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Covid-19

    BUSINESS SCENE

    Restaurant Relief Fund Brings Almost $9 Million to Outer Cape

    23 P’town restaurants, plus one each in Wellfleet and Eastham, get funding

    By

    PROVINCETOWN — The Restaurant Revitalization Fund (RRF), created by Congress in March of this year to help restaurants and bars that suffered extreme loss of revenue due to the Covid-19 pandemic, has made awards to 25 Outer Cape restaurants, according to recently published data from the U.S. Small Business Administration (SBA).

    Nearly all the awards on the Outer Cape went to businesses in Provincetown. The largest amount was $2.9 million, to the Boatslip Resort on Commercial Street. The smallest was $14,300, which went to Weiner Stand Inc., also known as John’s Footlong in Lopes Square.

    Nationwide, only one-third of the applicants received any money, because the program was funded with $28.6 billion, but received applications totaling $72 billion. Multiple bills have been filed in Congress to top up the program with more money so that all applications can be funded, but so far none have passed.

    In the meantime, about 101,000 businesses nationwide received funding in May and June of this year. Similar to prior relief programs such as the Paycheck Protection Program (PPP), the funds must be used to pay specific business expenses including payroll, utilities, inventory, and rent.   Unlike other programs, however, the money can be used across a three-year window that runs from February 2020 to March 2023.

    And unlike the more-famous PPP loans, which were developed directly from businesses’ payroll numbers, the RRF awards aim to cover a restaurant’s or bar’s entire losses from 2020. The funding formula is surprisingly simple: take total 2020 revenue and add the proceeds of the two rounds of PPP forgivable loans to find a total. If that total is less than 2019 revenue, the RRF award will cover the entire difference up to $10 million (or up to $5 million per physical location.)

    In other words, the RRF aimed to make restaurants whole, relative to their 2019 sales numbers.

    It’s not possible to know how many Outer Cape restaurants applied and didn’t receive an award, because the SBA has not published the full list of applicants. But it is possible to know which restaurants did receive an award. (The SBA calls PPP disbursements “loans” that are forgivable under certain conditions, but it calls RRF disbursements “awards.”)

    After the Boatslip, the Canteen in Provincetown received the next-largest award, at $929,000.  Joon Bar received $777,000, and Pepe’s Wharf received $628,000.

    Four restaurants received between $400,000 and $500,000: the Squealing Pig, Cafe Heaven, the Mews, and Harbor Lounge. Three received between $200,000 and $350,000: Pilgrim House, Ross’ Grill, and Ceraldi’s in Wellfleet.

    Five more businesses received between $100,000 and $150,000, and nine, including Brine in Eastham, received under $100,000.

    The Independent contacted the owners of several restaurants that did not receive awards and found a bit of good news: for many of them, the two rounds of PPP loans had been enough. The Outer Cape had a reasonably strong summer in 2020, and the two PPP loans together equaled six months of payroll costs. (Restaurants and hotels were afforded larger PPP loans in the second round than in the first.) The owners of Way Downtown and Tin Pan Alley in Provincetown, and CShore Kitchen and Flying Fish Cafe in Wellfleet, all told the Independent that their own sales in 2020, combined with the two rounds of PPP loans, were enough to make them ineligible for the RRF program.

    Similarly, Steven Latasa-Nicks, owner of Strangers and Saints in Provincetown, said that outdoor dining, good weather, and two rounds of PPP loans meant that his restaurant would barely qualify for anything under the RRF.

    “So, we are an 80-seat restaurant, and we ran all 80 seats outside last year, and it basically never rained,” said Latasa-Nicks. “Being able to run a normal seat count is one of the reasons we qualified for less in this program.”

    Because of the funding formula, businesses that got small or no PPP loans last year stood to benefit particularly from the RRF awards. The same is true for restaurants that had to greatly reduce their seating capacity compared to 2019, as happened to many restaurants without outdoor space. Because the awards can be so large or so small, Latasa-Nicks said they have the capacity to even out some of the disparate economic effects of 2020.

    Latasa-Nicks’s restaurant would have received only $4,000 from the RRF, for example, but he went through the application anyway. He also helped a few other restaurant owners with their applications.

    “One thing I noticed — we were sitting side by side that day — Quinn Taylor of Cafe Heaven had his tax returns already prepared, while we had only profit and loss reports and bank statements and such,” said Latasa-Nicks. “Once we got into the application, there was a statement from the SBA: if you don’t upload your tax return, your application will take three to four weeks longer to process. I will bet you the bulk of the people that got awards had filed their returns already.”

    Strangers and Saints did not get an award before the program funding was exhausted.

    Jimmy McNulty, an owner of Jimmy’s Hideaway, is another restaurateur who applied but didn’t receive anything.  His restaurant normally has 50 seats in a close-packed, lively setting. He was able to move 25 seats outside last year, but still had a large revenue gap that the RRF could have made up.

    “I get emails from the National Restaurant Association, and they say they’re still working on this,” said McNulty. “I’ll say, though — we sure didn’t realize how quickly this summer was gonna turn.”

    Jeri Boccio of Way Downtown and Paul Melanson of Tin Pan Alley mentioned this as well. “We’re dying in here,” said Boccio. “It’s just crazy — all the news companies came down on this one little place.”

    “Last year, there was a lot of relief in various forms,” said Melanson. “There’s no way for us to recoup this last month. We were having such a tremendous banner year, and business just nose-dived with this Provincetown cluster.

    “We never laid anyone off in 2020,” continued Melanson, “but if this continues, we might have to.”

    Sophie Hills contributed reporting for this article.

    BREAKTHROUGH

    Covid Cluster Puts Provincetown on the Bleeding Edge

    By some measures, the outbreak peaked here on July 19

    By

    PROVINCETOWN — The entire nation got a new universal indoor masking advisory last week, and the Centers for Disease Control and Prevention put Provincetown squarely in the middle of their rationale.

    The CDC reversed its May 13 advice that vaccinated people did not need to wear masks, writing in bold red text that “given higher transmissibility and current vaccine coverage, universal masking is essential.”

    There is no difference in the observed viral load of vaccinated and unvaccinated people infected with the Delta variant of COVID, according to a CDC presentation leaked to the media last week. While viral load in the nose is not a direct measure of transmissibility, it’s close enough that the CDC decided the risk of transmission through the vaccinated population and back to the unvaccinated was too great.

    The data underlying that conclusion were released two days later, in the form of a CDC report focused entirely on the Provincetown Covid cluster.

    Over the weekend, reporters from around the world descended on Provincetown to find out what had happened here. It felt as if the pandemic were starting anew — but with Provincetown at the center of the story.

    The answers to the question “Why here?” are elusive, but anomalies and unexplained delays in state reporting of data are clearly involved. If the Delta variant can be this explosively contagious, why isn’t the same thing happening in other busy vacation towns and major cities? Here are some possible answers.

    Happening Everywhere?

    One possibility is that breakthrough infections among the vaccinated are more widespread than has been reported.

    Until last week, the CDC said vaccinated people without symptoms did not need a Covid test, even if they were in direct contact with an infected person. According to the New York Times, nationwide testing volume has declined steadily since April. The CDC stopped gathering data on breakthrough Covid cases in vaccinated people on May 1.

    “As of May 1, 2021, the CDC transitioned from monitoring all reported breakthrough cases to focus on identifying and investigating only hospitalized or fatal cases,” says the CDC website. “The number of Covid-19 vaccine breakthrough infections reported to CDC likely are an undercount.”

    Late Reporting Elsewhere?

    Case reporting frequently lags by one to two weeks. This means an outbreak can be well underway before it becomes publicly known.

    There are indications an outbreak is happening now on Nantucket. In the two weeks between July 19 and Aug. 2, 122 cases have been found on the island — up from zero in late June.   Recent wastewater tests show very high concentrations of virus. The seven-day-average positivity rate for the island was at 15 percent last week — higher than Provincetown’s mid-July average of 13.5 percent.

    State reporting, however, shows almost none of that. As of Aug. 3, the state’s “Interactive Data Dashboard” shows just 22 cases for Nantucket and a 3.7 percent positivity rate. That’s because the dashboard excludes the most recent 10 days of case discovery.

    Late Reporting Here?

    Similarly, Provincetown’s Covid outbreak was not visible in the public data until about 10 days after it started.

