As a new COVID-19 surge engulfs Maine, leading forecasting models predict cases will increase markedly here in the coming weeks, adding pressure on hospitals and creating conditions that could eventually exceed the state’s intensive care unit capacity.
The number of new cases could more than double to about 500 by the end of November, one model predicts, while another predicts the number of new daily COVID-19 hospital admissions will double in Maine a week later if current trends continue unchecked.
After a remarkably healthy summer tourist season in which the new case rate fell to fewer than 25 a day, the coronavirus has been in rapid resurgence over the past three weeks. The state broke new-case records with 80 on Oct. 29, 103 on Oct. 30, 204 on Nov. 9 and 248 last Thursday. On Tuesday it added another 246, the second-highest total yet.
Hospitalizations followed – acutely affected patients typically don’t become sick enough to be admitted until one to three weeks after exposure to the disease – exceeding the spring surge peak of 60 on Nov. 12 and hitting a new record of 73 on Tuesday.
“It’s very concerning to see these kinds of increases in the number of cases and the slow, seemingly steady uptick in hospitalizations,” says Dr. Joan Boomsma, chief medical officer for MaineHealth, the state’s largest hospital network and parent entity of Maine Medical Center. “The good news is that we are in a much better condition overall than we were last spring in terms of having the right procedures in place, sufficient PPE (personal protective equipment), and a better understanding for treatment of the disease.”
Dr. Evangeline Thibodeau, an infectious-disease physician at York Hospital, said the surge represents a threat to the state’s hospital system.
“I am concerned about overwhelming our health care systems in general as the rates have risen in Maine quite quickly over the past two or three weeks,” Thibodeau said via email. “I do feel we will be more prepared for a surge, as we can monitor things on a more finite level and respond more decisively. … However, models can only go so far as to predict how much of a surge we will have and we have to be prepared for anything.”
Several leading forecasting models tracked by the U.S. Centers for Disease Control and Prevention predict the pandemic will continue to get worse in Maine in the coming weeks, with the Columbia Mailman School of Public Health model predicting that the number of new daily cases will more than double to about 500 a day by the end of the month under the median, status quo scenario.
The widely cited COVID-19 Simulator run by Harvard Medical School, Massachusetts General Hospital, Georgia Tech and Boston Medical Center hasn’t updated its Maine forecast since Nov. 9, when the state’s worst daily new case load still stood at 111. Nonetheless its median scenario predicts the number of active cases in the state will double by the third week in December, and for ICU availability to be exceeded in mid-January if no new policy changes are enacted.
New COVID-19 hospitalizations are forecast by the COVID-19 Simulator to double from six per day to 12 by Dec. 7, while another forecasting engine created by Google and the Harvard School for Public Health put that figure at 11. The Columbia model, despite not incorporating the steep spike in cases last week, put the number at 21 under its median scenario, which would be more admissions in a single day than the number of COVID-19 inpatients statewide on any given day between July 3 and Nov. 1.
HOSPITALS READY FOR SURGE
Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said those scenarios are unlikely to come to pass because they presume no change in policy or public behavior.
“Am I concerned about rising hospitalizations? Absolutely. Is there a possibility we could run into ICU bed jeopardy? Definitely,” Shah told the Press Herald Tuesday. “But that’s not a scenario likely to happen, because we won’t give up.”
If Maine went into a total lockdown, Shah said, the Columbia model estimates there would be just 10 ICU patients statewide by Christmastime, meaning less draconian measures would likely keep demand well below the statewide ICU capacity of 105 beds. He said his agency was “dusting off” contingency plans created in April that would have created field hospitals at arenas in Portland and Bangor to ensure patients receive treatment.
Asked whether more restrictions are envisioned to try to check the spread of the disease, Shah said he couldn’t put a probability on it. “That’s the governor’s call, but those conversations are underway right now,” he added. “No options are off the table.”
Representatives of three major medical systems said their hospitals are in good shape to face the storm, though they are concerned about the stress on clinical staff eight months into the nation’s greatest public health crisis in more than a century. Despite pre-pandemic nursing and respiratory therapist staff shortages, they said the health care networks have what are in effect strategic reserves of staff and beds – in a crisis they can dial back elective and non-emergency medical procedures to divert resources to the pandemic.
