There are 117 cases of COVID-19 in Maine today, up 47 since I posted just three days ago, and the first case was reported just 12 days back. COVID-19 now involves 10 counties in our state. While this sounds bad, and it is a growing number, I want to cautiously point out that the rate of growth is not as bad as it could be. And, I want to emphasize again that we are only testing the very ill, high risk patients, and healthcare workers who have come into contact with COVID-19 patients. We have no idea how many cases there really are. Still, we have a reason to be happy, in that the numbers we are seeing are lower than they could be. I think this is in large part due to the efforts of people who have stayed home. We have a little bit of a geographic advantage also due to the fact that Maine is the least densely populated state along the eastern seaboard, and in New England. Businesses are doing their part at a dear cost in those that have had to close, and some have changed to the manufacture of medical equipment. The entire medical community is making huge, and often heroic efforts in the face of this pandemic. I am proud of my colleagues around the state. Every person who works in healthcare, no matter the position, is being asked to take risk, and is doing their part. My hospital has never seemed more vital. I see every person there as an important member in the fight against this disease. So how are we doing?
First, a look around the U.S.
Yesterday the Surgeon General, Dr. Jerome Adams, advised people to stay home. He noted that COVID-19 is “going to get bad” this week in the U.S. This was in reference to the rapid acceleration of cases around the country, and the need to take action at many levels. His message was mostly directed at the individual however. Between the lines, he advised strongly for us to take it seriously, and don’t become part of the problem.
Today the CDC in Atlanta notes there are a total of 44,183 cases of COVID-19 in the U.S., and there have been so far 544 deaths.
Washington state,where COVID-19 was first detected in the U.S., has 2221 cases, about half in King county (Seatle).
As discussed in my last post, New York City, the most affected municipality in country, has 14,900 cases (up 150% in three days, a large exponential growth rate) and FEMA has made a major disaster declaration. The news coming out of NYC is very troubling, and there are 25,665 cases in that state. We don’t want to replicate it here.
What are we doing to stop or slow COVID-19 in Maine?
Every health system in the state is grappling with this issue, and there are daily policy and strategy changes. Most offices have switched to tele-medicine for non-urgent outpatient medicine, and elective procedures are being delayed to free up space, equipment, and providers in medical facilities. Even in the offices we are attempting social distancing as much as possible.
Our state agencies and government have been hard at work on the issues as well. Meanwhile, medical and emergency personnel are dealing with shortages of protective equipment.
The governor and the Maine CDC
Today via a press conference with Governor Janet Mills and Dr. Nirav Shah of the Maine CDC, we learned that there are 15 COVID-19 patients hospitalized in Maine so far. And, of the 117 positive patients, seven have recovered. The total number of negative tests in Maine is over 3000. Dr. Shah wanted to emphasize however, that the “cases we detect in any outbreak setting…merely represent the tip of the iceberg.” By this he meant there are many more cases that are not tested, people whose illness does not rise to the strict criteria for testing, in no small part due to rationing of the test (see below). There are also many asymptomatic carriers who would test positive, and are capable of spreading disease. We simply don’t have enough tests to check everyone. Thus, the few we test and find positive represent the tip of the iceberg, with a huge mountain (of other cases) beneath. Because of this, because of questions from Mainers about when to take action he noted, “now is the time to start taking public health action…there is no need to wait…the absence of evidence of cases in your county is not evidence of absence…” He noted it is time to behave as though the virus is in your town.
Dr. Shah reported there are now several labs doing tests for Maine, three more added today. Maine has 1300 tests pending currently, which Dr. Shah noted was unacceptable, and due to a national shortage of the reagent needed to test for the virus that causes COVID-19, affecting labs around the country. Dr. Shah noted we are working to acquire an additional piece of equipment that hopefully will have a more steady supply of a different reagent.
As for personal protective equipment (PPE), there is a shortage. This is because under these circumstances we are consuming unprecedented volumes of the equipment in the testing, evaluating, and caring for potential and actual COVID-19 cases. Another issue is that we are not receiving the volume of equipment needed from the federal stockpile, as there is need in all directions: every state has cases. One of the stated tasks of the Maine CDC then, is to distribute available equipment around our state fairly. And, it is not just to hospitals. Yesterday Maine CDC distributed 22,000 pieces of equipment to fire and rescue, local law enforcement agencies, first responders, and regional medical facilities. This morning Maine CDC received the second distribution of PPE from the federal stockpile. It was still not enough. See my last post about a few requests.