    Numbers provided to the Independent by Outer Cape Health Services (OCHS) show that the rapid testing program there discovered one Covid case on July 6, one on July 7, and two on July 8. On July 9 and 10, however, there were seven cases each day. According to the CDC report on the Provincetown cluster, the state Dept. of Public Health was alerted on July 10.

    OCHS recorded one new positive case via rapid testing on July 11 (a Sunday), 9 cases on the 12th, 14 cases on the 13th, and 9 more on the 14th.

    The state deployed a van with PCR tests to Provincetown on July 14. It performed 251 tests that day, finding 28 more positive cases.

    On the evening of July 15, however, the state published its weekly report, showing only 5 confirmed cases in Provincetown. By the previous evening, OCHS had already found 51 cases, including 28 Provincetown residents, with rapid tests. But due to the state’s delayed reporting window, and the fact that the state reports only “confirmed” PCR test results, and not “probable” rapid test results, most of what OCHS had found was not in the state’s data.

    The CDC report on the Provincetown cluster notes that the state DPH issued an “Epidemic Information Exchange” on July 15 to the health departments of the other states. In other words, the DPH was alerting other health departments and the CDC of an outbreak on the same day that it published a report showing only 5 cases here.

    The Provincetown cluster wasn’t actually revealed to the public until the morning of July 19, at a joint meeting of the select board and board of health. At that meeting, county health officials Sean O’Brien and Vaira Harik described the state data summary. Their presentation said that, as of Friday evening, July 16, there were 38 Provincetown residents, 51 other Massachusetts residents, and 43 out-of-state residents associated with the 132-person cluster.

    The CDC report shows the scope of the outbreak in Provincetown and reveals that state officials did not make a public presentation until nine days after they were first notified of a surge in positive tests here. (Centers for Disease Control and Prevention)

    According to the CDC report, however, as of Friday the 16th, specimens had been collected from 192 Massachusetts residents eventually associated with the cluster, more than twice the number reported to the public.

    A team of contact tracers, including four Barnstable County public health nurses, did a huge amount of work to assemble the cluster data. OCHS communications director Gerry Desautels noted that, just because a test was conducted in Provincetown, it cannot automatically be assumed that that person is a part of the Provincetown cluster.

    Data Are a Lagging Indicator

    All of this simply shows that the public data lags incoming positive test results — sometimes significantly. The DPH was alerted to rising cases on July 10, but did not make a public presentation until July 19. Meanwhile, the first Provincetown resident to post his diagnosis to Facebook did so on July 9.

    In fact, by some measures the outbreak here actually crested on July 19. Positivity at the mobile testing site at Veterans Memorial Community Center peaked at 15 percent on July 15. The largest number of samples that were eventually connected to the cluster were taken on July 19.   Positivity held steady around 10 percent through the week of the 19th, before declining to about 6 percent the week after.

    As a technical matter, the cluster is now nearly closed. According to Town Manager Alex Morse, “per the guidance of the DPH, July 31 was the last day that someone can have symptom onset or a positive test [and be added] to the overall cluster number.”

    This is, of course, a wonderful development. The positivity rate on Aug. 1 was down to 4 percent. More than 1,000 people in the cluster have gotten Covid — with almost every sequenced sample being the Delta variant — and, so far, no one has died. Less than one percent needed to be hospitalized. From a health point of view, Provincetown may have gotten lucky.

    There was no luck, though, in being the world’s case study. Provincetown spent at least three weeks on what is sometimes called the “bleeding edge,” learning painful and unexpected lessons that the rest of the world is now absorbing.

    PANDEMIC

    Provincetown Brings Back Indoor Mask Mandate

    Rising case count includes 171 Provincetown residents

    By

    PROVINCETOWN — The board of health and select board held their second emergency joint meeting in only seven days on July 25 and imposed an indoor mask mandate, effective immediately.

    The cause was the rising case count in the “Provincetown Covid-19 cluster” — which, as of July 23, included 171 Provincetown residents, 223 other people in Massachusettts, and 157 people who live out of state.

    The boards also voted to give Town Manager Alex Morse the power to adjust the mask mandate in response to changing rates of positive Covid tests, and the power to impose other restrictions, such as capacity limitations on businesses.

    Only six days earlier, on July 19, the same two boards had enacted an indoor mask advisory. That was in response to the first significant data about the “Provincetown cluster,” which had been presented by Barnstable County and the state Dept. of Public Health that morning. In that first presentation, the total confirmed case count was 132, including 38 cases among Provincetown residents.

    By Wednesday, July 21, the total count had risen to 256. By Saturday morning, the 24th, the count had risen to 430, and at the Sunday evening presentation it was 551.

    Select board member Bobby Anthony proposed requiring universal masking indoors and outdoors throughout the town, but his motion was not seconded. Select board member Leslie Sandberg later asked for required outdoor masking on Commercial Street only, but with only two apparent votes in favor and three declared votes against, she withdrew her motion.

    Indoor and outdoor masking were the only significant policy options discussed at length at the emergency meeting. While the boards also gave Town Manager Morse authority to enact “further restrictions” little was said about what that might actually mean.

    That and other responses to the crisis were discussed at the regular select board meeting on July 26. Chair David Abramson asked what authority the town might have to order businesses to require vaccination of their customers.

    “It gets a little tricky, legally,” said Morse. “I’m consulting with our legal counsel to find out what rights a municipality has, in terms of licensees and businesses in town.

    “Businesses have the right to require it,” Morse continued. “Any business owner listening should impose a vaccine requirement. If we have the right incentives, we can send the message: if you’re not vaccinated, you’re not going to be able to do much while you’re here.”

    Abramson asked if employers could require employees to be vaccinated. Some have told employees to either get vaccinated or get a negative test on a regular basis, said Morse.

    “There are legal ways to do that,” he said. “People want to know they’re going into a business where the employees are vaccinated.”

    Sandberg asked about requiring vaccination of town staff. “We are having those conversations with town counsel,” said Morse. “It’s likely a combination of a vaccine requirement, or, if not vaccinated, you have to provide a medically eligible reason for why you cannot get vaccinated.”

    Outside Provincetown, positions on mandatory vaccinations shifted over the weekend. Only a handful of large hospital chains had previously announced vaccination requirements, for example, but on Monday, July 26, the American Medical Association, American Nurses Association, and nearly 60 other medical groups endorsed mandatory Covid vaccination for all health care workers.

    Also on Monday, New York City and California announced a get-vaccinated-or-get-tested-weekly requirement for all their employees. California’s rules will apply to the entire health-care industry in that state, effective Aug. 23.

    Select board member John Golden also asked what the capacity restrictions on businesses might actually look like, and if “there’s any sense of whether we will be going there or not.”

    “If we saw the positivity rate go back up, or stay flat and not decline, we would look more closely at capacity guidelines,” said Morse. “The decision last night does a good job protecting many of our people that depend on the economy in the summer, while not forcing businesses to close. The reason we are doing this is to accelerate that decrease [in the positivity rate] and get back to what is gonna be a new normal.”

    Daily Positivity Rate

    The daily positivity rate, which is the percent of tests on a given day that come back positive for Covid, is now going to be used as a key benchmark for town policy. The joint order on Sunday delegates control over the mask mandate to Town Manager Morse — but it also advises that the mandate remain until the daily positivity rate is below 3 percent for five days in a row.

    At that point, the joint order advises, the indoor mask mandate should become a mask advisory, which itself should continue until the daily positivity rate is below 1 percent for five days in a row. Those numbers were 5 percent and 2 percent in the original text of the joint order, but the board of health approved an amendment by vice chair Dr. Susan Troyan to lower the thresholds to 3 and 1.

    The daily positivity rate at the Fallon Ambulance mobile testing site in Provincetown has ranged from 15 percent on July 15 to 7 percent on July 23, according to the Barnstable County Health Dept.’s presentation to the joint meeting.

    Before the July 4th weekend, nearly every community on Cape Cod, Martha’s Vineyard, and Nantucket were at or near a 1-percent case positivity rate, according to Vaira Harik of the Barnstable County Dept. of Human Services, who presented the data to both boards.

    Missing Case Numbers

    No data was presented on case positivity rates from July 1 through July 13, even though the “Provincetown Covid-19 cluster” is deemed by the state DPH to have begun on July 1. The Independent has filed a records request for the daily testing and positivity data for those days, when there was a high demand for rapid testing at Outer Cape Health Services’ Provincetown clinic, but hardly any PCR tests were being conducted in town.

