Home prices have continued to rise across the state over the past five years, but popular destinations for warm beach days have been on a blazing hot streak.

Communities on Cape Cod, Martha’s Vineyard, and Nantucket top the list of places where median sale prices for single-family homes have soared the most, according to data from The Warren Group, a real estate information firm. Coastal regions are home to 13 of the 20 towns with the sharpest growth in prices between 2019 and 2024, when looking at places with 50 or more sales in 2024.

Topping the list are Cotuit and Osterville, charming and relatively non-touristy villages within the town of Barnstable. In both villages, the median price of a single-family home more than doubled over the past five years, hitting $907,500 in Cotuit and $1.2 million in Osterville.

Rising prices have hit less high-end coastal towns as well: Dennis, Yarmouth, and the Barnstable villages of Hyannis and Marstons Mills all saw notable increases. In each of those communities, however, the median sale price is still below $700,000, which might even qualify as a bargain in the Cape’s real estate environment.

On Nantucket, the median home sale came in at more than $2.8 million last year. It’s hard to believe, but prices on the island keep getting more expensive: Nantucket saw an 87.5 percent increase in its median sale price, compared with five years ago.

How did we get here?

The story of coastal Massachusetts real estate exemplifies the recent dynamics of the state as a whole. Prices began their steep ascent during a market frenzy in 2020, when COVID lockdowns prompted people to look for a little room to breathe while they were stuck at home. Mortgage rates below 4 percent helped even a big purchase make financial sense, says Todd Machnik, president of the Cape Cod and Islands Association of Realtors. Then, even when lockdowns loosened, prices remained stubbornly high because of a lack of supply, Machnik says. There is little new housing being built in the region, and interest rates that have been stuck above 6 percent since fall of 2022 have made homeowners reluctant to list their properties and look for others.

“There was really no way to replenish the inventory,” Machnik says.

Of course, surging prices aren’t limited to the Cape and Islands, as other high increases are spread out across the state. Many of these are towns with lower prices that have gained popularity as buyers seek out affordable options in a market that has flummoxed many would-be homeowners. In rural Athol, the median price was $320,000 last year, up more than 88 percent from five years earlier. Prices in the former factory cities of Lawrence and Springfield, meanwhile, rose nearly 70 percent, landing at medians of $500,000 and $280,000, respectively.

What now?

Current conditions suggest high prices aren’t going away. In some Massachusetts places, prices continued to climb sharply last year. Seven towns — from Monson out toward the west to Merrimac in the northeastern corner — saw a bump of over 20 percent between 2023 and 2024. In Medfield, Newburyport, and Norwell, the median home price crossed the $1 million mark for the first time last year.

At the same time, market conditions do not seem to augur widespread price drops. In March, there was only 1.4 months’ worth of housing inventory on sale across the state, according to the Massachusetts Association of Realtors. Anything less than a six-month supply is widely understood to tip the market to sellers’ highly-priced advantage.

For some Massachusetts communities, however, the trend of annual price increases surprisingly reversed in 2024. In 33 communities, the median price fell in 2024 compared with 2023, dropping anywhere from 0.1 percent in Lexington to 12.7 percent in Lynnfield. These declines could be an early signal of a more even future for home prices, says Sarah Gustafson, president of the Massachusetts Association of Realtors. She cautions the variations between towns mean buyers and sellers need to thoroughly familiarize themselves with the individual markets they’re interested in.

“Prices are starting to stabilize a little bit overall as a state, and that’s a good sign,” she says. “But understanding of the market is going to be very important for people as we are coming into [spring] 2025.”

Sarah Shemkus is a regular contributor to The Globe Magazine. Send comments to magazine@globe.com.

The outcome was heralded for years as a victory for public health work. But earlier this month, Massachusetts officials received notification that the entire staff of the federal lab had been laid off, erasing a significant node in the nation’s network to identify and track public health threats, state officials said.

As the Trump administration reshapes how the federal government finances and communicates scientific findings, Massachusetts’ health laboratory is now at a crossroads, facing dramatic changes to its mandate and uncertainty over its future. The state is in a legal battle to protect nearly $84 million in federal funding the Trump administration is trying to claw back. Meanwhile, the state could face other significant additional cuts in Congress’ coming budget. While all of this is unfolding, the lab’s staff is struggling to figure out how to perform in-house work the feds used to reliably handle.

Congress’ budget could force some public health programs to shutter, but how widespread the cuts will be remains unknown, said Dr. Robbie Goldstein, the state’s public health commissioner.

“We can’t put anything on an untouchable list right now,” he said as he joined leading DPH staff on a recent visit to the lab building. “That’s not the happy answer the folks in this room wanted to hear.”

At stake, health officials said, is their ability to mount a well-informed, nimble response to public health challenges. Operating without the CDC’s full partnership is akin to being blindfolded.

