A Covid-19 outbreak in Provincetown helped change the CDC’s mask guidance. Here’s what residents learned and how they’re responding

The July 4 holiday is always a huge celebration in the small town of Provincetown, Massachusetts, with a long lineup of parties and festivities that usually bring in thousands of visitors from across the country to the top edge of Cape Cod.

“That’s what we kind of say is the official start of summer,” said Christopher Roberts, who owns a puzzle and game store in Provincetown. “July 4 is just packed … and then really from that day on, it’s like that.”

Closed retail stores line the usually crowded Commercial Street, Monday, May 25, 2020, in Provincetown, Mass. (AP Photo/Michael Dwyer)

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Provincetown, home to roughly 3,000 year-round residents, was thrust into the national spotlight last week after it became the subject of a study that persuaded the US Centers for Disease Control and Prevention to change its face mask guidelines.

Published Friday by the CDC, the study said 469 Covid-19 cases were identified in Massachusetts residents who had traveled to Barnstable County – which includes Provincetown – between July 3 and July 17. The cases were associated with “multiple summer events and large public gatherings,” the CDC said.

Roughly three-quarters of those cases were among fully vaccinated people, a finding that suggests inoculated people can also spread the virus, including the dangerous Delta variant that’s been fueling the country’s latest surge. There were five hospitalizations associated with the outbreak – four of whom were fully vaccinated people – and no deaths reported, the CDC study said.

The agency updated its mask guidance last week to recommend vaccinated people wear masks indoors when they’re in areas with “substantial” or “high” Covid-19 transmission to prevent further spread of that variant.

People walk down Commercial Street in Provincetown on Tuesday, July 20.

“I personally was under the impression that it would be difficult to contract (Covid-19)” after getting the vaccine, said Ken Horgan, a Provincetown hotel owner.

“But I was educated quickly, as all of us were here, getting vaccinated does not give you the ability to engage in high-risk activities or otherwise assume that you don’t have to take any precautions,” he told CNN’s Alisyn Camerota on Friday.

To curb further spread, local leaders have brought back a mask mandate for Provincetown, and fully vaccinated residents and business owners say they’re doing their part to double down on safety measures again and push for more vaccinations.

They say the cluster was a wake-up call that while the vaccine is very effective at preventing serious illness and death, it works best when paired with other precautions.

“We were told that if you’re vaccinated, you’re almost invincible and I think we … wrongly assumed that,” town manager Alex Morse CNN’s John Berman on Friday.

‘A petri dish for the country’

Debbie Nadolney, director and curator at the AMP Gallery in Provincetown, said while she, her partner and most of the other people she knows in town have been vaccinated, she felt mask requirements and other safety measures were lifted too soon. She said she mostly continued to wear her mask after her vaccine and encouraged others to do so when they were in the gallery.

Health care workers assist a patient in the ICU inside Little Company of Mary Medical Center Friday, July 30, 2021 in Torrance, CA.

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“It just seemed to me like common sense to continue on,” she said. “Only half the country … has been vaccinated, we haven’t reached, you know, the 70 or 80% vaccination rate in the country yet. So why are we celebrating?”

Roughly 57.5% of the US population has received at least one Covid-19 vaccine dose and about 49.5% is fully vaccinated, CDC data shows. In Barnstable County, roughly 76% of people have received at least one dose of their Covid-19 vaccine, according to the latest state data.

With the influx of people the town saw in July and no widespread mask requirements, Nadolney said the outbreak didn’t surprise her. Local leaders held an emergency meeting last week and issued an indoor mask mandate for Provincetown. The requirement applies to all indoor restaurants, theater or performance venues, bars, dance floors, lodgings, fitness centers, retail and personal service shops, offices and other public facilities.

LOS ANGELES, CALIFORNIA - JULY 19: A sign is posted about required face coverings in Grand Central Market on July 19, 2021 in Los Angeles, California. A new mask mandate went into effect just before midnight on July 17th in Los Angeles County requiring all people, regardless of vaccination status, to wear a face covering in public indoor spaces amid a troubling rise in COVID-19 cases. (Photo by Mario Tama/Getty Images)

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Nadolney said she now mandates masks in the gallery and hopes the town’s mandate isn’t lifted any time soon. Doing away with mask requirements was a “mistake” in the first place, she said, and she hopes other parts of the country learn from the town’s experience and require masks in addition to pushing for more vaccinations.

“Provincetown is such a little place but obviously we’ve been a petri dish for the country,” she said.

Roberts, who owns the puzzle store, said he’s enforcing the mask requirement and if customers don’t have a face covering, employees will offer one to them. Now that he knows vaccinated people can spread the virus, too, Roberts said he’s extra careful not to get infected since his 7-year-old son is still ineligible for a Covid-19 shot.

‘Heading in the right direction’

Horgan, the hotel owner, said the outbreak was both a sobering and an eye-opening experience. Local leaders and business owners “banded together” and implemented their own mask and vaccine requirements, he said. His hotel, like others in the town, is now requiring proof of vaccination.

“If you’re planning to travel and you’re not vaccinated, please, please don’t come to Provincetown,” Horgan said. “We really take our health seriously and for our local businesses to survive, we need to stay operational. And to stay operational, we need to stay healthy.”

In an update on Friday, the Barnstable County Department of Health and Environment announced that 934 Covid-19 cases were associated with the Provincetown cluster as of July 29 – 560 of which were Massachusetts residents and 231 of which live in Provincetown.

LOS ANGELES, CALIFORNIA - JULY 19: People wear face coverings as they gather in Union Station on July 19, 2021 in Los Angeles, California. A new mask mandate went into effect just before midnight on July 17 in Los Angeles County requiring all people, regardless of vaccination status, to wear a face covering in public indoor spaces amid a troubling rise in COVID-19 cases. (Photo by Mario Tama/Getty Images)

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There are now 103 active cases in town, according to Morse, the town manager.

The local test positivity rate has plummeted since the start of the cluster from a peak of 15% on July 15 to 4.6% on July 29, Morse said in a recent Facebook update.

The latest numbers, in addition with the new mask mandate, mean the town is “heading in the right direction,” Morse told CNN on Friday.

“What we’re taking from here is that this Delta variant is highly transmissible, more contagious, more likely to have a breakthrough infection but it’s not likely you’re going to be hospitalized and you’re certainly not going to die,” he said.

“The Delta variant is incredibly dangerous to unvaccinated individuals and while we have a mask mandate in the short term, our longer-term way out of this is really through vaccination.”

Dr. Jane Aronson, 69, was among those who were fully vaccinated and infected in Provincetown. She said she developed symptoms including shortness of breath, a cough and a low-grade fever. But the vaccine saved her life, she said.

“That’s exactly what happened,” she told CNN’s Anderson Cooper on Friday. “I felt immediately like, ‘I’m scared, but I know this vaccine will work.’”