    Only PCR tests generate “confirmed cases,” and since the beginning of the Provincetown cluster, the state DPH has released data only on “confirmed cases.” As yet, there is no public information on the results of the hundreds of rapid BinaxNOW tests that were performed at OCHS in Provincetown between July 1 and July 14, when the PCR testing at the Fallon Ambulance mobile testing operation began.

    Select board member Bobby Anthony asked whether the results of the rapid testing program were being included in the presentation but received contradictory answers from county leaders.

    “You’re asking an excellent question,” said Harik. “For a case to be added to the cluster tally, the sample has to be confirmed via PCR testing.”

    “So, what Bobby is asking,” said Abramson, “if someone goes to Outer Cape Health, they test positive on a rapid test, that test then goes for a PCR test to confirm the positive, and gets counted in the totals, correct?”

    “Yes, it does,” said Sean O’Brien, director of the county health dept. — incorrectly.

    “There’s a retest,” admitted Harik. “The BinaxNOW cartridge is not sent for further analysis.  That’s discarded. A new sample from the patient is taken for PCR testing.

    “If there are rapid tests that are positive, they are confirmed, is my understanding,” Harik continued. “They go ahead and confirm that by PCR test. If that is in fact still positive, they enter that into the cluster.”

    That statement, too, is almost certainly not correct, at least when it comes to the rapid testing program at OCHS.

    The state’s guidance to community health centers on the BinaxNOW testing program, issued on Dec. 7, makes it clear that confirmatory PCR tests for positive BinaxNOW testing is not indicated, and is in fact discouraged, when used at community health centers.

    Gerry Desautels, communications director at Outer Cape Health Services, also told the Independent in April that confirmatory PCR tests were not taking place at OCHS. “Regarding the BinaxNOW positives, we report them as such without retesting,” wrote Desautels in an email, “following in line with the same reporting protocol by local towns.”

    CONSPIRACIES

    Misinformation on Covid Vaccines Abounds

    The U.S. Surgeon General urges everyone to join the fight, a ‘moral imperative’

    By

    A bitter rift has opened between those vaccinated against Covid-19 and those who have chosen to remain unvaccinated. Evidence of it is easy to find: just check out the comments following vaccine-related stories, where the debate is intense and acrimonious.

    The level of animosity between the two groups is not surprising, as the choice can be a life-and-death decision.

    Those who are vaccinated argue the vaccine protects them as well as those around them, while many vaccination opponents say it’s the shot and not the virus that will kill you.

    Dr. Barry Zuckerman, professor of pediatrics at Boston University School of Medicine and a Wellfleet summer resident, says the evidence shows that Covid vaccines save lives.

    “Disagreement about implications of health data is common, however the recent data that shows 99 percent of Covid deaths occur among nonvaccinated people is pretty clear cut,” Zuckerman wrote by email.

    Well-organized social media campaigns have spread misinformation about the vaccines, saying that Covid testing is deeply flawed. They claim that Covid is not a threat and the large case numbers are the result of faulty testing. Vaccines are therefore unnecessary, they say, and possibly dangerous, due to adverse reactions. What’s not mentioned are the more than 600,000 deaths from Covid in the U.S. alone.

    The Biden administration sees the misinformation campaign as a significant obstacle to reaching vaccination goals. U.S. Surgeon General Vivek Murthy issued an advisory on July 15 “to slow the spread of misinformation,” which he called an “urgent threat.”

    Murthy said the intent of those spreading misinformation may simply be to inform, not realizing the claims are false. The result, however, is that “it can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts,” Murthy said. “Limiting the spread of health misinformation is a moral and civic imperative.”

    Many of the anti-vaccine campaigns back their claims with data from a government site called VAERS — the Vaccine Adverse Event Reporting System — used by the Centers for Disease Control to investigate reports of possible vaccine reactions.

    Anyone can submit a report to VAERS; the data are raw. Vaccine safety experts at the CDC take the raw data and investigate reports of serious reactions, using patients’ medical records to learn more about what happened and to determine whether the reaction was connected to the Covid vaccine or to other medical conditions.

    A nonprofit called the Center for Countering Digital Hate has identified 12 people behind most of the misinformation that’s posted on social media, calling them “The Disinformation Dozen.”

    Topping the list is Joseph Mercola, an osteopathic physician. The New York Times called him “the most influential spreader of coronavirus misinformation online.” He uses Facebook, Twitter, Instagram, and YouTube. Facebook has labeled or removed some of his posts, the Times reported. Twitter has also removed some posts, but Mercola’s anti-vaccination message is easy to find on YouTube.

    The Center says “Joseph Mercola is a successful anti-vaccine entrepreneur, peddling dietary supplements and false cures as alternatives to vaccines. Mercola’s combined personal social media accounts have around 3.6 million followers.”

    Robert F. Kennedy Jr. is Number 2 on the Disinformation Dozen list. Kennedy, an anti-vaxxer long before Covid, gets his message out via his Children’s Health Defense website.

    Closer to Home

    The Independent received an email from an off-Cape vaccine opponent last week, who sent numerous links to reports on adverse reactions to the vaccine. She identified herself as a registered nurse named Rose Birrell and said she was cofounder of Health Professionals for Covid-19 Policy Correction.

    The only evidence that this group exists is on a website called unite4truth.com.

    Some checking by the Independent showed the woman was using a false name, which she later confirmed, saying she and other medical professionals who oppose the Covid vaccines fear they may be putting their jobs in jeopardy. Her real name is Deborah Lusignan.

    When asked for information about other members of her group, Lusignan became agitated and broke off communications with reporters.

    Most of the claims Lusignan made and links she provided were based on VAERS data, despite warnings by the CDC that the data had yet to be investigated.

    It appears that she had been trying to spread her anti-vaccine message via smaller media outlets. The Vermont Independent published a lengthy account, promoting the Unite4Truth position that Covid testing should be discontinued and the emergency approval of the vaccines should be rescinded. Unite4Truth was described as a “global network of lawyers, doctors, scientists and citizens.”

    United Cape Patriots

    Members of the United Cape Patriots recently held a day-long demonstration on MacMillan Pier outside the state’s VaxBus, which had come to Provincetown to provide walk-in vaccinations following the Covid spike. The Patriots see vaccination as a medical freedom issue, “based on the most God-given right of bodily autonomy.” The group says its role is medical advocacy: giving people the tools to make informed decisions.

    The group’s handouts at the VaxBus called the vaccines “experimental” and said “the vaccine may be more dangerous than the virus based on vax adverse events to date.” The flyer used VAERS data to promote its message.

    Zuckerman called it a misuse of information. “VAERS specifically states their information does not prove a vaccine caused an adverse event,” he said by email. “Further investigation is needed to determine whether it was caused by a vaccine or a health-related problem of the patient.”

    Adam Lange of Brewster, founder of the Patriots, argued that even if the raw data show considerably higher numbers than actual Covid vaccine-related adverse effects, they still show there is an adverse effect.

    Lange would not say whether he has been vaccinated. “I’m healthy, I’m not elderly and not overly concerned about the virus,” he said. The elderly or immune-compromised would have to weigh the risk of COVID against the risk of adverse reactions from the vaccine, he said.

    United Cape Patriot Jennifer Raffloer, who was distributing pamphlets in Provincetown, said they aren’t anti-vaccine. “We are pro-freedom,” she said. A few group members wear masks “but the majority do not.” Some are vaccinated, she said.

    During a phone interview, Raffloer said she and her children will remain unvaccinated, having been “vaccine injured” in the past. “We are not anti-vaxxers. We are ex-vaxxers,” she said.

    Raffloer said the public is putting people like Dr. Anthony Fauci “on a pedestal, following them blindly and trusting what they’re saying.”

    Zuckerman took issue with Raffloer’s comments. “Testing of the vaccines has shown they are safe and effective, leading the FDA to give it conditional approval, which includes approval by an independent outside group of scientists,” he said.

    The agency has continued to closely monitor millions of vaccine recipients, he said. “Based on this, the FDA will likely give final approval soon.”

    PANDEMIC

    ‘Provincetown Cluster’ Now Has at Least 430 Cases, Officials Say

    Select board calls emergency meeting for 5 p.m. Sunday, July 25

    By

    Editor’s note: This article has been updated with the latest information from local and county public health officials as of Saturday, July 24. We will continue to update as new information is reported to us.

