Six months into the pandemic, the coronavirus is continuing to spread at an alarming rate in Maine’s southernmost county, where new cases are being identified at nearly twice the rate as during the previous surges in early April and the end of June and close to triple the current statewide average.

Case numbers are also climbing at a worrisome rate in Oxford County, where a paper mill outbreak may be seeding infections in the wider community.

Fueled by outbreaks connected to a wedding reception in the Millinocket area, York County is now at risk of a geometric surge in cases, with public health and hospital officials urging residents to be diligent about mask wearing, social distancing, and other practices that impede the spread of COVID-19.

“It’s not just that we have several outbreaks there, but that they are coalescing into one big fire,” says Dr. Dora Anne Mills, chief health improvement officer at MaineHealth, the state’s largest hospital network. “We’re seeing a lot of people testing positive from that area – young, old, healthy, not so healthy – and a lot of them don’t have any idea where they got it.”

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said the spread in York County now had the potential to go from exponential to geometric growth. “With community transmission you can go from having one to four cases, from eight to 16, and then to 32 and suddenly it starts going not from 32 to 64 but to 100 or 300,” Shah said in an interview Thursday. “I am extremely, extremely concerned.”

On Friday, York County’s seven-day average of new cases hit an all-time high of 15.7 per day, nearly double the previous peak of 8.7 set on July 2, and far above the rate in mid-August of around two new cases per day. The per-capita number of new cases for the past week in the county – 52 per 100,000 residents – was quadruple that of Cumberland County (12) and more than 2.7 times the statewide average of 19, according to the widely followed pandemic tracker at The New York Times.

At the same time most area hospitals have seen growing numbers of people requiring hospitalization for the disease over the course of the month. The week ending Thursday was the busiest in this respect for Biddeford-based Southern Maine Health Care Medical Center since mid-June, with an average of 4.6 COVID inpatients each day, up from three the week before, 1.1 the week before that and weeks of having only the occasional such patient. The past two weeks have been the busiest since early August at Maine Medical Center in Portland, which also had 4.6 COVID inpatients per day this past week.

Most of York County’s outbreaks are located in Sanford and adjacent inland towns, including Sanford High School, Sanford Regional Technical Center, the Sanford Wolves Club, Hussey Seating Co. in North Berwick, the York County Jail in Alfred, and Sanford’s Calvary Baptist Church. Its pastor, the Rev. Todd Bell, also founded the Millinocket-area church where the super-spreader wedding was held and presided over the services that day.

While there have also been outbreaks at the Portsmouth Naval Shipyard in Kittery and the Ogunquit Beach Lobster House, the coastal part of the county hasn’t been hit as hard yet. York Hospital had no COVID inpatients for the week ending Thursday. The positivity rates for tests conducted at the hospital and its drive-thru rapid testing site on Route 1 stood at 0.9 percent last week, compared to 1.9 the week before and 0.6 the week before that.

“We’ve seen an uptick in cases, but I don’t think we’re feeling it as much as the inland areas in the Sanford region,” said Dr. Evangeline Thibodeau, the hospital’s infectious disease expert.

Oxford County is also showing danger signs, 10 days after an outbreak was reported at the ND Paper mill in Rumford, which has now affected at least 21 workers and their family members or close associates and led to the death of one worker and the closure of many area schools. On Friday, Oxford County had the highest per-capita weekly case rate in the state at 69 per 100,000, according to the Times tracker, and the Maine Department of Education downgraded the county from green to yellow status, meaning gatherings and extracurricular activities will be more closely restricted.

“One question is whether Oxford County is where York County was three to four weeks ago, when they were starting on the same trajectory,” Shah said. “Much of the transmission we see seems to be related to the paper mill, but given the contours of small-town life, the same folks that work together also worship together, eat together and lots of other things, so Oxford is very concerning.”

Public health and hospital officials are urging Mainers to remain diligent in wearing masks, observing social distancing practices, washing their hands and other measures known to be highly effective in slowing the spread of COVID-19, especially in York County and the Rumford area.

