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Nantucket

    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.”

    ENVIRONMENT

    Math Looks Bad for Right Whales

    With females dying at higher rates and fewer births, hope for species dims

    By

    PROVINCETOWN — Dragon, a female right whale who gave birth to a calf as recently as 2016, was spotted two weeks ago entangled in rope 50 miles south of Nantucket. She was malnourished and underweight, likely because the entanglement was preventing her from feeding.

    This might be the last we see of Dragon. Because she has lost so much blubber, she will likely sink, rather than float, when she dies. That’s a problem for scientists, because whale cadavers can help them determine the cause of death, update mortality statistics, and identify the source of the entangling gear.

    Center for Coastal Studies scientist Stormy Mayo said that Dragon’s plight is part of a larger trend: female right whales are dying at a higher rate than males. With fewer females to produce babies, the chances of a future for the species are reduced.

    “The numbers of calves over the past five years has been very low, and the mortalities have been very high,” Mayo said. Although the number of calves this year — 10 were spotted off Florida last month — is “wonderfully higher than the past four years, it’s not enough.”

    Richard Pace, a wildlife biologist with the National Oceanic and Atmospheric Administration, estimates that 133 right whales died between 2010 and 2017, or about 19 animals each year. But only 39 carcasses were found, as the remaining 94 sank before being spotted. During the same time period, 115 calves, or about 16 per year, were born, resulting in a higher mortality than birth rate.

    Because only 50 percent of calves reach adulthood, Pace estimates that at least 30 births would be needed this year to compensate for deaths.

    Changing Patterns

    Scientists understand right whale deaths better than they do reproduction. “There are lots of gaps,” said Mayo. “The animals are roaming bodies of water, areas out in the ocean that we just don’t know about.”

    What is known is that female whales typically migrate to warmer waters in Florida and Georgia to give birth. Their calves need three weeks to grow enough blubber to survive the colder northern waters. Afterwards, the pair begins the journey to Cape Cod and as far north as Nova Scotia, where plentiful food can be found in spring and summer.

    Right Whale calf
    A right whale calf and her mother swim in Cape Cod Bay in 2019 (Photo Courtesy Center for Coastal Studies, NOAA federal permit #19315-01)

    It is this reproductive migration that puts female right whales at greater risk than males. As they travel from Canada to Florida and back, the chances they’ll come into the path of fishing boats and gear are higher.

    One of the calves born this year has already suffered a major injury from being hit by a boat. Mayo is concerned that the calf cannot form a seal to nurse milk from its mother, and its recovery, like Dragon’s, is unlikely.

    Cape Cod Bay is a seasonal home for right whales. Mayo estimates that at least 278 animals, or 65 percent of the North Atlantic population, were in the bay last spring, and dozens have already returned this season. They’re easily spotted from Herring Cove and Race Point.

    But these patterns are changing.

    Reproduction has dropped in recent years. Healthy female right whales should give birth every three years, but the current average is every six or seven years, Pace said. Scientists don’t know why that is so, but say it is likely due to nutritional and other stresses. The result, though, is clear: fewer births.

    Bigger mammals, like right whales or elephants, tend to reproduce less frequently than smaller mammals because of their longer life spans, Pace said. Right whales typically lived well over 60 years, but these days their life expectancy is closer to 40 years with increased mortality from boat strikes and entanglements in fishing gear. With female right whales dying at a rate of 5 percent per year, Pace said, they are not living long enough to replace themselves.

    Complicating scientists’ abilities to understand whale behavior, the geographic distribution of right whales is changing with the climate crisis.

    For example, right whales typically eat copepods, tiny crustaceans swimming in the ocean. In the past, these could be found near Nova Scotia and the Gulf of Maine, carried in by ocean currents. Those currents have slowed because of warming, however, and right whales are moving elsewhere to find food. Recently, whales have been spotted south of Nantucket and near George’s Bank instead of farther north.

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