the common cold to allergies. There’s no one thing that’s the Crud. It’s basically a lot of things that come to fruition, often in late August and September.

    “It’s the equivalent of Augustitis for your body,” Jorgensen added — referring to the also-colloquial mood disorder that can affect hospitality workers at the end of a hard season.

    “People have worked hard, they haven’t had a day off, they’ve put their bodies through a lot of stress,” he said. “They have a variety of musculoskeletal complaints from overwork.”

    Add to that ragweed, other allergens, and thousands of people in town for Carnival, and Cape Cod’s bodies become increasingly vulnerable to circulating pathogens.

    There has also been a slight increase in patients testing positive for Covid, Jorgensen said. Staff at OCHS have resumed wearing masks “out of an abundance of caution.”

    The Boston area’s wastewater testing program shows an uptick in Covid prevalence there. Provincetown’s wastewater testing program has consistently yielded results that are “spikey,” with lots of high and low readings in quick succession. Nonetheless, those readings are higher now than they were during the lull in cases that came immediately after the powerful Omicron wave of January 2022.

    Covid Vaccines

    This year’s annual Covid vaccine was approved by the Food and Drug Administration on Sept. 11 and recommended by the Centers for Disease Control (CDC) for all people age six months and older on Sept. 12.

    Boston wastewater test results show an enormous spike when Omicron first arrived in January 2022; smaller spikes in May and December of that year; and a gradual rise in viral prevalence through July and August 2023. (Image courtesy Massachusetts Water Resources Authority)

    The new formulations of the Pfizer and Moderna vaccines target the XBB.1.5 variant of Omicron, and in a departure from last year’s booster shots, they no longer target both Omicron and the original variant of Covid that swept the globe in 2020.

    Variants of Omicron have completely replaced the original Covid virus as well as the Alpha and Delta strains of Covid that emerged in 2021. CDC data show that 100 percent of Covid variants circulating in the U.S. right now are substrains of the Omicron variant, and World Health Organization charts show that the same is true globally.

    Nationwide, only 20 percent of American adults received a booster shot last fall and winter, according to the New York Times, and only 62 percent of nursing home residents took booster shots.

    In Barnstable County, 34 percent of residents received booster shots, including 78 percent of people over 75 years old, according to the state’s weekly vaccination report.

    With the necessary approvals now in hand, this year’s annual shot should be deployed to health care centers around the country very soon.

    “It’s a slight update to protect against the newer variants of Omicron,” Dr. Jorgensen said on Sept. 11, just before the FDA and CDC announcements. “As soon as it’s approved, it will be shipped out.”

    COUNTY LINE

    Respiratory Illnesses Threaten Health-Care Systems

    Covid, flu, and RSV stress hospital staff

    By

    We have become accustomed to living in the Age of Covid. Even blasé about it. For almost three years, we have faced existential threats from potentially every person we come close to. It has been wrenching for all, and terribly painful for far too many. But with vaccines, we saw the surge in hospitalizations and deaths wane. The headlines went away.

    But Covid didn’t go away. And it won’t. It will keep on mutating, sometimes allowing the virus to evade our immune defenses and therapeutics.

    If that isn’t enough to make us all keep up on boosters, we are now seeing rapidly rising case numbers of two other serious respiratory viruses. Influenza, which causes a spike in deaths every winter, is off to an early and aggressive start. It is a champion mutator, requiring new vaccine formulations every year to combat it.

    And the less well known Respiratory Syncytial Virus (RSV) has become, in the past year, a growing threat. Long known to pediatricians as a potentially life-threatening condition in young children, it is now commonly sickening older people. I learned a lot about it when I was infected while traveling last December. I was sick for three weeks, and I know others who have been quite ill with the virus.

    We are now seeing, very early in the season, case numbers larger than are usual even later in winter. One hypothesis is that the precautions we took against Covid over the last few years reduced our exposure — and thus our immunity — to other respiratory viruses.

    Emergency departments are seeing large volumes of all three respiratory infections. Sick patients are sometimes turned away for lack of capacity to care for them, or they are “boarded” in emergency rooms waiting for a bed. Dr. Paul Biddinger, chief of emergency preparedness at Mass General Hospital, says he is very concerned by “the high levels of crowding that we see today.”

    It isn’t only patient volume. Staff shortages have become chronic because of both illness and “burnout.” Skilled hospital care is critical with respiratory illness. Hospitals currently face a statewide nurse vacancy rate of 56 percent and have come to rely heavily on traveling nurses working per diem to supplement beleaguered staffs. And with less available post-acute-care beds, people stay longer in the hospital, which is typically not reimbursed for “unnecessary” days.