“With their limited presence, we are limited in our understanding of what’s going on, even around us in our neighboring states,” said Nicolas Epie, the lab’s director.

The federal Department of Health and Human Services in a statement to the Globe described the layoffs and lab shutdowns as part of a streamlining effort that will ultimately strengthen the CDC.

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The Massachusetts Public Health Laboratory is the hub of the state’s public health work. Doctors, hospitals, and health officials statewide look to it for information about the germs, environmental contaminants, or food borne illnesses that might have made someone sick, how best to treat them, and what they mean for the health of the rest of the state. Each year, roughly 300,000 samples pass through the lab, tracking illnesses such as HIV, tuberculosis, avian flu, and COVID-19.

The lab is housed in a scaffolding-encased brutalist office tower in Jamaica Plain, where more than 400 epidemiologists, virologists, chemists, microbiologists and other workers help assemble microscopic clues into a coherent picture of the state of health in Massachusetts. During a visit to the lab in April, workers said they were trying to maintain a stoic focus despite the news from Washington.

“It doesn’t matter what’s going on in the country,” said Erika Buzby, a veteran microbiologist and supervisor of the 8th floor molecular biology lab. “We just have to keep going.”

One floor beneath, workers carried racks filled with dozens of samples for inspection in the sexually transmitted infections lab, the same one responsible for identifying the worrying gonorrhea infections. Next door, behind a door warning of biohazards, staff hunkered over counters to review the results of tuberculosis bacteria analysis. Cases of TB, a bacterial infection of the lungs, increased by 13 percent in Massachusetts in 2024 compared to the year before.

“Samples are coming from a lot of the hospitals all over the Commonwealth,” said Bernie Chirokas, director of sexually transmitted diseases and mycobacteriology.

Workers here raise their voices to be heard over the loud droning of air coolers that keeps machines operating smoothly.

“It’s the constant hum of public health,” said Goldstein. “What we’re nervous about is that we will be silenced here.”

The $84 million for the lab is what remains from an almost $776 million CDC grant allocated in 2019 that was expected to last into 2026.

That money is supposed to help pay for data system modernization, supply stockpiles and upgraded equipment, a needed compliment to a multi-year renovation project nearing conclusion. Near the top of the wish list is a biosafety cabinet that protects staff from samples of infectious agents. The current cabinet is so old executives fear just moving it during the renovations could break it, putting workers at risk.

The lab’s grant makes up the bulk of the more than $105 million in CDC funding for Massachusetts public health services that is at risk, according to a DPH affidavit shared with the Globe. The Trump administration announced March 26 it intended to reclaim the money by April, saying it was no longer needed because the pandemic was over. It’s loss, though, would hobble programs supporting community health, children’s vaccinations, and addressing health disparities. Nearly $5 million for substance use programs from a different federal agency is also in jeopardy.

One example of the lab’s recent pivot toward self-sufficiency is a new viral genetic sequencing program to track how different strains of hepatitis C are spreading. It’s a service the CDC used to perform through another program kneecapped by layoffs this month, according to a notification state officials received from the CDC on April 3. Massachusetts set aside funding for the testing program well before Trump’s election in part, Goldstein said, because the state foresaw what another Trump presidency might mean for public health. President Trump and Robert F. Kennedy, Jr., who now leads HHS, had campaigned on promises to shake up public health institutions.

“We didn’t know which way the November election was going to go,” said Goldstein, who worked for the CDC before joining state government. “We had to prepare for what could be a very friendly environment for public health and continued investment, or a very hostile environment.”

Another attempt to replicate federal functions locally is a proposed program to recommend vaccinations for adults and a fund to help purchase them.

To be sure, Massachusetts health leaders acknowledge the state’s lab alone can’t fully replace federal public health resources. And there are challenges ahead without an established communication workflow between various health leaders across the nation to share intel and spread warnings.

Avian flu gets attention as a possible threat, but experts said a novel virus isn’t the only worry when it comes to what public health crises may lie ahead.

“It could be a food borne pathogen,” said Dr. Larry Madoff, medical director of the bureau of infectious disease and laboratory sciences. “It could be a mosquito borne pathogen.”

“I’m actually worried about the every day suspects,” said Catherine Brown, state epidemiologist and public heath veterinarian, “measles, or the increase of tuberculosis cases that we’re seeing, drug resistant gonorrhea, or the EEE (Eastern Equine Encephalitis) outbreaks that we have regularly in Massachusetts.”

Tackling an outbreak, whether a new virus or an old foe, without the resources and reach of some cancelled CDC programs is intimidating, said Epie, the lab’s director.

“The world is not as compartmentalized as it was before,” he said. “We cannot protect ourselves without ever knowing what’s going on in other countries as well.”

Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.