    PROVINCETOWN — The number of confirmed cases of Covid-19 in the so-called Provincetown cluster “officially reported” to the Mass. Dept. of Public Health was 430 as of Friday, July 23, town and county officials reported on Saturday morning.

    “Of these cases,” the press release said, “342 are Massachusetts residents, 153 of which reside in Provincetown. The remainder of individuals who tested positive reside in other states.”

    The press release was issued by Town Manager Alex Morse under the imprimatur of the select board, board of health, and Barnstable County Dept. of Health and Environment. It said that 69 percent of the Mass. residents who tested positive were reported to be fully vaccinated, and that three people in the cluster had been hospitalized, two of them in state. The other 427 cases, apparently, “are known to be mild and without complication.”

    The select board and board of health have called an emergency meeting for 5 p.m. Sunday, July 25 in the Judge Welsh Room at Town Hall to “discuss further actions to contain the spread of Covid-19.” A representative of the Mass. Dept. of Public Health will be there. There will be no public comment period at the meeting.

    At a previous emergency joint meeting of the board of health and select board on Monday, on Facebook, in restaurants, workplaces, and everywhere people talk and gather, Provincetown debated a new question this week: what do lots of Covid cases in vaccinated people mean?

    As of Tuesday, the number in the Provincetown Covid cluster was reported to be 132. That number included 38 residents of Provincetown, one other resident of Cape Cod, 32 residents of Boston, and 43 people living out of state. “Overwhelmingly, the affected individuals have been fully vaccinated for Covid,” according to a statement issued by county and town leaders on Tuesday.

    “It’s important to recognize the symptoms have been mild among the vaccinated,” said Sean O’Brien, Barnstable County’s director of health and environment at the Monday joint meeting. “The vaccine works.”

    “A year and a half ago, we knew very little about this virus, we had no vaccine, we didn’t know how to treat it,” said Town Manager Alex Morse on Monday. “If we saw this number of cases with highly ill individuals, not mild symptoms — if hospitalizations started to spike — then we could throw around words like emergency. But that’s not the conversation we are having this morning.”

    Instead, the select and health boards adopted a public health advisory with several components. It calls for people to get tested, get vaccinated, and stay home from work if they feel sick. It “strongly advises” venues with high social density to require proof of vaccination for admission. It says that “masks are advised indoors where social distancing cannot be achieved.” And it says that “individuals are encouraged to take steps to manage their personal risk appropriately.”

    Both testing and vaccination continue to be available at a mobile testing site at the Veterans Memorial Community Center through Friday, July 30, and possibly beyond. The mobile site offers both the Pfizer and Johnson & Johnson vaccines, and “vaccination is free, easy, and no appointment, I.D., or insurance is required,” according to the advisory.

    “We’re testing about 250 to 275 people a day at the mobile testing site,” said Morse. “We’re constantly monitoring the data — every day, what’s the percent positivity?

    “Over the last week, more business owners have decided to require proof of vaccination” from customers, said Morse. “Employers have the right to require masks and vaccination of employees.”

    In addition, the advisory highlights the state’s Temporary Emergency Paid Sick Leave program. Starting on May 28 and continuing until Sept. 30, the state will reimburse employers for up to a week of sick pay for employees who contract Covid, need to recover from the vaccine, need to quarantine, or need to care for a family member with Covid.

    The advisory was not met with universal acclaim. Select board member Bobby Anthony and board of health member Dr. Janet Whelan both argued for an indoor mask mandate. The other four members of each board preferred to wait for more information, however, noting that the new cases are among the vaccinated.

    “I struggled with where we would end up on this,” said board of health chair Steve Katsurinis. “I have been convinced that we’re not in an emergency, in large part because the vaccines keep people from becoming extremely ill. There is a spike, people are getting sick, and it is a shift in my view. I felt like we were done with Covid, and we’re not done.”

    How Many Cases?

    Monday’s joint meeting heard from Vaira Harik of the county Dept. of Human Services and from Sean O’Brien of the Dept. of Health and Environment. The state epidemiologist, Dr. Catherine Brown, also spoke briefly.

    First came the state’s definition of a Covid cluster: “Two or more confirmed or probable cases of Covid that are linked by the same location of exposure.” From then on, however, only confirmed cases were discussed or described. Probable cases were never mentioned again — despite being included in the state’s definition of a cluster, and despite the fact that there are almost certainly dozens of probable cases in Provincetown.

    That is because from Dec. 23 to July 14, almost all testing on the Outer Cape was done in the state-supported rapid testing program at Outer Cape Health Services (OCHS). Because rapid tests, also called antigen tests, were at one point prone to false positives and negatives, the results of rapid tests are still called “probable cases.” Rapid tests are also vastly outnumbered by molecular PCR tests in the state. Partly because of these factors, the state does not report “probable cases” at the town or county level — only a statewide daily total.

    There are clear indications, however, that there are a lot of probable cases here.

    One is the sheer number of people, including Provincetown residents, who posted their positive results to Facebook before the state-supported mobile PCR testing began on July 15.

    Another is that Sen. Cyr told the Independent on July 13 that “several cases per day” were being discovered at OCHS since just before the July 10 weekend. He would not elaborate, but those were almost certainly found through the rapid testing program.

    Another data point comes from Truro. Health Agent Emily Beebe still posts “active cases,” which includes both confirmed and probable cases, on the town website. (This used to be Provincetown’s practice as well, but was discontinued after the vaccine rollout.) On Saturday, July 17, Beebe updated the site to reflect 10 active cases among Truro residents.

    Meanwhile, Harik stated that, as of Friday afternoon, July 16, there was only one “confirmed case” outside of Provincetown, but on Cape Cod, that was linked to the Provincetown cluster.  That one case may or may not be in Truro — but there are definitely nine other cases in Truro, and the odds are they’re mostly “probable cases” discovered through rapid testing and linked to the Provincetown cluster.

    The Independent has filed records requests with the state and county health departments to find out how many probable cases are in the cluster, and how many reside here, but it’s not clear the agencies will have to release that information.

    “Public health surveillance, for any disease, is about getting the information right,” said Cyr in a phone call with the Independent on Tuesday. “The process to confirm these cases is always going to require due diligence and science. What’s most important is to get right whatever information is shared publicly, so people can take the appropriate protective measures.”

    COVID-19

    Baker Ends Nearly All Pandemic-Related Restrictions

    Business closures, rules for gatherings will disappear May 29

    By

    PROVINCETOWN — Citing a first-in-the-nation vaccine rollout and a plummeting count of Covid-19 cases, Gov. Charlie Baker moved the state’s “end of restrictions” date from the previously announced Aug. 1 all the way to May 29 — the Saturday of Memorial Day weekend, the traditional start of summer on Cape Cod.

    Baker announced the change on Monday the 17th, which means a host of limitations on businesses, social gatherings, and events would be ending in just 12 days.

    The governor also previewed a new mask order that will be issued on May 29; it will mostly end the requirement to wear a mask indoors. This follows the federal Centers for Disease Control’s abrupt change in indoor-masking guidance on May 13, which has had a cascading effect on state and local mask orders nationwide.

    The new mask order will still require all adults to wear masks in health-care settings and on many forms of transportation, including taxis, ride-shares, buses, and ferries, in accordance with a still-standing CDC order from January 29. Beyond that, the governor’s order will also require indoor masking by all people — adults and children, vaccinated or not — in child-care settings, K-12 schools, summer camps, nursing homes, assisted living facilities, jails, homeless shelters, residential rehabilitation facilities, and every other kind of “congregate care facility” in the state.

    Venues that will be able to resume normal operations on May 29 include bars, nightclubs, sporting events, indoor performance spaces, restaurants, wedding halls, and houses of worship. Some of these, like nightclubs and dance floors, have been fully closed since March 2020; most have been open, but limited by social distancing requirements. Maintaining six feet of distance between groups of people has meant removing tables from restaurants, blocking off chairs in theaters and churches, and banning standing and mingling in bars.

    In addition to limiting social interaction in these places, these rules cut deep into the bottom line of many local businesses. Now, those social distancing rules will be removed at the very beginning of Cape Cod’s summer season.

    Baker cited the state’s vaccination rate and Covid case rate as reasons to move the opening date to May. Seventy-five percent of all adults in Massachusetts have received at least one dose of Covid vaccine, according to state data. Hospitalizations due to Covid are down 88 percent from their peak on Jan. 1. The new case count is down 89 percent from its peak in early January, and the positivity rate across all testing sites in the state is down to 1 percent.

