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Covid-19

    REST AND REASSESS

    Covid-19 Pauses Outer Cape Entertainment

    Two venues canceled a week of performances in July

    By

    PROVINCETOWN — Four years after Covid-19 brought live performances worldwide to a halt, the virus is still working its will on Outer Cape arts venues.

    Jody O’Neil and the cast of Reefer Madness, which wrapped a week earlier than planned at the Wellfleet Harbor Actors Theater because of Covid-19. (Photo by Michael and Suz Karchmer)

    The Wellfleet Harbor Actors Theater on July 20 canceled its remaining showings of Reefer Madness, which had been scheduled to run until July 27, after five members of the cast and crew tested positive for Covid. Three were asymptomatic.

    “In the event of a Covid-19 case in the company, we start strict testing, masking, sanitation, and isolation protocols,” Artistic Director Christopher Ostrom said. “Following the current Centers for Disease Control guidance around isolation and masking, performances were simply not possible.”

    That same week, the Provincetown Theater canceled four performances of The Rocky Horror Show because of Covid. The production resumed on July 29 and is expected to run through Sept. 5.

    “We are a city of entertainment, which means we congregate in groups,” said Gary Garrison, the theater’s managing director. “We pack into events where people are dancing and joyously celebrating and singing. That makes it exciting, but now that Covid is back on the landscape, that also makes it problematic.”

    Garrison declined to say how many people in the company were sick last week. It was “enough for us to be concerned,” he said. “We thought it was prudent to withdraw so performers could rest and staff could reassess.”

    A Summer Spike

    According to data provided to the Independent by Outer Cape Health Services, which monitors weekly reports from the state Dept. of Public Health and maintains its own internal database of Covid cases, the positive test count among patients at the OCHS clinics in Provincetown, Wellfleet, and Harwich was about five times higher in July than it was in April.

    Boy Radio as Frank-N-Furter, the pansexual ringleader of The Rocky Horror Show, flanked by Zack Johnson (left), Evan Montgomery, and Devon Whitney (right). Rocky Horror resumed production on July 29 after four Covid-induced cancelations from July 22 to 25. (Photo by Bob Tucker/Focalpoint)

    “There has been a noticeable spike in Covid-19 infections this summer across the United States and locally,” said Dr. Marie Constant, medical director of the Provincetown clinic.

    Constant said that symptoms of the current Omicron variants are consistent with earlier strains and include coughing, sore throat, body aches, and fever.

    She said that most people experience mild symptoms, and high vaccination rates have lowered the overall risks from infection — but immunosuppressed people and those with chronic conditions remain at higher risk of complications.

    In Massachusetts and 19 other states, coronavirus levels are currently “very high,” according to the CDC’s National Wastewater Surveillance System, which monitors bacterial and viral particles in untreated wastewater.

    Provincetown’s wastewater testing program ended in March due to “the exhaustion of sampling kits and the end of program funding,” according to an item in Town Manager Alex Morse’s March 11 report to the select board. The last report is still on the town’s website, although it shows data that is unusually “spiky,” or inconsistent, over time.

    In Boston and its suburbs, wastewater numbers from the Mass. Water Resources Authority show a springtime decline in Covid-19 particles there, followed by a noticeable spike starting July 1.

    The Cape and Islands led the state in June for the percentage of hospitalizations from respiratory illness, including Covid-19, influenza, and RSV, according to the Dept. of Public Health’s Respiratory Illness Dashboard. As of July 3, about 9.5 percent of emergency department visits in Barnstable County were due to acute respiratory disease — down from about 21 percent in January.

    Current Guidance

    Tracking Covid-19 as one of several respiratory illnesses reflects national guidance from the CDC, which updated and simplified its respiratory virus recommendations in March.

    The agency now advises people to isolate until respiratory illness symptoms have improved and they have been fever-free for 24 hours.

    For the next five days after that, people should monitor symptoms, practice good hygiene, wear a mask indoors, maintain social distance, and test themselves, the agency advises.

    Free Covid-19 tests are no longer widely available on the Outer Cape, but while supplies last, free tests are available at OCHS clinics and at the community development dept. in the basement of Provincetown Town Hall.

    Free test kits are not currently available in Eastham or Wellfleet, and in Truro, the last batch of free kits expired, so the health dept. is no longer handing them out.

    “They’re very difficult to get,” said Gary Locke, assistant health agent in Wellfleet. “People have come in and asked us, but we just don’t have any more.”

    An updated Covid “booster shot” that targets the now-common KP.2 strain of Omicron is expected to become available this fall. In the meantime, Constant said patients should consult their primary care practitioners with questions about booster shots, which are available at OCHS clinics and at the CVS and Stop & Shop pharmacies in Provincetown.

    PANDEMIC

    Covid Returns, but Not to ICUs

    A summer wave of cases is blunted by Paxlovid

    By

    PROVINCETOWN — The summer of 2022 has brought a long-awaited but still frustrating event to Cape Cod: a Covid wave that doesn’t include high levels of hospitalization.

    Case numbers are high here — both direct and indirect indicators show that — but for most of the last month, there have been almost no Covid patients in the intensive care unit (ICU) at Cape Cod Hospital. The same is true at Nantucket Cottage Hospital and Martha’s Vineyard Hospital; Falmouth Hospital has typically had one Covid patient in its ICU.

    Meanwhile, Provincetown and Nantucket have been reporting Covid-in-wastewater data that are double or triple the numbers from last summer’s Delta wave, and Provincetown actually had the highest wastewater reading in the entire country on May 12.

    CDC data on hospital patients with Covid (not necessarily being treated for Covid) largely mirror the overall case counts in Barnstable County. The graph of ICU admissions, a frequently used indicator of the most severe Covid cases, shows many fewer ICU patients than during the Alpha or Delta waves. (Image courtesy CDC, notations by Paul Benson)

    In prior Covid waves, high case counts were followed by hospitalizations and ICU admissions. State and CDC data both show that is not happening. Paxlovid and other treatments deserve a lot of the credit, according to Dr. Andy Jorgensen of Outer Cape Health Services.

    “Having access to this medication has been a tremendous help,” said Jorgensen. “You can go back to the studies that show a dramatic decrease in hospitalization in the populations that received Paxlovid.” He has seen that same effect among the patients he serves, Jorgensen said.

    Paxlovid is prescribed to people who have one or more of a long list of potential risk factors for serious Covid, such as cancer, diabetes, or heart disease, as well as those over 65. OCHS has prescribed 382 courses of Paxlovid, according to communications director Gerry Desautels — 250 of which were in the last two months.

    Paxlovid must be taken within the first five days of symptoms to be effective, however, so health care providers are telling their at-risk patients to call them early in the course of infection rather than trying to wait the disease out.

    “I think people feel a little less afraid because they know treatments are available,” Jorgensen added.

    Indeed, the fact that Covid is less lethal is part of why there is so much more of it around. With mask rules, vaccine passports, and mandatory tests for international travel all suspended, the opportunities for viral spread have increased. Public testing is limited — but the Cape and Islands have the highest positive test rates in the state.

    On May 12, 2022, and again on July 17, Provincetown had some of the highest Covid-in-wastewater readings in the entire country. (Biobot wastewater analysis courtesy Town of Provincetown, notations by Paul Benson)

    People who live here are finding out what a season of less-lethal Covid looks like. It’s not as scary as the ICU, but getting sick during the summer is still hard.

