Let’s talk about active cases of COVID-19 in Maine. By this, I mean people here in the state who are currently sick with COVID-19. It sounds simple enough, but it is not a number that we have, because while we are shown a count of infections among state residents, we in the public sector do not know the number of infections among visiting non-residents. Those that have tested positive in our state are counted in their home states (and the same is true for out-of-state Mainers, another number we don’t have). I think these numbers should be public, because if people are ill in Maine (or anywhere for that matter), they impact healthcare and could influence decisions about opening businesses, and influence Mainers as to calculating their own risk. So what do the numbers of active cases mean, and how can we count them?
Because the state is posting totals at midnight, we will reference data as of July 10, 2020. To calculate how many Maine residents have an active infection we take the total number of cases since testing began (3,520), subtract recoveries (2,971) and deaths (112), to arrive at 437 active infections (Maine CDC lists these as “other” cases). The peak of active cases so far in Maine occurred on May 24, 2020 at 714. The number declined steadily following that peak until June 23, (two days after Father’s Day), with 393 active cases. The average time for symptoms to show after infection is 5 days, and testing of people with COVID-19 is usually a few days after that. Since this virus spreads when people congregate, we could expect a “bump” in active cases a week or two after Father’s Day (if people were congregating, especially indoors). By July 3 (12 days later) we reached 529 active cases (a 35% increase), which was not simply a function of increased testing. Numbers of hospitalized patients did not fall during this time.
I was on call July 4th weekend, and drove to the hospital a few times. I saw a lot of people in town, a lot of shopping, crowding, gathering, and a lot of out-of-state tags. The one hopeful issue about July 4 is that most gatherings were likely outside, where chance of infection is lower. And, in the six days of data available following July 4, active cases trended down. The current 7-day average of new cases has dropped from 33 to 19. While those declines might sound very hopeful, they might also represent the other side of the Father’s Day “bump.” However, we might be about to see another bump. We are now 7 days out from July 4. Let’s hope that over the next week we do not see an increase.
We are also seeing the ongoing opening up of Maine and the tourism industry. New York, New Jersey, Connecticut, Vermont, and New Hampshire residents are not being asked to quarantine, and we are seeing a lot of visitors from those states. According to the CDC in Atlanta, in the last week new cases in each of those states has totaled the following: New York (4,476), New Jersey (1,914), Connecticut (563), Vermont (45), and New Hampshire (151). Maine has seen 131 new cases in the past week. Since our states have different population sizes, we can look instead at the number of cases per 100,000 of population to get a sense of how widespread infection is in those states compared with our own: New York state excluding NYC (1,628), New Jersey (1,956), Connecticut (1,321), Vermont (203), and New Hampshire (440), and Maine (261). We are not even close to the numbers being seen in New York, New Jersey, or Connecticut. And, we are all seeing a lot of Massachusetts tags, though they are asked to quarantine or show a negative COVID-19 test if they want to visit Maine. Massachusetts has had 1,559 cases in the last week, and the case count per 100,000 is 1,606.
While we hope that visitors are being tested before coming here, the problem is that in traveling itself we all visit the same rest stops, gas stations, and so on. The virus spreads where people congregate. And, asymptomatic carriers likely represent a high percentage of spread. People may come here thinking they are well, but still spread virus. For reasons that are still not completely clear, some people have no symptoms, or only mild symptoms, but they may give someone else a fatal infection.
Cases in New England are improving overall, but case trends around the country are not looking good. Texas is experiencing a huge increase in cases, currently counting over 114,000 active cases (from over 230,000 since testing began), and having suffered over 3000 deaths due to COVID-19. In the last seven days Texas has seen 54,369 new cases. I trained at the Texas Medical Center in Houston, which was the world’s largest, with over 50,000 employees and multiple huge hospitals, including the DeBakey VA Hospital (one of the largest federal buildings in the country), the Ben Taub County Hospital, huge Methodist and Presbyterian hospitals, and the MD Anderson Cancer Center Hospital. Recently, Texas Children’s Hospital (also in the TMC) had to start housing adult patients with COVID-19 because space had run out elsewhere. Florida has seen over 63,000 new cases in the last week.
Here in Maine tourists and summer home owners are arriving, and the number is not trivial. The Maine Office of Tourism reported 33 million people visited Maine in 2015. During just the summer of 2018 11 million overnight visitors came to Maine.
To that point, when I last posted on this topic I noted that there was some confusion (at least in my mind) regarding the numbers being stated at Maine CDC briefings when compared with the data given on the same agency’s website. I want to take a moment here to say I truly appreciate what the Maine CDC and Dr. Shaw have been doing. The numbers were confusing nonetheless, and I want to follow-up on that. As discussed in that last post, the case trend numbers given during briefings did not match the data shared in the website table “All Reported COVID-19 Tests in Maine,” which has consistently shown a higher number than the total cases in the state. I called the Maine CDC and asked for clarification. In order to get this information, I became one of the Maine CDC’s “consultations.” What I learned was that the number given in briefings is basically a headcount of positive and probable cases among Maine residents; whereas the “All Reported” table includes only lab test results, and does indeed include non-residents who have tested positive while visiting Maine. That table includes all positive results, even if they belong to the same person. Put another way, if a person has had more than one positive test – for example, a hospitalized patient who needs a negative test prior to discharge, they are counted. A breakdown of those numbers explaining how many of each category was not given. However, we do know that the table does not include “probable tests,” which currently stand at about 400 of the 3520 cases. Thus, 3120 Mainers have tested positive. We can use these numbers in a simple calculation and say that 4652 total positive tests minus 3120 individual Mainers leaves 1532 additional positive tests, some out-of-staters, some duplicates. It should be obvious that we are doing better than many other states. And, it should be obvious that raising our summer population by millions is a risky proposition during a pandemic.
So, please don’t let down your guard. Remember, health resources are also limited. This includes people. Since testing began 831 health care workers have tested positive in Maine (24% of reported cases), and this number grew by 100 new cases in just three weeks. Around the country about 700 health care workers have died from COVID-19.
The way to avoid COVID-19 is to practice physical distancing. If the virus can’t get to another host, it can’t spread. Stay at least 6 feet away from others not in your household. Stay as far as possible from people who do not wear masks in public and avoid sharing indoor spaces with these people. It would seem very likely that people who don’t wear masks are more likely to carry the virus that causes COVID-19 than those who do. Of course, stay away from people with COVID-19, and if you are ill, stay home.
If you are healthy and are around others in public, wear a cloth face cover or a mask. Remember that the mask does not mean you are free to stand closer. It is a simple barrier which helps, but does not guarantee safety. Also, wear a mask the right way. Studies by the Center for Infectious Disease Research and Policy (CIDRAP) have reported that in review of news footage an average of 25% of Americans are not wearing their mask correctly. Many do not cover the nose, for example. A mask should cover both the mouth and the nose at all times. There is also a great deal of inappropriate handling of masks. You should only touch the mask with clean hands, handle the mask by the drawstrings, and do not touch the part through which you breath. If you touch your mask, remember that it is a filter for the virus that causes COVID-19. You could be contaminating your fingers. Wash your hands. A mask should not be moved under the chin, put in a pocket, or otherwise handled carelessly. A wet or damaged mask is not helpful.
Finally, the U.S. has seen over 3 million cases of COVID-19 and over 132,000 people have died from this preventable viral infection. Please do your part. It is not a political issue, wear a mask and do all that you can to avoid contributing to this pandemic.