    “Everyone in Provincetown, our heads are spinning,” said Bob Sanborn, director of the Provincetown Business Guild. “With excitement, but also some trepidation, because this happened so quickly. There’s a worker shortage, and it takes people to run a tourist town, and everyone’s trying to pull the necessary staff together to reopen.

    “You can feel it in the air, though — people are excited to get back out and reclaim their life,” Sanborn added.

    The governor’s decree, combined with the new mask order, mean we could see a kind of split-screen on the Cape — adults partying on the dance floor and in bars, while children and even fully vaccinated adults wear masks indoors in schools and summer camps. According to the most recent announcements, children age six and older will have to wear masks at school — but they will not have to wear them at church, restaurants, weddings, youth sporting events, or almost any other indoor setting.

    It’s possible that a future revision to this mask order would exempt vaccinated people in schools or other congregate care settings — but drawing a line between the vaccinated and unvaccinated has proved difficult in both theory and practice. None of the governor’s new protocols attempt to do so. Instead, his revised mask order will lump everyone in these “congregate settings” together — staff and clients, young and old, vaccinated and not — and require masks indoors for all of them.

    Locally, Provincetown’s last remaining board of health orders expire on May 28, according to Town Manager Alex Morse — so all four Outer Cape towns will be in line with the governor’s new rules on the 29th.

    Also, restaurants that were granted outdoor seating plans during Covid will be allowed to keep them for at least two months past the end of the governor’s state of emergency order, which is now set to expire on June 15. Those extra two months are mostly a function of state and Alcoholic Beverage Control Commission decisions, according to Morse.

    “We are encouraging them to extend that date, as any big change on August 15 would be disruptive to many businesses,” Morse said. “I would ask that they be allowed to continue outdoor dining until late October. We are currently investigating what actions the town can take.”

    One decision that would lie with the town: whether to now make a plan for fireworks on the 4th of July, or permit a regular Carnival parade in August.

    “The select board has already voted not to issue permits for fireworks or a Carnival parade this season,” Morse said. At the joint meeting of the select board and the board of health on April 29, Health Director Morgan Clark pointed out that street fairs were limited to 50-percent capacity, and she saw no way to measure or control crowds of people watching fireworks.

    Now that those capacity rules are ending, however, a fireworks display would not be against any state guidelines. Sanborn said the PBG was “exploring all options” regarding Carnival, including going back to the select board to seek a parade permit.

    COVID-19

    Walk-In Vaccine Clinics Now Available

    Everyone is eligible with a valid I.D.

    By

    PROVINCETOWN — Good news for the technologically challenged and the bad-at-planning: three vaccination sites on the Outer Cape are now offering the Covid-19 vaccine to walk-in patients.

    All you need is your insurance card if you have one and a valid form of identification. In addition, you should ensure that you have no Covid symptoms on or around the day you plan to get vaccinated.

    Vaccines are getting easier to find on the Outer Cape. (Photo Nancy Bloom)

    Both the Wellfleet and Provincetown clinics of Outer Cape Health Services are taking walk-ins. Provincetown OCHS offers walk-in appointments Tuesday, Wednesday, and Friday from 8 a.m. to 5 p.m. and Thursday from 9 a.m. to 6 p.m. Wellfleet OCHS offers walk-in appointments Tuesday and Thursday from 11 a.m. to 3 p.m.

    When you receive your first vaccination, a clinician will also help you schedule your second dose.

    “Being uninsured is not a barrier to being vaccinated,” said Gerry Desautels, senior communications officer at Outer Cape Health this week. The clinic is able to apply for reimbursement through a federal program. “All we have to do is validate that they are, in fact, not insured,” he added.

    Cape Cod Healthcare is also providing walk-in appointments at the Melody Tent in Hyannis. Current clinic hours are Friday, May 14 from 8 to 10 a.m.; Monday, May 17 from 3 to 5 p.m.; Thursday, May 20 from 8 to 11 a.m.; Friday, May 21 from 1 to 3 p.m.; and Wednesday, May 26 from 3 to 5 p.m.

    “Patients will get a notice for a second appointment through the MyChart patient portal, a method that has worked well,” said Patricia Pronovost of Cape Cod Healthcare. “Those who have not signed up for MyChart will be given details on how to enroll. The process is easy to follow.”

    The CVS in Provincetown is accepting walk-in appointments for Covid-19 vaccinations during its regular pharmacy hours, 11 a.m. to 5 p.m., seven days a week. The two CVS pharmacies in Orleans, however, are not currently offering walk-in vaccinations.

    COUNTY LINE

    We Need a Stronger, More Integrated Public Health System

    Some powerful lessons learned from a year of pandemic

    By

    The daily Covid updates from the Barnstable County Health and Environment Dept. epidemiologist Vaira Harik continue to trend very favorably, with a few exceptions, and give us a genuine basis for cautious optimism about the coming summer season. Quite possibly, by this time a year from now, with all willing Cape Codders fully vaccinated — and likely, by then, booster shots, as well — we will be able to let down the cloak of contagion fear that has enveloped us for the past year.

    Part of the credit for our generally better-than-state-average Covid statistics here must go to the collaborative efforts of the county in establishing links with Cape Cod Healthcare, the four community health centers, and town boards of health, and our legislative delegation.

    This collaboration organized testing sites and contact tracing early on to slow transmission, and made preparations for the potentially overwhelming surge of hospital cases that, fortunately, we avoided. Currently, the drive to reach all willing residents (and maybe persuade some of the skeptics) has involved close ongoing coordination of vaccination clinics and dose-sharing when there is an excess.

    There are powerful lessons to be learned from the past year, perhaps none more significant than the role of public health in modern society.

    Generally, when we think of health care systems, we picture hospitals, clinics, and the doctor’s office. This is the network of services that keep us healthy and work to heal us when we are sick or broken.

    In contrast, the public health system, which long antedates modern health care, cares for us at the population or community level, primarily through efforts to prevent disease and its contagion and to ensure that every person has a standard of living adequate for maintaining health.

    Of the three decades or so of life expectancy that we in the U.S. gained in the 20th century, only about five years can be attributed to personal medical care. Eighty percent of the gain — or 25 more years of life — are the result of improvements in our living standards, especially sanitation and drinking water, air quality, and control of infectious outbreaks. This is the domain of public health work.

    In recent decades, as health care became more profit-driven, public health budgets declined. Public health spending was estimated to account for only about 1.5 percent of the U.S. budget in the late 20th century, and the last two decades saw more cuts, especially at the federal level.

    The Barnstable County Assembly will likely approve an 8.6-percent increase in health and environment spending for the next fiscal year, in response to the demands of Covid control. That will represent 9.4 percent of the total county budget.

    There have been tough lessons in the last year as well.

    We have learned, painfully, that access to urgent medical care matters when illness strikes. We have learned that social and economic status matter greatly to disease outcomes. We have learned that people without access to care are not only at risk themselves but also put at risk everyone with whom they come in contact.

    One key piece of our national public policy response reflects the understanding that all are potentially vulnerable: the determination to have no financial barriers in the way of vaccination. Insurance is billed when available, but no one is supposed to be denied the vaccine for not being able to pay, nor for citizenship status. This has theoretically made vaccine available to all who are willing to receive it.

    The 1948 United Nations Declaration of Human Rights prominently includes access to health care. Here on Cape Cod in 2006, a ballot initiative declaring “health care is a human right” was overwhelming approved by voters.

    What has taken place here, driven by the urgency of need, has been the emergence of a prototype for an integrated and comprehensive health system, bringing in public health, hospitals, clinics, medical offices, and outreach workers. Those who fell ill have been skillfully cared for by our acute health system, and much of the greater community has been tested, educated, and vaccinated by our public health service.

    At the same time, outreach efforts to the most vulnerable residents of the Outer Cape, especially the homebound elderly and immigrant populations, have been shockingly inadequate. We must do better.

    This experience can and should preview a more functionally integrated health system, one which would certainly deliver health care more effectively and at lower overall cost than our traditional silos of autonomous health units. When we are able catch our collective breath and reflect on pandemic response successes and failures, this union of our traditional health care and our public health system clearly belongs on the agenda.

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

    STIMULI

    Covid Relief Targets Outer Cape’s Smallest Businesses

    Programs fill earlier gaps in CARES Act awards

    By

    PROVINCETOWN — When much of the American economy was forced to shut down last March due to Covid, Congress passed trillions of dollars of relief spending in just weeks. There was a scramble to access emergency funding such as the Paycheck Protection Program (PPP), which offered forgivable loans equal to 2.5 months payroll for businesses with 500 or fewer employees.

