WASHINGTON — If you want to cast blame for the return of face masks, you will have to look to the charming fishing village of Provincetown, Mass., at the tip of Cape Cod. An outbreak of several hundred cases there earlier this month alerted public health officials to the fact that the Delta variant of the coronavirus transmits much more easily than people had previously thought.
“The war has changed,” the Centers for Disease Control and Prevention acknowledged in an internal presentation that summarized the new findings about Delta, which led the agency to reimpose a mask mandate earlier this week in an urgent bid to keep the pandemic from spiking again across the U.S.
And if you want to find a reason for why no such spike will take place — or how such a spike can be effectively prevented — you would do well to look to the same charming fishing village. A combination of high vaccination rates and renewed masking appears to have significantly slowed growth of the Provincetown cluster just as that cluster was making national news.
“Day by day, things are improving,” town manager Alex Morse told Yahoo News.
Provincetown shows how at least the next battle in the war against the coronavirus can be won. New variants could emerge, either more transmissible or more severe, or both. For now, though, Delta is the primary target, the reason why some fear schools may revert to remote learning, and why restaurants and bars may have to close again, as they did in 2020.
Provincetown seems to argue strongly against such measures, even as it calls for others.
Earlier this month, news began to emerge of hundreds of cases stemming from Fourth of July festivities in Provincetown, probably better known today as the nation’s most famous gay resort. A CDC study of that outbreak released on Friday presented some alarming new facts but also gave reason to be optimistic about where the pandemic is headed in the U.S.
According to agency analysis, the Delta variant is much more transmissible than previously thought, in line with the chickenpox and Ebola. The CDC study concluded with advice for public health officials to “consider expanding prevention strategies,” which could include masks and limits on indoor gatherings.
In fact, such impositions are returning to parts of the country, as the nation appears to be losing steam against the pandemic. The Provincetown cluster, however, shows that that’s not necessarily the case.
While the Delta variant presents a new challenge, one whose scope was not fully understood until earlier this week, the experience of Provincetown also shows a clear path to defeating the variant.
“Yeah, delta variant is bad. Like really bad,” tweeted Dr. Ashish Jha, an epidemiologist and dean of public health at Brown University.
He then added a crucial caveat: “Our vaccines are good. Like really good.”
Provincetown is proof of that, and of how putting masks back on when infection rates spike can help blunt what might otherwise be a spike. By the time the CDC published its paper on Provincetown, the town seemed to be returning to normal.
“P-town is still very much a lively place," said Morse, using the term of affection locals use for Provincetown. Earlier this week, test positivity rates were down to 5.9 percent, from a high of 15 percent some days before.
That is largely because of vaccines, which remain effective in preventing people from becoming infected in the first place, as CDC officials have been at pains to note.
“While it’s as contagious as it is,” a federal health official told Yahoo News, speaking on the condition of anonymity, “and while these breakthrough infections are occurring — and they seem to be occurring more frequently than we once thought — the vaccine appears to be highly effective in preventing hospitalizations and deaths, even against the Delta variant."
Though effectiveness varies by vaccine brand, most are quite potent against infection and exceptionally so at preventing the kind of infection that causes serious illness. Of the 833 people in the Provincetown cluster as of Wednesday, only seven had been hospitalized. And zero had died.
In the CDC study, which accounted for the first 469 cases in the cluster — the only ones the agency had time to study — 74 percent, or 346, occurred in fully vaccinated people. That has given rise to the fear of infections that break through the vaccines and cause people to become sick with COVID-19.
Of those 346 people with breakthrough infections, 79 percent reported symptoms, but those tended to be mild, such as cough or headache. Nearly everyone recovered at home. Of the few who had to go to the hospital, several had underlying conditions.
“The power of the vaccines is their ability to prevent severe disease and death,” said Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco. “In fact, the vaccines are showing amazing persistence in achieving this goal, as evidenced by this large outbreak.”
Nationwide, Gandhi said, 0.002 percent of vaccinated people have experienced severe breakthrough cases.
Earlier this month, CDC Director Rochelle Walensky revealed that of the people who died from COVID-19 during the month of June, 99.5 percent had been unvaccinated.