    At Cape Cod and Falmouth hospitals, influenza has indeed arrived early and strongly, but capacity and staffing have been adequate, probably reflecting the Cape’s higher levels of immunization, according to Chief Medical Officer William Agel. Covid bumped after Thanksgiving, but it has not strained the system. If there is a feel-good piece to this story, we’re it — so far.

    What must be done? Quite simply, we must each work at staying healthy. That means limiting crowd exposure and, certainly, wearing a mask in public indoor spaces. While mask protection is not absolute, it is a simple intervention that has conclusively proved to reduce the risk of viral disease transmission. Your immunizations against flu and Covid should be current. (There is no vaccine for RSV.)

    By taking good care of ourselves, we are doing the same for those around us — and for our overloaded health-care providers.

    Brian O’Malley, M.D. is Provincetown’s elected delegate to the Barnstable County Assembly. Write him at [email protected].

    PANDEMIC

    Cape Cod Has Entered Its 6th Covid Wave

    Testing is down, but numbers show a significant Covid presence here

    By

    PROVINCETOWN — The subvariants of Covid-19 that are currently prevalent in the Northeast — Omicron BA.2 and Omicron BA.2.12.1 — may not have their own Greek letters, but this scientific slight doesn’t seem to be slowing them down.

    Barnstable County case data, wastewater data from Provincetown, Nantucket, and Boston, and the CDC’s “Covid Community Level” formula all show that Cape Cod is in a sixth wave of the pandemic. The infection rates are roughly comparable to the Alpha and Delta waves of last spring and summer.

    The CDC has most of New England, including Cape Cod, at a “High Covid-19 Community Level” as of Tuesday, May 10. Almost the entire rest of the country is at a “Low Community Level.” (Photo courtesy CDC)

    Fortunately, these indicators still show levels far below the massive Omicron wave of December 2021 and January 2022, when case rates and other indicators soared 5 to 15 times higher than in all previous waves.

    Every wave is different, and this one has been defined partly by the widespread adoption of at-home testing, and partly by the presence of therapeutics such as Paxlovid — a short course of antiviral pills. It is prescribed to especially vulnerable people early in the course of the infection and can help keep people out of the hospital. It must be delivered within five days of the onset of symptoms to be effective.

    Testing Goes Private

    Testing at public locations, such as the sites sponsored by Barnstable County and the three Outer Cape Health Services clinics, has declined. The total supervised testing number for Provincetown residents for the month of April — 389 tests — is the lowest since June 2021.

    Eastham recorded 310 supervised tests in April. There were fewer than 200 supervised tests of Wellfleet residents, and fewer than 170 supervised tests of Truro residents.

    These numbers come not from the state’s Covid dashboard, which includes only PCR testing, but from a more obscure state source called the Chapter 93 Daily Report. That report aggregates both kinds of testing — molecular PCR tests and supervised rapid tests, such as those performed at OCHS Provincetown and OCHS Wellfleet — into a single spreadsheet that is updated every weekday.

    Barnstable County Health Dept.’s Covid case graph shows six distinct waves on Cape Cod. Purple notations by Paul Benson. (Graph courtesy Barnstable County Dept. of Health and Environment)

    Supervised testing has decreased because at-home rapid test kits are now widely available. OCHS gives them away at medical appointments, and they are available for free at all Outer Cape town halls. In Provincetown, they are at the walk-up window in the town hall basement; in Wellfleet, people are advised to call ahead to make an appointment to pick up test kits.

    Free test kits can also be ordered from the federal government by mail at covidtests.gov.

    At-home testing was a key solution during the Omicron wave in December and January, when case numbers outpaced all prior Covid waves and governmental resources were stretched thin. At-home testing spared medical workers and county employees from having to supervise every test.

    The widespread use of at-home tests, however, means public testing data is now catching only a fraction of all cases. And it’s hard to guess what that fraction is.

    Even so, the formal case count still shows Barnstable County in a Covid wave. The graphs maintained by the Barnstable County Health Dept. show a county-wide rise in cases similar to the Alpha and Delta waves, with a county-wide positivity rate of 7 percent.

    Wastewater Testing

    With at-home testing accounting for an unknown number of cases, other data sources become an important way to keep tabs on the surge.

    Wastewater testing in Boston, Provincetown, and Nantucket all suggest that the current wave is similar in scale to Alpha and Delta, but not nearly as bad as the winter Omicron wave.

    Boston has wastewater data going all the way back to March 2020. The Deer Island treatment plant serves Boston and 42 nearby towns, totaling almost 3,000,000 people. Covid tests there are currently averaging about a half-million copies of the virus per liter of wastewater. That’s a bit above the level during the Alpha and Delta waves, but only about a 20th of the peak readings during Omicron.

    The graph from Nantucket’s most recent wastewater report from Biobot Analytics, May 5, 2022. Purple notations by Paul Benson. (Graph courtesy Nantucket Health Dept.)