Dr. Shah gave an update on the availability of scarce medical resources. Currently available are 77 intensive care unit (ICU) beds, 248 ventilators, and about 84 respiratory technicians to assist in using those ventilators. During the later Q/A session Dr. Shah discussed ventilators, noting they are really a three part issue: the ventilator, the person to operate the ventilator, and the space to put the ventilator and a patient. In Maine certain ventilators (for surgical procedures) can be adapted to use for these patients also.
Governor Janet Mills spoke of the ways Maine people have met this challenge, noting for example that ND Paper had donated 1000 N95 masks to the state, that “everybody with a sewing machine wants to sew masks,” and “LL Bean workers are helping the Good Shepherd Food Bank.” She gave several examples and spoke about the goodness of Maine People. “People are stepping up to the plate.” For those that are thinking of donating supplies or helping Maine is setting up a portal in the next few days. It will be on the Maine.gov website.
Mills noted she has been on the phone with VP Pence four times “stressing needs (of Maine) with the federal government.”
New steps
Today Mills renewed her previous Executive Order prohibiting gatherings of more than ten people and the closure of dine-in service at restaurants and bars in Maine, extending the timeframe to April 8, 2020 at 12:00 a.m. More steps are being taken to prevent the spread of the SARS-CoV-2 virus that causes COVID-19. The governor is mandating a 14 day closure of physical locations of non-essential public-facing businesses (Homeland Security definition), such as shopping malls, fitness and exercise gyms, spas, barber shops, hair salons, tattoo and piercing parlors, massage facilities, nail technicians, cosmetologists and estheticians, electrolysis services, laser hair removal services, and similar personal care and treatment facilities and services. The order closes non-essential business sites that require more than ten workers to convene in a space where physical distancing is not possible. “Non-essential businesses and operations may continue activities that do not involve these types of in-person contact and convenings, and should facilitate the maximum number of employees working remotely.” The order is effective March 25, 2020 at 12:01 a.m. through April 8, 2020 at 12:00 a.m.
Essential businesses that are excluded from the mandate include food processing, agriculture, industrial manufacturing, construction, trash collection, grocery and household goods, convenience stores, home repair stress, hardware stores, auto repair, pharmacy, other medical facilities, biomedical, behavioral health and health care providers, child care, post offices and shipping outlets, insurance, banks, gas stations, laundromats, veterinary clinics and animal feed and supply stores, shipping stores, public transportation, and hotel and commercial lodging.
A request from the governor
She did not mandate, but strongly urged, all large, essential, public-facing businesses to immediately employ strategies to reduce congestion in their stores, including limiting the number of customers in the store at any one time and enhancing curbside pick-up and delivery services. These steps were meant to better protect customers and employees. She urged physical distancing measures, enhanced curbside pick-up and delivery services, staggering of hours for shoppers of a certain age, closing fitting rooms, cautioning customers against handling merchandise they are not purchasing, marking six-foot measurements by the cashier stations and reminding customers to remain six feet apart while in the store, staggering break times for employees, requiring frequent hand-washing, frequently sanitizing high-touch areas, such as shopping carts.
Stay away from other people. Just because a store is open, doesn’t mean it is safe to go there, and it doesn’t mean you should take your family with you…the next 15 days are critical for flattening that curve…we are confronting an unprecedented challenge…
Janet Mills, Governor of Maine
She was asked about the rise in out-of-state visitors we are seeing: “if they believe they can escape that by coming here, if they believe they escape the virus, they are wrong, because it is here…” As for whether snowbirds should return home to Maine, she answered “if you’re safe where you are, stay where you are,” noting that you cannot travel without rest stops, and a lot of contact.
As for future restrictions, she noted “I hope that we can avoid taking further steps, but it depends on our collective actions… (it) depends on whether we stay apart today so that we can come back together tomorrow.” She also noted that in Maine those afflicted are not just the elderly or those with underlying illnesses. “We have cases of all ages,” but in taking measures, in helping others, “we want people to be cautious and courageous.” When asked about behaviors of some people in Maine, she responded “I am not going to speculate on what people might do, because I expect them to do the right thing.”
When asked about Bath Iron Works, which is still in operation, and the subject of heavy public outcry, she noted that she had been in contact with federal officials, and reviewed a letter from the Department of Defense re BIW which was “not satisfactory at all.” BIW has thousands of workers, and at least one case of COVID-19 has been confirmed in a worker. There is legitimate concern that the facility may be the cause of a surge of cases due to the concentration of workers and the close proximity of the work environment. While many employees have opted to take unpaid leave, some steps have reportedly been put in place to reduce risk of spread.
In conclusion
Thank you for all you are doing, and know that it matters. These are difficult times, but we can get through them. Please stay safe, practice hand washing, social distancing, and flatten the curve.
