Behind the federal advisory last Tuesday that everyone wear masks indoors regardless of vaccination status is a slew of COVID cases in Provincetown on Cape Cod, where vaccinated individuals were close to three-fourths of an outbreak of infections since Fourth of July. The surprising news upended current thinking about COVID — that the vaccinated were less likely to infect others — leading to the Centers for Disease Control and Prevention (CDC) rushing to release the advisory without accompanying studies. The more highly infectious Delta variant was found in 90 percent of sequenced cases, leading to health and safety implications, including for Santa Barbara’s Fiesta celebration set to start August 4.
Late last week, the CDC provided additional information behind its decision, reporting that among 469 positive individuals in Provincetown, 346 had been fully vaccinated. What was new is that the nasal swab tests told them both vaccinated and unvaccinated people had roughly equal amounts of virus in their nasal passageways. In other words, even the vaccinated in this group could spread the virus through coughing, sneezing, or simply breathing.
The information behind the mask advisory, while alarming, comes with caveats aplenty. Though the report was critically important, said Dr. Lynn Fitzgibbons, an infectious disease specialist at Santa Barbara’s Cottage Hospital, it was observational, a report of what happened, and not a randomized controlled trial. “It’s important to use the information,” she observed, “but also to know its limitation.”
Dr. Henning Ansorg, the county’s health officer, agreed, pointing to the section of the CDC report that stated, “data from this report are insufficient to draw conclusions about the effectiveness of COVID-19 vaccines against SARS-CoV-2, including the Delta variant, during this outbreak.” He issued an advisory on July 30 to wear a mask in all indoor spaces outside the home, stay home if ill even if vaccinated, avoid crowded events, and get vaccinated.
CAPE COD CONUNDRUM
For the lay public, new to scanning COVID medical reports, Cape Cod is a case in point. The data needs context, which has yet to be collected, such as: the quantity of people vaccinated on Cape Cod — the Barnstable Patriot reported an “overwhelming majority of Provincetown residents were vaccinated” — potentially underreported breakthrough asymptomatic cases, and that the large public gatherings between July 3 and July 17 had been marketed to adult males — 85 percent of cases were men, median age 42.
Cape Cod is an idyllic sandy peninsula that curves into the Atlantic Ocean with Martha’s Vineyard and Nantucket islands to its south. Its population of 3,000 swells to 60,000 during the summer months, crowding the narrow stretch to such an extent that bicycles are the most reliable form of transportation. Much like any tourist town, it features art openings, opera and live theater events, beer fests, and, with its fabled seafaring history, whale-watching tours and the Wellfleet OysterFest sponsored by the Shellfish Promotion and Tasting nonprofit. The op-ed page of the Cape Cod Times reflects residents concerned about a runaway real-estate market, rude and unruly customers, preschool subsidies, and their public library. Nearly half of the infected were residents of Cape Cod. The Patriot reported 833 cases late in the month, including 33 at a nursing home in West Yarmouth. The Provincetown Independent reported an indoor mask mandate was imposed on July 25 after a cluster of 171 cases was identified in town, related to 223 others in Massachusetts and 157 out of state.
The Massachusetts Department of Public Health cited “densely packed indoor and outdoor events at venues that include bars, restaurants, guest houses, and rental homes” were reported by those stricken. The case rate on July 3 had been zero cases on average over the past 14 days; on July 17, there were 177 cases per 100,000 persons. The Delta variant was found in 90 percent of the 133 sequences performed. Five people were in the hospital, among them four who were fully vaccinated. No deaths had been reported, though a terminal outcome generally takes several weeks to reach finality. The most common symptoms were cough, headache, sore throat, muscle pain or weakness, and fever, with the onset anywhere from six to 178 days after clearing the final vaccination period.
SANTA BARBARA’S SITUATION
Since the Fourth of July, Santa Barbara has experienced a soaring infection rate that would put the county back in the purple tier, if the rainbow of categories were still in effect. The number on July 20 was 10.1 people newly diagnosed per 100,000 residents; of that quotient, 2.1 were vaccinated, and 15.3 were unvaccinated. As of Monday afternoon, the latest County Public Health report indicated an additional 39 people were reported to be infected with COVID since Friday. This brings the total number of active cases to 442, and the total number of deaths to 463. Perhaps more dramatically, there are now 33 COVID patients recovering in one of the county’s hospitals. That’s an increase of 10 from this weekend. This Monday’s report from California public health stated more than 10,000 daily cases had been reported between Friday and Sunday. Last weekend’s number was 7,000.
Downtown Santa Barbara is set to host 1st Thursday on August 5, the first one since the pandemic closed everything down. Last week, Sullivan Goss art gallery told organizers it would remain closed. “If we’re being honest about putting community safety first, a decision is really obvious,” said Nathan Vonk, who took over the well-known gallery in 2016. The show would have featured Nicole Strasburg, and Vonk said of his decision process, “I had thought about masks, not serving wine. … I’m just a gallery owner. I rely on people who have spent their careers in public health to make these decisions.” But he read the news and watched the county’s health portal daily. “Much as I would love to have everybody here, good as that would be for my business, there’s no morally justifiable way to do that.” As it has throughout, the gallery remains open seven days a week, with just a few visitors at any one time, and masks are on hand at the door.
The City of Guadalupe just canceled plans to celebrate its 75th birthday on August 8 after Public Health weighed in. “[I]t would be best to cancel so that vendors, participants, representatives, etc., who were scheduled to participate in the celebration, are not held up in terms of their future planning,” City Administrator Todd Boden said in a press release. According to the latest from the CDC, based on its Provincetown investigation, were recommendations to events and health departments to consider limited capacity at gatherings or event postponement.
The big party in the wings is Old Spanish Days’ Fiesta celebration, which took a break from in-person events last year because of the pandemic. This year, organizers have planned dance performances at the Old Mission on August 4 and at the courthouse through August 7. “We have been checking day to day,” said Stephanie Petlow, La Presidenta for Fiesta this year. She indicated they planned to proceed with all health protocols in place, “unless something drastic happens,” suggesting that participants and viewers wear masks and remain six feet away for social distancing.
Petlow said the Fiesta committee was in close contact with the county’s health officials last week and based their decision to cancel the De la Guerra Plaza Mercado on their advice. “The health and safety of our community come first,” Petlow said, recalling the quantity of people who flood the plaza for the food booths and entertainment.
De la Guerra Plaza is also home to City Hall, where Mayor Cathy Murillo said she supported the Old Spanish Days decision to cancel the mercado right outside their doors and to urge people to wear face masks. “People were shoulder-to-shoulder at the mercado,” she recalled, “and they would be taking their masks off to eat and drink.” Murillo said she wore a mask wherever she went, not only to set an example but to protect herself. They mayor’s inbox was not full of emails asking for Fiesta to be canceled, she said, though people lamented to her in person of the loss of the city-wide party again this year.
The Delta variant continues to take health officials by surprise, most recently dropping from 400,000 cases a day in May in India — its place of origin — to 40,000 in July with little understanding of what caused that to happen. It’s certainly more contagious than other variants — as bad as chicken pox — and reports are emerging that show a trend toward more hospitalizations, said Dr. Fitzgibbons. Whether people will be able to react just as quickly to the evolving pandemic may be all that stands between us and a beast of a virus.
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