HYANNIS, Massachusetts—As the freezing water sloshed up against the sides of the boat and the first winter Nor’easter formed off the shores of Cape Cod, a team of men hoisted a small white box onto a ferry.
Under a gray sky, morning commuters shuffled up a ramp and onto the high-speed ferry and sat next to the package. No one on the boat knew the importance of that box. How could they? It was so nondescript as to elicit non reactions among the gathered. But inside were a few dozen doses of the Pfizer COVID-19 vaccine—doses that, at the end of an hour-long journey south to the small Massachusetts island of Nantucket, would be the first step toward helping end an outbreak that has roiled one of the country’s toniest vacation enclaves.
Over the past several weeks hundreds of people on the small island have tested positive for the virus, kickstarting a local game of whodunnit. Residents have begun accusing others of contributing to the spread of the disease. For every individual charged with disregarding public-health guidelines, there seemed to be another calling their neighbors out for their reckless behavior either on social media or privately on calls with the board of health.
For a community on such an edge, the arrival of a vaccine was highly anticipated. And when the high-speed ferry docked in the island’s port, the passengers seeing a nurse in scrubs sign off for the package finally caught on. Hospitals throughout Massachusetts had received their deliveries earlier in the week on Dec. 15. But Nantucket’s didn’t show up until two days later. Hospital administrators on the island were unsure if it would make it to the island that week at all given the impending storm. The doses, as luck would have it, arrived just hours before the snowfall.
For nearly four weeks between Thanksgiving and Christmas, more than 70 people a day had showed up at the Nantucket Cottage Community Hospital for testing. And each day, island officials reported dozens of new positive cases. For an island with a current year-round population of around 18,000, those slight upticks had the potential to overwhelm the hospital and its staff. During the week of Dec. 14, Nantucket reached a test positivity rate of 13.1 percent—one of the highest in the country. At points over the last few weeks, doctors at the hospital, fearing their COVID-19 patients may take a turn for the worse, transferred several individuals to Boston hospitals via helicopter.
It wasn’t just the rising infection rate that had health-care workers and officials on the island on edge. Nantucket is a small community known as an escape for the wealthy during the summer months. But many of those who own summer homes chose to stay on the island throughout the pandemic, joining the 11,000 people who live there year-round. And some who had little to no previous connection to Nantucket moved into rentals and apartments there to flee the East Coast cities where COVID-19 was spreading rapidly. That uptick in residents meant more people shopping at the supermarket and more people showing up at bars, coffee shops, and churches. One full-time islander, a local bartender, told The Daily Beast she thought the full-time population had swelled by “maybe 5,000.”
The influx alarmed portions of the island population, primarily older individuals who were anxious about catching the virus in a community with limited medical resources. Instead of unifying the community, however, some residents of Nantucket seemed to turn on one another.
On one of the island’s local Facebook pages, residents after the Thanksgiving holiday began to blame their neighbors for contributing to the community spread, calling out nonbelievers. In a recent post about the rising number of cases on Nantucket, one user said the numbers were “inflated.”
“The scheme is for more positive tests for more federal money,” the person said. Another user urged people to “Keep more than” six feet from one specific individual. People even called out others for appearing maskless in public spaces and demanded officials penalize local businesses whose employees did not follow public health guidelines.
“I get rat phone calls where people will be like, ‘I know that so and so is positive, and they’re at work and they’re driving around without a mask.’ And I say, you know, ‘you should call a board of health about that,’” said Elizabeth Harris, a nurse working at the local hospital in Nantucket who is in charge of investigating COVID-19 cases on the island. “There’s a lot of stigma about this whole thing. And a lot of people get really upset.”
The situation grew so intense that the hospital released a statement on Dec. 5, just as the surge was emerging, calling for calm and unity.
“Now is not the time to panic or point fingers,” the statement said.
Medical professionals said the reaction on Nantucket to the rising number of cases illustrates how frayed the social bonds of a community can become when placed under the strain of the pandemic. Class divides are worsened, community tensions are exacerbated, and institutions—whether educational, economic, medicinal, or political—come under intense stress.
On Nantucket, health officials have had to debate how much information to transmit to the public. The fear, officials said, was that the more detailed material they posted, the greater the chance that residents target their neighbors.
“We’ve struggled with this—the privacy concerns. From the hospital’s perspective, but from the board of health as well, where is that line... the need for transparency for the sake of public health versus privacy in a small town?” said Jason Graziadei, the public information officer for Nantucket Cottage Hospital. “In larger towns and cities, public health officials will say this business had a positive patient and they are closed. Whereas here I think the public health director is trying to be transparent but not maybe to the level that would be disclosing things that could get people identified. It’s sink or swim for many businesses. Once someone is named, that restaurant could just be out of business.”
As the number of positive cases continued to increase on the island, so too did the curiosity among residents about exactly how the recent outbreak started. For much of the summer, healthcare workers on Nantucket said they had relatively low test positivity rates and very few people come into the hospital with COVID-19 symptoms. But as the weather turned cooler, the number of cases slowly began to increase. Then, the Thanksgiving surge hit—the island was clocking dozens of new cases a day. That’s when the accusations started.