    Nantucket’s Surfside wastewater facility is also returning numbers very similar to the island’s Alpha and Delta readings, and about a tenth of the island’s Omicron peak.

    There are only 1,100 properties on Provincetown’s sewer system, which is probably why the wastewater data in Provincetown is so much “noisier” than in Nantucket or Boston, with many ups and downs in the readings that don’t directly correlate to case counts among residents. But Provincetown’s wastewater data from last month is similar to the Omicron wave, and only slightly lower than the numbers during Delta.

    On Friday, May 6, the CDC designated Barnstable and several other Mass. counties as having a “High Covid-19 Community Level.” The agency’s system is complex, involving a comparison of hospitalization levels to overall case rates. Most of New England is now at the CDC’s High Community Level; so is upstate New York, while most of the rest of the country is currently at a “Low Community Level.”

    Paxlovid

    Key pieces of Covid-related legislation have started expiring, but OCHS communications director Gerry Desautels confirmed that Covid testing, vaccines, and booster shots are still free at the health centers regardless of insurance status. CVS also has a large supply of free booster shots, with same-day appointments available in Provincetown and Orleans at cvs.com.

    Paxlovid, an important new therapeutic that was approved for emergency use in December, is also free regardless of insurance status, Desautels said.

    “We have prescribed and dispensed nearly 100 courses of the medication since it became available in January,” said Desautels. People who test positive at home can call their provider at OCHS and a telehealth visit can determine if the medication is warranted.

    The graph from Provincetown’s most recent wastewater report from Biobot Analytics, dated April 27, 2022. Purple notations by Paul Benson. (Graph courtesy Provincetown Health Dept.)

    The Mass. Dept. of Public Health has also just rolled out a website where people can set up free telehealth appointments, upload a photo of their rapid test results, speak to a doctor in one of four languages, and find out if they should take Paxlovid. If the medicine is indicated, it is delivered to the patient’s home for free the next day, or it can be picked up at a pharmacy. That website is mass.gov/info-details/free-telehealth-for-covid-19-treatment-with-paxlovid.

    Paxlovid contains a powerful “pharmacokinetic boosting agent” called ritonavir, which can create “significant and complex drug interactions,” according to the National Institutes of Health.

    Partly for this reason, Paxlovid is approved only for people who are thought to be at “high risk of progressing to severe disease,” a list that includes older adults, cancer patients, and people with various chronic diseases. “Treatment should be initiated as soon as possible, and within five days of symptom onset,” according to NIH guidelines.

    Paxlovid is the newest variable in this sixth covid wave, but it’s important that people know when and how to get it, because BA.2 and other Omicron variants can still kill people.

    Barnstable County recorded eight deaths from Covid in April, according to the county health dept. That is fewer than Alpha, which killed 17 people in April 2021, or Delta, which killed 18 people last September.

    Paxlovid is “widely available,” according to the county health dept. — but for its lifesaving potential to be realized, people need to know to reach out for it as soon as they fall ill.

    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.

    TESTING

    As All Students Return to Class, Covid Cases Are Expected to Rise

    State to publish weekly numbers for school districts

    By

    None of the Outer Cape’s public schools had any Covid-19 cases in the state’s first report of positive tests, issued last Thursday. But as of Tuesday this week, cases were starting to appear, with two reported in Provincetown, one at Nauset Regional High School in Eastham, and one at Nauset Middle School in Orleans.

    Statewide, last week’s report showed 1,230 cases of Covid-19 among the 920,000 students who had returned to classrooms. There were 190 positive tests among 140,000 staff members during that same period.

    The numbers were from just three days, Sept. 13 to 15. Going forward, the reports will be published each Thursday and reflect positive tests in the state’s public schools for the previous seven days. The state has done away with remote learning this year, so with more students in the classroom, case numbers are expected to be higher than last year.

    What’s different this year are new testing programs that mean fewer teachers and children will have to be quarantined.

    On Tuesday, Provincetown Schools Supt. Suzanne Scallion told the Independent that, because the district is small, she did not want to say whether the two cases found there were among students or staff.

    She did explain the school’s new testing protocol. When a case of Covid is identified, all students in that class and any other asymptomatic children considered close contacts are tested daily for at least five days with the BinaxNOW rapid antigen test. The tests are provided free by the state. The students can remain in school as long as they test negative.

    If parents have opted out of the testing program and their children have been in close contact with an infected person, the children must be quarantined.

    “We do not have any parents who have declined,” Scallion said.

    This year is not much different from last year in terms of protocols like masking, Scallion said, but “we’ve come a long way,” she said, thanks to the tests.

