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Covid-19 testing

    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.

    CHASING THE NUMBERS

    State Undercounts Outer Cape Covid Cases

    Rapid test results are not included in state reports

    By

    covid2
    The state’s Covid dashboard includes only “confirmed cases,” which come from PCR tests, and doesn’t include the results of free rapid testing offered by Outer Cape Health Services. (Source: Mass. DPH)

    PROVINCETOWN — The Covid testing program at Outer Cape Health Services (OCHS), which relies on rapid BinaxNOW tests provided by the state, has been a local success story. The tests are free, appointments are available, and the wait time for results is often less than two hours.

    “I think it’s tremendously valuable,” said state Sen. Julian Cyr, “particularly since 60 percent of the people testing positive have been asymptomatic — people who wouldn’t have known they were carriers.”

    But because rapid tests (also called antigen tests) once had a poor reputation for accuracy — mostly for false negatives — the state classifies their positive results as “probable cases.” Only molecular PCR tests, which cultivate viral RNA through dozens of growth cycles in a laboratory, yield “confirmed cases.”

    Most state metrics include only “confirmed cases,” including the Dept. of Public Health’s published reports on cases in each town.

    covid1
    Provincetown’s “blue box” reports active and recovered cases of Covid and includes rapid test results. (Source: Provincetown Health Dept.)

    That means the thousands of rapid tests that have taken place at OCHS since Dec. 23, and the dozens of positive cases they’ve uncovered, aren’t included in the state’s town-by-town data report. And for towns that rely mostly on rapid tests, state reports of testing rates, percent positivity, total infections, and recent cases are all going to be inaccurate.

    The DPH reports data this way because the state overwhelmingly relies on PCR tests. Since the pandemic began, Massachusetts has tallied 15 million PCR tests, and only 530,000 rapid tests. On one recent day, Feb. 11, there were 118,372 PCR tests and only 2,841 rapid tests statewide, the latter accounting for just 2 percent of the total. Rapid tests are just a rounding error for Covid data in most parts of the state.

    But on the Outer Cape, they’re the principal testing resource, so their exclusion distorts the count significantly. Town and county leaders are taking a variety of approaches to the problem.

    Positively Unreported

    Provincetown’s health dept. reports “active cases” and “recovered cases” on the town website. Active cases include both those discovered by PCR and by rapid testing, according to Health Director Morgan Clark.

    Provincetown’s total of active and recovered cases reported on its website was larger than the state’s case number even before the advent of rapid testing, because Provincetown has taken a more expansive view of residency.

    “The town reports any confirmed positive case where a person resides in Provincetown during their isolation and treatment,” said Clark in November. Anyone that the health dept. is managing, regardless of permanent residency, is included in the “blue box” tally on the town’s website.

    Truro takes a similar approach, but posts only active cases on its website, not recovered cases. This number includes confirmed and probable cases, Health Agent Emily Beebe said. Truro doesn’t maintain a “recovered” category because the state can reallocate cases as people’s residencies change, she added.

    Indeed, the state’s weekly Covid report says “case counts for specific cities and towns change throughout the day as data cleaning occurs and new demographic information is obtained.”

    In January, Eastham started reporting totals of confirmed and probable cases. “We have recently started reporting probable cases due to the increase in availability of the antigen tests,” the town’s website says. “Our objective is to inform the public,” said Eastham Health Director Jane Crowley.

    Wellfleet Health Agent Hillary Greenberg-Lemos said she is happy to report Wellfleet’s case counts to anyone who calls or emails for the information, and she reports them at select board meetings as well. She gets the numbers directly from the state’s contact tracing system, MAVEN, and includes both confirmed and probable cases in her tallies.

    Greenberg-Lemos said there were 10 new cases in the two weeks ending Feb. 2, and another five new cases in the two weeks ending Feb. 16.

    Having multiple sets of numbers is confusing. At press time, Provincetown’s all-time case total was 81 on its website, while the state says 60. Eastham reports an all-time total of 132, while the state says 105. Provincetown’s health dept. has released multiple statements to the public explaining how the numbers work.

    The Independent asked the county to produce a town-by-town report that includes both PCR and rapid test results, but it declined, because, said Sonja Sheasley, communications manager for Barnstable County, “All hands are dealing with a surge in confirmed and probable cases, and with vaccine planning and implementation.”

    The case numbers live inside MAVEN, and only a few people have access to that system. Until Cape Cod’s vaccine crisis has abated, the case reporting situation is likely to remain tangled.

    COVID AND SCHOOLS

    Provincetown Students Head Back to Classrooms

    Three positive cases lead to two-week quarantine

    By

    PROVINCETOWN — Students in pre-kindergarten through 8th grade are on track to return to school on Monday, after a staff member’s positive Covid test prompted a 14-day switch to remote learning that began in the last week in January.

    “We had several members of the school community who were symptomatic in addition to learning that we had at least one positive case,” said Supt. Suzanne Scallion in an email. “We have since learned we have two additional positive cases and are working with the Board of Health and Department of Education.”

    It was the first time since opening last fall that all students were put on remote learning. “We have had single classes quarantine out of an abundance of caution when there was any suspicion of Covid or while awaiting known contacts,” the superintendent said.

    Scallion said the plan will be re-evaluated at the end of this week to make sure Monday’s return to school remains safe. All grades will resume the ongoing hybrid model of in-house classes on Mondays, Tuesdays, Thursdays, and Fridays, and remote classes on Wednesday to allow for a deep cleaning of the two school buildings.

    A new protocol will be in place for students and staff. The state is picking up the cost for a pool testing program over the next eight weeks along with the addition of a per diem nurse, Scallion said.

    Short Q-tips will be used to swab the nostrils of students and staff at the school. In many cases, students can do their own swabbing, she said. The Q-tips will be bundled into batches of 24, which will then be tested by the state. Positive results would prompt further testing of individuals and staff within that bundle.

    Parents can opt out for their students, but Scallion plans to strongly urge participation.

    The quick switch to full remote learning at the end of January didn’t present many challenges, according to Scallion, since classes are already remote one day each week.

    David McGlothlin and Beth Francis, co-presidents of the local teachers’ union, the Provincetown Association of Educators, had only positive comments about the current school year.

    “Our two buildings just went through a major renovation of their air systems, so we don’t have a lot of concerns other schools have with aging buildings,” McGlothlin said. “I have family members in other school districts and, compared to the stories I’ve heard, Provincetown has done an amazing job of keeping safe.”

    The size of the buildings and small school population also allows for effective social distancing, the union leaders said.

    “We’ve been working hard, and everybody has supported each other,” Francis said. “Our size allows us to respond almost immediately to needs and concerns.”

    Students will have classes during the next week, but then have school vacation the week after that.

    Nauset School District Supt. Thomas Conrad shifted to fully remote learning at Stony Brook Elementary School and Eddy Elementary School, both in Brewster, on Jan. 28, “in the interest of public health,” according to the district’s website. The students won’t return to school until Feb. 22.

    “It is our hope that during the period of remote learning and school vacation that the cycle of increased transmission will have subsided,” wrote Conrad.

    In the final week of January, three Falmouth students, two Mashpee students and one staff member, two students in the Dennis-Yarmouth district, and three Barnstable staff members tested positive for coronavirus, according to the state Dept. of Elementary and Secondary Education.