    The situation now is more orderly, and significant sums are flowing again. In addition to a new round of payroll loans, there are several other programs, many of them targeting the smallest of businesses. But those businesses may not be aware of them.

    The Targeted EIDL Advance is a $20-billion program (based on the Emergency Impact Disaster Loan program in the CARES Act) that was included in the near-trillion-dollar stimulus bill that Congress passed in December.

    The original EIDL program wrote large loans that are repayable over 30 years to the Small Business Administration (SBA), as well as $10,000 “advances,” which were essentially grants.

    But not every applicant got a $10,000 advance. After a crush of nearly four million applications, the SBA changed the terms to $1,000 per employee, up to a total of $10,000. Data released by the agency in December show that 615 businesses in the four Outer Cape towns received EIDL grants — but only 71 received the full $10,000, and 336 received only $1,000.

    Census tracts marked in purple are “low-income communities” — relative to the state’s average family income — and eligible for extra EIDL advance funds. (Source: SBA)

    The Targeted EIDL Advance program aims to circle back to these businesses and top up their grants to $10,000. Only businesses that can show a loss of 30 percent over any eight-week period in 2020 are eligible — but given the two-month lockdown, that’s a threshold many can meet. And only businesses located in a “low-income community” are eligible — meaning census tracts with a median family income that is less than 80 percent of the state’s median.

    By this standard, Provincetown, Truro, Wellfleet, and the northern half of Eastham are low-income communities. The southern half of Eastham — south of Doane Road from Route 6 to the ocean, and south of McKoy Road on the bay side — is not. That means between 400 and 500 of the smallest local businesses, most with five or fewer employees, can apply for these expanded grants.

    “There hasn’t been much publicity for the Targeted EIDL loans,” said Marc Goldberg, a director at the Service Corps of Retired Executives Cape Cod, which provides mentoring and other assistance to local small businesses.

    One reason for limited visibility may be that the SBA sent emails to business owners inviting them to apply, and they’re easy to miss. They were sent starting Feb. 1; in the subject line was the application number of the original disaster loan.

    More Grants

    Another program focused directly on the smallest businesses is managed by the Community Development Partnership (CDP) in Eastham and is still taking applications from residents of the eight Lower and Outer Cape towns. The CDP’s microenterprise program includes $10,000 forgivable loans that can be used for a range of business expenses. Only businesses with five or fewer employees can apply, and only if the owner is personally earning less than 80 percent of “area median income.”

    One reason the targeting is narrow is that this program only has about $400,000 to give out. Only 28 grants have been awarded so far. CDP staff are available to help people who haven’t applied yet, said CEO Jay Coburn. (Details are at capecdp.org.)

    Another 86 businesses on the Outer Cape have received larger grants from the state via the nonprofit Mass. Growth Capital Corporation (MGCC). Like the CDP grants, this money originated with the CARES Act, was delivered to the state in the summer, and was allocated to a nonprofit to administer it in the fall. Unlike the CDP grants, the MGCC program covered the whole state, and ultimately had more than $650 million to give away.

    Applications for the MGCC grants are closed now, but the program has delivered almost $4.4 million to the four outermost towns, and grants are still being paid. They range from $5,000 to $75,000 and are fully forgiven after proper documentation.

    PPP Redux

    Finally, the Biden administration has just announced new rules to help sole proprietors and independent contractors access the second round of PPP loans.

    Previously, people who are in business alone had to use their net income (after deductible expenses) to calculate the size of their payroll loan. As a result, some people’s April 2020 PPP loans were only a few hundred bucks.

    For the ongoing second round of PPP loans, independent contractors and other self-employed people can use gross revenue to calculate the size of their forgivable loans, making them significantly larger.

    The first round of PPP loans generated $37 million for 571 local businesses on the Outer Cape. Of those, at least 130 were one-person enterprises that might do better in this second round.

    Businesses in food services and accommodations can also look forward to the second round of PPP loans. The December stimulus bill authorized PPP loans equaling 3.5 months of average payroll for those businesses, instead of 2.5 months.

    The hospitality industry is the largest employer in each of the Outer Cape’s four towns, according to the Cape Cod Commission, and the next round of payroll loans has the potential to bring well over $40 million into the local economy.

    Meanwhile, there’s another bill nearly the size of the CARES Act working its way through Congress.

    ELDER CARE

    Privacy Protections Leave Gaps in Covid Death Reports

    Data from assisted living facilities are mostly blacked out

    By

    elder2
    Sixty percent of assisted living facilities in the state have had at least one resident die of Covid as of Jan. 14, 2021. (Source: Executive Office of Elder Affairs)

    PROVINCETOWN — When it comes to Covid, Massachusetts is pro-data. The Dept. of Public Health (DPH) publishes a weekly Covid report, daily Covid updates, and a weekly report on vaccinations. Case rates and death rates for individual nursing homes have been published every week since May, as well as other data, such as staff testing rates and infection control surveys.

    But when it comes to assisted living, information is not that forthcoming. Covid reports don’t identify death rates for residents in assisted living facilities, even though they’re one of the most vulnerable populations in the state.

    Partly, this has to do with legal differences. Nursing homes, or long-term care facilities, are treated like hospitals and regulated by the DPH. Assisted living facilities are a housing arrangement with medical support, and are thus regulated by the Executive Office of Elder Affairs (EOEA).

    Medical privacy laws are also a factor, and, since the pandemic began, family visitation to elder-care facilities has been dramatically curtailed. This has made information about conditions in assisted living facilities difficult to assess. Covid fatality reports are one of the few kinds of data that can be requested from state regulators.

    elder1
    Because of medical privacy rules, the state’s Executive Office of Elder Affairs won’t reveal the exact number of Covid fatalities at assisted living facilities if the number is 1 to 10.

    The Independent asked the elder affairs office for three reports on Covid deaths in the state’s 267 assisted living facilities — for the springtime wave (March 1 through May 31), the summertime lull (June 1 to Sept. 30), and the winter wave (Oct. 1 to Jan. 14).

    The goal was to find out if Covid protocols instituted in the spring were keeping residents safe through the summer and into the winter wave that swelled in November and December.

    But the reports that were delivered are so heavily redacted it’s hard to discern patterns.

    It’s widely known that the beginning of the pandemic was horrific in elder-care facilities. By the time the lockdown was enforced, Covid had already spread to nursing homes and other kinds of elder housing across New England. Death numbers were staggering. To this day, more than half of all of the state’s Covid deaths are among nursing home residents.

    The new data on assisted living facilities line up with that story. Almost half of all assisted living facilities in the state experienced Covid fatalities last spring.

    But because of the redactions, a full tally of those deaths can’t be made. (The Independent has put in a request to the EOEA for the total number of spring fatalities; when it is provided, this story will be updated online.) Even so, it’s still possible to see that, of the 143 facilities that had no deaths in the spring, only two went on to see their first deaths in the summer. The protocols on personal protective equipment, social distancing, visitation, and staffing that the industry and regulators put in place helped prevent the spread of Covid, at least in the summer, when the case counts in the Northeast were low.

    Between Oct. 1 and Jan. 14, however, 34 assisted living facilities that had previously not seen deaths from Covid saw their first deaths. One of them, Atria Marland Place, in Andover, saw 14 people die during that period.

    In Barnstable County, the Mill Hill Residences, in Yarmouth; Atria Woodbriar Park, in Falmouth; and Bridges by Epoch, in Mashpee, had no deaths from Covid as of Oct. 1, yet all have seen from 1 to 10 people die of Covid since then.

    Five other Barnstable County facilities have seen deaths from Covid, all of them beginning in the spring wave: Cape Cod Senior Residences at Pocasset, in Bourne; Atria Woodbriar Place, in Falmouth; Brookdale Cape Cod, in Barnstable; Maplewood, in Brewster; and Harbor Point, in Centerville. All of them had between 1 and 10 deaths as of Jan. 14, except Harbor Point, which had 12.

    The unspecified range of 1 to 10 deaths is due to the EOEA’s redaction protocol: all numbers from 1 to 10 are obscured. Only eight facilities in the state crossed beyond 10 deaths and were unredacted. That means the most significant information that can be gleaned from the documents is the point at which facilities had more than zero deaths. (The highest tally was 27 deaths, in the Falls at Cordingly Dam, in Newton, all before May 31.)

