Over the swell of piano chords, whistles and cheers reverberated through Cherry Street Pier Wednesday afternoon as masked and temperature-checked young dancers took the stage on Philadelphia’s Delaware River waterfront.

A year ago, the moment — a tech rehearsal before welcoming a live audience — would have been unthinkable for the Bearded Ladies Cabaret. But with news of falling COVID-19 case counts and rising vaccination rates, hope — and a sense of normalcy — has begun to return.

The theme of the night’s show: “The Art of Resiliency.”

“Each relaxation [of COVID-19 restrictions], even though it’s a tiny shift, feels amazing to us — like an element of coming back and what it feels like to be back in the world,” said Brandi Burgess, general manager of the cabaret, eyes crinkling into a smile hidden by her mask.

A little more than a month ago, Philadelphia notched a seven-day average of almost 45 confirmed coronavirus cases per 100,000 residents, one of the highest peaks of the entire pandemic. As of Friday, that average was down to 8.3 cases per 100,000. That downward trend is uniform across the region.

The reason, health officials said, is vaccination, with weather that encourages people to spend time outside lending a hand.

“I absolutely think it is vaccine-driven,” said Jeanne Franklin, Chester County’s health director. “I also think we’re in a seasonal change. We get more people outside, there’s better space, there’s better air circulation.”

In Philadelphia, more than half the population has received at least one vaccine dose, and about 652,000 people are fully vaccinated. Statewide, 5.6 million have received at least a shot and 4.3 million are fully vaccinated. New Jersey reported 4.7 million receiving a shot, and 3.9 million fully vaccinated.

Nationally, 60.5% of the country has received at least one dose, according to the Centers for Disease Control and Prevention.

» READ MORE: Philly rolls out plan for vaccinating seniors and disabled people at home as advocates ask what took so long

Last year, holidays and winter weather drove big surges in cases. How severe those will be this year will depend on how widespread vaccination is.

“If we look into the winter, if the virus activity is going back up again,” said Jing Huang, a biostatistician at University of Pennsylvania, “areas with low vaccination rates will be at higher risk than areas with a high vaccination rate.”

Clear trends

Across the country, Huang said, there’s ample evidence that vaccinations are making a difference. Case counts in the Northeast and West Coast, where vaccination rates are highest, are lower than less vaccinated states in the Midwest, Southeast, and some parts of the Southwest. She noted that the highest case counts in California are in the Sacramento area, where vaccination rates are lower.

Pennsylvania and New Jersey are not currently tracking whether people hospitalized with COVID-19 are vaccinated, state officials said, but Bucks County has, said David Damsker, the county’s health director.

“We have 50 people in the hospital right now with COVID-19 and 49 are not vaccinated. If that’s not indicative of the efficacy, I don’t know what is,” he said this week. “I’m completely and utterly sold that this vaccine is doing what they said it would do.”

He noted hospitalizations overall were significantly down in Bucks County from a few weeks ago. In both Pennsylvania and New Jersey, admissions have been in decline since late April.

» READ MORE: National COVID-19 infections drop below 30,000 daily for first time in 11 months

Though the CDC said last week that masks aren’t necessary for vaccinated people outdoors or in most indoor settings, some health officials are being more cautious. Pennsylvania followed CDC guidance; Philadelphia is taking it slower, requiring everyone to wear masks in public buildings until at least June 11.

“If folks continue to get vaccinated and we see hospitalizations continue to drop, fully vaccinated people can go back to normal,” said Cheryl Bettigole, the city’s acting health commissioner, in a news conference Wednesday.

Damsker said he felt any mask requirements for vaccinated people could be lifted now.

“No more shut downs, no more mask mandates, I think that should never be done again now that we have the vaccine,” he said. As for those who decline shots and get COVID-19, “you have a higher risk of being in the hospital, you have a higher risk of dying.”

The mixed messages — plus months of politicized debates over masks — have some people worried about what could happen if unvaccinated people ditch their masks, too.

On a bench outside Christ Church in Old City Thursday, Melissa Hammel paused over her scoop of ice cream.

“Opening up is happening way too fast,” said Hammel, a bartender from South Philly. “Most people, as soon as they heard, ‘Oh you don’t have to wear masks outside,’ they didn’t hear the rest of the stipulations … I’m definitely very anxious about being out.”