    TESTING, PART 7

    Free Rapid Covid Testing Extended to Feb. 28

    Asymptomatic testing is finding new cases every day

    By

    PROVINCETOWN — Free asymptomatic coronavirus testing will continue on the Outer Cape. The free rapid-testing program that began here on Dec. 23 was scheduled to end on Jan. 10 and be replaced by a sliding-scale program that would cost most patients $75 per test. But Outer Cape Health Services (OCHS) has received permission and supplies from the state to continue offering free access to BinaxNOW rapid tests until at least the end of February.

    Demand for the tests has been high, and testing asymptomatic people has helped uncover new cases. According to OCHS CEO Pat Nadle, the expanded testing has been finding three to six new cases a day, and about 60 percent of newly discovered positives have been asymptomatic people.

    “Because of the testing that’s available at Outer Cape Health Services, people who would not know that they are carriers now know about it,” said state Sen. Julian Cyr. “That’s tremendously valuable.”

    Before the expanded program, OCHS was giving tests in Wellfleet and Provincetown but only to about 25 to 30 people per day. Only those with symptoms or who had been identified by a contact tracer could get tested, because those are the categories of tests that insurance companies are obligated to pay for. Even if asymptomatic people were willing to pay $150 for a Covid test, they still had to drive to private pharmacies or urgent-care clinics in the mid-Cape to get one.

    Now, with the protocols expanded to include asymptomatic people, and with testing free for everyone, OCHS is averaging more than 100 tests per day, said Nadle. Testing takes place at drive-through tents in Wellfleet, Provincetown, and Harwich Port.

    “Opening to the asymptomatic, or the folks who were worried about their contacts, we have determined that it drove our positive results,” said Nadle. “Probably about 60 percent of our current positives have been in that category. I think we have learned a lot over these last two weeks. Our team has worked really hard — the volume has been about twice what we expected.”

    “It’s taken us a long time to get here with this testing,” said Cyr, “but finally it’s up and running. It’s really important, and I’m grateful for Outer Cape Health Services’ efforts here.

    “I will speak personally,” Cyr continued. “I received a test at OCHS, it was extraordinarily efficient. I had an appointment at 2 p.m., I ran a bit late, arrived at 2:03, was swabbed at 2:06, and got a phone call with my results at 2:37. It’s been an extraordinary effort, and I want to thank Pat and her entire team that have been making this happen.”

    The rapid tests were provided by the state Dept. of Public Health (DPH) to community health centers to support extra testing around the holidays. They were meant to be a temporary supplement to other testing efforts, but Cape Cod has been a “testing desert” for months, deprived of the free state-supported testing that is common in the rest of the state. The continued lack of state-supported “Stop the Spread” free testing sites here may have played a role in the state deciding to supply OCHS with free BinaxNOW tests for an extra seven weeks.

    Rapid antigen tests have not always had a good reputation, but the DPH recommended these particular tests to community health centers for a wide range of uses. The state tested the BinaxNOW against molecular PCR tests at one of its large drive-through testing sites, and found that the BinaxNOW test performed very well, especially at detecting people with high viral loads who were more likely to be contagious.

    Keeping Track of Numbers

    The fact that the Outer Cape will be relying on rapid tests while the rest of the state uses molecular PCR testing will have some consequences for state-reported health metrics, however. The state uses only molecular PCR tests to calculate several indicators, including testing rates, percent positivity rates, and even “confirmed cases.” Since the summer, positive results on rapid tests have technically been called “probable cases,” confirmed Vaira Harik, deputy director of the Barnstable County Dept. of Human Services.

    For contact tracing and other purposes, there is no real difference in how “probable cases” and “confirmed cases” are handled. The state’s weekly Covid reporting is built around “confirmed cases,” however — and that weekly report is the primary source of data for cases in individual towns.

    Wellfleet and Eastham don’t report a town-generated tally of cases; their websites point directly to the state’s numbers. The Barnstable County Health Dept. also draws directly from the state’s reports. Truro and Provincetown, on the other hand, post their own tally of “active cases” on their town websites.

    “The active case count includes people who have received positive molecular PCR or BinaxNOW antigen test results,” said Provincetown Health Director Morgan Clark. The “blue box” on the town’s website includes all cases that Provincetown’s health dept. is managing — including people who are living here now but have a permanent address elsewhere.

    The Independent could not establish by press time exactly which cases are included in Truro’s online tally.

    “It is great news to have more testing capacity for the Outer Cape,” said Eastham Health Director Jane Crowley in response to an inquiry. “We will re-evaluate as new test results come in. Our objective is to inform the public.”

    “The public health data is going to lag,” said Cyr. “I think the most important thing here is, this testing is helping people identify that they’ve been exposed. It’s helping to keep more people safe. Many people would not know they’re positive if we didn’t have this expanded testing.”

    COVID TESTS, PART 6

    Bill That Expands Free Testing Lands on Baker’s Desk

    Asymptomatic frontline workers would be covered

    By

    PROVINCETOWN — A long-running legislative effort to secure free asymptomatic Covid testing for many classes of frontline workers — particularly those employed in health care, restaurants, and retail and hospitality businesses — has passed both houses of the state legislature and is now being reviewed by Gov. Charlie Baker.

    If the governor signs the bill, insurance companies would be required to pay for asymptomatic testing for those workers throughout the state. Under current law, insurance companies are required to pay for testing only for people with symptoms, and for the close contacts of known cases, even though it has been well established that people without symptoms can spread Covid.

    Expanding testing to the asymptomatic has been an ongoing challenge, and this legislation aims to eliminate any financial obstacles by covering such tests with insurance.

    “I knew from talking to my constituents that testing resources for asymptomatic people was a problem,” said state Rep. Sarah Peake of Provincetown, who authored the provision. The four industries that were called out in her amendment — health care, restaurants, retail, and hospitality — together account for the lion’s share of employment on the Outer Cape, particularly in the summer months.

    According to the Cape Cod Commission’s Covid-19 Data Dashboard, those industries together account for 82 percent of Provincetown’s July employment in a normal year, 61 percent in Truro and Wellfleet, and 51 percent in Eastham.

    Provincetown’s average July employment, by industry, according to the Cape Cod Commission. State Rep. Sarah Peake’s amendment would mandate free asymptomatic testing for the vast majority of those working here.

    Peake’s amendment is not limited to workers in those four industries, but it does specifically include them.

    “I drafted and filed this provision with my many constituents in mind who go to work every day (but are often overlooked), like grocery store workers, restaurant staff, and retail workers, who have faced too many challenges getting tested even though they are exposed to the general public every day through their work,” said Peake. “I look forward to the regulations being promulgated, so we can move forward with no-cost-to-the-patient testing.”

    Peake’s amendment was adopted by the state House of Representatives in July, but it was attached to a larger health-care bill, and only on Dec. 22 did the House and Senate reconcile their competing health-care bills and release a final legislative text. The final version of the bill passed both chambers of the legislature this week, and Gov. Baker has 10 days to sign or reject it.

    The current legislative session ends on Jan. 5, and there has been a flurry of final votes on major bills as the deadline approaches.

    Peake’s amendment, now called Section 70, gives the Baker administration authority to work out the details of this expanded testing. The state dept. of health and human services could write the guidelines narrowly, citing limited availability of tests or limited capacity for processing them — or it could write them broadly, perhaps by making greater use of less expensive rapid tests that don’t require laboratories.

    “Now, my work begins again with outreach to drafters of the regulations, so they don’t gut the whole idea,” said Peake. “The insurance companies … tried to weaken and torpedo this effort. They can well afford to cover these costs.”

