The Martha’s Vineyard Hospital confirmed Wednesday that it had admitted its first patient for treatment from Covid-19.

“As of this writing, MVH currently has one patient hospitalized who had tested positive for Covid-19," the hospital reported in its daily press briefing, which went out around noon on Wednesday.”

Hospital testing area, only open by appointment for people who have received prior clearance. — Jeanna Shepard

No further information was available, communications spokesman Katrina Delgadillo told the Gazette by phone, although in a followup email she said the patient is stable.

She could not confirm whether the case was a new case or one of the previously reported cases on the Vineyard. As of Tuesday, two confirmed cases had been reported by Island boards of health, one in West Tisbury and one in Tisbury. Both patients are male and in their 50s and were reported to be recovering in quarantine at home.

The news come one day after five Island towns moved swiftly and unanimously Tuesday to adopt a tough new stay-at-home order, sharply limiting the number of “essential activities” for which residents are allowed to travel.

The emergency order, drawn up quickly out of widespread concern that the statewide order announced by Gov. Charlie Baker was insufficient, limits public gatherings to five people or less, bans all construction and landscaping work, and generally restricts travel to health care activities, take-out and food delivery and caregiving.

Chilmark acted first, with the boards of selectmen and health unanimously approving the order. Oak Bluffs, Edgartown, Tisbury and West Tisbury soon followed, passing nearly identical measures.  The orders take effect at 5 p.m. on Tuesday in Chilmark, midnight Tuesday in Edgartown and 5 p.m. Wednesday in Oak Bluffs, Tisbury and West Tisbury, and run until noon on April 7.

Aquinnah is due to take up the issue at a meeting Thursday morning.

Action on the emergency measure came hours after the second confirmed case of Covid-19 was announced by the West Tisbury board of health. Officials said the patient is a 50-year-old male living with two family members. 

“The patient is under quarantine at their West Tisbury home and appears to be recovering,” a statement from the board of health said. “The patient’s family and close contacts have been identified and are in self-quarantine and taking all recommended precautions.”

The first case was confirmed by the Tisbury board of health last Friday, a Tisbury man also in his 50s who is recovering at home, according to the board of health in that town.

Statewide, the total number of confirmed cases of Covid-19 rose by 382 since Monday. A total of 1,159 positive cases were confirmed as of Tuesday, and 11 deaths.

Summit meeting held Monday by teleconference included officials from around the Island. — Noah Asimow

The emergency order on the Vineyard was fashioned after a similar stay-at-home order enacted by the town of Nantucket over the weekend and includes travel restrictions both in and out of the town. Language in the order was drafted and tweaked by a working group that included town counsel Ron Rappaport, Tisbury town counsel Jay Doneski and the Island’s six town administrators.

Island leaders formed the working group on Monday, when towns scrambled to hold an emergency teleconference summit to implement and address what they felt were “gaps” in Gov. Charlie Baker’s statewide stay-at-home order.

The new order also includes a variety of travel restrictions. It bars anyone who has tested positive for Covid-19 from traveling to the town unless they have proof of two negative tests, and — with the exception of in Edgartown and West Tisbury, which removed the provision — requires that any person traveling to the town for purposes other than those outlined in the order has to self-isolate for 14 days at their place of residence. 

Full-time residents of the town are permitted to return to their homes, and people who are not full-time residents are permitted and "encouraged" to leave.

"Unfortunately and reluctantly, we need to limit people coming here. In the next five to 10 days we are going to see what's happening with our curve," said Chilmark selectman James Malkin. "The hospital and the boards of health are pretty uniform that we need to do everything we can to restrict travel to the Island. This is one of those things we can do to help them."

The operation of hotels, motels and rentals are permitted to maintain their current lodging arrangements, as long as they precede the order. Otherwise, they can only operate in the event that the virus’s spread worsens and are needed for use as quarantine facilities.

Residents are allowed to engage in outdoor activities, such as walking, hiking, biking and surfing, provided they keep a six-foot social distance from others.

Violation of the order is punishable by a $1,000 fine.

Enforcement of the order is left up to police departments and Island health agents.

Speaking to the Gazette by phone on Tuesday, Chilmark police chief Jonathan Klaren described his philosophy of enforcement in that town.

"I won't be parked on the road, flagging cars over and asking them who they are and where they are coming from," he said. "But we are taking it very seriously. We hope that people would voluntarily heed the warnings, becuase it really is for the good of the community."

At meetings held by teleconference in each of the towns, selectmen acknowledged that the orders were onerous, but essential to protect public health.

Time of emergency Islandwide. — Mark Alan Lovewell

"We are painfully aware that is a very difficult position to put the people of the Island in," said Tisbury selectman Melinda Loberg.

"It's unfortunate that this is where we are, but this is where we are," said Edgartown selectman Margaret Serpa.

At an unprecedented summit meeting held by teleconference Monday afternoon, selectmen agreed to direct their town administrators to draft the stay-at-home order.

