Waiting to exhale: COVID-19’s resurgence has many on edge

Vaccines, say many infectious disease experts, are a shining light amid the gathering clouds.

A sign outside a Provincetown venue described its vaccination policy.Barry Chin/Globe Staff

This is not the worry-free summer many envisioned as recently as Memorial Day, full of long-awaited travel, joyous family reunions, and idyllic evenings in favorite restaurants.

Since July Fourth, there’s been a steady drumbeat of discouraging COVID-19 news: Infections are climbing rapidly across the country. Hospitalizations in several Southern and Western states are spiking, too. Vaccinations rates have dwindled. And communities from Cambridge to Los Angeles County are advising or mandating a return to mask-wearing, even for vaccinated people.

The highly contagious Delta strain of the virus, estimated to be responsible for recent outbreaks on Cape Cod and at least 83 percent of cases nationwide, has cast a long shadow.

“It’s difficult to be back in this saddle, on this trail again,” said Vaira Harik, deputy director of Barnstable County’s Department of Human Services. Harik has been flat out dealing with a post-July Fourth outbreak in Provincetown that has so far infected at least 256 people, many of them vaccinated, from Boston and beyond.

“But now at least,” Harik said, “we have vaccines.”

Vaccines, say many infectious disease experts, are a shining light amid the gathering clouds. While infections are rising, the rates of hospitalization and death in highly vaccinated states, such as Massachusetts, are inching upward rather than skyrocketing.

A study this week in the New England Journal of Medicine offers fresh hope that vaccines are holding up well against new strains of COVID-19. Researchers found that a full two-dose course of the Pfizer-BioNTech vaccine, which is widely available in the United States, is almost as effective in preventing symptomatic disease from the Delta variant as it is against the Alpha, previously the most dominant strain in the country.

While reports are increasing nationwide of breakthrough infections in people already vaccinated, the cases are still uncommon and most do not involve serious illness or death. More than 97 percent of people hospitalized with COVID-19 are unvaccinated, federal officials say.

“If we didn’t have highly effective vaccines, things would be dramatically different. The lockdowns would have continued,” said Dr. Leonard Mermel, medical director of the epidemiology and infection control department at Rhode Island Hospital.

One of the most striking examples of the vaccines’ power can be seen at the Maplewood at Mayflower Place senior living facility in West Yarmouth, where officials Tuesday reported 33 people testing positive for COVID-19 since July 10, including 24 elderly residents.

Early last year, when the first wave of COVID-19 infections swept through nursing homes, elderly people died in scores, including 76 at the Holyoke Soldiers’ Home alone. In all, long-term care deaths accounted for roughly 40 percent of the nation’s COVID-19 deaths before the vaccines rolled out.

Today, the vast majority of nursing home residents statewide are vaccinated, including most Mayflower Place residents, and the contrast to 2020 is striking. So far, one resident who tested positive earlier this week has died, said Bruce Murphy, Yarmouth’s health director. But most of the residents who tested positive are either asymptomatic or have mild symptoms, the state health department said.

Nationally, the outlook is more concerning. The seven-day average of new cases has nearly tripled since July Fourth, data from the Centers for Disease Control and Prevention show. Hospitalizations in the past two weeks have jumped 53 percent and deaths 30 percent, according to The New York Times COVID-19 tracker.

In Massachusetts, where 69.4 percent of residents have received at least one vaccine dose, new cases are also on the rise, with the seven-day average more than tripling since July 5, state data show. But the increase in hospitalizations and deaths has been modest: a 17 percent increase in hospitalizations since July 5, while deaths, a lagging indicator, have held about steady.

And yet, anxiety levels are rising.

More Americans are now saying a return to “normal life” is risky, finds a new Axios/Ipsos poll. Thirty-nine percent said returning to their pre-coronavirus life right now poses a large or moderate risk to their health and well-being — an 11-point increase from the end of last month.

“Humans don’t do well with uncertainty and we are in uncertain times.,” said Jen Kates, senior vice president and director of global health & HIV policy at the Kaiser Family Foundation.

Fueling the anxiety, Kates said, is the realization that a sizeable portion of Americans — roughly one in five — say they will definitely not get vaccinated or will get a vaccine only if required to do so for work or other activities, a measure that has remained relatively unchanged since January.

“We’ve reached a plateau in people wanting to get vaccinated, leaving huge swaths of unvaccinated parts of the country,” she said.

And it’s not just this country. Billions of people globally are unvaccinated, as many countries, especially poor ones, still lack widespread access to the shots.

“Everyday around the world the virus is continuing to evolve and we haven’t kept pace with our vaccine initiative globally to try to mitigate further mutations that would make the virus more transmissible.” Mermel said.

The death rate has declined globally since the Spring, but each day thousands of people are still dying, the Johns Hopkins University COVID-19 tracker shows. The world has witnessed how rapidly a virus in one country can infect billions globally. And yet, Mermel said, vaccine distribution to many developing countries has stalled.

“The fuse is burning,” Mermel said, “and we are running around town looking for a pail of water.”

With America at a crossroads — roughly half the country is still unvaccinated — and the virus continuing to mutate, everyday life, unlike in 2020, will become an ongoing calculation about what’s safe and what isn’t, said Dr. Sandro Galea, dean of Boston University’s School of Public Health.

“In a world where people are now vaccinated, risk of transmission and severity are totally different than last summer,” Galea said. “The question is, what level of risk are we willing to accept in our lives.”

In Massachusetts, some officials are wasting no time in taking aggressive steps to block the virus’s spread. On Thursday, Acting Mayor Kim Janey announced that Boston’s public school children will be required to wear masks when they return to school in the fall. And Cambridge is urging residents, whether vaccinated or not, to wear masks and practice social distancing “where transmission is likely and when around unvaccinated people, including young children.”

Nationally, top White House officials are reportedly debating risk levels and whether to advise a return to indoor masking, even for those who are vaccinated.

A return to masks is gaining traction with infectious disease experts, some of whom say federal regulators dropped the ball too early on this in May.

“It’s a really gray zone now and it’s really hard to go backwards,” said Shan Soe-Lin, a lecturer at Yale University’s Jackson Institute for Global Affairs, and managing director at Pharos Global Health Advisors, a Boston global health advisory firm.

“I think we should return to indoor masking everywhere,” she said.

Soe-Lin is advising her friends to start masking up indoors.

“Don’t live like a hermit anymore,” she said, “but you also don’t want to go to a party with a whole bunch of people without wearing a mask.”

Soe-Lin’s caution is a far cry from the sunny optimism earlier this year when Governor Charlie Baker lifted most COVID-19 restrictions, allowing crowds to return to Fenway Park, bar patrons to return to their favorite watering holes, and life to return to something like normal.

So far, at least, Baker has resisted calls for new statewide restrictions in the wake of the surge in infections, saying it’s up to local officials if they want to re-impose mask rules or other restrictions.

“We have a set of statewide standards, and they’re based on what we see on a statewide basis,” the governor said at an event on Cape Cod on Thursday. “And if communities believe they need to pursue strategies that are more effective and appropriate to them, then they should do so.”

Despite the rising concerns about breakthrough infections, Soe-Lin said people should be optimistic about how well the vaccines are working.

But she equated them to a bulletproof vest: a last line of defense that is no substitute for avoiding danger in the first place. Just because you’re vaccinated, she said, doesn’t mean you shouldn’t take commonsense steps to minimize your exposure. Or, as Soe-Lin puts it:

“Don’t test your vest if you don’t have to.”

Globe correspondent Camille Caldera contributed to this story.