    Roxanne Layton is a server at the Red Inn in Provincetown in the summer and a musician who tours with the concert group Mannheim Steamroller in the winter. She got Covid for the first time in June — in the middle of a crosstown move.

    “I was sick as a dog, and I tested positive for 12 days,” said Layton. “The hardest part was being sick and not being able to rest.” She said the move was, “one of the hardest things I’ve ever done, physically and emotionally.”

    Layton plays the recorder, and she was worried about her lungs as well. “Luckily, when it was done, it was done,” she said. Her lungs have cleared.

    At least a few people who get Covid this summer will not be so lucky.

    Provincetown resident Cary Bryant was one of the first people to get the Delta variant during last year’s Provincetown cluster. He has been battling the persistent symptoms called Long Covid ever since — in his case, extreme fatigue, loss of coordination, and brain fog.

    “I had a pretty mild case in early July last year,” Bryant said, “and I felt OK right after it. But over the summer and into the fall, I had less and less energy and would be overcome by these waves of extreme fatigue, where I really couldn’t do more than lie down.

    “Usually, I could do two or three little things — like, do the dishes, or take a shower,” Bryant said. “But that would be all I could do in a day.

    “I also think less clearly, I don’t have the memory I had, and just doing simple tasks is harder. I drop things a lot. I’ll drop the same thing three times, even when I’m focusing on it.”

    Bryant thinks his condition has been improving. “I felt like I was 90 years old,” said Bryant, who is 57. “Now, I feel like I’m maybe only 78. I can walk into town for dinner, and I stop at every bench on the way home, but I’m not destroyed the next day.”

    As recently as April, when he thought his whole life might be like this, Bryant was depressed and angry, he said. Lately he believes he might get better in a few years.

    There are few data on Long Covid, partly because what studies do exist use widely diverging definitions of the condition. “Because the definition is still being determined, it will be a while before we have any statistics on that,” said Jorgensen.

    The ICUs are largely empty of Covid patients — and that is a welcome change. It hasn’t made Covid easy, though, and a long and mysterious illness remains a grim possibility.

    PANDEMIC

    Covid-19 Self-Reporting Tool Implemented in 3 Towns

    Health agents hope to cover the data gap caused by at-home testing

    By

    WELLFLEET — The health agents in Provincetown, Truro, and Wellfleet have launched an online Covid-19 at-home test reporting tool that they hope can help solve a new gap in tracking coronavirus data and keeping the public informed.

    The Outer Cape’s Covid self-reporting tool includes a QR code that takes people directly to the form from their phone’s camera app. (Image courtesy Town of Wellfleet)

    The relative decline of PCR testing and medically supervised rapid testing, such as that performed at Outer Cape Health Services, means that the state’s official data on Covid are capturing a smaller and smaller percentage of tests and cases. At-home testing has become much more common, but positive results of at-home tests are not systematically reported to any government agency. The health agents created the self-reporting tool in hopes of keeping a better eye on the development of cases on the Outer Cape.

    “We had a serious lack of surveillance — on the Outer Cape and everywhere — because of the increase in home testing and decrease in PCR testing,” said Hillary Greenberg-Lemos, Wellfleet’s health and conservation agent. “We wanted a tool that would give us a bit more surveillance, because one of the things that health departments are charged with is surveilling for disease.”

    The nationwide shift to at-home testing came in response to the Omicron wave of the virus, which shattered case records last December, January, and February. Public testing sites across the country were overwhelmed with patients, and the Biden administration promoted at-home testing to help resolve the demand for tests. Free rapid tests are still available through the mail at covid.gov/tests.

    The at-home tests helped solve the testing crisis but created a problem for disease tracking. Some jurisdictions have relied more heavily on wastewater testing for Covid, but nearly all of Cape Cod is served by septic systems rather than wastewater plants. The self-reporting tool could help close the knowledge gap.

    “Without any type of surveillance, we don’t know what’s going on,” Greenberg-Lemos said. “This is a voluntary tool, and there is no regulatory requirement that folks fill it out — but it’s going to help us see what’s going on in our communities.”

    The state’s weekly report of Covid cases comes out every Thursday and covers the previous two weeks. It includes only results from PCR testing. The June 23 report, which covers the period June 5 to 18, shows zero Covid cases in Provincetown and Truro, and “less than five” in Wellfleet.

    The time period is not exactly comparable, but for the dates June 3 through 23 the self-reporting tool has received reports of three cases in Wellfleet, five in Truro, and one in Provincetown.

    The tool will be especially important heading into the summer, Greenberg-Lemos said. “Because our population swells so much and we get such a major influx of visitors in the summertime, we wanted an easier way to see what was going on,” she said.

    It is crucial that the tool be well publicized, Greenberg-Lemos added.

    The tool originated in part with a suggestion from a Wellfleet citizen.

    Lauren Kaufmann contacted Wellfleet Town Hall after she tested positive for Covid-19 on an at-home rapid test last month, only to find that the town was not collecting data from self-administered tests. “I realized that the numbers posted in the local papers are based only on PCR test results that are reported by Outer Cape Health Services or other clinics,” Kaufmann said.

    Kaufmann encouraged the town to develop a Covid-19 self-reporting tool so that residents like her could anonymously report their results. She told the department about a similar tool used in Brookline, where she lives for part of the year.

    “Communities need accurate data that reflect community spread so that they can adapt to surges and revise protocols as needed to keep people safe,” Kaufmann said. “I understand that all of us are experiencing some degree of Covid exhaustion. But the reality is, it’s still here, so we can’t just put blinders on and move into a state of denial.”

    Meredith Ballinger, assistant health and conservation agent for Wellfleet, analyzed existing self-reported Covid-19 test result tools from Vermont, Brookline, and a county in California — some of the few places where self-reporting mechanisms exist — before developing the Outer Cape’s own version. All the tools had several things in common: they were simple, quick, and anonymous.

    As of mid-June, there were no other self-reporting tools in use on the Cape or Islands, Ballinger said.

    Kaufmann emphasized the importance of publicizing the tool. “It’s going to be key that they continually get the message across, because the population is ever-changing here in the summertime,” she said.

    Ultimately, however, it is up to the public to report results. “It’s anonymous and voluntary, so a lot of this hinges on the public wanting to participate,” Greenberg-Lemos said.

    Senior Reporter Paul Benson contributed to this article.

    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.

    ANCHORS AWAY

    Mass. Maritime’s Sea Term Departs, After Pandemic Delays

    Students and staff sidelined by Covid-19 will join later, ferried by tugboat

    By

    BUZZARDS BAY — Massachusetts Maritime Academy’s training vessel, the T.S. Kennedy, departed the dock on Jan. 10 for its annual winter Sea Term three days late and an undisclosed number of sailors short, after predeparture testing produced a wave of positive Covid-19 tests among students and staff.

    Capt. Elizabeth Simmons, the academy’s vice president of external affairs, said she did not have “an exact number” of the total positive tests.

    Those who tested positive will be joining the ship by tugboat on Jan. 14, according to an email sent to staff and students by Rear Admiral Francis McDonald, the academy’s president.

