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Nine days back I wrote about active cases of COVID-19 in Maine.  Recall that the active infections we are tracking are among Maine residents who have either had a positive test, “confirmed” cases, or are “probable” (close contact with a confirmed case and meeting certain clinical criteria as defined by the CDC).  These cases have not recovered or died, and are thus actively ill. As of yesterday there had been 424 probable cases and 3287 confirmed since testing began 131 days back.   These numbers do not reflect those who were ill but never tested, and likely do not reflect the majority asymptomatic carriers, who for the most part have not been tested.  The numbers also do not reflect out of state visitors who test positive in Maine.   

In the July 11 post I discussed the bump in cases seen after Father’s day, and expressed concern about the possibility of the same following July 4.  We have now passed two weeks since that holiday, and numbers of cases among Maine residents have been shared by the Maine CDC, as outlined in the above graphic (view the article on the website if you cannot see that).   What the numbers tell us now is that we did fairly well for most of that two weeks.  The number of active cases dropped to 385 on July 14, which was the lowest level we have seen since April.   However, those numbers have since been slowly climbing, and the current number of active cases is 435.  Recall that in Maine the peak of active cases so far was 714 on May 24.  The current 7 day average is 22 cases per day (up from 15 on July 11).  So far, 117 Mainers have died from COVID-19. 

On Friday of last week Maine was one of three states in our country whose numbers were going down.  My concern is that it appears our numbers might be starting to go up again.  And, though it appears to me the number of out-of-state visitors is lower than normal, there are still many here.  The concern expressed by many of my patients and their family members is that visitors tend to have a false sense of security when they visit here, saying to Mainers that there are practically no cases here, or that they don’t need to worry when they come here because the risk is so low. It seems lost on them that they are a risk to Mainers. Many are also not wearing masks, and don’t appear to be quarantining.  This is how the virus is spread.  Remember, a significant number of people will be asymptomatic carriers of this disease.   

We are not doing a good job dealing with this virus in our country.   The CDC found in late June that antibody tests in six different states showed viral exposure at a much higher magnitude than prior testing had revealed. After reviewing thousands of blood tests in each state, CDC estimated the differences between reported case counts and actual was as follows:  western Washington State (11x higher than reported positive tests), New York metro area (12x), southern Florida (11x), Missouri (24x), Utah (11x), Connecticut (6x).   But this is nowhere near the levels of infection we would need to see to have herd immunity, which would require somewhere north of 50% of the population immune (more likely over 70%). 

As of today there have been 14,608,517 cases of COVID-19 across the globe, with 3,808,104 in the U.S. (26% of cases though we have just 4% of the world’s population).  Our case numbers are now 11 times that of Mexico, 15 times that of Italy, 19 times that of Germany, 34 times that of Canada, and 45 times that reported by China-who hosts 36% of the world’s population.   We have had several days with over 60,000 new cases of COVID-19 in the U.S. lately and the trend is going up.  Over 137,000 Americans have already died from COVID-19, and the CDC estimates the overall case fatality rate of COVID-19 to be 2.3%.  That means for each day that we have 60,000 new infections, we can expect close to 1,400 additional deaths. 

We are seeing more young people around the country with COVID-19. The problem with this is that although they are still at risk of serious illness or death, they are also more likely to have a minor illness or be an asymptomatic carrier.  We need people to take this seriously. 

It seems to me that although everyone knows about the virus, they are getting information from a lot of suspect sources.  The CDC is a good source but I don’t think everyone is listening.  There should be PSAs in all kinds of media about COVID-19 telling people how to avoid catching or spreading disease, how to wear a face cover or mask, how to do their part. 

On Tuesday of this week Dr. Nirav Shaw of the Maine CDC reported that since testing began in our state there had been 111 positive tests among non-residents.   Dr. Shaw took care to note that “many” of these cases are from people who live in New Hampshire but get their healthcare in Maine.   Further, he noted that among the total of 374 people who have so far been hospitalized with COVID-19 in Maine, some of the cases were out-of-staters, though the number was not given.  As of today, he notes that there are 13 people hospitalized in Maine with COVID-19, 11 of whom are in ICUs, and 4 of whom are on ventilators. 

Today the total number of cases given (posted as of midnight last night) was 3598 cases among Maine residents since testing began (391 probable cases).  Subtracting 3094 recoveries, and 114 deaths, we are left with a total of only 390 active cases.  The current 7-day average of new cases is 15 per day.  Overall, numbers are falling in Maine.  

The total number of healthcare workers who have been infected in our state since testing began is 844.   As always, if you cannot see the graphic in the email of this post, please view the post on the website.

Maine is doing so much better than many other parts of the country. But those problems can come here. A surge of cases in another state can for example deplete resources such as PPE or testing materials needed everywhere. Speaking of that, it has been a strange week in our country for COVID-19.  Every week of this pandemic has been for that matter, but a few points really stand out. 

• On Tuesday of this week there were 64,000 new cases in the U.S., and the Trump Administration unilaterally removed the ability of the leading public health agency -the CDC – to collect hospitalization data on COVID-19-requiring hospitals to report elsewhere.  That information will now be given to a central database in Washington, in part run by a private company.  Health experts around the country are calling this an alarming and unprecedented move because public health data is being taken from the experts who need it.  There is also concern the information will be suppressed, spun or politicized. 

• The White House and Trump have made disparaging remarks about the country’s leading infectious disease specialist, Dr. Anthony Fauci. We are no longer hearing from Fauci via the the White House. America needs to hear from an expert. I have a feeling that most of America trusts Fauci.

• Georgia’s governor Brian Kemp has sued Atlanta  over a mask mandate, even as cases there climb. And, Kemp banned cities in Georgia from ordering people to wear face masks.  There have been 127,834 cases of COVID-19 in Georgia (almost 24,000 in the last seven days).

• Nearly a third of the 54,022 children tested for COVID-19 in Florida have been positive (16,797 kids).  Four of the children have died, and 213 have been hospitalized.  The Trump administration is demanding that schools reopen in the fall. 

There are other concerns, lots of them.  Where are the checks and balances in our government? Where is the leadership? Where are we going with the out-of-control exponential growth down south and the failure of politicians to recognize it is an emergency?

Note, the links are current as of the time of posting, and are subject to change.

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 4^th 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.