    Frontline workers like Julie and Frank Grande, taking orders at the Box Lunch in Truro, would no longer have to pay for asymptomatic Covid testing if Gov. Baker signs a bill passed by the legislature. (Photo Nancy Bloom)

    Whether they will, though, and on what terms, is now in the governor’s hands. Section 70 could make way for free testing for the majority of working people here — or, if the administration chooses to minimize it, it could add up to something less comprehensive.

    In the meantime, a temporary free asymptomatic testing program that began on Dec. 23 continues at Outer Cape Health Services in Provincetown, Wellfleet, and Harwich Port. The state has given OCHS a free supply of BinaxNOW rapid tests, which it has approved for symptomatic and asymptomatic people. This free testing program ends Jan. 10; call 508-905-2888 to make an appointment.

    HEALTH

    Free Covid Testing Has Come to Outer Cape Health Services

    Asymptomatic rapid tests are now available at three clinic sites

    By

    tests
    All was quiet on Tuesday, Dec. 22 at the testing tent at OCHS in Provincetown. Free asymptomatic testing is now available by appointment at all OCHS locations. (Photo Nancy Bloom)

    PROVINCETOWN — Until this week, only people with symptoms of Covid-19 and those who have had direct contact with infected people have been able to get tested for the coronavirus at Outer Cape Health Services. Yet it’s well established science that people without symptoms can spread the virus.

    Asymptomatic testing has now finally arrived here.

    The state is giving OCHS a supply of rapid tests — known as the BinaxNOW — that should support almost three weeks of completely free asymptomatic testing at all three OCHS sites from Dec. 23 through Jan. 10, according to CEO Patricia Nadle.

    “If we run low,” Nadle said, “the state has agreed to provide additional tests.”

    These tests detect antigens — proteins that are part of the virus. They are fast, and they’re considered most accurate when they give a positive result, though they can miss some cases where the infection is present but has not yet produced antigens.

    A county-supported testing program offering molecular PCR tests is also expected to reach the Outer Cape soon. PCR tests detect the virus’s genetic material even when the amount is very small and are often used to confirm previous tests. A PCR testing site has already opened in Hyannis. The charge for these tests is on a sliding scale.

    “The BinaxNOW test will be used for both our symptomatic and asymptomatic testing,” said Nadle. “It is a very effective test, and the trust in the result is very high. The only time we would do a PCR to confirm a result is if the provider really thinks that a person has Covid, based on symptoms or exposure, and the BinaxNOW comes back negative. They would do a further PCR test then.”

    The state Dept. of Public Health has issued instructions for the use of the BinaxNOW rapid test. The test, produced by Abbott Laboratories, has received only emergency use authorization from the FDA for symptomatic cases, but the state conducted its own research to validate it for asymptomatic patients.

    At one of the state’s drive-through testing sites, 1,380 people were given both the BinaxNOW test and a PCR test, and the results were compared. The state judged the BinaxNOW test to have “very high sensitivity in adults with high viral loads,” meaning it correctly identifies positives and negatives in the people most likely to be actually contagious.

    “Based on what our providers have been reading, and the release of all this information, they are comfortable with this use, and have high confidence in this testing,” Nadle said.

    Scaling Up Testing

    OCHS has been averaging about 25 to 30 tests per day in December, and only for people with symptoms, said Nadle. People have been calling and asking for asymptomatic testing, she added. She expected her organization will be doing about 50 to 60 tests per day in each of its three locations, once asymptomatic testing has begun.

    Testing in Wellfleet will be on Mondays, Wednesdays, and Fridays from 1:30 to 3:30 p.m. In Provincetown, it will be Tuesdays, Thursdays, and Saturdays from 1:30 to 3:30 p.m. And in Harwich Port, the plan is to do testing on Tuesdays and Thursdays from 1 to 3 p.m.

    If each of those sites is doing 50 to 60 tests per day, that would total 400 to 500 tests per week — roughly double the prior testing rate.

    The testing locations are configured as drive-throughs (or walk-ups) and tests are by appointment only. Appointments can be scheduled with a phone call to 508-905-2888, and are not limited to Outer Cape residents or to prior patients of OCHS.

    What Will Be Found?

    The big question about free asymptomatic testing is this: how many positive cases will be uncovered? If virus prevalence is low, large-scale testing efforts can come up with no cases, as happened on the Outer Cape several times in the summer. If virus prevalence is high, two weeks of free testing might find a lot of cases. Some new light is about to be shed on our situation here, but it’s hard to guess what we will see.

    As of Barnstable County’s Dec. 17 weekly Covid report, there were 5 active cases in Provincetown, 3 in Truro, 8 in Wellfleet, and 11 in Eastham. This is a significant rise from only a month ago, but it is also a much lower prevalence per resident population than almost everywhere else in the state.

    Provincetown’s wastewater testing is one indicator that’s independent of individual tests. The town’s numbers went through a massive spike in the days after Thanksgiving, with readings 4 to 20 times higher than the previous high-water mark, which came the weekend after Election Day.

    But Provincetown’s sewer system readings are affected by people who come to town, visit Commercial Street, and go home, pointed out Morgan Clark, Provincetown’s health director.

    After the Thanksgiving weekend spike, the wastewater numbers came down. But they’re still much higher than they were in November. Free asymptomatic testing is a chance to find out if cases are being missed.

    “One thing I would stress is that some of our cases report mild symptoms,” said Clark. “I’ve been telling people lately there’s no such thing as ‘just a cold,’ or ‘it’s just seasonal allergies.’ Please get tested if you have any of the symptoms of Covid-19. We want people getting tested, especially while these additional testing opportunities are opening up.”

    Editor’s note: This story has been updated to include the beginning date of free testing, Dec. 23, which OCHS could not provide at press time. The story has also been corrected to indicate which days of the week will see testing in Wellfleet and in Provincetown, which had been incorrectly described in an earlier version.

    COVID TESTING, PART 4

    County to Open Affordable Testing Sites

    Falmouth, Hyannis will open next week; OCHS sites to follow

    By

    PROVINCETOWN — Cape Cod’s struggle to get expanded access to Covid testing took a big step forward this week.

    Legislators and county leaders announced that drive-through testing sites will open in Falmouth and Hyannis next week. Pat Nadle, C.E.O. of Outer Cape Health Services, said that asymptomatic testing will begin in Provincetown and Wellfleet the week after that, just before Christmas.

    Testing at these sites isn’t through the state’s Stop the Spread program and won’t be free for everyone. Instead, in order to stretch limited resources, the tests will be billed on a sliding scale, and some tests will be billed to insurance. Local legislators have been agitating for a Stop the Spread site on Cape Cod, because it would offer free, no-appointment testing, paid for by the state. The availability of tests on Cape Cod is among the lowest in the commonwealth, even though a serious outbreak is spreading through the middle Cape.

    On Monday, Gov. Charlie Baker announced five new free testing sites in Western Mass., plus “expanded testing” in Falmouth. A closer look reveals that four of those Western Mass. sites will be Stop the Spread (Great Barrington, Greenfield, Pittsfield, and North Adams), while the sites in Amherst and Falmouth are described as “free community testing.” This appears to refer to the sliding-scale arrangement, in which many people are eligible for free tests, some tests are billed to insurance, and other people pay out of pocket.

    The cost should be less than a commercially available PCR test, although how much less is not yet known.

