Two additional Maine counties, Somerset and Hancock, had high enough COVID-19 transmission rates Friday to trigger state and federal recommendations that people wear masks in indoor public settings regardless of their vaccination status.

But one public health expert cautioned that because of how the federal government calculates those rates, even small changes in the number of COVID-19 cases will cause significant shifts in whether some counties are classified as “low” or “high” transmission rates.

“They use some excellent methodology except that it is really geared toward urban areas and not rural areas,” said Dr. Dora Anne Mills, chief health improvement officer at MaineHealth and a former director of the Maine Center for Disease Control and Prevention.

Under the latest federal updates, Somerset and Hancock counties are now classified as having “substantial” levels of community transmission of the coronavirus, while Waldo County went from “substantial” to “high.”

Consistent with federal guidelines, the Maine CDC recommends that vaccinated people in counties with substantial or high transmission levels resume wearing masks in indoor public settings. Unvaccinated people, who account for the vast majority of severe cases and deaths, are recommended to mask in public settings regardless of the local transmission rate.

But the ever-shifting transmission rates and the patchwork of classifications in Maine are causing confusion. Business owners are struggling to decide how to respond to the masking recommendations both among staff and customers. Additionally, the expiration of Maine’s civil state of emergency at the end of June means state health officials can no longer mandate mask-wearing.

The other 13 counties in Maine are designated as having “moderate” levels of transmission. But Mills noted that COVID-19 incidence rates and positive test rates are headed upward in all 16 counties at a time when the more transmissible delta variant is causing more infections, hospitalizations and deaths nationwide.

“We are in a very different chapter of this pandemic,” said Mills, who is the sister of Gov. Janet Mills.

The Maine CDC reported 111 new COVID-19 cases on Friday, marking the second straight day with a triple-digit increase. There were no new deaths reported and the number of hospitalizations statewide held steady at 41.

The seven-day average of new cases in Maine stood at 78 on Friday, compared to 59 for the week ending on July 23 and nearly quadruple the average at the beginning of the month.

The Maine CDC also reported three new outbreak investigations – all at summer camps – during the past two weeks after none during the previous two-week period. Those outbreaks occurred at Camp Caribou (three cases), Camp Good News of Maine (four cases) and Camp Laurel South (three cases).

Maine continues to have one of the highest vaccination rates in the country, although the pace of vaccinations has flatlined in recent months. As of Thursday, 809,888 residents of the state – or 60.25 percent of the state’s 1.3 million residents – had received their final dose of vaccine. That percentage rises to 68.39 percent when zeroing in on individuals age 12 and older who are eligible for vaccination.

The Maine CDC also released new data showing that 656 vaccinated individuals have tested positive for COVID-19 since monitoring began. That’s an increase of 60 so-called “breakthrough cases” since last week.

While vaccinated individuals can still contract and spread the coronavirus – particularly the new delta variant – they are significantly less likely than the unvaccinated to develop severe cases requiring hospitalization or leading to death.

A Maine CDC spokesman noted that the state investigates breakthrough cases differently than routine COVID-19 cases. For instance, a case identified as a breakthrough case this week may have first been confirmed as a new COVID-19 case more than a week ago, thereby complicating week-over-week comparisons between the two buckets of cases.

“Given what we have seen in other areas, we do expect that the delta variant could cause an increase in the number of breakthrough cases in Maine moving forward,” Maine CDC spokesman Robert Long said.

The delta variant, which was first detected in India but has since swept around the world, is at the root of the current surge in the United States and other countries. Research suggests that the variant is at least twice as contagious as the previous, dominant strain and that it may lead to more severe illness.

The delta variant is also infecting vaccinated individuals with such high levels of the virus that they are able to pass it on to others.

New research published in the U.S. CDC’s weekly scientific journal on Friday stated that roughly 75 percent of the cases in a recent outbreak in the Cape Cod tourist hotspot of Provincetown, Massachusetts, were fully vaccinated. The study also found that vaccinated people infected during the outbreak, which has swelled to more than 900 cases, carried about as much of the virus as those who were unvaccinated.

But health officials also pointed out that only a handful of the vaccinated people became so severely ill that they had to be hospitalized, which they said illustrates the effectiveness of the vaccines.

After reviewing the Provincetown study, Mills said it is important to put the rising number of breakthrough cases in Maine and nationwide into context.

Roughly 60 percent of the total population of Maine – and nearly 70 percent of those eligible – are vaccinated against COVID-19 right now. Yet the vast majority of new infections are still occurring within the pool of unvaccinated people who account for the minority of the state’s population.

Putting it into mathematical terms, Mills said the “denominator” of vaccinated people is much larger in Maine. “So even a small percentage of that is going to be a larger number because you have a larger denominator,” she said.

Since the pandemic began in March 2020, the Maine CDC has reported 70,372 confirmed or probable cases and 899 deaths linked to the viral disease.

The research into the Provincetown outbreak was apparently a key factor in federal officials’ decision to recommend that even fully vaccinated individuals resume wearing masks in indoor public spaces in locations with high or substantial rates of transmission. The Maine CDC endorsed that recommendation a day later as well as a separate guidance to schools that all students and staff wear masks regardless of their vaccination status.

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