Yesterday in Maine the total number of confirmed COVID-19 cases as counted since the beginning of testing on March 12th had risen to 796. Healthcare workers in Maine represented 173 of these cases (22%). Per the Maine CDC 333 Mainers had recovered, and unfortunately, the death count had risen to 27. Thus, the total number of Maine residents with confirmed active COVID-19 infections was 436, down 5 cases from the day prior. The overall trend in active cases however, had been otherwise steadily increasing since testing began.
On April 5 I wrote that on that the total number of confirmed cases had tripled over the prior 10 days. I wondered what the next 10 days would look like, and was hopeful that additional restrictions put in place by the governor would help prevent us from having a rapid exponential rise during an upcoming week, predicted by Dr. Anthony Fauci of the NIH and Surgeon General Jerome Adams to be very bad week in our country. When the doubling time of an epidemic begins to shrink, the total number of cases rises rapidly (as in New York City, for example).
Consider this example of very rapid exponential growth. If you have 1 case, but the number of cases doubles every day, then that number will increase as follows from the first to the last day of the month: 1, 2, 4, 8, 16, 32, 64, 128, 256, 512, 1024, 2048, 4096, 8192, 16,384, 32,768, 65,536, 131,072, 262,144, 524,288, 1,048,576, 2,097,152, 4,194,304, 8,388,608, 16,777,216, 33,554,432, 67,108,864, 134,217,728, 268,435,456, 536,870,912.
We don’t have that many people in our country, let alone our state, but I hope you get the message. Rapid exponential growth rates are scary in epidemics. If we had a steady doubling time of even 10 days, then a month from now the total number of confirmed cases would grow to 796 to 6,368. The current doubling time of the total number confirmed cases in Maine is about 2 weeks. This is manageable currently, and a reason for optimism, but if we hold at that number, it would still mean that in a month the total number of confirmed cases would rise to 3,184. I doubt that will happen because the doubling time is getting longer instead of shorter, and the average number of daily cases over the last few weeks has been much more consistent (instead of growing).
To go back to my April 5 post, and the question I posed, in Maine from April 5 to the 15th the number of cases grew from 470 to 770, a growth not of 3 times as many cases as we had seen in the prior 10 days, but 1.6 times as many, a good sign. The rate of increase was actually slightly slower over the period leading to the 15th than it had been for the prior 10 days. One simple way to see this is to compare the daily number of cases. During the 10 days leading up to April 5, the number of new cases averaged 32.6 daily. Over the next ten days the number of new cases rose by an average of 30 daily. If we hold at an average of 30 cases daily then we can expect 300 new cases every 10 days. In one month we would increase to 1696 cases. We are hopeful in Maine however, that we may be approaching a peak and we might see the numbers of new cases dropping. I am hopeful we will see stability in the numbers of cases at congregate living facilities, which have seen an increase in the past week. The numbers outside of those facilities have actually looked better.
The avoidance of a rapid expansion is no doubt helped a great deal by social distancing, executive orders by the governor, strong leadership at the Maine CDC, and the tireless effort of healthcare workers across the state. Maine Responds volunteers have grown rapidly in numbers, and a variety of strategies have been used to triage testing-given that there is still such a short supply. To paraphrase Maine CDC Director Dr. Nirav Shah in his daily COVID-19 briefing yesterday afternoon, all of these efforts have raised the line above which the health system would have been overwhelmed: in other words, in addition to flattening the curve, we are raising the bar. Good job Maine.
This is not to say any of this is easy, or that it is not hurting people and businesses. There have been many changes. Over the last week and a half Mainers have had to stand in lines to get into grocery stores, and U.S. citizens have been asked to wear cloth face covers in public, to mention a couple of the changes. These, and other steps were put in place to slow the spread of the SARS-CoV-2 virus so that health systems would not be overwhelmed, and so that Maine people would all be protected.
Due to these efforts, and numbers discussed above, the Institute for Health Metrics and Evaluation (IHME) modeling has downgraded the severity of projections for Maine, and is now forecasting a total number of deaths at 63, rather than the 364 projected a week and a half ago. Any reduction in that number is a very good thing. Projected resource demands have dropped also, and per the IHME we should have passed our peak a few days ago. If we keep at it, we may scrape through, but still need to tread carefully.
Reopening businesses and relaxing restrictions can be dangerous. We can estimate that the number of people we have confirmed with tests represents about 20-25% of all infections. It is also estimated that another 25% are asymptomatic carriers capable of spreading disease. Since we do not have widespread testing yet, we don’t know who is a carrier, who has immunity, and who is on the way to getting sick. We do not yet have a reliable treatment, a cure, or a vaccine. We need to find a way through this without suffering the devastation seen in other parts of the country.
The U.S. leads the world in confirmed cases (671,425) by a wide margin, representing about a third of the over 2 million cases worldwide, and 3.5 times the number of cases in Spain, which is the next country after us. To see a graphic of the top several countries by cases, and to get a sense of the unfortunate lead the U.S. has over other countries, Bangor Daily News has been keeping a lot of data, and updating daily.
We are not out of the woods, and we do not know what the coming months will look like. We have reason to be grateful in Maine because through leadership and clear communication in medicine, public health, and government, we have been able to work together and make the best of a bad situation.
Note, if you cannot see a graphic at the top of this article on a handheld device, please view the article on a computer.
All URLs verified at time of publishing. Remember that these sites are changing and updating numbers, thus may not reflect the same values I have listed if viewed at another time.