    “I want to note that not all these tests will be free,” said state Rep. Dylan Fernandes (D-Falmouth). “They shouldn’t cost more than $60 per test, with less expensive options available, and anyone who cannot afford a test will not be turned away.”

    Barnstable County Health Director Sean O’Brien cautioned that the exact numbers for the sliding scale haven’t been fully worked out. “We should have a better idea [of the out-of-pocket cost] by the end of the week,” said O’Brien.

    The tests will cost less than $150, though, because they’re being processed at the Broad Institute, an independent research laboratory affiliated with M.I.T. and Harvard. Broad is charging universities as little as $25 per sample, as opposed to the roughly $100 charged by many commercial labs.

    Making a Lasting Program

    There’s more than $1 million behind the county’s new testing program, but leaders are preparing to stretch that money into the spring. That’s because much of the funding has come from one-time allocations that legislators put into the budget — and the state delayed paying for months. With the money finally in hand, leaders are looking to make it last.

    State Rep. Dylan Fernandes speaks at a press conference at the new drive-through Covid testing site in Falmouth. (Photo courtesy Frank Schulze)

    An earmark of $300,000 was inserted by Rep. Fernandes in July, specifically to support testing in Falmouth. Another $250,000 was earmarked by state Sen. Susan Moran (D-Falmouth), which will go to support the Hyannis drive-through site. Cape Cod Healthcare is matching that $250,000 with a donation. The Hyannis location should be able to process 1,500 to 2,000 tests a week, according to O’Brien and Cape Cod Healthcare C.E.O. Michael Lauf.

    The Barnstable County commissioners voted to release $125,000 from an emergency fund to support the expansion of testing. And state Sen. Julian Cyr (D-Truro) added another earmark to the budget currently being considered. That $200,000 has made it through conference committee, according to Cyr’s office, but the overall budget bill still needs to be passed by the legislature and signed by the governor.

    In total, that would be $1,125,000 for expanded testing on the Cape. That is a significant achievement, representing the coordinated work of many people — but the scope of the problem is vast. At even the lowball price of $60 a test, $1,125,000 would fully pay for 18,750 tests. That’s fewer than the 19,800 people who were tested in Barnstable County in the last two weeks of November.

    The $1.1 million is enough to double testing for two weeks. Then it would be used up. Hence the need for some people to pay on a sliding scale, and the need to bill insurance for some tests.

    “We are pretty confident this is not going to meet all of the needs,” said Cyr. “If you look at the public service announcements on TV — ‘Go get tested! It’s free!’ — that’s not what we’re able to do with these sites, because we have limited resources and we’re uncertain if more will be provided. We have to be judicious about the million in resources that we have cobbled together to solve this problem. We’ve got to make that stretch.

    “This will put a dent in that ‘testing desert,’ ” Cyr continued. “It will be a big, big help. But we want to be clear that this is not a Stop the Spread site. The delegation will continue to make the clear case that we need additional ongoing resources here.”

    The state has spent $150 million on free Covid testing thus far. That, more than anything, helps explain why a million-plus is both great news and just the beginning of what’s needed.

    PANDEMIC

    Outer Cape Expects More Testing in December

    County leaders hope for a durable program

    By

    covid1
    Cape Cod is a “testing desert,” says state Rep. Sarah Peake.

    PROVINCETOWN — Resources are arriving to expand Covid testing on Cape Cod — at about the same time as the coronavirus itself is arriving.

    The timing wasn’t exactly planned, but it’s not a coincidence, either. Resources have been directed at the worst outbreaks statewide, and, for many months, the Cape has seen comparatively few cases. Now, with infections raging just across the canal and surging in the Mid Cape, leaders are working to get testing that matches the urgency of the moment.

    “We are in a testing desert here on Cape Cod,” said state Rep. Sarah Peake of Provincetown. “I think we are missing a lot of people who should be tested. We are working united as a Cape delegation to shine a spotlight on our needs, so we don’t have to see the administration staging a press conference to talk about all their successes … while rural areas like ours are seemingly not on the radar.”

    For weeks now, legislators have been calling for Gov. Charlie Baker to release $550,000 for testing on Cape Cod that was authorized in July.

    “The Baker-Polito administration has not taken the initiative here,” said state Sen. Julian Cyr of Truro. “When Cape Codders wonder why they can’t get low-barrier testing, that is in part because of slow action by the administration. The state DPH does hundreds of millions in contracts a year. Frankly, these dollars weren’t released until we loudly complained in the press about it.”

    Technically, the money is still en route. “We have just received the contracts for the first $300,000,” confirmed Sean O’Brien, director of Barnstable County’s health department. “That earmark has a geographic clause in it — the testing has to be conducted in Falmouth.” Contracts for the remaining $250,000 should follow shortly, and that money can be used for testing anywhere on the Cape, said Cyr.

    The state senate just approved another $200,000 for testing on Cape Cod, added Cyr, but that bill is not yet signed into law.

    A testing site in Falmouth will come first, said O’Brien, probably by the first weekend in December, followed quickly by locations in the Mid and Outer Cape, and potentially a mobile testing site as well.

    OCHS Will ‘Move Quickly’

    According to Pat Nadle, CEO of Outer Cape Health Services, “OCHS will be in partnership with [the county], and as the money is acquired, we will start to roll out asymptomatic testing at both our Provincetown and Wellfleet sites. The good news is it looks like that second pack of money will be available, and when that happens, we will move quickly.

    “There’s a sliding fee schedule that the county is working on,” added Nadle. “We haven’t seen it yet. But we agree it’s important — there are access and equity issues.”

    A molecular Covid test costs about $150 — but that’s a lot more money for some people than it is for others. A sliding fee scale would be pegged to a person’s income; some people are asked to pay full price, others pay half price, and others might not pay at all.

    The Community Health Center of Cape Cod, which serves the Upper Cape, recently began an asymptomatic testing program with a sliding scale. Nantucket’s asymptomatic testing program, CastNet, relied almost entirely on self-pay and employer-pay options, with town resources paying for only 10 percent of tests.

    “We don’t want to go through this money and then be done,” said O’Brien. “We want to keep this sustainable for the next six months.”

    Another way to stretch resources is to bill insurance. “We’re going to talk directly to the state about what’s feasible,” said O’Brien. “How many times will they let you bill? Will they even let you bill the first time? Those are things we have to have answers to.”

    Peake has proposed requiring insurers to pay for asymptomatic testing for frontline workers — but her amendment is attached to a bill that’s in conference committee, and its fate may not be known until the legislative session ends on Jan. 5.

    In the meantime, Peake wants the state to step in and open one or two “Stop the Spread” sites on Cape Cod. Stop the Spread is the state’s fully funded asymptomatic testing program, which is deployed to communities with high rates of Covid.

    “We are putting on the full-court press with the administration to get at least one Stop the Spread site here,” said Peake. “Those are no questions asked, no appointment needed, just show up.

    “The other component of Stop the Spread is everything goes to the Broad Institute labs in Cambridge, and they turn around results in 24 to 30 hours,” Peake added. “At CVS in the Mid Cape, you can’t even get an appointment for three days. And then it takes three to five days for a result. That’s eight days of either being an asymptomatic spreader, or actually coming down with the disease. Or quarantining and being worried about your housemates.”

    Mid Cape Deteriorates

    “Meanwhile, Barnstable town turned red today on the spreadsheet,” Peake said.

