Today many businesses around the state are reopening as part of a staged process under Executive Orders from Governor Mills. Social distancing and mask or facial covering requirements are still in place to prevent spread of the virus. Just to recap the last few days, on May 28 Dr. Nirav Shaw, Director of the Maine CDC, started giving daily briefing updates remotely due to a cluster of complaints at the Maine Emergency Management Agency (EMA): “a number of individuals…have developed signs and symptoms consistent with symptoms consistent with COVID-19.” He and EMA Director Peter Cook noted the 7 individuals reported fever, chills, aches. They team deployed to alternate work sites away from the Emergency Operations Center, and the individuals were tested. On May 29 Dr. Shaw noted all the tests had come back negative for the 7 individuals. They planned to run other tests for other potential viruses and bacteria. It is possible that some other organism infected the workers. It is not clear which modality of testing was used for these workers.
The U.S. passed the horrible marker of 100,000 fatalities due to COVID-19 last week. We still stand apart as a country in terms of cases and deaths. In fact, by comparison with one of our neighbors, on May 31, Canada reported 92,479 cases, which from a population 37 million represented 0.25% of Canadians. The same day, the U.S. counted 1,806,813 cases from a population of 328,239,523, representing a case rate of 0.55% of the general population, a rate over double that of Canada. The U.S. has four times the number of cases of any other country in the world, and over 104,000 Americans have died with COVID-19 in the last four months.
Today in Maine the total count of cases since testing began stands at 2349, including a little over 200 “probable” cases” (discussed in MPDN on May 20, 2020), 1586 recoveries, 89 (3.8%) deaths. The number of health care workers infected since testing began is 563 (24%).
In the 12 days since I last reported on trends in case rates here in Maine, the number of new cases per day has averaged 45 (on May 20, 2020 the prior three week average number was 40 cases per day). Overall, since testing began 83 days back, we have averaged 28 new cases per day. Sixteen Mainers have died from COVID-19 over the last 12 days.
To date there have been 284 hospitalizations in Maine due to COVID-19 (12% of all positive cases). The current number of active cases is 674 (29% of cases since testing began). Of the active cases, 52 (8%) are hospitalized. Among the 52 hospitalized, 17 (33%) are in intensive care unit (ICU) beds (a higher percentage), and 10 (19 %) on ventilators, also a higher percentage. The highest number of active cases occurred on 5/24/20: 720 cases.
To be clear, Maine has had an increase in the case rate since I last reported on this topic. This is in part due to outbreaks and testing at congregate care facilities. Per Dr. Shah on Maine Calling last week, congregate care facilities represented about 40% of total cases. Today Dr. Shaw gave an update on the Cape Memory Care Center, which has had a total of 84 cases (23 of whom were staff, the remainder residents). Also listed were outbreaks at four new facilities. Birchwoods at Canco Assisted Living has 5 staff members who have tested positive for COVID-19. One of the John P. Murphy Homes in Auburn has 5 cases. The Family Shelter in Portland has 15 cases. The Barron Center in Portland has 4 cases.
Presumably, the new cases at congregate living facilities are being brought in by staff or some other visitor (a vendor, for example). Since patient visitors are not allowed, the numbers must be small. However, I know from facilities with which I have had contact, that there is screening, that staff with signs or symptoms disease, or travel out of state, are not being allowed in facilities unless first quarantined or tested negative.
This means many (or probably most) cases at these facilities are caused by asymptomatic carriers who do not know they are ill and are bringing the virus into the facility. As discussed in my last post, asymptomatic carriers are those people who are infected but not showing symptoms. Asymptomatic carriers represent a significant number of people, people who can spread disease without knowing it. So, why not institute a policy of regular testing of all employees at congregate living facilities? The limitation has been the number of tests available. In May the state testing lab increased capacity to 1000 tests per day. This is a lot, but perhaps not enough. We need more tests, but we need to use them wisely also. That would mean regularly testing of all health care workers, workers at meat packing plants, any place where people congregate.
And, we still do not know the number of asymptomatic carriers in the general population-a great reason to keep wearing that face covering, and keep on social distancing. To figure out the rate of asymptomatic carriers, the state could conduct tests on samples of the population, for example, 100 people each in several communities. These would have to be volunteers, of course. This sentinel testing could make a big difference and guide the reopening of businesses, schools, and so on. Such tests would also allow notification, isolation, contact tracing to try and curb other outbreaks. To date, the state of Maine has run over 54,000 tests in a population of 1.3 million. As mentioned previously in MPDN, many of the tests were repeats of patients who for example, had a syndrome very suspicious for COVID-19, but initially tested negative. Or, these may have been patients with confirmed COVID-19 who recovered and needed a negative test for discharge from a hospital. The Maine CDC is in the planning stages of sentinel testing.
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