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Vermont, the most vaccinated state in the nation, has been weathering a spike in COVID cases. But why?

A ‘mask up!’ sign greets customers at the entrance of the Brattleboro Food Co-Op on Friday afternoon. The co-op is one of the busiest places in town, with 10 thousand customer transactions a week, and many businesses in downtown Brattleboro followed the co-op's lead on their decision to mask up again starting in late summer.Erin Clark/Globe Staff

Throughout the pandemic, Vermont has been a beacon for the country, with its highest-in-the-nation COVID-19 vaccination rate, and often one of the lowest infection rates, too. On several days last summer, the state reported close to zero new COVID cases.

But since August, Vermont has been grappling with an alarming spike, often topping 200 new cases per day. The unexpected turn has triggered a sharp debate — at least by Vermont’s polite standards — over how forcefully to respond. The surge has leveled off in recent days but the case count remains high, tied with Maine for the most per capita in New England.

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Infectious disease experts suspect that Vermont, in a way, may be a victim of its own success, leaving it more vulnerable to infections now, especially compared to states that didn’t blaze as impressive an early path.

Because so many Vermonters stepped forward early to get their shots, many may have waning immunity now, making them more susceptible to breakthrough infections. And because the state did such a good job of keeping COVID case numbers down through much of the pandemic, fewer Vermonters developed natural immunity from actually fighting the virus.

Add the sheer public weariness with masks and social distancing after 20 months of COVID, doctors say, and Vermont had a combustible mix as it headed into fall.

“It could be our success in vaccinations has undermined our investment in other measures,” such as masking, said Dr. Tim Lahey, an infectious diseases physician and professor at the University of Vermont Medical Center.

Now, as people are drawn indoors with the cold weather, Lahey and other public health leaders worry that Vermont, and especially its governor, Phil Scott, may have grown complacent. COVID is still an imposing foe, they say, especially now that the more highly contagious Delta variant dominates.

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“Delta has changed the equation in so many ways, yet our policy making has not shifted in response to that,” said Anne Sosin, a policy fellow at the Nelson A. Rockefeller Center for Public Policy at Dartmouth College.

Perhaps Brattleboro, a postcard-perfect Southern Vermont town on the banks of the Connecticut River, best embodies the debate.

Worried about rising infections in August, town leaders passed an indoor mask mandate for all public spaces. They sent it to the state health commissioner for final approval, as required by Vermont law. Days later, Scott, a Republican, stepped in and overruled the action.

Downtown Brattleboro, Vermont, the state with highest-in-the-nation COVID-19 vaccination rate.Erin Clark/Globe Staff

Brattleboro’s town manager, Peter Elwell, appealed. Sorry, but no, came the response, again from Scott’s office. It said the town’s relatively low number of infections and high vaccination rate did not warrant such emergency action. More than 90 percent of its eligible population is vaccinated, among the highest in the state.

“Mandatory masking has only been exercised or permitted by the Governor during a declared state of Emergency,” and that emergency ended in June, Wilson wrote.

State data show that COVID cases in Brattleboro have climbed sharply, with 208 since Sept. 1, accounting for roughly a third of all the cases in the town since the start of the pandemic.

Blocked from adopting an indoor mask mandate in late August, Brattleboro leaders passed a “face coverings encouraged” resolution, instead. They haven’t been alone in their concern.

An open letter to the Scott administration from dozens of Health Department workers in late August expressed “deep concern at what we believe to be a lack of adequate COVID-19 prevention guidance” from the state.

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The workers were concerned that the state’s public guidance encouraged only unvaccinated people to wear a mask and didn’t mention the risk of COVID-19 among people who are vaccinated but not wearing face coverings. The group urged the administration to recommend mask use for everyone in all indoor spaces, and to encourage testing before and after large social gatherings.

Two months later, not much has changed, said one worker, who asked to remain anonymous for fear of reprisal.

“We are trying to understand why [more clear guidance] is not happening.” said the worker. “It’s mystifying all of us.”

Jason Maulucci, Scott’s press secretary, said the governor and state Health Department have been “very clear” about recommending that people wear masks in crowded places. But mask mandates are off the table, he said,

“It’s a delicate balance,” Maulucci said. “We are promoting mask wearing, but we don’t want to do anything that would damage the public belief that vaccines work.”

He said the administration believes Vermonters cannot “live in a perpetual state of emergency,” and need to transition to a post-pandemic world.

“Some people want to move backwards to mandates and social distancing and I don’t think there’s an appetite anywhere in the country for that right now,” he said.

Matt Maranian and Loretta Palazzo, a husband-wife team who own Boomerang, a clothing store on Main Street in Brattleboro, know all about that push and pull.

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“It’s a bone of contention between us for sure,” said Palazzo, who laughs when asked about the couple’s debates on COVID safety measures.

“Masks required,” reads a sign in red lettering on the shop’s front door. “Thanks for respecting the wishes of our staff.”

Maranian didn’t want to require customers to wear masks, and certainly didn’t want to drive off the hordes of leaf-peeping tourists who have been descending on Brattleboro. But Palazzo, who has an autoimmune disease that makes her more vulnerable to infections, was adamant. And, she said, she wants to protect her workers, too.

Store owner Loretta Palazzo removed the shirt from a mannequin while helping a customer at her shop ‘Boomerang’ in Brattleboro.Erin Clark/Globe Staff

Scott added fuel to the debate over mask mandates on Tuesday when he recommended — but did not require — the state’s schools to extend their indoor mask rules until mid-January. Just to the south, Massachusetts has a mandatory school mask mandate, and on that same day, Governor Charlie Baker, also a Republican, announced it would continue until mid-January.

“Last year we had 44 pages of guidance to keep kids in school, and this year it was an advisory memo. It’s just not as clear what our guidance is,” said Karen Conroy, superintendent of schools in Canaan, a tiny district of 180 children from prekindergarten through 12th grade in Essex County. The rural northeast corner of the state has a 62 percent vaccination rate, the lowest in Vermont.

Yet the school board has twice rejected a mask mandate for schools.

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Although an impressive 71 percent of Vermonters are vaccinated, that figure obscures the concern that so many were vaccinated more than six months ago. As a result, their defenses against the virus may be waning.

Likewise, relatively few of Vermont’s unvaccinated residents may have natural immunity to COVID. Federal data show Vermont has one of the nation’s lowest levels of people who have recovered from COVID and developed natural immunity. The data from the Centers for Disease Control and Prevention estimate that only 1.4 percent of Vermonters tested in January, before vaccines were widely available, had protective antibodies in their blood — a percentage that has grown slightly since then.

By comparison, the data show roughly 9 percent of people in Massachusetts have such antibodies.

As Vermont plots its path forward, Betsy Bishop, president of the state’s Chamber of Commerce, is confident it will, at the very least, retain a civil level of discourse.

“We are allowed to have differing ways to get to the same results, pushing the governor for mask mandates, and the governor’s reluctance to do that. But they all agree people should mask up,” Bishop said.

“You don’t have to all agree on the path, but we all do get there.”





Kay Lazar can be reached at kay.lazar@globe.com Follow her @GlobeKayLazar.