“We have confidence in our staff and other resources for a surge,” said Chuck Hays, president and CEO of MaineGeneral Health in Augusta. “We’ve also learned a lot over the past few months about the virus, how to prevent its spread, and how to treat those who are COVID-19 positive”
Dr. John Alexander, chief medical officer at Central Maine Healthcare in Lewiston, said hospitals had been able to prepare through the summer and are in a much better position than in the spring. But he, like his counterparts, emphasized that all hospitals are vulnerable to the possibility that their own staff would get the disease while off-site and therefore not be able to go to work. “Our health care workers are community members and are exposed just like anyone else in the community,” he said.
MaineHealth’s Boomsma agreed. “We worry about our own employees getting exposed in the community and not being able to come to work,” she said. “We screen everyone every day, and even the slightest exposure means we have to test them and take them out of work. That’s a big concern when the exposure risk is growing in the community.”
Health care workers had been asked to do so much for so long even while under the same stresses as others, Hays said. “Unpredictability of school operations is a stress for many of our employees,” he said via email. “Some staff have economic stress as they may have partners who are still out of work.”
Cokie Giles, a nurse at Eastern Maine Medical Center in Bangor and president of the Maine State Nurses Association, said hospitals are in a better position than they were at the onset of the crisis in late March, but staff are frustrated by the public behaviors that may have fueled the national resurgence.
“It’s very disheartening,” said Roberts, whose union represents some 2,000 Maine nurses, primarily at EMMC and several smaller Northern Light Health hospitals. “It may be your right not to wear a mask, but it’s not your right to have us take the disease home to our families.”
Emergency Medical Services providers – who were already under acute stress before the pandemic – have faced a grueling grind and additional stresses.
“You’ve got people who are in masks nearly 24 hours a day, and we start to worry about the same thing everyone worries about, which is COVID weariness, because it doesn’t look like this will go away soon,” said Rick Petrie, executive director of Atlantic Partners EMS, a resource agency for EMS in 12 of Maine’s 16 counties. Rural services have lost some of the retirees who act as volunteer ambulance drivers because they couldn’t risk exposure, he said, and rural fire chiefs and other EMS members fear bringing the disease home to their families.
“It’s taking a toll on people,” Petrie said.
HOW MAINE LOST CONTROL
After a lockdown in late March and a phased reopening in the spring, Maine managed to wrestle the novel coronavirus to the ground and pin it there for much of the summer tourist season. For months the state had among the lowest per capita new case trends in the country, vying with Vermont and New Hampshire from day to day for the best metrics. By the end of August, hospitalizations for the disease had descended to the lowest levels since the first days of the pandemic and per capita deaths from the disease were the second lowest in the country after Vermont.
But in September, York County was engulfed in a series of outbreaks, several of them linked to the now infamous wedding in East Millinocket presided over by Sanford independent fundamentalist Baptist pastor Todd Bell, who teaches his congregants to put their faith in God, not the advice of public health experts. Then, in October, cases began increasing across the state, many of them without clear links to a specific outbreak or incident. Hospitalizations have shot up and are spread across the state, rather than being concentrated in the three southernmost counties as was the situation in the spring surges.
“There are several factors that led to this, but all appear to be tied to weather,” Shah said.
Respiratory viruses have an easier time spreading in colder months because drier, colder air makes exhaled droplets smaller so they stay airborne longer and travel farther, he said, and the same is probably true of COVID-19. Meanwhile people are indoors more, increasing the likelihood of transmitting the disease to one another.
The new surge does not appear to be driven by any particular outbreak or incident, Shah said. Rather, the virus is out in the community and triggering outbreaks. Schools do not appear to be a major vector either, he said, as most cases found among students and staff at schools did not prove to have been transmitted during the school day itself, though that could begin to change if the prevalence of the disease within the community gets high enough.
Alexander at Central Maine Healthcare said the state had gotten the virus under control in the spring and summer via tight restrictions that were then eased at certain trigger points. “What we haven’t seen here in the fall is a gradual tightening of those restrictions as the situation has changed,” he said. “We haven’t seen the wide-scale restriction of indoor activities that we had seen previously and was a big part of what we were able to accomplish in the springtime.”
He urged Mainers to pull together again and observe public health measures to slow the disease as the country awaits a vaccine.
“We need to step up as a community to say, ‘We are going to do what we need to do to flatten the curve and tamp this back down,’” he said. “One of the things about Maine and Mainers is there is a strong spirit of resilience, and we need to rely on that again.”