Provincetown's Covid Outbreak Shows 'It's Nowhere Near Over'

PROVINCETOWN, Mass. — By the Fourth of July, Provincetown’s tourist season had built to a prepandemic thrum. Restaurants were booked solid, and snaking lines formed outside the dance clubs. There were conga lines, drag brunches and a pervasive, joyous sense of relief.

“We really thought we had beat Covid,” said Alex Morse, who arrived this spring as town manager. “We had internalized those messages, that life will be back to normal. We beat this. We are the most vaccinated community in the state.”

Mr. Morse didn’t think much of it, five days after the holiday, when the town’s Board of Health logged two new cases of coronavirus. A week later, though, the cluster of cases associated with gatherings in Provincetown was growing by 50 to 100 cases per day. Alongside the numbers was an unsettling fact: Most of the people testing positive were vaccinated.

Provincetown, a quirky beach community at the tip of Cape Cod, has provided a sobering case study for the country, abruptly tugging Americans back to the caution of winter and spring.

The Centers for Disease Control and Prevention cited the cluster on Friday as key to its decision to issue new indoor mask guidance, saying viral loads among the vaccinated people there were found to be as high as the unvaccinated.

A community of health-conscious, left-leaning Northeasterners, known as a vacation mecca for gay men, Provincetown had one of the highest vaccination rates in the country, upward of 95 percent among permanent residents, Mr. Morse estimates.

On the weekend of July 4, it was also crowded. Around 60,000 people had jammed into a narrow spit of land, where many congregated, maskless, on sweaty dance floors and at house parties.

From the 965 cases that scientists have traced to gatherings in Provincetown, among them 238 residents, scientists have drawn important conclusions about the Delta variant of the coronavirus, which has helped drive a rise in hospitalizations across the country, mostly among the unvaccinated.

The good news is that people infected in Provincetown were, for the most part, not seriously ill; no deaths were reported, and only seven people were hospitalized. The bad news is that the variant is extraordinarily contagious — as contagious as chickenpox, the C.D.C. said — and people with so-called breakthrough infections may spread the virus to others.

In Provincetown, this news has left behind a feeling of whiplash.

“We are winding the clock back to maybe April or May of 2021,” said Susan Peskin, a longtime summer visitor who moved there full-time four years ago. “Now it is clear, as clear as day, that you can be vaccinated and still get Covid. Bottom line, we have to really watch ourselves and not think it is over. It is nowhere near over.”

‘Like putting a toe in the water’

Ms. Peskin, a financial analyst, remembers how strange it felt to let her guard down this spring. One day, she went into a restaurant for happy hour and saw the Plexiglas barrier had vanished, so she could stare the bartender straight in the face.

Through the height of the pandemic, Provincetown had followed strict protocols. She had never seen the bottom half of her nail technician’s face. It was jarring the first time she walked into a business without a mask.

“It was like putting a toe in the water,” she said. “Slowly but surely, I was unwinding everything I had put in place. It was an unwinding of fear.”

Soon, visitors were arriving in Provincetown in waves, something Ms. Peskin watched with a twinge of apprehension. Beside Herring Cove Beach, where, on a normal summer day, 100 or 200 bicycles might be lined up on the fence, she counted five times that many.

That period marked “the best weeks our businesses have had in a very long time,” Mr. Morse, the town manager, said. It was, he said, a sense of release that they all needed.

“There was a collective feeling that everyone had been through so much, individually and collectively, over the last 18 months,” he said.

Steve Katsurinis, the chair of the town Board of Health, said the venues were in line with C.D.C. guidance.

“We were told, ‘Now you’re vaccinated, and everyone is vaccinated, you can go out and live the pre-Covid lifestyle,’” he said. “People did, they were living with gusto. We were led to believe, ‘If you get the vaccine, you can go to a dance club, you can go to a house party and meet someone and make out.’ That’s what we thought the situation was.”

‘Delta is a different thing’

By the end of the week, Mr. Katsurinis was taking reports of positive coronavirus cases — all gay men, with an average age of 30 to 35, many of whom who had seen a doctor for other reasons, like flu symptoms or sexually transmitted infections, not suspecting the coronavirus. What puzzled him, he said, was that so many of the infected people were vaccinated.

“I couldn’t believe, frankly, that vaccinated people were getting and spreading it, the way that the contact tracing people were saying,” he said. “I had that moment of saying, ‘I don’t believe that data is accurate.’”

Days passed, he said, before it was clear that the virus circulating was the Delta variant, “and I went, oh, OK. Delta is a different thing.”

“I don’t think we could have anticipated what Delta would do here,” he said.

Infectious disease specialists have praised the community’s meticulous contact tracing, carried out largely by four nurses in Barnstable County, for helping them to understand the scope of the outbreak.

As town leaders debated what health measures to reintroduce, Mr. Morse said he was concerned about overreacting, or making decisions “based on the loudest and most frantic voices.”

But successive waves of tests showed a rising positivity rate, hitting a peak of 15 percent on July 15. The town issued an indoor mask advisory four days later, Mr. Morse said, and made it mandatory on July 25.

“We are entering a new era of having to live with the virus,” he said. “In the long term, it’s not going to be feasible to mask up one weekend and let it go the next.”

‘We will take care of our own’

Late-summer Provincetown is a different Provincetown — still crowded, but cautious, alert for bad outcomes. The town’s positivity rate dropped to 4.6 percent on Thursday; its mask mandate will automatically become an advisory, and then be lifted, if it remains low.

Rick Murray, the general manager of the Crown and Anchor, a beachside inn that houses bars and nightclubs, says it is part of the community’s DNA to be “very, very responsible” in a health crisis.

“When the AIDS epidemic came, we took care of our own, and we will take care of our own now,” said Mr. Murray, who has been H.I.V. positive for 37 years. He said he anticipated that guarding against the virus will be challenging “for another two or three years, easily.”

“This is not going to go away,” he said.

It was simple enough for Liz Carney, 50, who owns the Four Eleven Gallery on Commercial Street, to revert to strict coronavirus protocols. There was muscle memory. For an opening scheduled for Friday, she went back to that old, restrained style: masks required, no beverages served, and only three people allowed in the gallery at a time.

Thinking back to the exuberant crowds of June, she said it was “a bit naïve” to think it was safe to congregate inside — but also, she misses them.

“There was just a joy and an exhilaration,” she said. “It was very exciting. I wish I had taken a twirl on the dance floor while I had a chance.”