    The EOEA cites the Center for Medicare and Medicaid Services and the Health Insurance Portability and Accountability Act (HIPAA) as its guidelines for redactions. The state DPH interprets those laws differently, and suppresses only numbers between 1 and 4. That, combined with weekly reporting of numbers, is why the situation at nursing homes is so much clearer than it is with assisted living.

    The state does publish a “Chapter 93 Elder Facilities Daily Report,” but that information is self-reported by the facilities and is filled with errors and omissions. For example, of the nine Atria assisted living facilities, only three had any deaths in the Chapter 93 report, yet the redacted state documents show that there were deaths in eight out of nine of them.

    Similarly, of the five Benchmark properties in the state’s listing, there were Covid deaths in all five. The Chapter 93 report shows deaths in only two.

    There’s no geographic pattern to the deaths. The statewide map shows that the losses aren’t concentrated anywhere. But when it comes to elder care, pain and loss is pretty much everywhere.

    THE ROAD TO NORMAL

    Glimmers of Hope for Vaccinations on the Outer Cape

    Community health centers could provide alternative to mass sites

    By

    PROVINCETOWN — When it comes to allocating Covid resources, Cape Cod has been treated like a distant afterthought. The state hasn’t opened a free Stop the Spread testing site here, and it was even a struggle getting the money to organize the self-pay, $75-per-test site in Hyannis.

    Initial inquiries were made about opening a MassVax site at Cape Cod Community College, but the state ultimately opted for only six sites, all on the mainland. Local boards of health representing the 15 towns of Cape Cod have received a pitiful 200 doses total since vaccinations began. The Barnstable County Health Dept. has taken a leading role in vaccine requests and delivery on Cape Cod, yet it has been given only 975 doses per week.

    The state’s vaccine rollout has been so flawed that state Rep. Sarah Peake called it the “Covid Hunger Games.” (Photo Nancy Bloom)

    The Baker administration has been prioritizing MassVax sites and the CVS and Walgreens pharmacy chains in its vaccine distribution decisions. Those outlets require people to register online for a vaccine appointment, a process that has been so frustrating and flawed that state Rep. Sarah Peake called it the “Covid Hunger Games.” Once secured, a MassVax appointment requires a long drive off Cape, which is why state Sen. Julian Cyr said, “The current registration and appointment system is benefitting the fittest, the most tech-savvy, and those with wheels.”

    Amid this uproar comes a glimmer of good news. Even though Gov. Charlie Baker told hospitals and local boards of health they wouldn’t be getting new vaccine allocations this month, he kept community health centers (CHCs) as part of his plan. President Joe Biden’s administration has also announced a plan to funnel vaccines to CHCs nationwide. This makes Outer Cape Health Services (OCHS) and the Community Health Center of Cape Cod, both of which are federally qualified CHCs, more important parts of the local vaccine picture.

    Even so, local leaders see a Cape Cod-sized loophole forming. On Feb. 17, the state announced that towns and cities would receive direct vaccine allocations only if they formed a “regional collaborative” that could collectively administer 750 doses a day. Barnstable County already is a “regional collaborative,” and it has administered multiple 800-dose-per-day clinics in various parts of the Cape.

    “If they can send us 800 doses per day, we can get that into people’s arms,” said Peake this week.

    “We could meet that capacity requirement,” said Sean O’Brien, the county’s health director.

    “We are organizing to make a request for vaccine on those terms,” confirmed Frank Schulze, Cyr’s communications director. “Hopefully, we’ll have more to say about this next week.”

    Calling the Vulnerable

    One of the reasons CHCs are receiving attention is they have existing provider relationships with vulnerable, hard-to-reach people. CHCs tend to be located in remote or under-resourced areas. They can directly schedule their oldest and sickest patients for vaccination appointments, instead of forcing those patients to navigate an online version of Thunderdome. They also do not present a transportation challenge. For remote communities such as the Outer Cape, it’s the difference between getting vaccinated at home or a few minutes away, in Wellfleet or Provincetown, or driving a few hours to Gillette Stadium in Foxboro.

    OCHS has administered first and second doses to 300 phase-one medical workers, said Gerry Desautels, the clinic’s communications director, and, as of Feb. 22, it had given first doses to another 1,100 people.

    “We are receiving a few hundred doses per week between our three health center sites” in Provincetown, Wellfleet, and Harwich, said Desautels. “We are working through a list of eligible patients as quickly as we can, making sure to personally reach out first to our most vulnerable patients.

    “For those who are homebound or otherwise unable to travel, OCHS will be working with the local towns to vaccinate those populations in their residences,” Desautels added.

    ‘Closed’ vs. ‘Open’ Clinics

    “If we can get to those oldest, most vulnerable people first, that’s going to do a heck of a lot of good in saving lives,” said Cyr. “If we’re going to have limited vaccine, I would prefer to see [vaccines going to] these targeted closed clinics that get to the most needy residents, instead of this privatized MassVax system.”

    Vaccination appointments at “closed clinics” are made directly. They’re not available to the wider public. Most of Barnstable County’s clinics have been “open” — like MassVax — with appointments made via the state’s main site, which has been plagued with problems. Barnstable County is running its first closed clinic on Thursday, Feb. 25, in Eastham, said the county’s communications director, Sonja Sheasley. Its 280 doses will be allocated equally to the four Outer Cape towns, with the local health depts. in charge of identifying underserved residents who are eligible for vaccination. The Feb. 25 clinic is the only closed clinic currently scheduled by the county, Sheasley added.

    This means that, for people who are currently eligible for the Covid vaccine, it’s a good idea to be in touch with your doctor, your local board of health, or possibly both.

    “Vaccine-eligible OCHS patients can call to schedule an appointment,” said Desautels. People who are not existing patients can go to outercape.org’s Covid page and fill out a patient registration form first.

    People who don’t have a doctor already may find it easier to go directly to their town’s health dept. If the CHCs and the county continue to get increased allocations, they may become an easier route to vaccination than a trek off Cape.

    Update: On Wednesday, Feb. 24 (after this week’s Independent went to press), Cape Cod leaders announced that the state had approved the Cape Cod Regional Vaccine Consortium. Cape Cod Healthcare will run a large-scale vaccination site at Cape Cod Community College in Barnstable, with the capacity to administer at least 3,750 doses per week. Outer Cape Health Services and the Community Health Center of Cape Cod will collaborate with the 15 municipal boards of health on a program to vaccinate homebound seniors in their homes. The county health department will continue vaccination clinics at four sites: Falmouth, Orleans, Eastham, and Truro. Collectively, these efforts will account for nearly 6,000 doses per week on Cape Cod, contingent on the state’s ability to supply that many doses.

     

    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.

    THE ROAD TO NORMAL

    Delay in Vaccinating Educators Causes Outcry

    Teachers’ unions and administrators make joint plea to governor

    By

    School administrators and teachers’ unions are often at odds with each other, but on Cape Cod, both sides agree on the need for educators to get vaccinated against Covid-19 as soon as possible for their own protection and for the safe return of all their students to in-school learning.

    The unions and school superintendents in the region have sent a joint letter to Gov. Charlie Baker, asking for the immediate release of vaccine for educators.

    “Vaccinating our early childhood and K-12 teachers and support personnel would be a major step toward getting our kids back to school full-time safely,” the letter said.

    Ten percent of the students in Truro are fully remote, along with 12 percent in Wellfleet, 23 percent in Provincetown, 20 percent at Eastham Elementary, 18 percent at Nauset Regional Middle School in Orleans, and 30 percent at Nauset Regional High School in Eastham.

    The letter to the governor includes a strategy for on-site staff vaccinations. “We have freezers and nurses in most, if not all, of our schools,” it said. “Additionally, we have relationships with local fire departments and EMTs, should we need additional assistance.”

    ‘An Outrage’

    Massachusetts educators had initially been scheduled for vaccinations right after those age 75 and older, but Baker abruptly changed the order on Jan. 25, placing those age 65 to 75 ahead of educators and other essential workers. The outcry was immediate.

    Mass. Teachers Association president Merrie Najimy called it “an outrage” that there was no advance notice.

    “Our members, our students, and their families feel like pawns in a chess game, a game whose rules keep changing,” Najimy said, adding that the change would delay vaccinating educators by several weeks.

