A flagger from Project Flagging Inc. wears a mask while on a job at Oak Street in Portland on Thursday. The bulk of new COVID-19 cases continue to be reported in southern Maine, where community transmission is occurring, Maine CDC Director Dr. Nirav Shah said on Thursday. Derek Davis/Staff Photographer

State health officials reported 50 new cases of COVID-19 and three additional deaths on Thursday, increases that the state’s top epidemiologist attributed to ramped-up testing and the continued spread of the coronavirus.

“The increase of cases that we have seen over the past days is concerning,” said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention. “Partly it’s a function of expanded testing, so in that respect it’s anticipated, but it remains concerning all the same.”

At the same time, the Mills administration pushed ahead with the phased reopening of the state’s economy, announcing Thursday that hotels and other lodging businesses can begin accepting reservations from residents or non-residents for June 1 or later. But that announcement did not include changes to a controversial 14-day quarantine requirement for out-of-state visitors.

The latest figures from the Maine CDC show 1,565 either confirmed or probable cases of COVID-19, the disease caused by the coronavirus. The 50 new cases reported Thursday represent the largest jump in a week and come at a time when the Maine CDC lab is significantly increasing its testing capacity.

At least 69 people with COVID-19 have died in Maine, about half of whom were residents of nursing homes or other long-term care facilities. Penobscot County reported its first death on Thursday – identified only as a man in 60s – while Cumberland County’s toll rose to 34 with the deaths of a woman in her 90s and a man in his 80s.

After accounting for the 69 deaths and the 958 people who have recovered from the disease, there were 538 active cases in the state as of Thursday. That is an increase of 32 from Wednesday. Maine’s seven-day average for active cases was 506 on Thursday, compared to 428 during the previous seven-day period.

‘IT IS OUT THERE’

Shah said there were no new outbreaks to report. Instead, most of the new cases were either among household members or other close contacts of known infected individuals, or among people who picked the virus up while “out and about … in their community,” Shah said.

So-called “community transmission” has been documented in Cumberland, York, Penobscot and Androscoggin counties, with Cumberland and York accounting for two-thirds of all cases. Those four counties are not part of Gov. Janet Mills’ accelerated economic reopening plan underway this month in Maine’s other 12 counties.

“The bulk of the growth in cases continues to be in those counties,” Shah said. “That is another way of saying: for those of you who are in counties where community transmission is occurring, it’s really occurring. It is out there.”

While Shah said that the rise in cases is concerning, he said Maine’s increased testing capacity is likely helping to drive those figures.

The Maine CDC reported this week that testing volume in the state has more than doubled in recent weeks – from roughly 3,000 to 6,424 during the past week – as the state lab as well as national laboratories run more tests. The Maine CDC expects to have the capacity to analyze an additional 5,000 test samples per week in the coming days as part of a partnership with the Westbrook-based veterinary diagnostic firm Idexx.

Maine averaged 34 additional cases per day over the seven-day period ending Thursday, which is the same as the previous seven-day period ending last Thursday. The 14-day average rose from 21 new cases per day during the two-week period ending April 30 to 34 per day for the two weeks ending Thursday.

“We might be at a level where we are talking less and less about a surge but rather a plateau,” Shah said. “A high plateau, to be sure. A plateau doesn’t mean that things are getting better, but that things are staying the same at a rate that might not be very desirable to us.”

MORE TESTS, MORE POTENTIAL CASES

Increased testing capacity is a key benchmark in Maine and nationwide as governments attempt to gradually lift stay-at-home restrictions and reopen segments of the economy that have been shuttered for weeks in order to slow the spread of the disease. The United States had nearly 1.4 million confirmed cases and more than 84,000 deaths as of Thursday, according to Johns Hopkins University’s COVID-19 tracking program.

State health officials caution that the number of COVID-19 infections in Maine is much higher than the daily tally of confirmed or probable cases because limited testing capacity has mean not everyone with symptoms is being tested.

But with the expansion of Maine’s capacity, Shah said he hopes doctors will feel more comfortable ordering tests for suspected cases. As testing increases, more cases of COVID-19 are likely to be identified, leading to additional spikes in the state’s case numbers.

Many public health experts say the conditions for safely reopening the economy must include: a two-week decline in cases, deaths and hospitalizations; widespread public access to testing; and a robust track-and-trace system for identifying and monitoring people who have been exposed.

Shah and Mills said the state is also paying close attention to hospitalization rates as well as the capacity of Maine’s critical care infrastructure. On Thursday, 37 people with COVID-19 were hospitalized in Maine – down four from a day earlier – while 18 people were being treated in intensive care units, with seven connected to ventilators. Maine had 163 ICU beds available on Thursday along with 646 traditional or alternative ventilators.

GOOD NEWS ON ONE OUTBREAK

Outbreaks at long-term care and other “congregate settings” continue to be an issue in Maine and nationwide.

The outbreaks in Maine include: 55 cases among residents and staff at the Maine Veterans Home in Scarborough, including at least 13 deaths; 66 cases at Falmouth By the Sea; 35 cases at the Springbrook Center skilled nursing facility in Westbrook; 22 cases at the Hope House homeless shelter in Bangor; 14 cases at the Oxford Street shelter in Portland; and 51 cases at Portland’s Tyson Foods poultry processing plant.

Shah reported that one of the hardest-hit nursing homes, Augusta Center for Health and Rehabilitation, reached an important milestone Thursday. The Augusta facility, which has reported 76 illnesses and seven deaths, has gone 15 days without a new COVID-19 case, which is one day longer than the 14-day incubation period of the disease.

The Maine CDC continues to monitor potential new outbreaks at other facilities.

In Skowhegan, all 90 residents and 130 staff at the Cedar Ridge Center were tested this week after one patient tested positive. Results of the tests were not announced Thursday, but Shah said the Maine CDC opted to recommend universal testing after a single case because there was another virus also circulating at the facility.

At Durgin Pines in Kittery, all 12 residents of the long-term care facility had tested negative, but one of the 63 staff members had tested positive. Test results were still pending on six staff members, including two with symptoms, according to Biddeford-based geriatrician Dr. Jabbar Fazeli.

PHASED REOPENING

Mills allowed retail stores in 12 of Maine’s 16 counties to begin serving in-store customers this week as long as they are able to follow health and safety guidelines to reduce the risk of transmission. Restaurants in those 12 counties – Aroostook, Piscataquis, Washington, Hancock, Somerset, Franklin, Oxford, Kennebec, Waldo, Knox, Lincoln and Sagadahoc – will be allowed to resume dine-in service on Monday, but must limit patrons in order to maintain physical distancing.

One of the roughly half-dozen metrics that Shah and the Mills administration are tracking as the state gradually reopens is the ratio of positive to negative test results. Maine’s positivity rate has been around 5 percent, which is lower than many other states. But Maine is also the only state in New England that is compiling reports on the positivity rate weekly rather than daily, which could affect health officials’ ability to quickly detect changes.

Under the current timeline of Mills’ reopening plan, all hotels and other lodging facilities statewide will be able to open on June 1 to Maine residents and non-residents who have self-quarantined for 14 days. On Thursday, the Mills administration released additional guidance to hotels, campgrounds and other sectors of the lodging industry.

The administration plans on Wednesday to provide additional guidance covering large gatherings, religious gatherings, public/community buildings, fitness centers or gyms, tanning salons, day camps and overnight camps, and non-professional sports.

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