    Indeed, the situation on the Mid Cape has deteriorated rapidly. In the first three weeks of November, 702 new cases have been discovered in Barnstable county. That is one quarter of all the cases that have ever been found here. The daily new-case record wasn’t just broken — it was doubled.

    Ninety percent of the new cases diagnosed in the first two weeks of November were in six towns: Bourne, Sandwich, Mashpee, Falmouth, Yarmouth, and, most of all, Barnstable.

    Wellfleet found five cases in those two weeks, Eastham four, and Truro and Provincetown none.

    Finding none and having none aren’t the same thing, however. Provincetown’s Health Dept. sent out a notice last week, saying, “Although our known case numbers are low, wastewater test results indicate that some people in town are carrying the virus.” Provincetown’s wastewater is tested twice a week, and a recent spike in the data suggests there are active cases that haven’t been found.

    “This is why we need a Stop the Spread site,” said Peake. “I want to be clear: Outer Cape Health Services has all the best intentions, and all the right protocols. The state needs to come in and support their efforts.”

    covid2
    The long-anticipated “second wave” of the coronavirus has definitely reached Barnstable County.

    This Week in Truro

    Meetings Ahead

    By

    Meetings are held remotely. To watch live, go to truro-ma.gov and follow the “helpful link” to Truro Channel 18.

    Tuesday, Dec. 1

    • Board of Health, 4:30 p.m.

    Wednesday, Dec. 2

    • Planning Board, 5 p.m.

    Thursday, Dec. 3

    • Zoning Board of Appeals, 5:30 p.m.

    Conversation Starters

    Covid-19 Update

    As of Nov. 17, Truro had two active cases of Covid-19, 16 resolved cases, and no deaths.

    No Rapid Testing for Outer Cape Schools

    Truro Central School Supt. Michael Gradone said he joined Provincetown and the entire Nauset District in saying “No, thanks” to free rapid Covid tests for students and staff.

    Under the program, announced last week by the state Dept. of Elementary and Secondary Education, 2 million Abbott BinaxNOW tests are available for students and staff who report any symptoms.

    So far, 134 schools have accepted the offer, which will launch in December.

    Provincetown Supt. Suzanne Scallion said the rapid tests are not reliable enough, and the health departments in Truro and Provincetown have provided several rounds of free tests for school and town staffs. Gradone said he agreed with her.

    Several Cape districts are taking advantage of the offer, however, including the Cape Cod Lighthouse Charter School in Harwich.

    Paul Niles, the executive director there, said he sees the usefulness of a rapid test because it could clear up confusion between having allergies or hyper-awareness and having Covid-19 symptoms.

    —K.C. Myers 

    PANDEMIC

    As Others Act, Outer Cape Still Lacks Asymptomatic Testing

    Upper Cape and Nantucket adopt multipronged approach

    By

    PROVINCETOWN — In the popular children’s book Stone Soup, the soup is started with no great resources — in fact, it’s just a large pot of water with one stone in it. But as every villager brings something to add — carrots here, potatoes there — the soup grows into something real.

    This “everybody brings something” method resembles the approach to asymptomatic testing on Nantucket and at the Community Health Center (CHC) of Cape Cod, which serves the towns of the Upper Cape. In both locations, a variety of actors are contributing resources to make asymptomatic testing a reality. That’s in contrast to the Outer Cape, which has no asymptomatic testing.

    The importance of asymptomatic testing was highlighted by state Sen. Julian Cyr last week, citing a map released by the state.

    “The map confirms our suspicions that barriers around appointment times and symptom requirements have resulted in lower testing rates on Cape Cod as compared to the rest of the state,” Cyr said.

    “Molecular tests are lower in Barnstable County than its percentage of the statewide population,” he added. “The Mid Cape has an active outbreak, and this is among the lowest testing rates in the state. We are in a dangerous phase, and what we do now is going to determine how dark of a winter we have on Cape Cod.”

     

    Testing rates on Cape Cod are low, particularly compared with Nantucket and Martha’s Vineyard. (Source: Mass. Dept. of Public Health)

     

    To dramatically expand testing involves both rules and resources. The key questions are: Who is eligible for a test? Who will pay for it?

    Since the CARES Act passed in March, insurance has been obligated to pay for testing for people with symptoms and people who have been identified by contact tracers as exposed to Covid.

    Asymptomatic testing means that people without symptoms or definite exposure are eligible to get tested as well. Once the doors are thrown open to this larger group of people, the question of who pays comes next.

    Large-scale testing is expensive. In all of Barnstable County, there have been 116,231 Covid tests performed since March. At $150 per test, that’s $17 million just in this county. The 7 million tests that have been done statewide cost about a billion dollars.

    When insurance can’t be billed, the money for expanded testing needs to come from somewhere else.

    Everybody Pitch In

    Nantucket began its asymptomatic testing program back in June, and it features a hybrid model in which the town pays for certain high-risk workers, individuals pay for themselves, and employers pay for their whole organization. The Nantucket Select Board allocated $100,000 to the program, but only about half that money has been used so far, according to Nantucket’s health director, Roberto Santamaria.

    That $50,000 of town money represents roughly 330 tests, or about 10 percent of the asymptomatic program, which is called CastNet.

    “We did, for a while, have a lot of employers paying,” said Santamaria. “Some of the landscaping companies had their whole crew tested. The golf club paid to test their entire membership, as well as their employees.”

    About 3,300 people had been tested through CastNet by mid-October, when a worsening outbreak caused the state to step in and open a Stop the Spread site on Nantucket. Stop the Spread is a state-financed asymptomatic testing program that is made available to communities with major outbreaks. Between Oct. 15 and Nov. 16, there were 1,841 tests done at the Stop the Spread site on Nantucket, according to Jason Graziadei, information officer at Nantucket Cottage Hospital.

    On Nov. 4, the CHC of Cape Cod, which has locations in Bourne, Falmouth, Mashpee, and Centerville, announced that it will begin offering asymptomatic testing as well.

    “We’ll be evaluating patients on a case-by-case basis,” said Karen Gardner, CEO of CHC of Cape Cod. “There are people who haven’t been contacted by a tracer, but feel they may have been exposed, maybe through a family gathering, or they hear by word of mouth that a friend of a friend has been exposed. Many times, you can bill insurance, and our triage nurse will go through a series of questions to determine whether it’s clinically appropriate,” said Gardner.

    “In other cases — say, someone’s planning to visit a family member, and they just want a test — we wouldn’t bill insurance,” Gardner added. “They either self-pay or we have a sliding scale for incomes under 200 percent of federal poverty level.” Two hundred percent of the FPL is $25,500 per year for a single person, or $52,400 for a family of four.

    Self-payment would be around $150, said Gardner, which covers the specimen collection and the laboratory fee. “We’re not charging it as a doctor visit,” said Gardner.

    CHC of Cape Cod received a donation from Martha’s Vineyard Savings Bank, which helped underwrite the scheduling software behind the asymptomatic program. “It takes a tremendous amount of I.T. interface and data entry work, and the grant, in part, is funding that,” said Gardner.

    “We were doing about 100 tests a week, right before we opened it up” to asymptomatic people, Gardner added. “At the end of last week, our staff said our phone calls had doubled and we had basically doubled our capacity. If we have much growth beyond that, we’ll need to expand our testing hours and have a dedicated testing team. We have the physical capacity — it’s just a matter of restructuring staffing to meet the demand.”

    Why Not Here?