    The ship is bound for a 52-day training cruise, with stops in Puerto Rico, Tampa, Fla., and Charleston, S.C. The 400-odd students on board the 540-foot converted cargo vessel are mostly engineers and deckies, that is, they’re studying marine engineering and marine transportation, which includes the requirement that they complete at least four Sea Terms, spending a minimum of 180 days at sea before graduation.

    The trip is no leisure cruise. Students cycle through different jobs, which include standing watch on the ship’s bridge or in the engine room, completing maintenance on deck or down below, and doing scullery duty — washing dishes and grinding down food waste to be discharged overboard. They also take classes and do lab work.

    The Kennedy, Mass. Maritime’s training vessel, departed Buzzards Bay on Monday for the school’s annual Sea Term. (Photo by Nancy Bloom)

    These students are working towards becoming Coast Guard Licensed 3rd engineers and 3rd mates, in hopes of jobs on vessels all over the world, transporting goods or oil, laying internet cables, or conducting research.

    Mark Murray, a sophomore deckie who lives in Provincetown and is on board the Kennedy now, said what he most looked forward to was the chance “to get out of my comfort zone and tackle the many different problems that arise while being out to sea.”

    The training cruise is scheduled for winter, between terms, although last year, due to Covid, the Sea Term was completed over the summer.

    There is concern this year about the possibility of facing Covid cases after the ship completes port visits. The school has already had to cancel a stop in St. Thomas in the U.S. Virgin Islands, because of an uptick of cases on the island.

    Cadet Murray told the Independent that being on board with the virus looming “has been a challenge, but health services has done a great job trying to limit its effect on us.”

    Simmons said the school is working closely with the Maritime Administration and with each port of call.

    “If the past 18 months have shown nothing else,” she said, “it is that we need to have backup plans and be ready to assess and adjust course when needed.”

    COVID UPDATE

    An Uptick in Cases at Outer Cape Schools

    Continued testing, more vaccinations, and a few new precautions

    By

    It’s been a tentative return to school for Outer Cape students after a nearly two-week-long holiday break.

    At the start of this week, school officials reported rising case counts and higher than usual absences among both staff and students.

    In the week before the holiday break, Provincetown had no Covid cases among students or staff, according to the weekly report from the Dept. of Elementary and Secondary Education (DESE).

    But on the afternoon of Monday, Jan. 3, the first day back, five asymptomatic cases were identified when Provincetown Schools nurse Mary-Beth Maloney tested every student and staff member with rapid tests. “We wouldn’t have known about those cases if we hadn’t tested everyone,” said Supt. Suzanne Scallion.

    In addition, about a third of the staff and students were absent Monday due to a combination of Covid-19 worries and travel delays, Scallion added.

    Truro also had no cases among students or staff before the break. Supt. Stephanie Costigan gave families credit for that.

    “Parents have been screening children and keeping them home if they have symptoms,” Costigan said. On Monday, Truro knew of one case identified during the break, she said. Staff were tested on Sunday before school started, with no positive results.

    Wellfleet had two cases among students and none among staff. Eastham reported one case among students and none among staff, according to the DESE data.

    Following a professional development day on Monday, students and staff at Wellfleet Elementary School and Nauset Regional High School returned in person Tuesday. There were three cases reported at the elementary school, with five absences. At the high school, there were 20 cases and 30 students absent, according to Interim Supt. Brooke Clenchy.

    But the numbers were similar to what they’d been prior to the winter break, Clenchy said. “We saw cases begin to rise about two weeks after Halloween,” said Nauset Public Schools nurse leader Mary Ellen Reed.

    At a press conference on Monday, Gov. Charlie Baker said he expected the return from holiday break to be “a challenging period of time,” but he held his position that all 180 days of in-person learning should take place this school year.

    During the holiday break, superintendents across the Commonwealth had Zoom meetings to plan for the students’ return, Scallion said. Districts also received 227,000 at-home test kits from the state.

    “We were distributing kits on New Year’s Eve,” Scallion said. “It’s been a very busy week for us to prepare for the opening. I think we’re ready.”

    The new Omicron variant spreads more easily than the original SARS-CoV-2 virus, according to the Centers for Disease Control and Prevention. But while breakthrough infections are likely to occur, current vaccines are expected to protect against severe illness, hospitalization, and death.

    Updated Procedures

    Provincetown Schools are now requiring three-ply masks. “Our kids are all in surgical masks,” Scallion said. “If they have a cloth mask, they’re required to wear a surgical mask under it.” The school is also reverting to the procedures followed when the first outbreak hit: not having two classes in the lunchroom together, taking mask breaks outdoors, and creating smaller groups for recess.

    Pooled testing is slated to resume Thursday, nurse Maloney said. It involves mixing several test samples together in a batch and then testing the pooled sample with a diagnostic PCR test. The approach increases the number of people who can be tested using the same amount of laboratory resources.

    Truro Central School has not changed any protocols, Costigan said: masks remain required indoors, as does physical distancing of three feet when masked and six feet when unmasked. She added that the school is looking at options to have more tests available.

    All Outer Cape schools continue to participate in the state’s “Test & Stay” program, in which students identified as close contacts of anyone who has tested positive are tested daily for at least five days following initial exposure. Students may remain in class if their daily test results are negative.

    All the schools also provide testing for students and staff who get symptoms during the school day.

    Nauset schools will continue their regular pooled testing program, Clenchy said. In accordance with the CDC’s latest advice, the school will shorten its recommended quarantine and isolation period from 10 to 5 days, followed by 5 days of required masking.

    Vaccination Clinics

    A few vaccination clinics will be available for students and staff across the Outer Cape in the coming weeks. Provincetown Schools is hosting one on Jan. 6, offering first, second, and booster doses from 1:30 pm to 3:30 pm.

    Five- to 11-year-olds are now eligible for Covid-19 vaccinations, and boosters were just approved Monday for children 12 and over. While vaccinations are not required in schools, Maloney said, almost all students are getting them.

    Truro Central School was scheduled to hold its first vaccination clinic Wednesday, Jan. 5. The clinic was to be open to the public, providing initial vaccinations and boosters for all eligible age groups.

    The Nauset School District has already had five vaccine clinics in the fall. There was a clinic in Wellfleet on Monday, Jan. 3 and another one is planned for Jan.13, Reed said.

    COVID-19

    Scouting Out Rapid, At-Home Covid Tests

    Tips on where to find and, eventually, score a kit

    By

    The holidays brought a boom-and-bust cycle on availability of rapid, at-home Covid-19 tests. Town officials have been trying to hand out free kits to residents while pharmacies have been selling them for up to $25. Either way, keeping tests in stock is the problem. Here’s the situation as of Tuesday, Dec. 28. Though the landscape may have shifted by the time you read this, below are places to keep on your radar as shipments filter in.
    At-home tests serve primarily as an initial screening. Positive results should be promptly followed up with a more accurate PCR test.

    Provincetown

    Town hall offered rapid, at-home tests to all on Tuesday, Dec. 21 — for two hours. Town residents claimed all 180 that morning, and the town’s stock, according to Assistant Town Manager David Gardner, was emptied. Officials are working on securing more kits from the county.

    The town’s stash consisted of kits that remained from the 4,800 issued by the county during the July cluster, said Health Agent Lezli Rowell. The kits were due to expire on Dec. 17, so “we allowed folks who came in last week to take as many tests or boxes as they felt comfortable using with the known expiration date, rather than discard them,” Rowell said.