    Truro has its own prekindergarten through grade 6 school district, with 112 students. Principal Patrick Riley reported Tuesday there had been no positive tests there so far. Truro also is participating in the state’s test-and-stay program, Riley said, though in his district not all parents had returned forms allowing their children to participate.

    Students head into the Truro Central School on Tuesday, Sept. 21. The state’s first report on coronavirus cases in schools, issued Sept. 16, said Truro had no cases. (Photo Nancy Bloom)

    Riley noted that it is still early in the year. “We’ll circle back to the parents who haven’t returned the forms,” he said.

    The state does not require students to wear masks outdoors. Truro students were initially allowed recess only with the children in their classrooms, but after conferring with Truro Health Agent Emily Beebe, Riley loosened that restriction, allowing multiple classes to be outside without masks.

    The state requires a distance of at least three feet between students indoors, with all wearing masks. “A lot of classes can maintain more than three feet,” Riley said.

    When three-foot distancing can’t be accomplished, such as during one-on-one instruction, staff can wear additional protection, such as multiple masks and face shields.

    Mary Ellen Reed, lead nurse for the Nauset Regional School District, said Tuesday there had been three cases in her district — two students and one staff member: one from Nauset High School, one from Nauset Middle School, and one from the Eddy Elementary School in Brewster.

    The district’s other schools — Eastham Elementary, Wellfleet Elementary, Orleans Elementary, and Stony Brook Elementary in Brewster — had not yet had any cases, Reed said.

    Nauset is not currently participating in the state’s test-and-stay program, although Reed said the district is trying to register for it. At this point, the school nurses in the district perform rapid tests on anyone who shows symptoms while at school but not on children who are asymptomatic.

    The Nauset schools are taking other steps to keep students and staff safe. They allow staff and students in the buildings only during the school day. Visitors and volunteers, including parents, are not allowed inside. When there is a positive test, those who are considered close contacts must quarantine for seven days (close contact is defined as sitting within three feet of an infected person). Asymptomatic close contacts may return after five days if they test negative, but “we still actively monitor them for symptoms through 14 days,” Reed said.

    Masks are currently required indoors statewide until at least Oct. 1 for students, teachers, and staff, whether vaccinated or unvaccinated. After that date, fully vaccinated students and staff, where at least 80 percent of the school population has been vaccinated, may not have to wear them, according to the state’s rules.

    At present, children 12 years and older can be vaccinated against the Covid-19 virus. Pfizer may soon have vaccine approval for ages 5 through 11, according to news reports.

    Scallion said that will be a great relief.  “We worry for our kids who are not vaccinated,” she said.

    The state report published last week showed other Cape Cod school districts with Covid cases: Monomoy reported six students and one staff member; Falmouth had 16 students and one staff member; Dennis-Yarmouth had six students; Barnstable had 12 students; and Bourne and Mashpee each reported one case among students.

    Those numbers will be updated on Thursday, Sept. 23.

    NEW NORMAL

    Covid Returns, ‘Less Severe, More Manageable’

    Many vaccinated people are infected, but none are hospitalized

    By

    PROVINCETOWN — There is a new outbreak of detected Covid-19 cases in Provincetown.

    “Since the end of last week, they’ve been finding several cases a day” at Outer Cape Health Services’ rapid testing site in Provincetown, said state Sen. Julian Cyr on Tuesday. Other people have posted on Twitter and Facebook and even appeared on Boston TV stations, saying they tested positive after their July 4th vacation here.

    But the overwhelmingly high vaccination rate here means there is actually good news to report: in all of the cases that OCHS has discovered, the symptoms are mild to moderate, and no one has gone to the hospital or suffered severe illness.

    “The moderate intensity of these symptoms means the vaccine is working as predicted,” said Cyr. “As we closely watch hospitalization data and severity of illness, we are not seeing those indicators that would truly cause alarm. As we move into living with this virus — I don’t want to make predictions here — but I think we are experiencing something a lot of communities will be experiencing soon.”

    “I want to say adamantly: we are not seeing anything that we didn’t expect as we enter a new normal,” Town Manager Alex Morse told the select board on Monday. “Like every other community, we are learning to live with this virus. It’s important that we have facts and data to guide our decisions. I am not recommending any changes in policy at this time.

    “If anything,” Morse added, “we have discovered that the vaccine is working.”

    The nature of Covid infections in the vaccinated population has been a long-anticipated subject. Primary questions have included the frequency of “breakthrough” infections, the intensity of illness, and the frequency of transmission by vaccinated people.

    All three American vaccines were tested specifically for their efficacy against severe illness and hospitalization, rather than for their efficacy against any kind of infection at all. So, it was expected that the severest health outcomes would be blocked by the vaccines, and so far, that is what appears to be happening.

    “Obviously, I don’t have specific medical information about individuals — but my understanding is, no one has progressed beyond the standard, cold and flu-like symptoms,” said Cyr. “In a certain sense, I find that comforting, and a real accomplishment as a community.”