“We want this to be rapid, and for it to be more extreme than governor’s orders,” said Mr. Malkin. “We definitely want it to be more restrictive.”

The all-Island summit Monday included selectmen from every Island town and all six town administrators, as well as town health agents and members of the boards of health. The emergency meeting was called in response to the governor’s order earlier Monday directing town boards of health to institute stay-at-home orders.

Vineyard leaders spoke in serious tones when describing the crisis and agreed on the need to act quickly. Among other things, it was agreed that the Islandwide stay-at-home order should include language that would prevent businesses currently closed from opening, ensure that restaurant pickup is curbside only, and ban construction.

The governor’s order lists construction crews as an essential service.

“I think really the only things that are included in [the governor’s] order are T-shirt shops and jewelry stores,” Oak Bluffs selectman Brian Packish said Monday, speaking of the actual impact of the order on Martha’s Vineyard. “I’m not sure if what the governor did has any teeth.”

The Nantucket stay-at-home order, which Vineyard leaders hoped to use as a guide, also requires anyone who travels to the Island to self-isolate at home for two weeks. Vineyard leaders said that they wanted their order to include similar travel restrictions, although the legal authority for enforcing them was still unclear.

Mr. Rappaport suggested that rather than including the travel restrictions in the order, they could come as an add-on to the vote approving the order.

“The message that we are trying to get out is for people to shelter at home as much as possible,” Oak Bluffs town administrator Bob Whritenour said. “Hopefully that includes travel restrictions.”

The state has been reluctant to limit travel to the Island partly due to legal concerns, according to Mr. Malkin, who is also the Vineyard Steamship Authority governor.

A working group with all six town administrators, as well as Mr. Rappaport and Tisbury town counsel David Doneski was formed to draft the stay-at-home order.

In a briefing Monday morning, Martha’s Vineyard Hospital officials painted a grim assessment of the coming threat from Covid-19. Officials said 35 people have been tested and more positive cases were expected. As of Monday morning, no one was hospitalized with the virus.

“We expect this to get worse before it gets better,” said hospital president and CEO Denise Schepici said, adding the hospital expects to see a surge of cases within the next few weeks.

With only 25 licensed beds and three intensive care beds, the small Island hospital could quickly become overwhelmed, she said. “We do not have enough staff in a pandemic like this,” Ms Schepici said. “That will be our biggest vulnerability, especially if they become sick.”

Ferries are running, but mainland travelers are urged to not come to the Vineyard during emergency. — Jeanna Shepard

Statewide, beginning at noon Tuesday, essential businesses including grocery stores, medical facilities and pharmacies will remain open, but non-essential businesses must close.

At a news conference Monday morning in Boston, Governor Baker urged common sense. “We’re asking everyone to . . . think about the impact this virus is having on the sick and elderly, and to limit their interactions with other people,” he said.

The governor’s order details what is considered an essential business. The order also allows most food services to continue takeout as long as they continue social distancing practices, and exempts most public works, transportation providers, agricultural workers, financial services providers and health care workers.

By Tuesday afternoon states of emergency had been declared in five of the six Island towns and also countywide, and individual construction bans had been adopted in all towns but Oak Bluffs.

The stay-at-home order includes a clause banning broad swath of construction activity including landscaping and housecleaners.

The clause was a topic for lengthy discussion among the Tisbury selectmen and board of health Tuesday afternoon before they voted the order. Some felt it was too restrctive, and conflicted with the town construction ban approved by both boards also on Tuesday. In the end the clause was removed from the Tisbury stay-at-home order and replaced with a reference to the town construction ban.

The Vineyard hospital and its parent company, Partners Healthcare, over the weekend put out messages on the Steamship Authority’s website indicating that people should avoid travel — and that second-home owners should stay put.

By Wednesday, the hospital plans to shut down its building to all non-clinical staff or staff that is necessary for their support. All staff allowed in the building would be required to wear masks. There will be a separate entryway for employees, different from the triage tent that is set up outside the emergency room.

The hospital is also developing a system to receive donated items, like masks and other personal protective equipment, expected to be in place by late Monday or early Tuesday. Leaders thanked those who have donated gear already.

Ms. Schepici reiterated that residents should stay home, continue to avoid contact with other people, and not come to the hospital unless instructed to do so or in an emergency -- and that failing to do so would put lives in jeopardy.

“We know that we have people traveling. We know that we have people not self-quarantining,” Ms. Schepici said. “People are not taking this seriously. And we had a positive patient here who had a lot of community contact.”

In a letter sent by Rep. Dylan Fernandes and state Sen. Julian Cyr to Governor Baker, the hospital says it has requested the use of the National Guard for safety concerns regarding their staff and to assist in triage, like constructing new tents or additional testing infrastructure, were a surge to occur.

“We are preparing for an influx of positives,” Ms. Schepici said.

The individual town orders are here: Chilmark, EdgartownWest Tisbury Others will be added when they are posted.

Will Sennott and Aaron Wilson contributed reporting.