    Rob Scott takes a break from wood carving to get his Covid-19 booster shot at the CVS in Provincetown. (Photo Nancy Bloom)

    The supply at CVS Pharmacy ran out swiftly before Christmas. On Dec. 26, the branch was restocked. Shoppers were limited to six kits per purchase to ensure equitable access, said Joe Goode, CVS senior communication director. But as of Dec. 28, this limit dropped to just one kit per person. Each unit costs $24.99.

    If you find that at-home kits are “out of stock” on CVS’s online store, you should still check a local branch. Online availability may not reflect the stock in your neighborhood pharmacy, which might have kits on hand. Temporarily curbing web purchases through “out-of-stock” designations, Goode said, is part of CVS’s effort to retain community-based access to tests.

    Meanwhile, at the Stop & Shop, tests have been sold out for “at least a month,” said pharmacy manager Arthur Januario. When future shipments arrive, Januario said, the store “will be imposing a limit of one per person.”

    “That’s the new toilet paper,” he said — a comment on shoppers’ compulsion to load up in advance of need.

    Neither Adams Pharmacy nor Essentials carry at-home Covid-19 tests. —Michaela Chesin and Abbey Dwight

    Truro

    Truro is currently in the midst of what Emily Beebe, the town’s health agent, calls an “absence of tests.”

    “We have communicated our need for rapid home test kits to the state,” she said, but the town doesn’t expect to receive any until early January.

    This summer, Truro, like Provincetown, secured some kits from Barnstable County to distribute to local businesses. Residents, however, did not receive any. Since then, Beebe, alongside health agents from Provincetown and Wellfleet, have been advocating for “further distribution of test kits,” she said, “but have not yet been successful.” —Jasmine Lu

    Wellfleet

    The town’s health and conservation department has not provided kits at Town Hall for a few months.

    At the Outer Cape Health Services Pharmacy here, as well as in Provincetown and Harwich Port, at-home kits have been “back-ordered indefinitely through our regular medical supplier,” according to Matthew Libby, OCHS’s chief clinical operations officer.

    OCHS is taking steps to provide free Quidel QuickVue at-home test kits to its patients at their regularly scheduled appointments by taking part in the federal government’s Covid-19 Testing Supply Program. Introduced Dec. 15, this is a joint effort of the U.S. Dept. of Health and Human Services and the Dept. of Defense.

    “We expect an initial shipment of test kits to arrive in early January,” wrote Libby. “In the weeks ahead, we also hope to receive a larger supply for community distribution. Once that inventory is in hand, we will announce an access plan for the Outer Cape communities.”

    Those with symptoms can schedule a PCR test on a Tuesday or Thursday in the Wellfleet office from 10 to 11 a.m. In Provincetown, these sessions are offered Monday, Wednesday, and Friday, from 12:30 to 1:30 p.m.

    OCHS does not offer testing for patients going into surgery or planning to travel. Its website recommends scheduling directly with Quest Diagnostics, Cape Cod Hospital, or for preoperative patients, the hospital where they will undergo surgery. —Abbey Dwight and Michaela Chesin

    Eastham

    Earlier this month, the Baker-Polito administration announced they would be distributing 2.1 million tests to 102 Massachusetts communities with the highest proportion of residents living at or below the federal poverty level. On Dec. 20, Eastham distributed 810 rapid at-home tests.

    Town health agent Jane Crowley could not be reached for comment by deadline. —Cam Blair

    Orleans

    Orleans was another town that received tests from the Dec. 20 state-issued stock. Alexandra Fitch, the town’s health agent, could not be reached for comment regarding this rollout.

    Both CVS Pharmacies in town, one located in Skaket Corners Plaza and another on Main Street, were stocked with at-home Covid-19 test kits before Christmas.

    On Dec. 24, people were seen flocking to both locations to purchase the QuickVue at-home test kits available in advance of an anticipated shortage. Both pharmacies quickly sold out of the kits that day.

    No kits were available at the stores on Monday or Tuesday this week, and staff posted signs on the doors to let customers know. An employee at the CVS on Main Street said Monday that the pharmacy hadn’t received any test kits in a delivery of products that morning, and she did not know when they would be restocked.

    The Walgreens, also sold out, was “expecting more on Wednesday,” according to a store representative. —Ryan Fitzgerald

    COVID PREVENTION

    After Mandates, Few Cape Health Workers Remain Unvaccinated

    98 percent of OCHS employees have been immunized

    By

    Very few health-care workers on Cape Cod have been fired for refusing to comply with vaccine mandates, according to spokespeople at three major providers.

    The vaccination rates among staff at Outer Cape Health Services, Cape Cod Healthcare, and Spaulding Rehabilitation are now all reported to be at or above 96 percent. Unvaccinated workers were granted exemptions for religious or medical reasons.

    Outer Cape Health Services, with clinics in Provincetown, Wellfleet, and Harwich Port, reported that 98 percent of its employees are fully vaccinated. Five of OCHS’s 250 employees applied for and received exemptions and are tested weekly, according to Senior Communications Officer Gerry Desautels. No staff were let go for failing to comply, and vaccination is required for all new hires, he said.

    OCHS employees who sought religious exemptions were required to provide “a statement of their belief and the religion or religious doctrine it is based in,” Desautels said in an email. Those exemptions are protected under Title VII of the Civil Rights Act. In August, the Diocese of Fall River announced it would not issue letters for members of the Catholic Church seeking a religious exemption.

    Those who applied for disability exemptions were required to submit a letter from a health-care provider within the scope of the provider’s practice “citing the specific reason as to why they cannot medically receive the vaccine.” People with permanent disabilities seeking exemptions are protected under Title VII of the Civil Rights Act and Title I of the Americans with Disabilities Act, Desautels said.

    According to the federal Centers for Disease Control and Prevention, only a handful of rare allergies make the Covid-19 vaccine unsafe. “Like one in a million,” Dr. Peter Chin-Hong told CBS News in September.

    Desautels said that, for confidentiality reasons, he could not disclose whether the five OCHS employees who received exemptions have direct contact with the public.

    One hundred percent of staff at Spaulding Rehabilitation’s Orleans and Hyannis facilities are vaccinated, according to Director of Communications Timothy Sullivan. Not every staff member is vaccinated at Spaulding Rehabilitation Hospital in Sandwich. But, Sullivan said, the number there is in line with the 99.3-percent compliance rate at Mass General Brigham, which owns Spaulding.

    Sullivan said that no employees were fired at Spaulding in Orleans or Hyannis, but some employees in Sandwich were. He said that the number of fired workers was in line with Mass General Brigham’s organization-wide figures. The parent company, which has 80,000 employees, terminated 430 of them (0.5 percent) for choosing to remain unvaccinated. Last month the Supreme Court rejected a challenge to Mass General Brigham’s vaccine mandate brought by a group of the fired employees.

    Cape Cod Healthcare had over 200 of its more than 5,000 employees claim exemptions, according to Senior Vice President of Communications Patrick Kane. In September, before the mandate was in effect, the Cape Cod Times reported that the number of unvaccinated employees was 500. Kane declined to say where the remaining unvaccinated employees who claimed exemptions work. Cape Cod Healthcare runs Cape Cod Hospital and Falmouth Hospital and has over 100 other facilities from Orleans to Bourne. Kane did note that four employees declined to follow the mandate and left the organization.