    The Independent’s questions about the outbreak were originally directed to Outer Cape Health Services, but spokesman Gerry Desautels forwarded the inquiry to Cyr, who has also served as the public information officer for the Cape Cod Covid Response Task Force.

    Cyr, state Rep. Sarah Peake, the town of Provincetown, Outer Cape Health Services, and Barnstable County released a joint statement on Tuesday evening about the outbreak. The statement announced a state-funded expansion of testing to the Veterans Memorial Community Center in Provincetown on Wednesday, July14, Thursday, July 15, and Friday, July 16. Those tests will be free, and OCHS will continue its free rapid testing program as well.

    A mobile vaccination clinic will also be on Ryder Street Extension, at the bus stop near the municipal parking lot, from 8:30 a.m. to 5:30 p.m. on Thursday. That clinic will feature the one-dose Johnson & Johnson vaccine. Free vaccination is also available by appointment at OCHS (which offers the Moderna vaccine) and at the CVS in Provincetown (which offers the Pfizer vaccine.)

    Data Reporting

    At Monday’s select board meeting, both board member John Golden and chair Dave Abramson asked Morse how the town would report case data on the town’s website.

    Morse said the town would link to the state’s weekly Covid data report, released every Thursday evening. That report includes town-by-town reporting of positive PCR test results, which are considered “confirmed cases.” It does not, however, include any town-by-town or even county-level reporting of rapid test results, which are considered “probable cases.”

    Early in the pandemic, rapid tests (also called antigen tests) produced a high rate of false positives and false negatives, so positive test results on rapid tests have long been segregated as “probable cases.” The rapid tests have improved, however, and the state authorized the BinaxNOW rapid test to be used without a confirmatory PCR test in December 2020. OCHS has been using a free supply of BinaxNOW from the state to support its free testing program — that’s thousands of tests in all — for more than six months now.

    This means the positive cases discovered by OCHS in the wake of July 4th will mostly not be included in the state’s weekly Covid report on Thursday, July 15 — because they were found with rapid tests, so they’re still only “probable cases.” They will be included in the statewide total — but not in the county or town numbers.

    “We will continue to be as transparent as possible with cases and with what’s happening in town,” Morse told the select board.

    “The number only tells us so much,” Morse added. “We need to operate as if Covid exists. I just want to advise the board and the public to listen to public health experts. It’s important to get factual information out.”

    CHIN UP

    A Walk Down Commercial St. Reveals Current Conundrums

    Mask preferences and policies mark this not really post-pandemic moment

    By

    PROVINCETOWN — Kohi Coffee Co., at 199 Commercial St., set back from the sidewalk in a beachfront space, currently has a sign on its front door informing customers as they enter that face masks are “preferred.” That word, polite and not insistent, but printed on a red background shaped like a stop sign, sums up the current confusion on the streets of Outer Cape Cod’s increasingly busy towns.

    The sign at Kohi reflects a compromise that the store manager, Diana Galligan, had to make when figuring out how to conduct business in a world that is not truly post-pandemic.

    “The rest of the staff and I would feel more comfortable if customers wore masks,” Galligan said. “But I’m also not in a position to turn customers away.”

    Even with the sign, Galligan estimates only about 10 percent of the people who come inside are wearing a mask.

    “I think everyone is confused right now about what to do,” she said. “People were told that, if they were vaccinated, they no longer had to wear masks, so now they’re not even carrying them around.”

    “We have all longed for this moment,” said Centers for Disease Control Director Rochelle Walensky at a White House press briefing on May 13 following the CDC’s announcement that people who are fully vaccinated against Covid-19 no longer need to wear masks or socially distance.

    At such a moment, it would be easy to miss some details. For example: “You will still need to follow guidance at your workplace and local businesses,” reads a bullet point in the CDC’s announcement. In fact, the law does allow business owners to require masks and even proof of vaccination of staff or customers.

    For business owners and managers, it’s a tricky situation. The world that seemed so frozen is now white hot again. The thaw happened fast. Following the CDC’s announcement, Gov. Charlie Baker lifted the state’s remaining Covid-19 restrictions on May 29.

    Jeff Peters, the owner of East End Books, said the governor’s order did not give businesses enough time to figure out their next steps. To him, it was “foolish” to lift restrictions on the Saturday of Memorial Day weekend.

    Peters just switched his “masks required” sign to a “masks preferred” sign on June 5. He wanted to consult with the American Booksellers Association and read the CDC’s guidelines and recommendations before making a decision about what to do.

    Overall, Provincetown quickly fell into step with the governor.

    Informal research conducted for this article uncovered just a few places where masks are still required, including MAP, a boutique on Commercial Street in the West End, as well as Far Land Provisions and East End Market, the two grocery and sandwich shops on Bradford Street.

