State may change vaccination plan to protect older residents sooner

State health officials are still discussing whether to diverge from federal vaccination recommendations and instead give older residents a higher priority than younger Mainers who have higher exposure to COVID-19 while working essential jobs.

Under the most recent federal recommendations, grocery store workers, postal clerks and teachers should be eligible for COVID-19 vaccines at the same time as individuals age 75 and older during the second major phase of vaccinations. But officials in Florida, Texas and a handful of other states plan to vaccinate older residents before such frontline employees because of their significantly higher fatality rates.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said Wednesday that Maine may not face as many logistical challenges if it vaccinates both groups simultaneously. Maine has a much smaller population than, say, Florida and has developed “great partnerships” with hospitals and pharmacies statewide as part of its COVID-19 vaccination plan.

“I don’t know that there has been a final decision,” Shah said. “Right now, we are still razor-focused on (Phase) 1A and making sure health care providers of all stripes … can get vaccinated. But we know that is a decision and we know other states have gone that route. I think there is more discussion to be had.”

That is just one of the discussions happening in Maine as state officials oversee the first phase of vaccinations focused on hospital staff, first responders and residents and staff of nursing homes. It is also another potential shift in Maine CDC’s inoculation policy – after initially opting not to separate the 65-and-older age group into different phases – in response to how federal recommendations are evolving as well as how the pandemic is unfolding in Maine.

Maine surpassed a symbolic milestone of sorts when the number of vaccinated individuals (23,527 as of Wednesday morning) exceeded the number of confirmed or probable COVID cases in the state to date (23,499).

Yet the daily reports of new infections, hospitalizations and deaths – particularly among the elderly – show Maine is still within the worst phase of the pandemic since the virus was first detected in March.

The Maine CDC reported 590 new cases of COVID-19 on Wednesday – the same number as Tuesday – as well as one additional death. The state’s single-day record of 748 new cases occurred one week ago but likely included backlogged cases from previous days.

At least seven people have died in Aroostook County nursing homes alone during the past week, while at the other end of the state, Shah reported a new outbreak involving at least 38 residents and staff at Kennebunk Center for Health and Rehabilitation.

In addition, the seven-day positivity rate for COVID-19 tests stood at 5.4 on Wednesday, compared to 4.6 percent during the period ending two weeks ago. There were 177 people hospitalized with COVID-19 statewide, down from a high of 198 hospitalizations on Dec. 14 but still five times higher than early November.

Responding to Maine’s high positive test rate and hospitalization figures, the administration of Gov. Janet Mills on Wednesday said it will continue the mandatory 9 p.m. closing time for restaurants, tasting rooms, theaters, casinos and other “amusement venues.” Mills established the 9 p.m. curfew in mid-November at a time Maine’s seven-day average of new cases was less than half the current average.

“With more people getting sick, going to the hospital, and dying from COVID-19 in Maine, it is clear we cannot afford to relax this rule now, especially as we wait to see the full impact of the holiday season on the rate of the virus transmission in our state,” Mills said in a statement. “Maintaining an early closing time for businesses will keep them open for the majority of their operating hours while curbing late night gatherings where we are more likely to lower our guard. I encourage all Maine people who want to sustain their favorite small business through these winter months to continue to order take out or delivery which is still allowed after closing time.”

To date, the Maine CDC has tracked 23,499 total cases of COVID-19 in Maine, of which 20,064 are confirmed and 3,435 are considered probable. The one additional death reported Wednesday – a man in his 80s from York County – increased the total deaths among individuals with COVID-19 to 334 since the virus was first detected in Maine in mid-March.

A woman walks on Fore Street in Portland on Tuesday. Derek Davis/Staff Photographer

At the same time, the initial phase of Maine’s COVID-19 vaccination plan is well underway.

As of Wednesday morning, 23,527 doses of either the Pfizer or Moderna vaccines had been administered in Maine to health care workers, first responders, residents and staff of nursing homes, or other top-priority individuals. That is an increase of roughly 3,900 vaccinations since Tuesday morning.

More than 2.3 million first doses in the two-shot vaccine regimens have been administered nationwide. Maine’s vaccination rate of roughly 1.5 percent of the population was higher than all other states except Alaska, North Dakota, South Dakota and West Virginia, according to tracking by Bloomberg.

Yet Maine’s vaccination rollout plan has not been without challenges or controversy.

The federal government has shipped roughly 5,200 fewer vaccine doses to Maine than allocated to the state, delaying the completion of the first phase of vaccinations.

The majority of the roughly 65,000 doses shipped to Maine through the end of this week have been delivered to Maine’s hospital networks – such as MaineHealth and Northern Light Health – for administration to emergency department and COVID ward staff and first responders. Thousands more went to Walgreens or CVS to be administered to nursing home residents and staff statewide.

But some independent primary care doctors, specialists and other medical practitioners not affiliated with hospitals have voiced frustration at seeing vaccines going to hospital staff who do not have regular, in-person contact with COVID-19 patients. Administrators at MaineHealth have said they are waiting for more guidance from the Maine CDC on how to carry out vaccinations of independent medical professionals.

Jeanne Lambrew, commissioner of the Maine Department of Health and Human Services, said Wednesday that some vaccines are already being earmarked for independent or private practitioners. Lambrew said she expects those vaccinations to accelerate next week with the next shipment of vaccines from the federal government.

“We hear their concerns,” Shah added. “They are squarely in line. It’s just a matter of getting them through the process now.”

Officials have suggested that Maine could begin the next phase of vaccinations in late-January or early-February. Under the recommendations from the federal Advisory Committee on Immunization Practices, those groups will include residents age 75 or older and essential frontline workers such as teachers and daycare workers, police officers, grocery store employees, postal workers and food/agricultural workers.

Shah noted that the federal recommendation represented “a tradeoff” meant to attack the virus on two fronts.

A 20-year-old grocery store worker is statistically more likely to contract COVID-19 because of their interaction with strangers at work and their other activities in the community and is, therefore, more likely to spread it to others. But that young person is less likely to develop serious complications or potentially die from the virus than someone over aged 75, Shah noted.

Shah said the committee’s recommendation aimed to “simultaneously reduce the number of cases of COVID by working to vaccinate frontline workers as well as reducing the number of deaths associated with COVID by working to vaccinate those 75 and over.”

Mainers age 65 to 74, meanwhile, may have to wait until mid-winter or spring for vaccination because they fall in the third phase of the state and federal plan. Shah said details are still being worked out but indicated that the state will likely rely on primary care physicians or other medical professionals to notify their older patients when they are eligible for vaccination.

Androscoggin and Cumberland counties continue to have the highest infection rates of 243 and 240 cases, respectively, for every 10,000 residents, compared to a statewide average of 176 cases for every 10,000 residents.

Cumberland County experienced the largest single-day jump in new confirmed or probable cases on Wednesday with 176 additional cases, followed by York County with 112 and Androscoggin with 83. New cases reported in other counties are as follows: 57 in Aroostook, 48 in Penobscot, 37 in Kennebec, 17 in Hancock, 15 in Oxford, 14 in both Somerset and Washington, eight in Knox, five in Lincoln, four in Sagadahoc, two in Waldo and one in both Franklin and Piscataquis.

Maine has the third-lowest COVID-19 infection and death rates per 100,000 residents in the nation after Hawaii and Vermont, according to daily tracking by The New York Times.