    Desautels and Sullivan both noted that their organizations had strong vaccination numbers among staff even before the mandates. Nationally, health-care workers are more likely to be vaccinated than ordinary Americans, but prior to the mandates in September, 30 percent of health-care workers were unvaccinated, according to the CDC.

    Each of the three Cape health organizations implemented their own private mandates separate from those taking place at the government level. Those mandates are ensnared in legal challenges. The Biden administration’s vaccine mandate for facilities participating in Medicare and Medicaid programs, announced this fall, is currently being challenged in Missouri and Louisiana federal district courts. The Centers for Medicaid and Medicaid Services stopped enforcing that mandate, which applies to 17 million health-care workers, on Dec. 2.

    The administration’s plan to require Covid vaccinations for private companies with 100 or more employees, issued by the U.S. Occupational Safety and Health Administration, is also on hold. On Nov. 6, a New Orleans federal appeals court said the order was too broad, calling it a “one-size-fits-all sledgehammer.” That mandate would apply to 84 million American workers.

    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.

    LOSING IT

    With Cases Up, Wellfleet Again Imposes Masks

    14-day Covid incidence rate is among highest on Cape Cod

    By

    WELLFLEET — Town officials imposed an indoor mask order for the second time on Nov. 17, after a meeting at which the police chief cautioned that the on-again, off-again orders were contributing to pandemic stress and that some people were “losing it.”

    At the end of the online meeting, board members’ own stress was apparent as tempers flared.

    The board of health and the select board voted jointly that evening to order mask-wearing in public indoor spaces indefinitely (though diners may still remove their masks when seated inside restaurants). Violation of the order is not a criminal offense, but fines of $100 to $300 can be assessed for repeated defiance.

    Board of health chair Ken Granlund voted against the order, saying he has always been opposed to mask mandates.

    Health board members Janet Drohan and Nick Picariello voted for it. Two members of the board, Deborah Freeman and Gary Locke, did not attend the virtual meeting. On the select board side, Helen Miranda Wilson, John Wolf, and Chair Ryan Curley voted for the order, while Janet Reinhart abstained and Mike DeVasto, who was driving, lost phone reception before the vote.

    Their decisions followed a report by Wellfleet Health and Conservation Agent Hillary Greenberg-Lemos on the rising number of Covid-19 cases in Wellfleet.

    Barnstable County 14-day average Covid daily incidence rate as of Nov. 18. (Source: Mass. Dept. of Public Health)

    Virus testing data from the state Dept. of Public Health as of Nov. 18 showed that, at 28.5, Wellfleet had the second highest 14-day average incidence rate in Barnstable County. Only Harwich, at 30.6, was higher. The 14-day average incidence rates of other Outer Cape towns were markedly lower: 6.2 in Eastham, 5.5 in Provincetown, and zero in Truro.

    As of Nov. 17, when the two boards met, Wellfleet had 11 cases. More than half involved vaccinated residents, Greenberg-Lemos said. Five of the cases were in two households, and the other six were in separate homes, for a total of eight households dealing with infections.

    “It doesn’t appear that these folks are transmitting out in the community wildly because half our cases are within two households,” Greenberg-Lemos said.

    Drohan said the rising case count warranted a mask mandate, even though, as Greenberg-Lemos said, it wouldn’t affect gatherings in private homes.

    “Unfortunately,” the health agent said, “no matter what we do with a mask mandate or a mask advisory, we are not going to stop gatherings and parties where we are seeing the actual transmission.”

    Wellfleet, like many other towns throughout the state, has been yo-yoing between mandates and less strict advisories all fall.

    The mandate-to-advisory dance, added to everything else about the Covid-19 pandemic, has created an emotional pressure cooker, said Police Chief Michael Hurley.

    The pandemic is worsening “mental health issues, substance abuse, anxiety, and stress,” Hurley said. “I think some of the mask on, mask off is contributing to it.”

    Whatever happens, he said, a question to consider is “how do we advance this to the next step to tamp down some of this anxiety.”

    A year ago, people appreciated the attention to detail on the mask rules and health advisories, said Hurley. But lately, he said, judging from social media, “the postings are getting a little gnarly.”

    Comments include “Leave me alone. You know what: I’m vaccinated. Let’s move forward,” the chief said.

    The other day, Hurley reported, the police received a 911 call “where a confrontation ensued when one party spit on another, claiming they had Covid. I mean, it’s real and it’s out there in the community. I don’t have all the answers, but I just want to throw that perspective out there tonight.”

    Curley said going back and forth with mandates based on small shifts in data is not good policy. He argued for imposing the mask mandate indefinitely and requiring a joint meeting of the board of health and the select board to change it.

    Wolf said setting a mask mandate at least through the holidays made sense.

    “Does it mean that businesses are going to remind people? Yes,” Drohan said. “But it does not mean that the high-risk situations are going to have any more compliance.”

    In the end, Drohan said, the two boards needed to come up with ways to educate people to make the right personal decisions.

    Personal choice stood at the heart of Granlund’s argument against reinstating the order.

    “Truthfully, I’m not in favor of a mask mandate,” Granlund said. “I never have been. I’m not sure why we can’t allow people to have their own personal responsibility instead of forcing something upon the populace. Like the chief said, people are losing it. You have kids that don’t see people smile.”

    “In a pandemic like this, I don’t know if we can depend on personal responsibility,” said Picariello. “I think someone has to take leadership and provide guidance, because the stakes are too high.”

    Granlund also objected to requiring a joint meeting to remove the mask order.

    “I don’t want to have to come back to the select board to do this kind of meeting again,” he said.

    To which Curley replied, “I mean — respectfully — tough.”

    When the health board members voted two to one in favor of the order, with Granlund in dissent, he announced, “It fails.”

    Several board members had to explain to him that the majority rules.

    Curley then said, “I think you need to reassess who is your chair.”

    At that point, Granlund responded with vulgarities, and said, “I think I am going to resign.”

    “Well, good, we don’t need this kind of leadership,” said Wolf.

    Following the meeting, Granlund did not respond to a request for comment. As of press time, it was not clear if he was still a member of the board of health.

    COVID-19

    A Death in Wellfleet, as Case Numbers Gradually Decline

    A total of 12 cases so far at Wellfleet Elementary

    By

    WELLFLEET — The number of new cases of Covid-19 was down slightly this week, according to the town’s health agent, Hillary Greenberg-Lemos, following the emergence of a cluster of cases that worried officials and led to the reinstatement of town-wide mask rules at an emergency meeting of the board of health on Oct. 7.

    That good news was tempered, however, by the fact that a Covid-related death — the second in Wellfleet since the pandemic began — was reported on Oct. 17.

    As of Tuesday, Oct. 26, there were 13 reported cases of Covid infection in Wellfleet, down from 31 active cases two weeks earlier, according to the health agent.

    While Wellfleet requires that masks be worn indoors everywhere in town, Greenberg-Lemos said, the town has not yet deployed any vaccine-focused strategies such as the voluntary “Stop the Spread” certificate program instituted in Provincetown after a July outbreak there. In Provincetown, businesses can opt into the program and receive certification from the town’s board of health verifying that the managers require all staff to be vaccinated, or require proof of vaccination to enter, or both.