“We thought we were out of the woods and then in September we had a big rush right after the Labor Day weekend. And that happened to be in some of our contractors and people who were painters, plumbers… people who are in the construction trades and landscaping. We think it was from maybe letting down the guard at the end of the summer,” said Dr. Diane Pearl, Nantucket Cottage Hospital’s chief medical officer. “After that we saw a little spike, which we thought was impressive at that time, but we were naive. After that we had a surge right around Thanksgiving which has been pretty astronomical.”
Nantucket is a 48-square-mile island located 30 miles south of Cape Cod. It’s known primarily as a luxurious vacation escape spot for the rich and famous. A slew of celebrities go there for vacations, including James Franco, Kevin Spacey, and Kourtney Kardashian who rented a $50 million property during her 2016 visit. As of June 2020, the average home value was about $2.9 million, according to an analysis by a real estate company in the area. According to Census data, which is now almost 10 years old, the average household income for a family living on the island is close to $130,000—one of the highest out of all the counties in the U.S.
While those who can afford it live in homes that sit on sprawling tracts of land, a portion of the island’s population lives in dense dwellings, including apartment complexes in long term care facilities. Those who live in these settings are often minorities and immigrants who work for or in industries that serve wealthier families on the island for very little money.
Because the island is so expensive, said Gary Shaw, the CEO and president of the Nantucket Cottage Hospital, many of these service workers live together in homes that are tightly quartered. On top of that, he added, Nantucket has been crowded by people decamping to their vacation homes because they view the island as safer from the virus.
“But the reality,” said Shaw, “is it is probably safer for some but only because they're not as densely packed.” He said the hospital is working with local officials to provide rental and food assistance to residents of the island who live paycheck to paycheck as a way to help positive patients make the decision to stay home and isolate.
Against the backdrop, tensions about who was the blame for the Thanksgiving outbreak began to stir. The “rat line” as health officials called it—where people would call in to report others—focused in part on essential workers who “were out driving around in gardening trucks without masks on,” as one local resident who refused to be named, said. Another call was about a woman who had tested positive for the virus after her children came home from college and was in the grocery store without a mask.
The problem, according to local health officials and health-care workers, is that no one knew for sure how the outbreak started. Case investigators didn’t link it to one big wedding or a sporting event at the high school. Some residents assumed it was because individuals who had moved to the island full time welcomed home students from college who then held house parties. (The majority of the positive cases were reported in individuals 20-50 years of age). Others blamed it on the restaurant workers.
Harris said the hospital began working with the state for contract tracing purposes but she was left with the responsibility of reaching out to all of the individuals who had tested positive. But with the state handling the contact tracing portion, she didn’t always have full access to the information that would have allowed her to determine where the outbreaks were taking place. All Harris knew—primarily through anecdotal evidence—was that people were getting infected in the home.
As health-care workers and officials worked to try and control the island’s outbreak, some residents on the island evaded calls from case investigators and continued to push back on social distancing and mask wearing restrictions.
“A lot of times when I call people they're not really happy to get my call. I've definitely been hung up on a bunch of times,” Harris said. “And a lot of people… in just a couple of particular demographics… when I asked them the demographic questions, they don't really want to answer. They get kind of insulted because some of the questions are like, ‘what country were you born in?’ And, ‘what makes up your household?’ People feel like you’re prying too much.”
It soon became clear to case investigators that the spread in Nantucket was worsening and they probed whether those who had tested positive were either still going to work, had chosen not to social distance, or were still gathering in large groups.
“Those positive people might be stuck home for three weeks or more. And that’s a huge hardship for some of the families that are living paycheck to paycheck. And so they really don’t want to hear it,” Harris said. “Then sometimes I call people and they’re so dismissive. And I can hear a saw in the background and I’m like ‘Are you at home or are you at work?’ And they just keep saying ‘Yeah, I tested positive but I’m fine.’”
Pearl, the chief medical officer at the hospital, said the number of people showing up to get tested has significantly decreased in recent days, raising questions about whether the community is healing from COVID-19 or if residents are beginning to pull even further back from public health measures. Pearl said she believes the local population is about 95 percent adherent to mask-wearing regulations. But the decrease in people wanting to get tested is still puzzling.
Health-care workers on the island say the arrival of the vaccine is welcome news not only for local health-care workers who are worried about being exposed to the virus this winter but also because residents of the island are itching to get back to normal. To residents in Nantucket, the COVID-19 vaccine is a signal that the road to recovery is near and that the tensions about who gave the virus to whom may soon dissipate. The next hurdle for health officials is ensuring that the population understands the vaccine is safe and shows up to get the shot.
“We all are just crossing our fingers that it comes in a timely fashion and that we can get it going. Everyone on this island, I think, is interested in receiving it,” Pearl said. “I think the community wants to stay well.”
The ongoing concern, though, is that the vaccine may have arrived just a bit too late; that the disease will remain in the community and that positive individuals will begin to experience more serious symptoms, overwhelming the hospital staff. If that does happen, the doctors and nurses at the hospital would not have the capacity to adequately care for seriously ill COVID-19 patients let alone people coming into the facility with other conditions, Pearl said.
“We're just worried that people are still exercising risky behaviors. And that's what contributes to spread. If you take the mask off and you're in close proximity with somebody that you know or you don't know where they’ve been or you were in frequent contact without a mass of people ... that's where the spread occurs,” Shaw, the CEO and president of the hospital, said. “Nantucket is a popular destination with a beautiful downtown… Christmas tree lights everywhere. But we’re discouraging public gatherings, we’re saying ‘Please stay home.’”