    “We kept the mask requirement to make an easy transition for the people who felt unsafe inside without masks,” said Pauline Fisher, the owner of MAP. “It might be a small number of people, but we err on the side of making everyone comfortable.”

    The owners of Far Land and East End Market both cited the safety of their staff as the reason behind their decisions to keep masks mandatory inside their stores.

    “We have between three and four hundred people walk through the door every day,” said East End owner Claudio Gervasi. “Each of those people comes in for about five minutes. But my staff comes into contact with all of them for a whole workday.”

    Far Land Provisions operated a curbside order and pick-up service throughout most of the pandemic. John Perrone, the only person who died of Covid-19 in Provincetown, had been an employee at the store. Owner Tom Boland said Perrone’s death is on his mind as he considers the store’s procedures.

    “We felt the announcements from Baker and the CDC happened kind of fast,” said Boland. “We had new employees who weren’t fully vaccinated yet. For their safety, we decided to continue the mask requirement until they got all their jabs.”

    According to the Equal Employment Opportunity Commission, the law allows employers to require employees physically entering the workplace to be vaccinated for Covid-19. The only exceptions would be people for whom a disability or “sincerely held religious belief” prevents vaccination.

    Employers requiring proof of vaccination must keep that information confidential.

    Gavriela Bogin-Farber, the president of the Mass. Employment Lawyers Association, recommends that whatever policies employers implement, they “apply them equally across the board.”

    For employers, workers, customers, and everyone, it seems, the situation is evolving.

    Walk down Commercial Street now and no longer will you be “entering a mandatory mask zone.” On that walk, you’ll see masks haven’t just been lifted, they’ve been left at home. You might wonder why that one woman still has her N95 on. You might walk into a shop and experience a moment’s hesitation about being indoors with all these breathing, salivating, sweating, sneezing strangers. Or you might find the street an Eden of proximity of noses and mouths and chins and a beautiful boy on a bike, stretching his neck out to the breeze caressing his bare face.

    The polite caution evident in Kohi’s sign seems like a reasonable strategy.

    THE JAB TAB

    Outer Cape Leads Mass. in Vaccination Rates

    All four Outer Cape towns are in the state’s top 10

    By

    PROVINCETOWN — The state’s April 15 Covid vaccination report has great news for the Outer Cape. The top-line numbers show that the four outermost towns have among the highest Covid vaccination rates in the entire state: 68 percent of Eastham’s population has received at least one dose of Covid vaccine, as has 69 percent of Wellfleet, 71 percent of Truro, and a whopping 93 percent of Provincetown.

    Those numbers place all four towns in the top 10 out of 351 towns and cities in Massachusetts.

    The Lower Cape is also doing well. Seventy-five percent of Orleans has received at least one dose, and Chatham’s 67 percent places it at number 11 on the list.

    The other towns in the top 10 are Tisbury and Chilmark on Martha’s Vineyard, and three small towns in western Mass.: Williamsburg, Great Barrington, and Shelburne.

    Provincetown’s 93 percent is second only to Shelburne, which the report says is 99.7 percent vaccinated: 1,826 first doses given to 1,831 people. There is a weakness in the state’s reporting, though: the percentages are based on the Dept. of Public Health’s 2019 estimate of each town’s actual population. Towns that contain many second homes can be difficult to count accurately, and many people have moved into their second homes since the pandemic began.

    The vaccination site at Cape Cod Community College on March 30. (Photo Paul Benson)

    Most of the towns in the top 10, including Provincetown and Truro, have vaccinated more people over age 65 than the state records as actually existing in those towns. (The state calls this a “greater than 95 percent vaccination rate” for these age groups.) This data discrepancy is elevating the percentage-vaccinated number in vacation towns across the state.

    But the Outer Cape’s high numbers are not just a function of having more senior residents than the state thinks we have. Vaccination rates on the Outer Cape are strong in all age groups. A combined tally for all four towns shows that 44 percent of people 20 to 29 years old have already received at least one dose, as have 63 percent of people ages 30 to 49. This is despite the fact that these age groups became categorically eligible for vaccination only on April 19.

    The high numbers are a reflection of how many people here work in frontline, public-facing industries, especially hospitality. People who have any role in delivering or serving food, as well as people who work in retail, transportation, sanitation, and utilities, all became eligible on March 22, and the Cape Cod Vaccine Consortium — a coalition that includes Barnstable County, all 15 towns on Cape Cod, the three community health centers, and Cape Cod Hospital — made a deliberate push to get these workers vaccinated before eligibility was opened to everyone on April 19. Partly as a result, the Outer Cape towns are running well ahead of the statewide average when it comes to these younger demographics. Provincetown, in particular, is running more than 30 points ahead of the statewide numbers for 20- to 49-year-olds.