    Employers in Massachusetts may require their employees to be vaccinated, but calls to several businesses in town suggested that it is not common practice here.

    The Wellfleet Marketplace, Box Lunch Wellfleet, and the Wellfleet Cinemas all confirmed that they are not asking employees to be vaccinated.

    The cinemas “did invest $10,000 in a better filtration system,” said John Vincent, president of Wellfleet Theaters.

    The Blue Willow Cafe was the only business reached in town that had an employee vaccination policy in place. Other establishments said such a policy wasn’t needed.

    JB’s Pizza and Bar manager Ylli Sadiku said he didn’t require it, but his staff is fully vaccinated. “We requested them to get vaccinated because we are a pizza place and a lot of people are in and out,” he said. “We have a very nice staff and they all complied easily.”

    On the door of the Bomb Shelter Pub, a sign honors the late Caroline Parlante. (Photo Michaela Chesin)

    “Unfortunately or fortunately, we had a Covid scare back in April and that took care of any staff reticence towards the vaccine,” wrote Eliza Fitts and Ken Kozack, owners of the Wicked Oyster, in an email to the Independent. “Now our whole staff is vaccinated, so we haven’t had to put a mandate in place. Going forward, we would want and expect potential new hires to be vaccinated.”

    Several other establishments, including CShore and the Bookstore & Restaurant, did not respond to inquiries from a reporter by press time.

    The Bomb Shelter Pub, in the basement of the Bookstore & Restaurant, closed a few days after the death on Oct. 17 of owner Caroline Parlante from sepsis related to Covid-19 pneumonia, according to her death certificate. On the door of the bar was a notice about a celebration of life in her honor, and a sign stating the business was closed. (See obituary on page A14.)

    In the Schools

    Wellfleet Elementary School nurse Claudia Cope-Crosen reported two active Covid-19 cases this week, marking 12 cases in total so far this school year. Several of those students live in the same household, she said. She added that she is contact-tracing several more potential cases, yet to be confirmed.

    “This is way different than what happened last year,” said Cope-Crosen. “I was completely prepared for this last year. We had all of the safety protocols in place.”

    The school had a total of four Covid cases in the last school year. Cope-Crosen attributed the uptick two months into the school year to students being present in person all day every day, with no option of remote learning, and to the increased contagiousness of the Delta variant.

    So far, the nurse said, the students’ cases have been mild, with many showing cold-like symptoms for a few days. She noted that many cases don’t seem linked. “I’m not seeing a common thread, like a super-spreader event,” she said.

    The school has adopted the state’s “Test and Stay” program for students in “close contact.” The state Dept. of Education defines “close contact” as being within six feet of a Covid-19 positive person while indoors for at least 15 minutes during a 24-hour period.

    The “Test and Stay” program, initiated on Oct. 5 after a positive case was identified in the fifth grade, involves collecting nasal swab samples from students using the BinaxNOW rapid antigen test, Cope-Crosen said. One case has been identified through the program, and two students were identified as close contacts who shortly after become symptomatic, she added.

    Tests are administered daily from the first day of exposure for at least five days. The program applies only to close contacts identified at school, not if the student was exposed outside the school, Cope-Crosen said.

    In case of a positive case in school, the nurse sends a notice to families saying whether their children were identified as close contacts or not. “The schools tend to know much more quickly in the contact-tracing world than the state,” she said, “typically because parents contact the nurse directly.

    “It’s important for parents to not send their kids to school if they’re feeling sick, and it’s really important for parents to not underestimate and say, ‘It’s just allergies,’ ” she added.

    Outside the Test and Stay program, Outer Cape Health Services provides free testing weekly in both Provincetown and Wellfleet.

    PANDEMIC

    Outer Cape’s Covid Infection Rates Remain Low

    Those who got the Pfizer vaccine and are over 65, or at risk, can now get boosters

    By

    PROVINCETOWN — Three months after a steep rise in Covid-19 cases tied to Provincetown’s 4th of July weekend crowds, the number of cases on the Outer Cape is low compared to other regions of the state.

    Thirty-five new cases of the virus have been reported in all of Barnstable County in the last 30 days, according to the state’s database.

    There are nine active cases in Eastham, Director of Health and Environment Jane Crowley said on Monday, Oct. 4.

    There are six active cases in Wellfleet and four probable cases, according to a statement from town Health Agent Hillary Greenberg-Lemos on the morning of Tuesday, Oct. 5. “Confirmed active cases” are those reported following positive results from PCR tests, whereas “probable cases” are those that follow positive results from rapid antigen tests and are still awaiting results from PCR tests.

    Four active cases were reported in Truro’s Oct. 2 report, the most recent update from that town.

    There were just two active cases in Provincetown, according to the health department’s website, updated on Monday afternoon, Oct. 4.

    As of Monday, Barnstable County had an overall 2.8-percent positivity rate, according to data from the Centers for Disease Control and Prevention. The “positivity rate” is the percentage of all coronavirus tests performed that yield positive results.

    According to the Johns Hopkins Bloomberg School of Public Health website, the positivity rate is a critical measure not only because it indicates how widespread infection is in the area, but also whether levels of testing are keeping up with levels of disease transmission. A high positivity rate can mean that the number of total tests is too low.

    Booster shots to supplement the Pfizer Covid-19 vaccine are now available at local pharmacies to people 65 and over and to people 18 to 64 with underlying medical conditions. Employees who work in settings with increased risk of Covid-19 transmission are also eligible. This includes front-line health-care workers employed at hospitals, nursing homes, and health clinics.

    To find out where to get a shot, go to vaxfinder.mass.gov and fill in your zip code. A list of pharmacies will pop up. Only the Pfizer booster vaccine is available at present, while the Moderna and Johnson & Johnson booster vaccines are still awaiting FDA approval, according to the database.

    Patients of Outer Cape Health Services are asked to stop in or call to book an appointment and to present their vaccination cards when they arrive.

    “People in the recommended groups who got the Moderna or J&J/Janssen vaccine will likely need a booster shot,” said Outer Cape Health Chief Medical Officer Andrew Jorgensen. “More data on the effectiveness and safety of Moderna and J&J/Janssen booster shots are expected soon.

    “Immunocompromised individuals may receive a third dose of the Moderna Covid‑19 vaccine,” Jorgensen added. “It is important to note that this is not a booster. It is a third vaccination shot. This Moderna third shot for immunocompromised individuals can be given at least one month after the second Moderna dose,” he explained, noting that, at Outer Cape Health Services, “We advise patients to first consult with their clinicians to determine eligibility.”

    Booster recipients need to be six months out from their second Pfizer shot, OCHS Senior Development and Communications Officer Gerry Desautels said.

    “There’s definitely a lot of interest, just as there was initially for the vaccination,” he said.

    NOT SO RAPID

    As Delta Wanes, So Do Easy Testing Options

    Still, the choices appear to provide ‘an early warning system’

    By

    PROVINCETOWN — The Delta variant of Covid-19 arrived in Provincetown like a hurricane. There was fear, economic devastation, a news camera on every corner, even a catchy name: the Provincetown Cluster.

    The cluster ended as hurricanes often do, with a long stretch of surprisingly calm days. Case numbers fell quickly and have stayed quite low. Provincetown’s mask mandate was suspended on Aug. 31 and something more like ordinary life resumed.