    Right now, Outer Cape Health Services tests only symptomatic and contact-traced people. The nearest site for asymptomatic testing is CareWell Urgent Care in Dennis.

    For many months, there were essentially no Covid cases on the Outer Cape. Provincetown’s health dept. ran three separate asymptomatic testing events, timed to follow high-traffic weekends in the summer and fall. Health Director Morgan Clark couldn’t be specific about the results of those tests, but case reports from those months show a long string of zero cases in Provincetown. Wellfleet and Truro showed a string of zeros as well.

    Now, however, the data are changing rapidly. There were four cases in Provincetown at the end of October. There are four cases in Wellfleet this week. Fall River, New Bedford, Rhode Island, and Nantucket have an explosion of cases.

    “I worry that we do not have the testing capacity that we need here,” said Cyr. “We’re going to continue to work on this. We need more testing resources if we are going to meet the challenges of this moment.”

    PANDEMIC

    Cyr Calls Out Gov. Baker on Testing Funds

    Asymptomatic testing is key to controlling new outbreaks

    By

    covid
    An antibody test looks for proteins made in response to infections. (Photo courtesy CDC)

    PROVINCETOWN — In a recent press call, state Sen. Julian Cyr sounded an alarm about coronavirus testing on Cape Cod.

    “We see the cases coming south and east towards Cape Cod,” said Cyr. “We have an opportunity to get ahead of this. Gov. Baker’s administration hasn’t released $550,000 in funding to Barnstable County for testing. My patience is wearing thin on the failure to release this money.

    “These are resources that state Sen. Moran and state Rep. Fernandes secured in the legislature,” Cyr continued, “specifically for Covid testing to be coordinated by the Barnstable County Dept. of Health. We want expanded asymptomatic testing. We want these resources released.”

    Allowing those without symptoms to be tested has become an issue because the number of Covid infections is rising dramatically in mainland Massachusetts. Given the nature of human transmission, health officials expect cases will travel here as well.

    covid
    A PCR test looks for the genetic material of the coronavirus, which is detectable when a person is actively infected. (Photo courtesy CDC)

    Indeed, four cases were reported in Provincetown in the last days of October, and contact tracers established that all four were related to travel, according to Provincetown Health Director Morgan Clark.

    Asymptomatic testing is important early in an outbreak. Because so many people can have few or no symptoms, an outbreak can be well on its way before people start showing up sick at clinics. Catching infections through asymptomatic screening can find cases early enough that contact tracing and isolation orders are still very effective.

    The catch, of course, is that testing large numbers of healthy people isn’t cheap. And if it’s overdone, it can gum up the labs that process tests and delay everyone’s results. Even when testing is kept well in line with lab capacity, the costs can add up quickly. Martha’s Vineyard seems to have found a way around this, however, by doing something bold: billing the insurance companies.

    How to Handle Costs

    The simplest approach to minimizing costs is emphasizing what insurance definitely will pay for — that’s testing for people with symptoms, and testing identified close contacts of those who have tested positive. The list of symptoms is quite long, and includes things like headache and fatigue. Who isn’t a little tired these days?

    But frontline workers are specifically instructed not to work if they feel any symptoms at all. It can be hard to coax them into a test.

    Both Provincetown and Nantucket have targeted frontline workers with free testing sites that are explicitly for asymptomatic people. Provincetown ran one such event on July 22, timed to follow the busy Fourth of July weekend.

    Nantucket has had a rolling invitation to various groups of frontline workers — including home health aides, grocery workers, clergy, and transportation workers. Provincetown spent $15,000 on the July 22 event, while the Nantucket Select Board allocated $100,000 to its testing-by-invitation program.

    At an industry-standard $150 a test, though, $100,000 would cover only 667 tests. Even at scale, and with labor costs trimmed by using volunteers where possible, Cyr said the per-test cost is between $80 and $140. At the lower number, $80, Nantucket’s $100,000 would fully cover 1,250 asymptomatic tests.

    That sounds like a lot, until you look at the scale of some testing efforts. Nantucket has done 12,000 tests in all since the pandemic started. Martha’s Vineyard has done a total of 26,000.

    Make Insurance Pay

    Three-quarters of the tests done on the Vineyard have been at a drive-through, anyone-can-come testing site for asymptomatic people. It relies on a mix of staff and volunteers to help lower costs, but 19,500 asymptomatic tests is still a lot of money.

    The Vineyard is relying on a mix of strategies to make this test center work, but one of the key ones is just billing health insurance companies.

    “We think there’s a gray area here, and it can be captured in two words — medically necessary,” said Cynthia Mitchell, CEO of Island Health Care. “We have chosen to interpret ‘medically necessary’ very broadly: it’s to protect people from getting Covid.”

    “Whether we’ll get the reimbursements we’re due across the board remains to be seen, but we are billing, and we’re getting a fair amount of revenue in,” Mitchell added.

    “This is a drive-through, so we’re billing for the specimen collection, and that’s all we’re billing,” Mitchell continued. Quest has not been donating the processing fees.

    “Quest Diagnostics bills the insurer for processing the sample,” said Mitchell.

    Mitchell said Island Health has had great support from Quest staff — Quest’s CEO is a seasonal resident of the Vineyard — who helped set them up with an online registration system for setting up appointments. This has been important, she said. “But it was actually our revenue cycle contractor that worked with us to get the insurance coding right, so the reimbursements would come,” she added.

    Mitchell isn’t aware of another community health center using this approach. “It was ambitious,” she said.

    The program also benefited from early support from Martha’s Vineyard Bank, which donated $100,000 to help cover testing for the uninsured. And seven Island families gave $150,000 in July to help staff the new online registration system.

    Mitchell also cited the CARES Act. “Every health center in the country received $500,000 as a base, and then there was a per-patient number tacked on,” she said. “Because we’re so small, the benefit of that $500,000 was wonderfully disproportionate.”

    When to Test

    “Who pays?” isn’t the only riddle to solve, though — when to test is important too.

    It’s possible to spend a lot of money to consistently find no cases. A long string of zeroes is a relief, of course, but it can also feel like a waste of resources — until suddenly it’s not.

    chart
    Wastewater testing in the northern and southern Boston metro area shows an alarming spike in the second half of October. Source:
    mwra.com/biobot/biobotdata.htm

    Martha’s Vineyard had a very low case rate for a long time. Now, however, the asymptomatic testing program has found 47 infections, and, according to Mitchell, some of the other 96 cases on the island were discovered because they’re contacts of those 47. Detecting that outbreak early has allowed for effective contact tracing, said Mitchell.

    “I worry that we relied on green / yellow / red to allocate testing resources,” said Cyr. Barnstable County had few cases, in other words, and now it’s doing little testing, leaving it exposed as the statewide situation grows worse.

    One possible solution involves testing wastewater for evidence of RNA from SARS-CoV-2, the virus that causes Covid-19. There’s no evidence that people can get sick with Covid from wastewater, but testing it can provide an indication of when large-scale screening should be deployed.

    A review of wastewater test results on Nantucket showed that the data tends to be “noisy” — but there were three significant spikes in the numbers, and they were each followed by a wave of newly discovered cases. Wastewater testing isn’t widely used yet, but if it can tell us when to roll out large-scale testing programs, it could help solve the when-to-spend puzzle.

    COVID UPDATE

    Eastham Student Is First in District to Get Virus

    Entire fifth-grade class sent home to quarantine

    By

    EASTHAM — The fifth-grade class at Eastham Elementary School will be quarantined for 14 days and educated remotely after a student tested positive for Covid-19 last week.

