Maine health officials plan to contact all 93 of the state’s long-term care facilities this week to ensure they have adequate emergency response plans after coronavirus outbreaks at several nursing homes contributed to a spike in COVID-19 cases.

The number of confirmed coronavirus cases in Maine jumped by 65 cases, more than 10 percent, from Sunday to Monday, rising to 698 total cases to date and 19 deaths, according to the Maine Center for Disease Control and Prevention.

The spike, which was the largest daily increase in cases to date, was largely because facility-wide testing at the Augusta Center for Health and Rehabilitation revealed 55 residents or staff members had contracted COVID-19.

Dr. Nirav Shah, director of the Maine CDC, said there are also 32 cases among residents and staff at Maine Veterans’ Homes Scarborough facility and 23 cases at Tall Pines Retirement and Healthcare Community in Belfast. Three residents of those facilities have died of the disease. Additionally, the OceanView retirement community in Falmouth has reported 11 cases.

Shah expressed concern about the outbreaks on Monday, but stressed that the spike is a result of his agency’s recommendation of aggressive, universal testing of both residents and staff at long-term care facilities as soon as the first COVID-19 case emerges.

“One of the things we know in public health is that when you look for things, you find them and, indeed, much of what we are seeing here is just that,” Shah said. “The fact that there are high numbers of individuals at these facilities does not mean that there are high numbers of critically ill individuals. In fact, many if not most of the positive results that we have seen in these facilities have been in individuals who do not have symptoms.”

But the outbreaks are prompting Maine Department of Health and Human Services officials to expand their outreach and assistance to nursing homes, retirement communities and other long-term care facilities.

DHHS Commissioner Jeanne Lambrew said staff will reach out to the 93 licensed facilities this week “to ascertain their level of preparedness, their gaps and what more we need to be doing to prevent additional nursing facility outbreaks.” That is in addition to the weekly webinars, phone calls and written guidance provided in recent weeks.

“So we are all-in,” Lambrew said Monday as she joined Shah for his daily coronavirus briefing. “We will continue to take the steps necessary to protect our older residents and people in our long-term facilities.”

The 698 confirmed cases of the COVID-19 disease caused by the coronavirus reflect only a portion of the true infections in Maine because not everyone with symptoms is being tested, and because some people carry the virus without showing symptoms.

As of Monday, 61 individuals were hospitalized with COVID-19, with 22 of those being cared for in critical care or intensive care units. Nine individuals were on ventilators, indicating the disease had progressed to the point of respiratory failure.

The Maine CDC reported that 273 individuals – nearly 40 percent of all confirmed cases – had recovered and been released from isolation. After accounting for the individuals who had recovered or died, Maine had 406 active cases Monday.

The total number of intensive care unit beds in Maine stood at 314 on Monday, with 158 available, the Maine CDC said. The number of ventilators was 328, with 283 available, plus 234 alternative ventilators.

The CDC also said that there were 22 COVID-19 patients in intensive care units statewide Monday and 39 others who are hospitalized but not in intensive care.

Piscataquis County remains the only county in Maine that has not had a confirmed COVID-19 case. Cumberland County has had the most cases at 299 followed by York at 151, Kennebec at 78, Penobscot at 34 and Waldo at 29.

The aggressive testing at the Augusta Center for Health and Rehabilitation caused Kennebec County’s case numbers to jump from 32 to 78 between Sunday and Monday.

Nationwide, there were 547,627 confirmed COVID-19 cases and 21,662 deaths, according to the coronavirus tracking system operated by Johns Hopkins University in Maryland. The World Health Organization reported nearly 1.8 million cases and 111,828 deaths globally.

While the vast majority of individuals with COVID-19 recover, the disease is particularly dangerous to older individuals with chronic health problems. The virus causes flu-like symptoms such as fever, sore throat and a dry cough, and can progress into severe respiratory failure requiring the use of a ventilator.

Shah said while there is no backlog of testing analysis at the Maine CDC lab in Augusta, his agency continues to give top priority to running tests for hospitalized patients, residents of “congregate care” facilities such as nursing homes, and health care workers. Doctors in Maine have the discretion to order tests for anyone and can submit those to a number of commercial labs for analysis.

Nationwide, there have been numerous cases of nursing homes being hit hard by COVID-19 because of the ease of transmission in communal settings and the vulnerability of residents.

Most facilities in Maine began restricting nonessential visitations weeks ago and have tightened access as the virus spread in Maine. Many homes closed dining rooms – offering room service or meal delivery instead – and segregated infected patients in order to reduce transmission.

There are concerns in Maine and nationwide about shortages of the masks, gloves, face shields and other “personal protective equipment,” or PPE, needed by health care workers. The Maine CDC plans to ship additional PPE to 77 nursing homes and other congregate care facilities this week in response to requests.

Shah said the facilities in Maine that have experienced cases have worked closely with Maine CDC staff who provide specific guidance.

“We haven’t learned anything in particular about any of these facilities that has suggested to us … that a different course of action should have been pursued” to prevent an outbreak. “But as Commissioner Lambrew noted, each facility has an independent obligation to make sure that they have an emergency plan in place as well as a plan for an adequate supplies of (personal protective equipment).”

The Maine CDC’s policy is to recommend “universal” testing of facility residents and staff immediately after an individual associated with the facility tests positive. The lengthy, incubation period of COVID-19 – up to 14 days before symptoms begin after exposure – creates testing challenges, however.

Maine CDC staff have discussed whether to recommend pre-emptive testing of congregate care facilities, but Shah said there are serious logistical challenges. One of the biggest is how to treat negative test results.

There are roughly 6,800 residents in nursing homes and other long-term care facilities statewide.

“Should we go back and test the next day, the next week, the next month?” Shah said. “It’s not as if we are against it. We are open to the idea, and our epidemiology team and I have openly discussed it. But we have got to have a plan in place for what to do with results and what actions we would take, especially around re-testing.”

Maine is in the middle of a monthlong “stay-at-home” order issued by Gov. Janet Mills on March 31, requiring all residents statewide to limit travel except for “essential” activities. Those include grocery shopping, picking up pharmaceuticals, caring for a child or another person, outdoor exercise, necessary home maintenance, caring for a pet or livestock or commuting to an essential job.

Hundreds of thousands of Mainers lost power following a spring snowstorm Thursday night that caused extensive tree damage. While utilities had restored power to the vast majority of customers by Monday morning, meteorologists and state officials were warning of potential additional outages due to a severe rainstorm that brought high winds to many areas along the coast Monday and Monday night. Central Maine Power Co. was reporting just over 15,000 customers without power at 11:30 p.m. Monday.

Offering a public service announcement on behalf of the electric utilities, Shah warned that it could take line crews additional time to restore service because they, too, are trying to follow physical distancing guidelines. And Shah reminded customers to do the same when interacting with utility crew members, even when expressing thanks.

“We’ve been asked to mention and remind folks to give utility workers the space that they need to do their jobs, to maintain that physical distance and get back everyone’s electricity as quickly as possible,” Shah said.

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