    “The data show that we are reaching essential workers,” said state Sen. Julian Cyr. “The coordinated effort on vaccination is a success, with credit due to local health agents, Barnstable County, Cape Cod Healthcare, and most especially Outer Cape Health Services.”

    None of this was a foregone conclusion for a region that is almost two hours away from the nearest state-run mass vaccination site. In February, when Gov. Baker was cutting hospitals and local boards of health out of the vaccine allocation process in favor of stadium sites, there were real fears that the region would be going into the summer season unprotected.

    Instead, with five of the 10 most-vaccinated towns in the state, the Outer and Lower Cape can think about having nearly everyone vaccinated by Memorial Day, including newly arrived seasonal workers.

    Meanwhile, the current “pause” on use of the Johnson & Johnson vaccine shouldn’t have too bad an effect here, according to Barnstable County Health Director Sean O’Brien. That’s because the county and Cape Cod Healthcare both receive mostly Pfizer vaccine, since they have the ultra-cold freezer capacity to store it, O’Brien said.

    Outer Cape Health Services has been mostly receiving the Moderna vaccine. CVS locations around Cape Cod had been receiving Johnson & Johnson shots through a federal program, Cyr said, and that channel could be disrupted for a while as a consequence of the “pause.” The consortium’s leaders are optimistic that their allocations of Pfizer and Moderna doses will continue at the current brisk pace, however.

    All in all, it’s quite a turnaround from only eight weeks ago. Two-thirds of everyone here has had a shot now, and the “vast majority” of them were able to get their shot locally, according to OCHS communications director Gerry Desautels. There are thousands of seasonal workers on the way, so there’s still plenty of work to do, but the Outer Cape looks to be well positioned for the summer season that’s nearly upon us.

    STIMULUS

    $41 Million in Covid Relief Headed to County

    Federal rescue plan is a boon to state and towns

    By

    PROVINCETOWN — The American Rescue Plan Act (ARPA), which President Biden signed into law on March 11, will siphon a lot of money to Cape Cod’s local governments in the near future.

    The Cape’s 15 towns will be splitting about $24 million in direct payments, while Barnstable County will get about $41 million. That’s double the county’s normal annual operating budget of $20 million — a huge infusion of cash, which county leaders hope to use for longstanding infrastructure needs as well as pandemic relief.

    The ARPA is the first legislation since the CARES Act of March 2020 to contain state and local aid provisions. Massachusetts received about $2.7 billion from the CARES Act — $500 million went to individual towns; $650 million was put into a small business relief program run by the Mass. Growth Capital Corp.; and smaller amounts were used for schools, Covid testing, contact tracing, personal protective equipment, and even National Guard deployment.

    The ARPA makes the CARES Act look modest in comparison, according to the National Conference of State Legislatures (NCSL). The state will receive $4.5 billion directly. Cities and towns will split another $2 billion, and county governments will split another $1.3 billion. In counties without functioning governments, that money will go directly to town governments, according to the Mass. Municipal Association. Cape Cod, however, has one of the most active county governments in the state. Barnstable County’s $41 million will arrive in two installments, in 2021 and 2022.

    County leaders are developing plans now for how that money might be spent.

    “The ARP identified priorities for the use of these funds,” said County Commissioner Mark Forest. “These priorities are very much in sync with the priorities we have on the Cape: water, sewer, and broadband. The ARP is also seeking to help communities wrestle with the costs and expenses of Covid.”

    At their March 17 meeting, the three commissioners discussed the incoming funding and its possible uses.

    “This is an opportunity to really look at these big issues and bring people together on how to go forward,” said Commissioner Sheila Lyons. “How do we invest this for the future, wisely, whether it be water, homelessness, housing? This is something we have to be very thoughtful about.”

    “We have to put in some work to understand the restrictions of the funding,” said Commissioner Ronald Bergstrom. “I’d like to dump a bunch of money on the economic development council, but we might need legislation to do that.”

    According to the NCSL, the money can be used for a relatively wide range of purposes. Water, sewer, and broadband are specifically indicated, as are economic aid to households, small businesses, nonprofits, and the tourism and hospitality industries. The money can also be used to “provide government services affected by a revenue reduction resulting from Covid-19,” and to provide premium pay to essential employees, or grants to their employers. These are all in addition to direct spending on Covid, such as on testing, vaccine distribution, contact tracing, school retrofitting, or PPE.

    With so many possible uses, even $41 million could be frittered away quickly. The commissioners directed the county administrator and seven department heads to develop potential plans and bring ideas back to them.