    As of Provincetown’s last update, posted on Sept. 13, there were seven “active cases” in town — a local metric that includes confirmed and probable cases in both year-round and seasonal residents.

    As of Sept. 18, Truro had six “active cases.” Eastham had seven confirmed cases in the two weeks ending on Sept. 11, and Wellfleet had fewer than five. (“Confirmed cases” are those identified by molecular PCR tests, rather than by rapid tests.)

    Against the background of Delta’s spread across the rest of the country, especially in the South and Plains states, the whole Northeast has exceptionally low case numbers. The state pulled its mobile testing van out of Provincetown on Sept. 6 because the positive test rate had been low and stable for weeks.

    That van offered free PCR tests for five hours a day, seven days a week, for the eight weeks it was here. Now, there is no single every-day location for people on the Outer Cape to get a Covid test. Instead, there is a constellation of sources: health-care providers, pharmacies, county sites, online deliveries.

    Outer Cape Health

    Outer Cape Health Services has been the primary testing resource on the Outer Cape since at least December, when the state started delivering a free supply of BinaxNOW rapid antigen test kits. Drive-through testing hours are 12:30 to 1:30 p.m. on Mondays, Wednesdays, and Fridays in Provincetown, and 10 to 11 a.m. on Tuesdays and Thursdays in Wellfleet.

    Because it is a health-care provider, however, rather than a standalone testing clinic, OCHS has some protocols that other kinds of testing sites do not. People with symptoms may require a telehealth screening to assess their symptoms and other possible causes of illness. And people who are not OCHS patients may be asked to fill out a patient-intake form before being tested.

    “We do test non-OCHS individuals … who are from here or out of town,” said OCHS Communications Director Gerry Desautels. People who live elsewhere, or who have a different health-care provider, can still get a test. But they will need to fill out forms for care authorization and for contact tracing, said Desautels. Drive-through appointments can be scheduled by calling 508-905-2888.

    Rapid tests at OCHS are always free. PCR tests, which are often required for large events or international travel, are $110.

    Eastham Police Dept.

    The Barnstable County Health Dept. is running a new once-a-week free testing clinic at the Eastham Police Station on Tuesdays from 2 to 4 p.m. It is staffed by volunteers from the Cape Cod Medical Reserve Corps and offers PCR tests.

    Cape Cod Healthcare

    The closest guaranteed seven-days-a-week testing resource to the Outer Cape is Cape Cod Hospital in Hyannis. Its community testing program offers free drive-through testing to everyone, symptomatic or not, every day from 7:30 to 11 a.m., and weekday afternoons from 3:30 to 6. The PCR tests are processed at an onsite laboratory and deliver results within 24 hours.

    Cape Cod Healthcare also offers a new rapid PCR test at its urgent care centers, including the one in Harwich. The Abbott ID Now is “a different type of PCR technology than RT-PCR,” according to capecodhealth.org, “which allows for more rapid turnaround, and results are available in 15 minutes.” An ID Now test costs $125.

    Through the Mail

    The state government has also endorsed a through-the-mail testing option offered by Labcorp.   A link from the state’s testing website now leads to pixel.labcorp.com/ma-testing, where it’s possible to enter insurance information and receive a free PCR test kit via FedEx. Testing is billed either to insurance or to the federal government, according to the website.

    In fact, nearly all the testing locations described so far are funded in roughly similar ways: by insurance when possible, and otherwise by the federal government’s Covid funds. Insurance companies are prohibited from passing along co-pays related to Covid testing.

    Where Are the Rapid Tests?

    Many of the pharmacies in Provincetown, Orleans, and towns farther up Cape sell rapid tests over the counter, but they are often out of stock.

    One Cape Cod CVS lets customers know that rapid-testing kits for home use are in short supply. (Photo Nancy Bloom)

    On Tuesday, Sept. 21, at the deadline for this edition of the Independent, there were no rapid antigen tests available for sale on Amazon.com. (There were three through-the-mail PCR testing kits available, and at least five books about Covid tests.)

    This was partly because rapid tests are becoming a major tool for large employers. The Biden administration’s new vaccine mandate for large private employers includes a weekly testing alternative for those who remain unvaccinated. Many of those weekly tests are likely to be rapid tests.

    Provincetown’s weekly testing alternative for unvaccinated staff, for instance, will be a state-provided supply of BinaxNOW rapid tests, according to Town Manager Alex Morse.

    Likewise, many school systems are moving toward rapid testing of students who are exposed to Covid, rather than forcing all exposed students to quarantine at home. Massachusetts is one of the first states to endorse the “test-and-stay” approach, which involves daily BinaxNOW rapid testing for every exposed student for seven days after exposure.

    These movements toward rapid testing by large institutions could keep the tests relatively scarce on store shelves, at least for a while.

    Is It Enough?

    State Sen. Julian Cyr said he thinks the testing options are more than enough to identify any new outbreak, and that resources could be ramped up if one were to develop.

    “I think we have a good early warning system,” said Cyr. “We were just days away from July 4th and Outer Cape Health Services had picked up on it,” said Cyr, referring to the beginnings of the Provincetown Cluster. “People were coming in with symptoms that they didn’t think were Covid, and the protocols they had in place identified them.

    “We also have wastewater data now,” added Cyr.

    Wastewater testing had been discontinued in Provincetown in spring 2021 but was resumed again during the Cluster. Nantucket’s wastewater testing from Biobot Analytics has tracked and even anticipated that island’s case count with a high degree of accuracy. Provincetown had been participating in a different wastewater testing program through Columbia University and AECOM, but is now also using Biobot tests for its wastewater.

    “I think this community saw the level of resources that will come in when the need is there,” Cyr said. “Until the data show otherwise, I think we need to stay the course, and continue to be focused on increasing vaccinations.”

    In other words, from an individual point of view, finding a test might be a hassle — but from a public health point of view, the amount of testing available now might be sufficient.

    PANDEMIC

    Provincetown Tells Workers: Get Vaccinated or Be Tested

    Eastham will also require tests of unvaccinated staff

    By

    PROVINCETOWN — Town Manager Alex Morse announced a new health policy for town employees on Monday: either Covid-19 vaccination or weekly virus testing will be required.

    The policy will take effect this coming Monday, Sept. 20, for non-union town employees, and shortly after that for union employees.

    “We have two meetings set up next week for collective bargaining, one with the union representing the police department, and one with the AFSCME chapter that represents the DPW workers and some of the clerical employees in town hall,” Morse told the select board.

    “I am not aware of what their exact position is,” Morse told the Independent by email, “but I do know that they wanted to have the weekly testing as an alternative to the mandate.” Since that’s part of the new policy, Morse is optimistic that all employees will be included “very soon.”

    The alternative to vaccination will be a rapid test conducted during work hours, Morse said.

    Meanwhile, in Eastham all unvaccinated town staff will be tested weekly starting Monday, Sept. 20, Town Administrator Jacqui Beebe told the Independent on Tuesday. “The town is providing test kits, and it will be self-administered at the beginning of the work week,” she said. “Some unions have requested that all staff in their unit do the weekly testing.”

    Beebe said a large majority of Eastham town employees were vaccinated. “It seems like we have roughly 12 staff not vaccinated — a 90-percent vaccination rate,” she said.

