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Even as cases rise, health experts say high coronavirus vaccination levels in Massachusetts have helped the state avoid the crisis that some other parts of the country are facing.

At the end of spring, as the average of new daily cases plummeted to zero, the Berkshires got a glimpse of what a COVID-free summer — or something very close to it — might look like.

Halfway through the summer, that’s now hard to imagine.

Infections in Berkshire County have climbed to a higher level than at any point last summer. The seven-day rolling average hit five new cases per day Monday, and those cases are taking place among a smaller, susceptible population than before, with many people protected by vaccines. 

More people are getting tested, and the county's positivity rate has climbed, according to Berkshire Health Systems, which also has seen an increase in severe illness among young, unvaccinated patients.

Meanwhile the Centers for Disease Control and Prevention on Tuesday recommended that vaccinated people wear masks in areas of high community spread. And an outbreak in Provincetown — it largely is taking place among vaccinated people — has captured the state’s attention, leading to mask-mandate reversals in some counties.

But, even as clouds gather over the post-vaccine summer, there still is very good news: Vaccines prevent serious illness, and the proof keeps rolling in.

In Provincetown, for example, health officials say that vaccinated people largely have been asymptomatic or had mild symptoms, according to The Boston Globe.

Meanwhile, Massachusetts, the second-most-vaccinated state, has not seen the major outbreaks that have bubbled up in states with low vaccination rates, such as Florida and Missouri.

In the Berkshires, where state data shows that about 60 percent of residents are vaccinated fully, cases still are far below fall and winter levels, and hospitalizations have remained few and far between. There were no COVID-19 inpatients at Berkshire Medical Center as of Tuesday.

“We’re a highly vaccinated state,” said Dr. James Lederer, chief medical officer and chief quality officer at Berkshire Health Systems. “Berkshire County is a highly vaccinated county. That’s good news.”

Here is what you should know about COVID-19 in the Berkshires:

The CDC has recommended masks for some vaccinated people. Does that mean me?

Not at this point.

The CDC recommends that people in counties with “high” or “substantial” community spread wear masks indoors, regardless of vaccination status.

Berkshire County's community spread is classified as “moderate” in the CDC’s tracker, which means the guidance does not apply here. All our adjacent counties also are classified as “moderate” or “low,” though some Eastern Massachusetts communities are rated as a higher risk. 

But, Lederer encourages mask wearing indoors, especially for people who live with unvaccinated adults or children. He says that even vaccinated people in the Berkshires should consider some basic precautions, not to protect themselves as much as to reduce the rate of virus spread. 

“It’s just a matter of common sense,” Lederer said. “Avoiding large crowds if you can. There’s nothing wrong with wearing your mask in a highly dense situation.”

The delta variant is here. Does my vaccination still protect me?

You still are protected.

The delta variant has spread widely through the U.S., accounting for about 83 percent of all cases during the first half of July. Health officials say the highly infectious variant has been behind much of the country's latest virus surge.

But, they also say the virus almost exclusively has hospitalized and killed the unvaccinated.

CDC Director Rochelle Walensky has called this the “pandemic of the unvaccinated.” This month, she announced that unvaccinated people account for more than 97 percent of hospitalizations. And Dr. Anthony Fauci, the country’s top infectious disease specialist, said that more than 99 percent of deaths in June were among the unvaccinated.

As the delta variant continues to spread widely, experts say infections among the vaccinated population, breakthrough infections, should be expected but not feared. Lederer says that only a tiny fraction of the tens of thousands of vaccinated county residents have tested positive.

“Get vaccinated,” Lederer said. “By doing so, you run almost zero chance of hospitalization or death, serious illness, even if you have a breakthrough infection.”

Experts also encourage vaccinated people to get tested if they have COVID-19 symptoms. 

I have a loved one at home that’s immunocompromised. What should I do?

“Getting vaccinated is step one, two, three and four,” Lederer said. “That's what you should do to protect your loved one.”

But, behavior still matters. In crowded settings, like a busy grocery store or at a church service, Lederer suggests that you consider distancing and wearing masks.

“It’s not that you’re worried about getting sick,” he said. “But, a low-level breakthrough infection, where you don’t have symptoms, you could take it home.”

There also is new evidence that vaccinated people might be more likely to spread the delta variant than other virus strains, according to Walensky.

With earlier strains of the virus, vaccinated people had low levels of virus and therefore appeared unlikely to spread disease. Now, new research shows that, with the delta variant, infected vaccinated people have a level of virus “indistinguishable” from that of unvaccinated people, Walensky said Tuesday.

The research has not been published yet, but it drove the CDC’s mask recommendation, and it means there is a chance you could take the delta variant home to an unprotected loved one. 

I’m immunocompromised. Should I get a third shot?

Federal health advisers have started to explore the possibility.

The CDC’s Advisory Committee on Immunization Practices presented data last week showing that a third shot could help people with weakened immune systems develop protection against the virus.

Regulators have yet to authorize an additional dose of any vaccine. But, some county residents have taken matters into their own hands by talking to their doctor about the extra dose — and have received that booster, Lederer says.

“Some immunocompromised patients ask their doctor about it, and the doctor says, ‘Here’s an order, go get it,’ ” Lederer said. “And we're in control of that, at our vaccine center, as long as they have a valid physician’s order.”

He said the hospital system has encouraged physicians to document their discussions with patients about the third shot, given that it has not been approved.

Francesca Paris can be reached at and 413-447-7311, ext. 239.