    Direct Payments to Towns

    Provincetown, Truro, Wellfleet, and Eastham are the four smallest towns on Cape Cod in terms of year-round population, which governs the formulas for direct allocations. Even so, funds allocated directly to those towns may be just as significant as what comes from the county.

    Using a population-based formula, the state gave out $500 million of its CARES Act money. Provincetown was allocated $260,000; Truro, $176,000; Wellfleet, $240,000; and Eastham, $429,000.

    ARPA gives some money directly to towns, bypassing the state, but the overall numbers this time will be only slightly higher for the Outer Cape. Provincetown is due to receive $292,000 in direct aid from the new law, according to estimates from the Mass. Municipal Association; Truro should receive about $198,000; Wellfleet, about $268,000; and Eastham, about $484,000.

    Meanwhile, some of the $4.5 billion the state will be receiving from ARPA will surely find its way to Cape Cod as well, although it’s too soon to guess how it will get here, or when.

    DEATHCARE

    Like Other Businesses, Outer Cape Funeral Homes Adapt

    But some worry, too, as grief goes online or on hold

    By

    PROVINCETOWN — Funeral home directors are the last responders on the frontline of the pandemic. And the national news has brought troubling images of overburdened funeral homes in the hardest-hit parts of the country. While we have not had to confront that particular part of the Covid-19 tragedy on the Outer Cape, funerals — and the work of funeral homes — have changed during this time.

    There have been fewer funerals, not more. That’s because families and friends of the deceased long for the opportunity to gather in one shared space, said Bill Gately, who owns Gately Funeral Services in Provincetown. “Most frequently, we’ve been helping families postpone services to a later date,” he said.

    Vine Hills Crematory in Plymouth, which Gately relies on, has been busier than usual, he said. He attributes that not to the almost 17,000 Covid-19 deaths in the state but to the fact that, because of the need to delay funerals, more families are opting for cremation.

    Chris Luciano, funeral director at Nickerson Funeral Home, whose outermost location is in Wellfleet, says that the pandemic has meant that a lot of his time and energy has been dedicated to providing online memorial services for families. He and his staff live-stream these services from Facebook and from their website.

    Luciano’s job spans all eight of the funeral home locations on the Cape owned by Dignity Memorial, a subsidiary of Services Corporation International, the nation’s largest provider of “deathcare” products. According to a press release issued by the company in February, fourth-quarter 2020 revenue grew by $120 million, or 14 percent, over the prior year’s fourth quarter, to $970 million.

    Luciano said there is no central home base for the company here, but that he goes “where the demand goes,” including to the Wellfleet location on Main Street. Despite the time online, “I’m a funeral director first,” Luciano said. “I still see families.”

    Another part of the shift for Luciano has been towards organizing and running what he calls online “educational seminars” in which he informs potential customers about the packages that Dignity provides. Most of these have to do with planning ahead. “You can pre-arrange your funeral with us,” Luciano said. When “you pay for everything and you put everything in writing,” he said, “it gives your family peace of mind.”

    Gately, who has, since 1990, practiced as a licensed therapist specializing in grief, is concerned about how the pandemic has interrupted the way funeral homes help people with the process. Funeral homes are one of the few public places where it is permissible to display sadness, Gately said. He worries about “what’s missing when we have to postpone things for so far down the road,” he said.

    Gately believes the displacement of funerals is particularly hard on friends of the deceased, rather than families, because more often families at least do have some opportunities to get together, “a place to gather and share their common grief.”

    Gately said that, like so much else, the pandemic has limited what we are able to do to celebrate the lives of loved ones. People are coping, he said, “but it’s not really a choice.”

    COVID-19 UPDATE

    Statewide Pre-Registration Is Now Available

    A more orderly and less traumatic system

    By

    People who are currently eligible for a vaccine, or who will be eligible later in phase two, can now put their names and contact information into a statewide pre-registration system and be contacted by the state when an appointment at a mass vaccination site is available. This new system is meant to provide a more orderly and less traumatic user experience than the every-Thursday-morning release of tens of thousands of vaccine appointments onto PrepMod, a widely maligned website that often crashes.

    The pre-registration website is vaccinesignup.mass.gov.

    A wide range of “frontline” workers is included in the later parts of phase two, including restaurant, retail, grocery, sanitation, public health, transit, and judicial workers. According to the Cape Cod Commission’s datacapecod.com, these sectors account for more than half of all working people in Provincetown and Wellfleet, and about a third of all working people in Eastham and Truro.

    People with one health condition on the CDC’s list of conditions that worsen outcomes of Covid may also pre-register now.

    The pre-registration system is connected only to the state’s seven mass vaccination sites. People with one health condition may also want to contact their doctors to be added to the lists being maintained by Outer Cape Health Services, Cape Cod Healthcare, and/or the Barnstable County Health Dept., as these vaccination clinics are not currently connected to the pre-registration program.

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