    Principal William Crosby sent a message to fifth-grade parents on Saturday, Oct. 17, telling them, “Your child has been a close contact with an individual who has tested positive…. Due to the fact that your child’s entire class will be out of school for 14 days, we will transition your child’s class to a remote teaching and learning model.”

    The remote learning began on Tuesday, Oct. 20. The principal’s memo did not specify, but the Independent has learned that the person who tested positive is a student, not a staff member.

    It’s unknown whether anyone else has tested positive related to the school case. Health Agent Jane Crowley said there have been new cases since Eastham last posted numbers, which is done every Wednesday, the day after the Independent’s deadline. As of Oct. 14, Eastham had one active case and 16 cases total.

    Contact tracing and related testing was ongoing as of Oct. 20, according to Crowley, who would not provide the number of new cases, saying results were “preliminary.”

    This is the first positive test since school began on Sept. 16 in the entire Nauset Regional School District, which runs from Wellfleet to Brewster, and comprises a total of 2,361 students. School Supt. Tom Conrad said the elementary school rolled out the health and safety protocol planned for such a scenario.

    First, Conrad said, the school and district nurses worked with the local health agent and contact tracers to determine who should be considered a close contact — that is, someone near the positive person for at least 15 minutes unmasked during the two days before the symptoms began.

    In this case, Crowley said, the school took a conservative approach and considered the entire class to be close contacts.

    “We are dealing with children and we need to think of any scenario where they may be in close contact,” Crowley said.

    Children’s unmasked contact with each other is hard to control during recess, bus rides, and other situations, Conrad added.

    Parents and siblings of the quarantined students who have not tested positive are not considered close contacts, Conrad said. Therefore, they don’t have to get tested or quarantine, unless they show symptoms or other contact tracing reveals a need.

    But, Crowley said, the entire class should quarantine for the full 14 days — even those whose test results come back negative before then.

    CURRENTS

    This Week in Provincetown

    Meetings Ahead

    By

    Meetings are held remotely. Go to provincetown-ma.gov and click on the meeting you want to watch.

    Thursday, Oct. 1

    • Recycling & Renewable Energy Committee, 10 a.m.
    • Public Pier Corp., 1 p.m.
    • Select Board, 3 p.m.
    • Licensing Board, 5 p.m.
    • Zoning Board of Appeals, 5 p.m.
    • School Committee, 6 p.m.

    Tuesday, Oct. 6

    • Council on Aging Board, 1:30 p.m.
    • Historic District Commission, 4 p.m.

    Wednesday, Oct. 7

    • Conservation Commission, 6 p.m.

    Thursday, Oct. 8

    • Scholarship & Trust Administration Committee, 3 p.m.

    Conversation Starters

    Covid-19 Update

    As of Sept. 29, there were zero new cases of Covid-19, 32 cases considered recovered, and one death as a result of the virus in Provincetown.

    Lower Cape Ambulance Food Drive

    The Lower Cape Ambulance Association, town agencies, and local organizations have partnered to hold a 17-day food drive beginning Thursday, Oct. 1.

    Drop-off boxes will be available at the following locations in Provincetown and Truro: Helping Our Women in Provincetown, Seamen’s Bank’s two branches in Provincetown and Seamen’s Bank in Truro, and Salty Market in Truro, according to an announcement from Leslie Sandberg, spokesperson for Provincetown’s Covid-19 response effort.

    Another opportunity for donations can be found at the Provincetown Crop Swap, located at Provincetown Public Library, which operates similarly to the swap shop at the town transfer station, except with food. People can drop off fresh, uncut fruits and vegetables or take some home.

    The organizations collaborating on the drive include the Provincetown Food Pantry (Lower Cape Outreach Council), Provincetown Crop Swap (a joint effort of the Provincetown Health Dept., Provincetown Public Library, and SKIP), AIDS Support Group of Cape Cod, Helping Our Women, the Soup Kitchen in Provincetown, Provincetown Council on Aging, and Truro Council on Aging. The food and funds donated will help the people of the Outer and Lower Cape through each of these organizations.

    Alex Juchniewich, Provincetown’s community support liaison and a case manager for the Homeless Prevention Council, said the council has seen a dramatic increase in the number of families in need of services during the pandemic.

    “Our Back-to-School Backpack Program served 200 families this year, versus the usual 130 to150,” Juchniewich said. “I’ve received multiple calls reporting housing, financial, and food insecurities. Families are diverting funds to meet expenses, and access to healthy food is definitely a concern for many.”

    Donation checks can be mailed to Lower Cape Ambulance, P.O. Box 1721, Provincetown, MA 02657. Please note that it’s for LCAA Food Drive. Or donations can be made online at the Lower Cape Ambulance Facebook page, or on the Lower Cape Ambulance Association website, lowercapeambulance.org.

    The ‘Swim’ Happened

    No, you didn’t see the orange-swim-capped masses plunging through the harbor from Long Point to the Boatslip. But even in the year when festivals were squashed by the fear of a deadly virus, the Swim for Life still attracted 220 swimmers, kayakers, and volunteers, who raised $110,000 for nonprofits, according to founder and director Jay Critchley.

    From oceans, pools, and ponds all over the U.S., swimmers pulled together to support the AIDS Support Group of Cape Cod, Helping Our Women, Outer Cape Health Services, and other local charities and nonprofits. On Sept. 12, a virtual Swim festival bestowed Marianne Clements with the David Asher Volunteer Award and recognized Joe Stewart of Baltimore, Md., for completing his 30th swim.

    Top fundraisers include Jim Youngerman, who raised over $16,000 and swam in Lenox and on Cape Cod; Hilary McHugh of Provincetown, who swam a mile daily from July 31 to Sept. 12 and raised over $8,000; organizer Jay Critchley, who swam for the first time since 1988, raising over $7,000; Barbara Jo Ravelle, who swam a mile daily from Aug. 15 to Sept. 15 in Duck Pond in Wellfleet and raised over $4,500; Maura Twomey, an open water swimmer who swam the English Channel in 2015 and raised over $4,500. Also, Reenie Desabrais of Provincetown, Jon Drew MacClaren of Sheffield, and Kathryn Rafter and Francie Beal of Dallas, Texas, all raised over or near $3,000. Jason Greene of Provincetown and Chris Nagle of Truro raised over $2,000. Other $1,000 Club participants include Christine Croteau of Worcester, Laurie M Shields of Sterling, Susan Goldberg of Provincetown, Jane Barber of Provincetown and Breckenridge, Colo., Joe Stewart of Baltimore, Md., George Stamides of Burlington, Bill Silvestri of Quincy, and Erik Koper of West Newton. —K.C. Myers

    CURRENTS

    This Week in Provincetown

    Meetings Ahead

    By

    Meetings are held remotely. Go to provincetown-ma.gov and click on the meeting you want to watch.

    Thursday, Sept. 24

    • Public Pier Corp., 2 p.m.
    • Planning Board, 6 p.m.

    Monday, Sept. 28

    • Select Board, 7 p.m.

    Conversation Starters

    Covid-19 Update

    As of Sept. 22, there were zero cases of Covid-19 in Provincetown, 32 cases considered recovered, and one death.

