No masking orders in place as increasingly contagious COVID-19 yields to milder illness

When Rob Cushing of Marstons Mills experienced sinus issues and fatigue, his first thought was it was an attack of springtime allergies.

His girlfriend said it could be COVID-19.

Cushing, 52, took a home test and — like hundreds of Cape Codders in recent weeks — tested positive for the coronavirus.

“I immediately had to cancel any in-person plans,” said Cushing, who runs a digital marketing agency.

“All these places are opening up for the season (like) Four Seas Ice Cream,” but he is isolating to keep others safe, Cushing said.

“I haven’t seen anybody” for days, he said.

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As the busy season kicks off in a few days with Memorial Day weekend, a rise in COVID-19 cases is causing some confusion and concern about whether to mask up again, stay home or risk getting a virus that seems to be losing its fearsome punch.

“All signs point to a very busy season, and there is concern that businesses will be stressed by having staff unable to work due to illness,” said Maura Valley, health agent for the Tisbury Board of Health.

She said Dukes County, which covers all of Martha’s Vineyard, is considered a high-risk area for contracting COVID-19 based on Centers for Disease Control and Prevention guidelines, whose metrics for the Island translate to 41 cases over seven days based on a population of 20,600.

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As of Sunday, the Island’s seven-day positive case count for PCR testing was 48 and the seven-day over-the-counter test positive-case count was 78.

Barnstable County on Cape Cod reported 1,440 new cases of COVID-19 over the last two-week reporting period. On May 13, Barnstable High School dismissed students early due to the number of staff absences, many attributable to coronavirus infections or caretaking responsibilities.

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All COVID home tests likely not included in new case numbers

It's notable that cases are underreported in the state Department of Public Health daily and weekly case counts. Many people are now relying on home test kits, the results from which are not typically reported to the DPH, Yarmouth Health Agent Bruce Murphy said.

“Really everybody needs to be taking precautions now,” he said.

However, the sharp increase in cases is not generating calls to reinstate mandatory masking.

Boards of health on Martha’s Vineyard have issued mask advisories, but not mandates, Valley said.

“Many people are wearing masks, but it does appear that most people are not,” she said in an email.

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Dennis-Yarmouth Regional School Superintendent Carol Woodbury said the school district is not experiencing infection levels like those in January when it reached 164 cases in a week.

“However, the numbers are the highest we have seen since unmasking,” she said.

The state Department of Elementary and Secondary Education said D-Y posted 65 COVID-19 cases during the last reporting period, from May 12-18, including 57 students and 18 staff members.

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Those numbers have more than doubled what the district reported earlier this spring, Woodbury said.

“I am not asking people to mask up, and there is no mandate,” she said. Woodbury said she is sharing information on case numbers with families in the district.

“Some families want to know because they want to send students to school with a mask if numbers go up,” she said, particularly if they have a household member who is older or immunocompromised.

“Knowing that numbers are up they may want to make the personal decision to have their child mask or decide not to visit a loved one as usual when numbers are up.”

Provincetown Town Manager Alex Morse said the town that famously experienced a spike in cases of COVID-19 last summer is not asking visitors or residents to mask up this spring.

“We encourage people to assess their own personal risk and make decisions that feel right for them,” he said.

Wastewater report trends indicate an increased presence of COVID-19 in the community, Morse said.

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“Businesses can choose to implement a masking or vaccine mandate on their own, and the Board of Health is still certifying those businesses that report that their entire staff is vaccinated,” he said.

Ten Provincetown businesses have confirmed they have fully vaccinated staff, and four of those — including the Provincetown Theater — also require proof of vaccination.

Hospital admissions for COVID remain low

Although case numbers are up, COVID-19 hospitalizations remain low.

Dr. William Agel, chief medical officer for Cape Cod Hospital in Hyannis and Cape Cod Healthcare, said there have been about 30 patients who have COVID-19 in Cape Cod Hospital and Falmouth Hospital in recent days.

But only 40% of those patients are being treated primarily for COVID-19. The other 60% are patients being admitted for issues such as heart attack or hip fractures who incidentally test positive for coronavirus, Agel said.

On a recent day, only one patient with COVID-19 was being treated in intensive care, he said.

The recent rise in COVID-19 infections “is not translating into the same kind of numbers we saw in the hospital back in December and January,” he said.

The BA.2 omicron subvariant now dominating Massachusetts is “significantly more communicable” than delta or original COVID-19, Agel said.

It also is likely less virulent, he said. “It doesn’t make sense to kill your host.”

The apparent devolution of COVID-19 along with vaccination and better care in the form of antiviral treatments such as Paxlovid and Remdesivir and monoclonal antibody treatments are keeping people out of the hospital.

“We’re seeing folks with mostly upper respiratory symptoms,” including scratchy throat, headache and fatigue, Agel said. “A lot of it is so mild people are mistaking it for allergy symptoms.”

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Unvaccinated, immunocompromised still face highest COVID risk

Those at highest risk are individuals who are unvaccinated or who have comorbidities, Agel said.

He recommends people get vaccinated and/or booster shot when appropriate, adding that the booster appears to be more protective against emerging subvariants.

Valley agreed that most infections do appear to be mild, but the elderly and (immunocompromised) continue to be at risk of more serious illness.

“We advise those at increased risk to consult with their primary care providers regarding steps they should be taking and whether they should begin antiviral treatment,” she said.

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Also as of this month, Massachusetts residents with mild to moderate symptoms of COVID-19 can bypass their regular practitioner and get a free telehealth appointment at www.mass.gov/covidtelehealth to see if they qualify for a prescription for Paxlovid pills.

Cushing, who was prescribed Paxlovid, said his primary COVID-19 symptom has been fatigue. “It just kind of sucks the energy out of you,” he said.

He is looking forward to emerging from his period of isolation and enjoying late spring and summer on Cape Cod, especially since taking precautions to protect himself from serious illness.

“I’m strong and resilient," Cushing said. "I’m vaccinated and boosted."

Contact Cynthia McCormick at cmccormick@capecodonline.com. Follow her on Twitter: @Cmccormickcct.

This article originally appeared on Cape Cod Times: Cape Cod COVID cases rise as masking guidelines remain vague