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Provincetown officials have issued a new mask-wearing advisory after a recent uptick in COVID-19 cases at the height of its busy summer tourist season, in which a “vast majority” were detected in vaccinated people, alarming public health experts.

The town is advising people to wear masks indoors, regardless of COVID-19 vaccination status, “where social distancing cannot be achieved.” The advisory also urges businesses to require customers show proof of vaccination when social distancing is not possible.

From July 1 through July 16, the town has reported 132 confirmed positive cases to the Massachusetts Department of Public Health, the advisory said. Of those cases, 89 are Massachusetts residents, 39 of whom live in Barnstable County.

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The rise in cases is notable because vaccination rates are high in Provincetown — and on Cape Cod as a whole. Town Manager Alex Morse said 114 percent of the eligible population has been fully vaccinated, a number that accounts for vaccination rates among part-time residents. According to state data, 76 percent of eligible Barnstable County residents are fully vaccinated.

Provincetown, a popular LGBTQ+ summer destination, is at the height of its tourist season. Morse said that the town has had “two of the busiest weeks out of the summer over the last 14 days.” The town’s population balloons during the summer from 3,000 people who live there year-round to about 60,000 people.

The most recent data from the state show that Provincetown’s 14-day positive case rate per 100,000 people was at 13.8, a significant increase from the week before, when that number was zero. However, 13.8 cases represents a falsely inflated number, because it uses the year-round population of Provincetown, and the summer population is significantly larger.

The advisory was approved Monday morning during an emergency meeting with the town’s select board and board of health that was convened to discuss the rise in cases.

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During the meeting, Vaira Harik, Barnstable County’s deputy director of the Department of Human Services, said 93 percent of the cases were detected in males, and the median age is 35, with cases detected in ages ranging from people 20 to 70 years old. Seventy-three percent of the 132 cases that have been reported through Friday are symptomatic, Harik said, and the majority of the symptoms are mild.

The number of cases among vaccinated people is being investigated, Harik said, but it is “significant” and “more than the 5 percent efficacy rate of the vaccine.” Morse said cases among those who are vaccinated represented the “vast majority.”

The town’s rise in cases has been declared a “cluster” by the Department of Public Health, and officials have found that “exposure opportunities were widespread in Provincetown, not focused on a single activity or venue,” Harik said.

At least 32 different businesses in Provincetown have cases associated with them, Harik added.

Dr. Shira Doron, an infectious disease physician and epidemiologist at Tufts Medical Center, said the cluster is “so unexpected” and “not what we’ve really seen anywhere else.”

Doron said she is concerned the situation represents “a hole in our knowledge of the current state and what’s to come,” because “it’s not consistent with what we expect based on the data we’ve been seeing.”

Doron raised the possibility that the increase in cases in Provincetown is due to a new, unidentified variant that is circulating.

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“I wouldn’t even be surprised if you told me it was a new variant that might even have more immune-evading capability than the Delta variant,” Doron said. “It’s statistically not likely to be that because we know that the Delta variant is what is now increasing in Massachusetts and taking over, and we don’t know of another variant. But the reason I say that is just because all of the data — from the UK, from Canada — is suggesting that the vaccines are nearly as effective against the Delta variant as they were against prior variants, so don’t expect to see huge amounts of breakthrough infection with the Delta variant.”

Doron said a case-control study needs to be conducted in order to understand the scope of the cluster.

“We need to look at the people who did get infected and the people who didn’t get infected and try to understand what the differences between them are in terms of where they went, in terms of what they were vaccinated with, when they were vaccinated, underlying medical conditions, all of those things,” Doron said.

The cluster has been felt in places beyond Provincetown, Morse said at the meeting, and even outside of Massachusetts.

“We are seeing this have an impact in other communities along the Cape and in Barnstable County, other places in Massachusetts, and then pockets beyond the state of Massachusetts,” Morse said.

Doron cast doubt that the mask-wearing advisory would be effective because data have shown that transmission occurs “in private settings where there is no sign on the door that says ‘wear a mask.’ ”

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“I suspect that asking everybody to mask in order to get the unvaccinated to mask isn’t really going to work in the settings when they’re actually most likely to transmit infection.”

Steve Katsurinis, chair of the Provincetown Board of Health, suggested more measures could be forthcoming if the outbreak is not contained.

“We do think that this is an interim step that’s appropriate,” Katsurinis said in a phone interview Friday afternoon. “I don’t know honestly if this is going to be enough, but I think it’s where we start.”

Officials will be watching closely to see if anyone who contracted COVID-19 in town becomes hospitalized, Katsurinis said.

“That is the fire bell in the night that would make us really sit up and reevaluate this, is if we start seeing hospitalizations as a result of these infections, especially among vaccinated people.”

Provincetown is also extending mobile COVID-19 testing after expanding it last week following the increase, Morse said on Facebook over the weekend.

Testing will continue to be available through Friday from 10 a.m. to 3 p.m. at the Veterans Memorial Community Center parking lot, Morse said on Saturday.

The testing site has averaged between 250 and 275 people per day, Morse said at the meeting. COVID-19 vaccines made by Johnson & Johnson and Pfizer will also be available at the site.

Morse said it appears that the cluster has driven people to seek vaccinations at the mobile clinic.

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“We have seen an uptick in vaccinations from workers in town and some folks that were originally skeptical of vaccines,” Morse said.

In state data released last week, Massachusetts’ Department of Public Health said 0.1 percent of people in Massachusetts who have been vaccinated have contracted the virus. As of last Saturday, the department said, there were 4,450 “breakthrough” cases of COVID-19 among 4,195,844 vaccinated people.

Massachusetts has one of the highest COVID-19 vaccination rates in the country. As of Monday, 83.4 percent of adults in the state have received at least one dose of a vaccine, according to data from the Centers for Disease Control and Prevention.


Martin Finucane of the Globe staff contributed to this report.


Amanda Kaufman can be reached at amanda.kaufman@globe.com. Follow her on Twitter @amandakauf1.