    Asymptomatic Testing for School Staff

    The health dept. staff will offer an “affordable and easy” test of asymptomatic employees of the Provincetown and Truro schools for Covid-19. This is a repeat of a successful Aug. 20 pilot program in which Lower Cape Ambulance Services and the Provincetown Health Dept. tested more than 100 municipal and school employees, all of them asymptomatic.

    The results came back in only 48 hours and the tests cost only about $70 a person, as opposed to tests that earlier in the summer cost about $150. The lower cost and faster turnaround time were made possible through a partnership between the Cambridge Innovation Center and the Broad Institute, according to Morgan Clark, Provincetown’s health director.

    This next round of tests for school staff is in preparation for when schools open for in-person learning. Truro Central School is scheduled to open Sept. 28. Provincetown Schools Supt. Suzanne Scallion has not announced a reopening date, though she said two weeks ago that outdoor classes may begin on Oct. 5.

    The date and time of the schools’ staff test has not been made public, though the health depts. do want the public to know this is planned, the spokesperson Leslie Sandberg said in an email.

    Any resident of Massachusetts can attend a “Stop the Spread” test site for a free test; the closest site is in New Bedford. Otherwise, asymptomatic testing is difficult to arrange, according to the announcement from the Provincetown Health Dept.

    Parks and Rec

    The Provincetown Parks Planning Team will hold online focus groups (and one in-person group) to help shape the first Provincetown parks plan.

    Focus groups for several types of park-goers will be held at the following times:

    • Families: Thursday, Sept. 24 at 7:30 p.m.
    • All community members: Thursday, Oct. 1 at 6 p.m.
    • Teens: Monday, Oct. 5 at 7:30 p.m.

    Personal trainers, group class instructors, and outdoor athletes can meet in person at Motta Field on Friday, Oct. 2, at 5 p.m. to walk to the soccer field on Jerome Smith Road. Masks are mandatory.

    Registration is required. To register or for more information, email Jessica Kent: [email protected]. —K.C. Myers

    HEALTH

    How the Outer Cape Dodged the Covid Bullet

    Visitors took cues from good behavior of local residents

    By

    TRURO — Summer 2020 came and went with nearly the usual influx of tourists, many of them from metropolitan areas with far higher incidence of Covid-19. But the infection rate here has remained low. How did we do it?

    In a typical summer, the population of the Cape more than doubles. In Truro, it grows from about 2,000 to more than 15,000; in Wellfleet, from some 3,000 to an estimated 17,000. And Provincetown, with just 2,800 permanent residents, swells to over 50,000.

    Some of these summer residents are restaurant workers, often jammed in close quarters that are unhealthy even with no pandemic. Others are people here to party.

    When summer began, Cape residents worried with good reason that visitors would infect our communities. There were tales, some apocryphal and some real, of hostile acts directed at cars with New York plates. The Truro Select Board and Board of Health even posted a (widely ignored) notice on the town website urging out-of-towners to stay away.

    And yet, the Covid infection numbers scarcely budged. While Hyannis had it much worse, the Outer Cape seems to have escaped almost unscathed.

    According to the official statistics in the state’s epidemiological database, which some wag named MAVEN (MAss. Virtual Epidemiological Network), the total numbers of Covid cases since the pandemic began have been Eastham 14, Wellfleet 7, Truro 12, and Provincetown 28. The latest report from the state shows, in the previous 14 days, one new case in Wellfleet, one in Truro, and none in Provincetown.

    Are these numbers too good to be true? The statistics code people by town of residence. So, the database may show just 12 cases among Truro residents since the pandemic started, but what about Truro visitors?

    If someone tests positive at Outer Cape Health Services and is staying in Wellfleet, what good does it do for contact tracers to know that the person’s permanent residence is Needham, or, for that matter, Hoboken? And what about the visitor who spends a few days in Provincetown, catches Covid, and goes back to New Haven before even getting tested? What about the restaurant worker in Eastham whose home is in Barnstable?

    More than a dozen interviews with town and county health officials, elected representatives, public health nurses, and local advocates provide persuasive evidence that the numbers are basically accurate. “It’s not an exact science,” said Deirdre Arvidson, the public health nurse for Barnstable County, “but we do learn of most of the cases.”

    How the System Works

    The state is the overall keeper of data. When someone tests positive, the clinic or doctor’s office reports that information both to the MAVEN database and to the local public health office at both the person’s permanent residence and local address.

    Each of the Commonwealth’s 351 cities and towns has at least one public health nurse who is responsible for contact tracing. The state database initially lists the case by permanent residence, but those numbers get adjusted based on what local officials learn on the ground.

    “We get notified by the state only of cases with Wellfleet addresses,” said Hillary Greenberg-Lemos, Wellfleet’s health agent. “But we do learn about other cases, either from doctors or from the people themselves. Sure, we’d like more comprehensive official numbers, but I don’t think we’re missing people.”

    State Sen. Julian Cyr of Truro, who worked in public health for six years in Gov. Deval Patrick’s administration, said he was initially concerned that the numbers might not be accurate.

    “It’s not airtight, but it’s less of a problem than I feared it would be,” Cyr said. “From an epidemiological perspective, there is enough interaction with locals. I think we’d be seeing a higher incidence if there were all these cases flying under the radar.”

    In short, while the system is far from perfect, it’s good enough. But how did we dodge that bullet?

    Behaving Responsibly

    First, most summer activity in these parts is outdoors. It’s possible, but really hard, to transmit Covid on a bicycle, in a kayak, on the beach, or at a campsite or cookout. Merchants have mostly cooperated by keeping down the numbers of customers allowed in stores, requiring masks, and providing for deliveries or drop-offs at the door.

    For the most part, businesses and ordinary people have been responsible about reporting cases. In late July, when a worker at Mac’s Shack in Wellfleet tested positive, owner Mac Hay worked with public health officials and put the information on his own website. There were no further cases at Mac’s. But there was no state or local mandate that the public be notified when a restaurant worker tested positive, as the Independent reported on Aug. 6.

    Outer Cape people recognize that the low incidence of Covid cases here is something precious, and they want to keep it that way. The local citizens tend to behave responsibly. We worry that visitors are far less conscientious, but apparently most took their cue from the good conduct of the locals.

    There are also some important civic groups working to make sure town officials do their jobs. In Wellfleet, five health professionals created the Wellfleet Well Line (508-514-1633) to help residents navigate the system, and as a citizen watchdog on government authorities.

    In Provincetown, no stranger to pandemics, the local government set up a mandatory mask zone and created a “community ambassadors” program, with paid staffers handing out masks and explaining the rules. Retailers that once displayed “No shirt, no service” signs began posting “No mask, no service.”

    “People get it, respect it, and practice it, whether they are local or visiting,” said Provincetown Health Director Morgan Clark. “One of the reasons people come here is that it is a safe place.”

    In short, everything that we cherish about the Outer Cape worked to keep the incidence of Covid low. Visitors must have absorbed some of this.

    Of course, we have no idea what the fall will bring. The outbreak of cases at universities shows that this is no time for complacency. As of Sept. 15, according to the New York Times, there were 86 reported cases at Boston College, 83 at Boston University, 43 at Harvard, and 33 at Northeastern. On Monday this week, Nantucket officials held an emergency meeting to deal with an outbreak of at least 77 active cases on the island, WCVB Boston reported.

    We also got lucky. Chatham restaurant workers and Falmouth lifeguard parties spawned three small outbreaks. That could have been Provincetown, but it wasn’t.

    Robert Kuttner is a founding co-editor of The American Prospect. He lives in Truro and Boston.

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