    Eastham’s policy is therefore, in practical terms, the equivalent of Provincetown’s for now: all town staff will have to be either vaccinated or tested weekly. “The policy will be in effect for four weeks,” said Beebe, “and then we will revisit it.”

    Provincetown’s policy was announced to town staff on Tuesday, Sept. 7 — two days before the Biden administration announced a similar policy that would affect all private companies with more than 100 employees. Those rules, implemented through the federal Occupational Safety and Health Administration, are not binding on state or local governments, however.

    On Sept. 9, President Biden also announced that all federal workers and all independent health-care organizations that accept Medicare or Medicaid funding must implement a full Covid vaccine mandate for their staff, without any option to test instead of vaccinate. Those rules apply to the federal executive branch, including the military, but not to Congressional or judicial employees. They include limited exemptions for religious or medical reasons.

    Locally, the health-care mandate will include Outer Cape Health Services, which had already reached a 98-percent vaccination rate without a mandate, according to Gerry Desautels, communications director at OCHS.

    “We did announce in late July that we would be moving to a mandate, which took effect on Sept. 1,” said Desautels. “Employees who fall under a qualifying exemption under the law are required to get weekly testing. OCHS welcomes the mandate from the White House.”

    Late July was when the American Medical Association and 57 other health-care organizations endorsed a vaccination requirement for all health-care workers. A wave of vaccine requirements were implemented then, including for New York City employees and all health-care workers in California.

    Town Manager Darrin Tangeman of Truro told the Independent this week that “we are awaiting review from our town counsel of the president’s executive order and the path moving forward. Whatever their recommendation, the town is well-positioned to facilitate vaccinations and testing in the future,” he added.

    Tangeman declined to provide information on the vaccination rate among Truro’s staff.

    In Wellfleet, interim Town Administrator Charlie Sumner told the Independent that town officials had “not had any discussions or deliberations about mandatory measures to date. Additionally, I do not have any information on our vaccination rate amongst staff.”

    At the County Level

    Barnstable County government and the Barnstable County Sheriff’s Office are two legally distinct entities. The county government includes the health department that has supervised the region’s Covid response, including many months of vaccination clinics and drive-through testing sites.

    “At this point, there haven’t been any official decisions with regard to the vaccine mandate and how the county will respond,” Barnstable County Health Communications Coordinator Bethany Traverse told the Independent. “We are still waiting for more direction or information from CDC.

    “With regard to employee vaccination rates, that information is not available at this time, but it may become available as we explore how to proceed,” said Traverse.

    According to Sheriff Jim Cummings, “​​we at the Sheriff’s Office have a 78-percent vaccination rate and have no plans to mandate at this time.” The sheriff’s office employs about 340 people, and its primary responsibility is supervision of the county jail in Bourne.

    By Sept. 20, vaccinated employees should have filed copies of their vaccination cards with the town’s human resources dept., Morse told the Independent. “I will then be able to provide more accurate figures, overall and by department,” he said.

    In the meantime, Morse noted that 24 of the 26 year-round employees of the Provincetown Police Dept. are vaccinated.

    “We are one of the first municipalities in Massachusetts to implement an employee mandate for vaccination,” Morse said to the select board. “Reflecting on the president’s decision … it’s obviously a model for both the public sector and the private sector.”

    Legally, the president’s mandate doesn’t bind town or county governments. Over the coming weeks, each government entity will be figuring out for itself what to do next.

    CASE LOAD

    Truro Sees a Jump in Covid-19 Cases and Takes Action

    The town reinstates a mask mandate both indoors and outdoors in crowds

    By

    TRURO — New Covid-19 infections here, some connected to the July Provincetown cluster, have led officials and business owners to reinstate pandemic protocols.

    At the beginning of July, Truro had reported only 57 cases through the entire pandemic, according to the Massachusetts Covid-19 dashboard. By July 31 (the most recent data for cities and towns available on the dashboard), Truro’s total had jumped to 94, about a two-thirds increase in just one month.

    In response, the Truro Board of Health enacted an updated mask mandate for the town on Aug. 3, requiring everyone to wear masks while inside any business or place of assembly. The previous order, which had been in place in some form since early in the pandemic, required masking in municipal buildings and in any business that had its own mask rule. The updated order also says that masks are required in any outdoor gathering of more than 100 people, or where physical distancing is not possible.

    On the day of the health board’s meeting, there were 30 active cases of Covid-19 in town. That, according to Truro Health and Conservation Agent Emily Beebe, is the largest number of active cases the town has seen.

    “For our little town, it’s a bigger impact,” Beebe said at the meeting.

    The rise in cases, Beebe said, is at least partially connected to the Provincetown cluster. But relaxed behavior by residents was also a factor, she said.

    According to guidance from the Centers for Disease Control and Prevention, fully vaccinated people should wear masks in areas with “substantial or high” levels of transmission. Barnstable County has had substantial or high levels since July 19, according to the CDC’s Covid-19 data tracker.

    At an emergency meeting on Aug. 6, the board of health unanimously approved amendments to the order, adding specific language about what venues require masks. The draft of the order considered at the Aug. 6 meeting also said that the mandate would be in place until rescinded by the board, which was expected to happen after Sept. 7.

    All language about an end date for the mandate was removed at the request of Beebe. Board of health chair Tracey Rose agreed with Beebe: “As we know, it’s an ever-changing situation,” she said.

    Beebe previously told the Independent that a stricter mask mandate was unlikely, despite Provincetown adopting an indoor mask mandate on July 27. But as cases continued to rise in Truro, she said, she was seeing unmasked customers in stores. That changed her thinking.

    “When we see community case counts going up every day, we have to look at the risk,” she said. “It became evident that folks weren’t going to do this willingly.”

    Beebe also said she had heard from business owners that a mandate from the town would help them with customers who were resistant to masking.

    “It’s easier to have the power of the town behind you,” said Kristen Roberts, one of the owners of Truro Vineyards, a week after the mandate was enacted. “When it was just our rule, it was a little bit more of a struggle with some customers.” Truro Vineyards began requiring masks again a week before the town adopted the new mandate.

    Frank Grande, owner of Box Lunch in Truro, finds masks uncomfortable. But he’s happy to wear one to keep everybody safe. (Photo Ben Glickman)

    Not all customers were happily compliant with the rule: Roberts said that one customer walked up to the front door, read the “masks required” sign, and left.

    Frank Grande, owner of the Truro Box Lunch, said he had also seen customers leave after being asked to wear a mask.

    “I think everyone is fed up,” he said. “Some people are going to fight it.”

    But Grande said the board of health made the right call on the indoor mask mandate “for everybody’s safety.” He finds masks uncomfortable, but “I can deal with it a little bit longer if it will keep everybody safe,” he said.

    At Savory and the Sweet Escape, masking was required before the order. Owner Diane Brigham-Costa said the mandate was “the right thing to do.”

    In some ways, Brigham-Costa said, being in business this year is more challenging than last year. “Last year, everyone was understanding of changes as they came,” she said. “This year, they don’t really care.”

    As of the Independent’s deadline on Aug. 10, there were 13 active cases in Truro, and there had been no new infections since Aug. 6. Beebe said the declining case number was a good sign that people had become more cautious with their behavior.

    “It looks like people remembered the mitigation methods that worked,” Beebe said. What’s important now, she added, is that people remain vigilant so that the town does not see another spike in cases.

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