“The vaccines are working,” Morse, the town manager, told Yahoo News, while also arguing that the town’s reimposition of a mask mandate helped lower infection rates.
Masks help compensate for Delta’s increased transmissibility. Even if vaccinated people do not necessarily get sick enough from Delta to go to the hospital, they could still potentially transmit it to others, and much more readily than they would have with one of the earlier coronavirus variants.
If it is able to take root, the Delta variant appears to replicate with disturbing speed, so that “the viral load of vaccinated and unvaccinated persons infected with SARS-CoV-2 is also similar,” said the CDC study. While breakthrough infections remain rare, when they do happen, they will almost certainly lead to heightened transmission.
While any outbreak is “of course tragic,” said Washington, D.C., internist Dr. Lucy McBride, this one “demonstrates the power of the COVID vaccines,” which have ensured that the overwhelming majority of Provincetown cases have been either mild or asymptomatic.
The cluster is, as McBride put it, “a stark reminder of the critical importance of getting vaccinated.” That’s because the unvaccinated remain at risk of full-blown COVID-19, with the variant’s heightened transmissibility only heightening that risk. Children under 12 remain unvaccinated, and millions of people have conditions that make them potentially more susceptible to serious disease.
Nobody expected the U.S. to reach 100 percent vaccination, but the Biden administration had hoped to be further along by the end of July. When a community is vaccinated to a sufficiently high degree, the virus remains highly unlikely to spread — especially if people put on masks when an uptick does occur, thus cutting off whatever routes of transmission remain for the virus.
That is precisely what appears to be happening in Provincetown, which as a gay mecca has the legacy of HIV/AIDS embedded deep in its psyche. “Provincetown has among the highest vaccination rates in the commonwealth [of Massachusetts], with nearly all residents age 12 and older fully vaccinated,” notes a town public health website.
Massachusetts, in turn, is the nation’s second-most-vaccinated state in the country, after Vermont.
High vaccination rates seemed to give Provincetown license to do what it does best throughout the summer months: party. The warm weather turns the sleepy village into a more colorful and inclusive version of New Orleans’s rowdy Bourbon Street. Thousands of visitors crowded into the bars and restaurants of Commercial Street during the Fourth of July weekend.
The cluster was at first a rumor around town, then a local news item, then a national headline. One early report appeared in the Washington Blade, a gay newspaper published in the District of Columbia. “Dozens test positive for virus after weekend getaway,” said an article published on July 14. Like all the reports that would follow, it noted that most of the people who tested positive after returning from Provincetown had been vaccinated.
Dozens quickly became hundreds. “‘Provincetown Cluster’ Now Has at Least 430 Cases, Officials Say,” went a Provincetown Independent headline on July 17.
“I felt like we were done with COVID, and we’re not done,” one local official lamented. That has become a common refrain. Provincetown was a warning that President Biden’s "declaration of independence” from the coronavirus, issued from the White House on July 4, had been misguided and premature.
The Delta variant has since become more prevalent, meaning that there will simply be more virus circulating in August than there had been in June; the climbing case counts are evidence of that unwelcome fact. But there is no definitive evidence that Delta causes much more severe illness.
Provincetown could easily become a symbol of the next stage of the pandemic, in which high-vaccination communities grapple with rising case counts. The federal government, meanwhile, will grapple with low-vaccination communities.
Now the focus is on vaccine mandates and, once again, masks. The CDC said earlier this week that even vaccinated people should resume wearing masks indoors if community transmission is high where they live.
Town and state officials reacted in Provincetown swiftly, advising people to wear masks last week. That guidance quickly became a mandate for universal masking in indoor spaces. The return of masking may have dampened some of the celebratory spirit, but it has also helped stop the Delta variant from spreading through town.
The U.S. as a whole is now essentially in the same place, though it is markedly less vaccinated (49 percent) than is Massachusetts (64 percent). Some states have vaccination rates that are significantly lower than the national average. Those states also tend to have Republican governors who are resistant to masking.
Still, epidemiologists cautioned on Friday that while the CDC’s findings were sobering, they did not necessarily change the trajectory of the pandemic.
“The sky is not falling,” infectious disease specialist Dr. Nahid Bhadelia said on MSNBC. “We are not in the same place as we were six months ago.”
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