Today the Maine CDC reports there are 303 confirmed cases of COVID-19 in fulltime residents of Maine. Since the start of the outbreak there have been 68 recoveries, 57 patients have been hospitalized, and 5 deaths. Among positive cases, 43 are healthcare workers. There is a current backlog of 600 tests to run, all patients in the lowest risk category. High risk patient tests are prioritized (more below).
Positive cases are present in 12 Maine counties with 169 cases in Cumberland County, and 59 cases in York County. Cases are represented by every decade of life, though over 87% of cases are in people 40 and up.
Non-residents who test positive in Maine are not listed in the total above, but are instead recorded in their home states. Those numbers (as far as I can tell), are not available on the Maine CDC website. From an epidemiology standpoint it makes sense to count the number in the state where the disease was contracted. If presumably a case was contracted in Massachusetts, but the person traveled to Maine and was tested here, MA needs to know not just the number of cases they have generated, but also the identities of cases. Knowing the identity allows public health officials to track contacts and hopefully limit spread.
From the opposite view, it is not clear to me how many cases we are counting who are Mainers with COVID-19 in other states. Many Maine residents are currently in Florida for example. A week ago Governor Mills advised people in other states to stay put, as the risk of encountering the virus would be higher with travel than staying in place.
As far as the numbers go, the total count of infected people in one place still matters. If an infected person is present in a state where they did not contract the virus, it can be important for the logistics of disease management to count those people, especially if the numbers of sick people become significant. Think of it this way: if you needed to feed a certain number people at a dinner it wouldn’t matter how they got there. All that would matter would be how many plates to set and how much food to cook. Managing a disease within a population can be the same way. You need to know how many cases there are so that you can plan on resources like hospital beds, ICU space, ventilators, supplies, and people to care for those patients.
There is another reason to know the total number. If you have an epidemic of an infectious disease it grows to some maximum number (the peak) before numbers of new cases start to drop off. Consider the total number of infected cases like a number that needs to fit into a math problem. If you know that for every person who has disease the overall size of the epidemic will expand in a certain way, then it becomes necessary to count those people. With relatively small numbers like we are seeing now, I am hopeful that the difference is negligible. A lot of effort in Maine is being put into predicting the growth of the epidemic and what that will mean in terms of resource and response.
Maine CDC
At his daily media brief today Dr. Nirav Shah of the Maine CDC noted that overnight two women in their 80s passed away in the hospital. He noted that two new pediatric patients (who are not school-aged) have been diagnosed. One person who spent some time at the Oxford Street shelter tested positive. Health officials are responding.
The Maine CDC is continuing with a plan to send some samples to an outside commercial laboratory (LabCorp) as a response to the backlog of tests. There is also an order for a new piece of equipment which should arrive in 1-2 weeks. Once that new equipment arrives it will take several days to calibrate and integrate into the workflow. See below for a new test.
In terms of the mechanics of testing, Dr. Shah noted that the way these numbers are collected is that overnight the commercial laboratories and the state lab combine results. When this occurs the PCP is contacted for more information about the patients with a positive result, including phone numbers. The patient is contacted by the Maine CDC and is asked about every contact they have had in the last two weeks. There is community transmission in many parts of the state.
“What we know about disease transmission, is that it occurs in places of congregation.”
Nirav Shah, M.D., Director of the Maine CDC
However, cell phone companies have been reporting to what extent people are straying from their homes (much lower), and traffic patterns have changed to reflect this. It appears social distancing is occurring, and it is having a curve-flattening effect on the rate of new cases. To be certain, number of cases is growing, but there are many factors at play. We are not done seeing a rise in the rate of cases, and we need to take it very seriously. There is of course a concern that if numbers continue to grow we will see a large rise in the numbers before the outbreak peaks in Maine. We don’t want to overwhelm health systems in our state. This brings us to supplies.
Yesterday Maine received a third distribution from the federal stockpile, including 60,000 N95 masks and other PPE. Maine CDC authorities are to soon distribute, primarily to hospitals.
Vital resources currently in Maine
- 190 ICU beds, 90 available
- 330 ventilators, 262 available
- 89 alternative ventilators (primarily ventilators used in short term medical procedures such as surgeries that can be modified for use in COVID-19 patients)
If those numbers seem like a lot, they aren’t. The Maine CDC is asking hospitals to increase reporting, including available numbers of PPE, and other data. “In any type of a situation, we have to know where were going, but in order to know where we are going we have to know where we are right now.”
A new COVID-19 test
In other news, Abbott labs has developed a new, FDA-approved rapid COVID-19 test which will give a positive results in 5 minutes, and a negative response in 13 minutes. Production begins at the Scarborough facility tomorrow. Abbott reports they will produce 50,000 tests daily, and will be working with the Trump administration in terms of distribution.
Stay Healthy at Home Mandate
Governor Janet Mills this afternoon announced “a series of substantial new mandates to protect public health and safety in the face of COVID-19, including a Stay Healthy at Home directive that requires people living in Maine to stay at home at all times unless for an essential job or an essential personal reason, such as obtaining food, medicine, health care, or other necessary purposes.” This new mandate will take effect 12:01 a.m. April 2, 2020 and will last until at least April 30, 2020 unless changed by the governor.
In brief, essential businesses and operations that remain open will limit the number of customers in buildings at any one time, implement curb-side pickup, delivery options, and enforce U.S. CDC-recommended physical distancing requirements for their customers and employees in and around their facilities. The mandate also prohibits the use of public transportation “unless for an essential reason or job that cannot be done from home and limiting the number of people traveling in private vehicles to persons within the immediate household unless transporting for essential activities.” Classroom and other in-person instruction will not resume until at least May 1, 2020. It is now mandated that when out of the home or at work at an essential business, “individuals shall maintain a minimum distance of six feet from other persons.”
Essential personal activities defined in the mandate “with relation to an individual, their family, household members, pets, or livestock” include obtaining necessary supplies for household consumption or use, medication or medical supplies, seeking medical or behavioral health, emergency services, providing care, traveling to and from an educational institution for purposes of receiving meals or instructional materials for distance learning, engaging in outdoor exercise activities, such as walking, hiking, running, or biking, “but, only in compliance with the social gathering restriction in Executive Order 14 and all applicable social distancing guidance published by the U.S. and Maine Centers for Disease Control and Prevention.” For further details please read the mandate.
Conclusion
This is a virus, a deadly virus. For it to spread, it has to be spread from one person to the next. If we could all isolate for two weeks, it would be gone. Do your part, please stay home.
