One year after Provincetown was thrust into the national spotlight with a large COVID-19 outbreak following July Fourth celebrations, the iconic tourist town is again threatened by a worrisome virus that is spreading in Massachusetts and globally: monkeypox.
This time, the community is taking a different, more unusual approach to warning people in the hopes of staving off another summertime outbreak.
Bartenders, waiters, and other employees of restaurants, spas, and inns have been recruited to educate visitors and locals alike about monkeypox, also known as MPV, and steps they can take to protect themselves and the community. The concern resonates in Provincetown, long a bastion for gay life, because most cases of the virus in Massachusetts and globally have been reported in men who have sex with men.
Instead of plastering the town with posters, local leaders have opted for a more low-key, grassroots approach, saying they have learned through the HIV-AIDS epidemic of the 1980s, and more recently from the Delta COVID outbreak from last summer, that personal conversations are more powerful and effective.
“The beauty of the one-on-one conversations is you can get into the nuance,” said Dan Gates, president of the AIDS Support Group of Cape Cod.
Memories are still fresh from last July 4, when tens of thousands of visitors poured into Provincetown, bolstered by guidance from federal health officials that such celebrations, even indoors and without masks, were safe for fully vaccinated people. But, before long, the revelers learned they had unwittingly triggered the first known major outbreak of COVID-19 among a highly vaccinated group of people. More than 1,000 in Massachusetts alone were infected.
Those memories still linger, and Gates said a higher percentage of people continue to wear masks in stores in Provincetown compared with other towns.
“But the good news is, with MPV and COVID, there is some commonality in the idea of monitoring how you’re feeling,” he said. “And that’s a really important part of the prevention in the community.”
State health officials have counted at least 21 cases of monkeypox, eight just in the past week. Nationally, the Centers for Disease Control and Prevention reports at least 390 cases of monkeypox from 29 states and the District of Columbia, primarily among men who have sex with men.
The current global outbreak, first identified in May, has climbed to more than 5,300 confirmed cases in 52 countries and territories. The disease has rarely been seen outside West and Central Africa, where it is endemic.
Monkeypox, a virus that generally starts with a flu-like illness, develops into a rash with pimples or blisters. It is infectious and spreads through direct contact with bodily fluids, such as through kissing, by contact with monkeypox sores, or touching items that have been contaminated with fluid from the sores, such as clothing or bedding, and, less commonly, through respiratory droplets following prolonged close contact.
While most of the cases in the global outbreak have been among men who have sex with men, it is not considered a sexually transmitted disease. And Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, said Wednesday he is concerned about the growing, sustained transmission because, “it would suggest that the virus is establishing itself, and it could move into high risk groups, including children, the immunocompromised, and pregnant women. We are starting to see this with several children already infected.”
Provincetown community and health leaders started crafting an education and prevention strategy after the first monkeypox case in the United States was detected in Massachusetts in mid-May. In the past two weeks, they’ve held several in-person and virtual sessions, featuring state health experts who have trained local “ambassadors,” including many hospitality workers, about the virus.
“The best ambassadors are the bartenders and waiters who are interacting with our guests on a daily basis, and many are gay and bisexual men,” said state Senator Julian Cyr, a Truro Democrat who represents Provincetown and spends much of his time there.
“Our community has a rich history of not panicking and learning about how you navigate and live with infectious disease,” he said.
The COVID-19 outbreak last summer could have become a super-spreader event, seeding infections across the country. But community and local public health leaders responded quickly to reports of people suddenly not feeling well after the holiday festivities, and ramped up testing, contact tracing, and indoor mask rules to quash further spread in Massachusetts, and raced to alert health authorities in other states.
Now, ambassadors are explaining to visitors the heavy economic toll monkeypox can take on individuals and communities. Infected people must isolate until all of their sores heal, and that can take up to four weeks — a crippling amount of time to be out of work or lose employees.
On Tuesday, the Biden administration said it was immediately shipping 56,000 doses of the Jynneos monkeypox vaccine to states with the highest number of cases and the largest population at risk. Some 240,000 more doses are coming in the weeks ahead and an additional 1.6 million doses in the next several months. Massachusetts has the sixth highest number of cases in the US.
Federal regulators also widened the criteria for who qualifies for the vaccine. Previously, only those with confirmed exposures to monkeypox were eligible. The category now includes those presumed to have been exposed to the virus, either through close physical contact with someone diagnosed with the illness, or men who have sex with men who recently had multiple sexual partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading.
Late Friday, the Biden administration said it shipped, or is in the process of shipping, a total of 31,500 doses to 18 states, Puerto Rico, and Washington, D.C. — including 2,004 doses earmarked for Massachusetts.
If given after an exposure, the shots are believed to be most effective within four to 14 days.
“Time is of the essence,” said Dr. Kenneth Mayer, an infectious disease specialist and medical research director at Fenway Health in Boston, which treats many gay and bisexual patients.
Mayer said the state needs to quickly develop reasonable criteria to help physicians identify who is at greatest risk, so there is consistency for who is offered the shots. The vaccine is a series of two shots given four weeks apart.
As health officials race to set up a vaccination system, tourists are flooding Provincetown, where there is an unmistakable sense of deja-vu.
Rob Anderson, co-owner of The Canteen restaurant, said he can hear luggage rolling down busy Commercial Street every hour as visitors disembark from the ferry.
“Provincetown showed, and the LGBT community showed last year, that we do take things seriously when we know there’s been an outbreak,” he said.
”We’re expecting a normal weekend,” Anderson added. “Maybe we’re letting our guard down, and maybe that’s OK and maybe it’s not — we’re just going to have to find out.”