Grim COVID-19 numbers from Maine show that nearly 19 months of warnings, struggles, and sickness have served only as a roller-coaster prelude to one of the state’s darkest hours of the pandemic.
Maine set records Wednesday with 226 patients in the hospital for COVID and 88 patients in critical care. New cases reached a seven-day average of 467.4, compared with 162.3 a month earlier. And in a sprawling state where hospitals are at or near capacity, the COVID death toll topped 1,000 since the start of the pandemic.
The highly contagious Delta variant is a catalyst for the surge, health officials said. But another driver comes from Maine residents who refuse to be vaccinated, many of them from rural, outlying counties where suspicions about the vaccine and government run deep.
“This is clearly a surge of the unvaccinated,” said Dr. Joan Boomsma, chief medical officer for MaineHealth, which operates a network of 10 hospitals, including Maine Medical Center in Portland.
More than 70 percent of MaineHealth patients hospitalized for COVID on Tuesday were not fully vaccinated, Boosma said, taking up beds that otherwise might be used by non-COVID patients and adding more burdens to already stressed nurses and staff. In the intensive care unit, that number was 87 percent.
“We are seeing higher demand for ICU beds than at any other time in the pandemic,” Boomsma said.
The burden and shortages also are being felt acutely in remote areas such as Piscataquis County, where the proportion of recent COVID cases is among the highest in the state. All but one of Maine’s 16 counties are considered at high risk for the virus.
“There is very little reserve in the system. It’s as close to broken as I’ve ever seen it because demand is exceeding capacity,” said Dr. David McDermott, vice president of medical affairs for Northern Light hospitals in upstate Dover-Foxcroft and Greenville. “We’ve exhausted all our creative workarounds to bring additional resources into the mix.”
The crisis is compounded by a dwindling number of beds for long-term care in Maine, where three facilities closed recently, Boomsma said. There have been days at Maine Medical Center when the hospital has had 100 patients, including nursing home and rehabilitation patients, who were waiting to be discharged but had nowhere to go.
On Tuesday, the MaineHealth system had only seven of 106 intensive-care beds available, Boomsma said. Few medical surgery beds were free. Emergency patients are sometimes diverted out of state, she said.
“On a daily basis, it means that there are certain types of care that we have to postpone, certain types of surgeries that we have to cancel and reschedule,” Boomsma said. “We’ve had days when we’re holding 20 or 30 patients in the Emergency Department” because beds aren’t available elsewhere.
“Many of the patients who are hospitalized with COVID in Portland are from rural communities in Maine. One day last week, there wasn’t a single person with COVID in the ICU from Cumberland County,” the most populated part of the state that includes Portland.
COVID has surged in Maine despite 67.8 percent of Mainers being fully vaccinated, the third-highest rate in the nation. The state closed its borders to most travelers from out of state for much of the early stages of the pandemic, and then reopened last spring as tourist season began.
New cases plummeted then, as they did in many areas of the country. But the combination of the Delta variant and vaccine holdouts appears to have fueled the crisis anew.
“Hospitals are strained,” Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, wrote Tuesday on Twitter. “If you are banking on a bed or an ICU — let alone . . . antibodies — as your strategy rather than getting vaccinated, you are miscalculating.”
McDermott said the resistance to vaccination in Piscataquis County, a place with broad conservative politics, has been deeply frustrating.
At the county fair in late August, he said, two people who had been diagnosed with COVID at the emergency room only a day or two earlier were spotted mingling among people without masks.
“They defied the quarantine recommendation and went to the fair,” said McDermott, who chose not to attend because of the risk of transmission. “We believe the fair was a driver.”
Piscataquis County was the last county in New England to record its first COVID case, but now it’s a hot spot. On Sept. 16, the county had a seven-day average of 60.8 cases per 10,000 residents. Cumberland County, by contrast, had an average of 28 cases.
“It’s really difficult to take care of somebody who is critically ill with COVID and was in the community actively opposing vaccination, and then shows up with the very disease that the vaccine could have prevented,” McDermott said.
“We have had some people who have come down with COVID, denied that the vaccine was effective, and still feel it’s a hoax,” he added. “The vast majority of what’s happening now could have been prevented if people had gotten vaccines.”
Predicting when the current surge will peak is a tricky calculation, said Melissa Maginnis, a virologist at the University of Maine who monitors pandemic-related matters for university leaders.
“I don’t know that there’s one clear answer,” she said. “What we have seen in other parts of the world and the Southern states is that there is about a two-month cycle for Delta. It’s possible we should be peaking soon . . . but we never know exactly what is going to happen.”
In the United Kingdom, for example, the Delta variant peaked, dropped, and then rose again, Maginnis said.
Maine ranks below the US daily average for new COVID cases, with 35.8 per 100,000 residents compared with a national average of 40 new cases, according to the Brown School of Public Health. Still, Maine has the highest case rate in New England, slightly ahead of Vermont and New Hampshire, which stand at 35.1 and 30.1, respectively.
For a rural physician such as McDermott, it’s a data point that underscores how vaccines that helped curb COVID in Maine’s cities and suburbs could have done the same up-country.
As of Aug. 31, only 41.1 percent of faculty and staff at the high school in Dover-Foxcroft had been vaccinated, compared with a statewide average of 75.6 percent. Currently, 83 percent are vaccinated, school officials said. Maine will be following recently announced federal requirements that all public school employees be vaccinated or tested weekly. A timetable has yet to be set by the US government.
On Monday, McDermott said he had two patients in the Emergency Department who did not have COVID but needed care from a gastroenterologist, a specialty that the hospital’s team could not provide.
“But there is nowhere in the state where we could send them,” he said. “Their care is suffering because they’re stuck in rural Maine.”
McDermott said he fears the possibility that “we have someone who needs access to critical care and we say, sorry, you’re going to have an adverse outcome. You may die from this because we don’t have a place for you.”
The surge eventually will exhaust itself, McDermott said. Until then, the seemingly endless struggle to provide care continues.
“There’s a saying that all bleeding eventually stops, and all smokers eventually quit,” McDermott said. “But I can’t predict how bad it will get between now and that point. We don’t know where the peak is.”
Brian MacQuarrie can be reached at firstname.lastname@example.org.