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“The first thing I thought about was ‘This is Delta for you’,” said Dr. William Hanage, associate professor of epidemiology at the Harvard TH Chan School of Public Health.
“Even in highly vaccinated communities, Delta is able to transmit,” Hanage said, adding that he was concerned “that we are now at the very beginning of the wave from Delta in Massachusetts.”
In response to the cluster, the city released a new public health notice on Monday that asks people to wear masks indoors, regardless of their immunization status, when they cannot socially distance themselves, and asks that ” high density “ businesses require proof of vaccination before allowing people to enter. Officials did not disclose whether any of the cases were confirmed to be the Delta variant.
Boston public health officials on Tuesday recommended Boston residents who have been to Provincetown since July 1 to get tested for COVID-19, self-isolate and avoid gatherings for at least five days , regardless of their vaccination status, after 35 local cases had been traced to the cluster “and the overwhelming majority of them were fully vaccinated”.
On Saturday, the city of Truro released a statement saying that after the July 4 holiday, the city of Cape Town has seen “an increasing number of cases” of residents of Truro who have tested positive, many of whom are vaccinated. The city is working to track the travel history of the cases and see “if they are related to the Provincetown cluster”.
Dr Cassandra Pierre, hospital epidemiologist at Boston Medical Center and assistant professor at Boston University, said she believes the extra step of implementing an indoor mask warrant in Provincetown would be appropriate given the possibility of unvaccinated people spreading the virus.
“I am concerned that this event potentially represents that unvaccinated individuals are also in the mix, removing masks, being nearby, being indoors, and potentially not paying as much attention to risks and hazards. exposure, ”said Pierre. “The reintroduction of this mask mandate would provide that extra layer of protection that will ensure the safety of people who have been vaccinated but much more for people who are not vaccinated. “
On Monday, Steve Katsurinis, chairman of the Provincetown Board of Health, said officials were monitoring the situation closely and suggested further action could be taken if the outbreak is not contained.
Provincetown officials said the infections were not attributable to a single super-spraying event, and that at least 32 different companies are associated with it, which Hanage said could indicate the presence of the Delta variant, “due to Delta’s creeping ability to be infectious and enter the next host.”
The outbreak comes as Provincetown, an LGBTQ + summer hotspot, is at the peak of its summer tourist season. Chief executive Alex Morse said on Monday the city had seen two of its busiest weekends in the past two weeks. During the summer months, the city’s population increases from 3,000 to 60,000, Morse said.
Dr Paul Sax, clinical director of infectious diseases at Brigham and Women’s Hospital, said he believed it was a “reasonable assumption” that the Delta variant is fueling the outbreak. On Tuesday, the chief of the Centers for Disease Control and Prevention, Dr Rochelle Walensky, said the variant accounted for 83% of cases in the United States, a dramatic increase from the week of July 3, when Delta was responsible for 50 %. country cases.
“This type of outbreak gives us a glimpse of what a post-opening society of vaccinated people will look like as the Delta variant circulates widely,” Sax said.
Sax noted that although vaccines offer significant protection against serious illness, death, and hospitalization, they are not 100% effective, and some activities, such as crowded indoor gatherings, are associated with greater risk. high spread of COVID-19.
“I think that’s the kind of thing that’s starting to give us the message that COVID-19 is unfortunately here to stay,” Sax said. “It looks like we’re going to live with it rather than get rid of it, in part because until we’ve basically vaccinated everyone, there will be a virus circulating, and as long as there is a virus in the world. circulation, there are possibilities of transmission, even among vaccinated people. “
“I think Provincetown should be a warning to all of us,” said Dr. Mark Siedner, clinician and infectious disease researcher at Massachusetts General Hospital.
“The Provincetown outbreak really highlights the fact that we remain susceptible to epidemics and that our job is not done,” Siedner said. “The message from Provincetown shouldn’t be that vaccines don’t work, because that’s not what this outbreak has shown. What he has shown is that even people who have been vaccinated can become infected, especially when participating in unmasked and potentially high-risk activities. “
The combination of Provincetown attracting visitors from across the country, allowing people to congregate indoors without a mask, as well as the Delta variant “invite epidemics,” Siedner said.
“You say, ‘Let’s come together, up close, indoors, without masks, with a highly contagious variant, and at least some of the population that is not yet vaccinated and unprotected. It’s going to lead to epidemics and we’re seeing it in Provincetown, ”Siedner said. “These will continue to happen until we can find ways to immunize the vast majority of the population.”
Some experts have wondered how much worse the situation would have been in a community with a lower vaccination rate than Provincetown.
“If Provincetown weren’t getting vaccinated at the rate it is being vaccinated, they would have 10 times the number of infections,” said Dr. Robert Duncan, infectious disease physician at Lahey Hospital and Medical Center.
Dr Shira Doron, an infectious disease physician and epidemiologist at Tufts Medical Center, said on Monday that the cluster was “so unexpected” and “not what we’ve really seen elsewhere.”
Doron said she was concerned that the situation represented “a hole in our knowledge of the current state and what will happen” because “it is not in line with what we expect based on the data we have seen “.
In an email Tuesday, the Massachusetts Department of Public Health said investigations into the vaccine status of cases were underway and explained how the state is helping Provincetown and Barnstable County manage the increase in cases. .
The state has provided a mobile testing unit that will remain in Provincetown until at least Sunday, and is helping Barnstable County investigate cases, analyze clusters and trace contacts, among other efforts, said the department.
Amanda Kaufman can be reached at [email protected]. Follow her on Twitter @ amandakauf1.
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