After hearing stories from her friends who have worked as servers and bartenders through the pandemic, she said she’s nervous about ever working in a restaurant.

“The people who don’t want to wear masks are just going to not wear them, and then they’re probably not vaccinated,” she said. “I just don’t trust it at all.”

Outside Independence Hall Wednesday, Omar and Amena Soliman stopped to take photos with friends. In town for the week from Arkansas, the 19-year-old twin brother and sister said they feel more comfortable traveling and being in public without masks since they got their shots.

“Outside, before I was vaccinated, big groups were a no,” Omar said. “Inside, now, I’m still wearing a mask.”

Vaccinations and outreach

While the region’s vaccination rates are among the best in the country, there are still plenty of people who have not received a shot. In Philadelphia, about 62% of people 65 and older have been vaccinated, well below the 84% nationally. And, as is the case nationally, local Black and Latino populations have lower vaccination rates than white and Asian communities.

Most vaccinations have happened in large clinics, settings that many people don’t feel comfortable in, or can’t get to. That’s changing.

“At this point, this has all been passive,” said Craig Shapiro, attending physician in pediatric infectious diseases at Nemours Alfred I. duPont Hospital for Children. He said public health systems now have to bring the vaccine to people. “If you showed up at their door and you just say, ‘Listen I’m here to vaccinate you now,’ they’re likely to accept that.”

The federally run clinic at the Pennsylvania Convention Center, which lately has been operating at a fraction of its 6,000-shots-a-day capacity, will close on Tuesday, and vaccine delivery will enter a new phase.

“Mass clinics simply don’t work at this point,” said James Garrow, a spokesperson for the city health department. “Our conversations with Philadelphians … need to be about answering their questions, providing them with facts to combat misinformation that they may have heard, and showing them how easy it is to get vaccinated.”

Teams of two to three people throughout the city, administering perhaps a few dozen doses per day, will be the new model, Garrow said. Vaccination efforts will have to find ways to incentivize too. The Black Doctors COVID-19 Consortium is offering $20 Saturday at the Dell Music Center to every person coming for a second dose who brings an unvaccinated, vaccine-eligible person with them.

“You’ve just got to be creative,” said the group’s founder, Ala Stanford, a pediatric surgeon.

In Chester and Delaware Counties, Franklin said, the Chester County Health Department is offering as many as four mobile clinics a day. The goal is to reach more residents of color, as well as farmworkers and the Amish.

“I don’t want to be twisting arms,” she said. “I just want to make sure everyone makes their personal decision in the most informed way that is not fear-based.”

Getting doses in more doctors’ offices, so they can be given like flu vaccines, will be an important next step to help overcome vaccine hesitancy in rural and conservative parts of Pennsylvania, Damsker said.

“It’s hard for patients to say no to their doctors,” he said.

The months ahead

Barring any new virus variants that can dodge the vaccines, health officials are optimistic about the rest for the year — provided more people get their shots.

“I feel a lot better about going into the fall because of this vaccine,” Damsker said. “We know it works.”

People who are unvaccinated, and aren’t wearing masks or keeping a distance from others, will continue to be at greater risk, Shapiro said. But even those people will gain some protection from others who are either vaccinated or have natural immunity through previous infection, though experts say COVID-19 survivors still should be vaccinated to ensure stronger, more durable immunity.

» READ MORE: As COVID-19 vaccination uptake slows, Philly Counts prepares for an outreach surge

“The department doesn’t expect to see a surge with as many cases and deaths as we experienced in spring 2020 and we are hopeful that numbers will not approach what we saw in the recent winter as well,” said Dawn Thomas, a spokesperson for the New Jersey Department of Health. “The more people who are vaccinated, the lower we would expect cases to be in fall and winter.”

Schools reopening in the fall shouldn’t pose a risk if a significant number of students’ family members, along with staff, are vaccinated, Huang said. The vaccines are not yet approved for children younger than 12, but schools now know what they need to do to protect students and staff, Franklin said. Health departments will need to monitor case counts in schools and adapt.

At Cherry Street Pier Wednesday, the cabaret troupe was not taking any risks. All attendees’ temperatures were checked at the door, masks required, and social distancing respected. But even with those precautions, Cat Ramirez, a line producer for the group, said they have a new appreciation for performance following the long-awaited return to stage.

“It’s been many months since we’ve seen live theater,” she said. “It’s really beautiful.”