“If we all continue to follow the guidance, that’s when we can keep the virus under control,” said Dr. James Jarvis, clinical lead incident commander for Northern Light Health, the 10-hospital network that includes Mercy Hospital in Portland and Bangor’s Eastern Maine Medical Center. “When we let our guard down or we flout our civic duty to protect each other, it can get out of hand.”

Shah said such individual measures were the most effective response, and if widely practiced would pre-empt the need for lockdowns. “If I could wave a magic wand and have face covering be the norm everywhere, we would start to see a decline in new cases in roughly 12 days,” he said.

Experts are also urging everyone to get their influenza vaccine as soon as possible so as to avoid swamping the health care system with sick patients who might appear to have COVID-19 and, even if they turn out not to, tie up hospital beds and other resources that might be needed if the disease surges in the late fall.

“We don’t want flu season and COVID to become a double whammy for us,” Jarvis said.

Much of the rest of the state has remained relatively healthy, with most counties in eastern, central and midcoast Maine still experiencing very low disease prevalence following an epidemiologically successful summer tourism season in which millions of residents from cities and states harder hit by the disease visited Maine without triggering outbreaks. Cumberland County, the state’s most populous and the previous epicenter of the disease, is also keeping the pandemic in check, with a seven-day daily average of new cases standing at 4.7 on Friday, far below its peaks in the mid-20s during the disease’s spring and early summer surges.

One exception is Androscoggin County, where an uptick in new cases – now averaging more than five a day – has the attention of the Maine CDC. Shah said Thursday that the cases may prove to involve people who commute to work at the Rumford paper mill, but if not they would be a worrying sign of community transmission. “We’re still in the early phases of investigating that,” he said.

If a new surge hits the state this fall and early winter, the health system appears to be well prepared. Shah said the Maine CDC has stockpiled 355,000 N95 masks and 180,000 testing swabs for rapid deployment to wherever they are needed, while Northern Light, MaineHealth, and York Hospital all said they don’t foresee shortages of personal protective equipment or COVID testing supplies.

“Right now our supply chain looks strong,” said Erich Fogg, who oversees testing for York Hospital, where much of the demand for rapid tests has shifted in recent weeks from tourists looking to avoid quarantine requirements to area residents fearful they may have been exposed. “We do monitor for possible shortages on a regular basis, but we have had no warnings on the horizon yet.”

Dr. Jabbar Fazeli, a southern Maine geriatrician and vice president of the Maine Medical Directors Association, which represents nursing home medical directors, said he is concerned about forthcoming policy changes regarding visitors to nursing homes. The federal Centers for Medicare and Medicaid Services on Sept. 17 issued new guidance recommending nursing homes that have not had a recent outbreak to allow indoor visitation, but it does not require visitors be tested for COVID.

“We understand the need for visitation, but if somebody is coming into our building on a weekly basis, we want them to be treated like a staff member as far as testing,” Fazeli said Friday. “CMS believes staff should be screened on a regular basis even though they don’t have symptoms. Anybody coming into the building regularly should meet the same definitions.”

There is also concern around whether the disease will spread more rapidly once cold weather forces people and business activity indoors. Steve Hewins, president and CEO of HospitalityMaine, which represents the state’s restaurants and lodging businesses, said restaurants are continuing to invest in Plexiglas partitions, better ventilation systems, and outdoor heating systems and are hoping for state and federal funding to subsidize the costs.

“With regard to the transition to indoor dining, most want to see capacity increased to more than 50,” Hewins said via email. “Many others simply will close or do takeout only.”

Mills, the MaineHealth executive who is a former director of the Maine CDC and sister to Gov. Janet Mills, said people will need to “turn up the dial” on protective measures.

“I think we’ll all have to think very hard about this because as the weather gets colder and we have holidays coming up, people need to think about how to modify the way we gather,” she said. “It may be a long winter and we can’t do a bunch of things, but think about the fun things we can do safely and start planning some of those.”

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