    “The governor keeps pushing schools to reopen for in-person learning more quickly,” said Beth Kontos, president of the American Federation of Teachers Massachusetts. “Yet he has just made it much harder to do that safely.”

    “Schools themselves are not super spreaders, but students come to school having been exposed, been infected, or possibly asymptomatic,” said Cheri Armstrong, a Monomoy Regional Middle School teacher and chair of the Cape and Islands Area Mass. Educator Action Network. “This puts everyone at risk.”

    Gov. Baker has stressed that the first two groups in Phase Two, those 75 and older and those 65 to 75, are at the highest risk from the virus. “It’s hard for me to understand, when we look at the data and talk to the experts, that we should be organizing in a way any different than the way we set up,” the governor said on Feb. 4.

    Katelyn Reilly, communications director for the Covid-19 Response Command Center, wrote in an email that early education and K-12 educators “are the first group of prioritized workers after healthcare workers and first responders.”

    Schools have several other layers of protection in place, Reilly said, “such as nearly $1 billion in funding, a first-in-the-nation pooled testing initiative and access to air purifiers.”

    Is Vaccination Necessary?

    Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said during a White House briefing last week that data do not suggest that teachers need to be vaccinated for schools to reopen safely.

    CDC spokesperson Jasmine Reed wrote in an email that “Dr. Walensky’s comments are based on her review of the science.” Accumulating data suggest that if mask wearing, distancing, proper cleaning and ventilation, and hand washing are followed, Covid-19 does not spread rapidly in schools, said Reed.

    While teachers on the Outer Cape would like to be vaccinated as soon as possible, those willing to speak to the Independent praised current safety measures.

    “I’m very proud of how the kids are managing and proud of our colleagues who come in every day,” said Nauset Regional Middle School teacher Anne Needel. Each school has a safety committee with union representatives, school nurses, education assistants, and principals who meet regularly with custodial staff to discuss problem areas and solutions, she said.

    David McGlothlin, co-president of the Provincetown Association of Educators, said union members are satisfied with measures implemented over the last 11 months by the school committee and superintendent. He said in an email that they support any means of vaccinating teachers and support staff as soon as possible.

    State Sen. Julian Cyr expressed his frustration at the “halting pace and disjointed communication” of the state’s vaccine program.

    “Choosing between vulnerable populations like teachers, essential workers, those over 65, and those with multiple comorbidities, who all deserve vaccine, will leave some at risk for transmission no matter which way the decision is handed down,” Cyr said in an email. “I supported the initial vaccination plan, which placed essential workers like teachers earlier in the sequence of vaccination. However, the best and only solution is more vaccine on Cape Cod, and I will continue to use every lever available to ensure its timely arrival and disbursement.”

    THE ROAD TO NORMAL

    Heartburn and Heartache in Vaccine Rollout

    Hopes for quick access were raised, then dashed

    By

    vaccine
    The last groups eligible in Phase One never enjoyed easy access to the Covid vaccine, because Gov. Baker moved up the beginning of Phase Two. (Source: mass.gov/covidvaccine)

    PROVINCETOWN — Massachusetts had a plan for rolling out the Covid vaccine. First up would be the entire health-care industry, police and fire depts., and congregate living facilities where large numbers of people sleep under the same roof, including not only nursing homes and assisted-living facilities but also homeless shelters, jails, rehab facilities, and even residential schools for the disabled — places where pathogens could spread with deadly speed.

    This early focus served several purposes. Getting home health-care workers vaccinated in Phase One, for example, made sense: besides working in elderly people’s homes, they often live in multi-generational housing themselves, and the intimate nature of their work makes them particularly vulnerable.

    Another purpose in keeping Phase One limited to certain groups was that it allowed time to prepare for the much larger Phase Two population. Health officials expected Phase Two to begin in mid-February. As of mid-January, the state’s own graphics showed the last groups in Phase One becoming eligible in the first week of February, with Phase Two beginning sometime after that.

    But on Jan. 25, Gov. Charlie Baker threw his own plan into chaos by starting Phase Two weeks earlier than he had originally signaled.

    The statewide population of the first subgroup of Phase Two that became eligible — people 75 and older — is half a million. In Barnstable County, there are around 29,000 people in that bracket — almost 14 percent of the county’s total population.

    There was neither the organization nor sufficient vaccine doses to support that expansion. Telling hundreds of thousands of people that they are eligible for a lifesaving vaccine without being able to deliver it caused anguish and confusion.

    Available Appointments: Zero

    The first vaccine appointments for those 75 and older became available at midnight on Jan. 27. Senior citizens and their families and friends huddled around computer screens across the state, trying to secure a slot.

    Vaccination clinics can be found on a map at mass.gov/covid-19-vaccine, which then links to more than a dozen websites, including those run by Stop & Shop, Walgreens, CVS, the state, hospital groups, and a handful of other pharmacy chains. Having so many websites is a hurdle, but the real problem is not having sufficient vaccines.

    On Cape Cod, a county-run vaccination clinic was posted on the state’s scheduling site, mavaccinations.org, before it was posted on the map. By the time that Falmouth clinic made it onto the map, the Cape Cod Times reported, its 600 appointments were already taken.

    Two days later, another county-run clinic, in Hyannis, went live with 600 more appointments. There was a frenzy of phone calls and emails, and all the spots were taken in about an hour. (Barnstable County has now announced that an email alert will go out 24 hours before registration at its vaccine clinics is possible. To sign up for those alerts, go to barnstablecountyhealth.org/vaccine-registration.)

    The cycle of heartburn and heartache will persist, however, until vaccine deliveries are more in line with eligible populations. Having 29,000 people age 75 and up on Cape Cod competing for 1,000 vaccines a week is going to mean dashed hopes and frustration for as long as that ratio continues.

    “I want to be clear — no one is sitting on doses on Cape Cod or the Islands,” said state Sen. Julian Cyr, who also serves on the Cape Cod Recovery Task Force. “The inventory and distribution of this vaccine is beyond my control, beyond the control of this task force, our partners at the county, at Cape Cod Healthcare, or in municipal government. Inventory depends on availability from the federal government and on the state for distribution to us.

    “We have a readiness to be able to administer this vaccine,” Cyr continued, “but unless we have the vaccine, we can’t administer it. They should have held back on Phase Two until the supply was there. When we’re not able to come anywhere near close to meeting the demand, that’s when you have this frenzied situation. It was a big breakdown this week.”

    Phase One Is Incomplete

    Besides the Phase Two shortfall, there still are people eligible in Phase One — such as home health-care workers — who haven’t been vaccinated. And now that Phase two has begun, it’s not clear that it would even be legal under current guidelines to host a clinic specifically for Phase One workers.

    According to state guidance, congregate living facilities can still make special arrangements with the state for vaccination. Small private medical practices whose staffs may not be fully vaccinated can reach out to certain designated hospitals to try to procure vaccine. But for individual health-care workers — such as chiropractors, psychiatrists, physical therapists, and home health-care workers — the only option is to book a vaccination along with the half million others in Phase Two who are now scrambling for scarce appointments. Those health-care workers were essentially robbed of their spot in the vaccine line.

    “We have all been receiving hundreds and hundreds of calls,” said Cyr. “I have a real concern about folks who were in Phase One who might not have gotten a vaccine. There’s such a crush of people in Phase Two … it resembles something Ticketmaster would use for a Beyoncé concert.”

    Where to Go Locally

    Planning is in progress for vaccination sites in Provincetown and Wellfleet, according to Morgan Clark, Provincetown’s health director. Provincetown’s site may be the Veterans Memorial Community Center, which also houses the council on aging, but other locations have been considered as well.

    No one at the local or county level appears to know if Stop & Shop or CVS locations in Provincetown will ever become vaccination sites. The state’s contracts with those companies were only recently revealed and came as a surprise. At the moment, there doesn’t appear to be a large amount of vaccine moving through those companies, though that could change.

    Outer Cape Health Services (OCHS) attempted to order 300 doses of vaccine specifically for some private practices, home health-care agencies, and congregate housing facilities that had reached out to them, said CEO Pat Nadle. This was after OCHS had first secured doses for its own staff and the staffs of several private practices in the area earlier in January.

    That request for 300 doses was denied by the state on Jan. 26, heightening concern about vaccine access for those in Phase One. OCHS has since gotten authorization for those 300 vaccines, however, raising hope that medical organizations can remain an alternate pathway to the vaccine for vulnerable Phase One frontline workers.

    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.

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