Lisa Caswell, director of pharmacy at Redington-Fairview General Hospital in Skowhegan, draws the hospital’s first dose of the Moderna vaccine Wednesday. Rich Abrahamson/Morning Sentinel Buy this Photo

The Maine Center for Disease Control and Prevention reported 702 new cases of COVID-19 on Thursday and 13 additional deaths, closing out a tumultuous year on an ominous note.

But state officials said the vaccination of front-line health care providers and the highest-risk individuals is progressing and will likely expand next week to additional tiers, including some private medical practices and assisted-living homes.

The Maine CDC also said it has placed an order for 17,075 doses of the Pfizer and Moderna vaccines for delivery next week. The 17,075 doses is the maximum number allotted to Maine by the federal government based on availability.

The now weekslong surge in Maine shows no sign of abating, with the final day of 2020 bringing some of the highest new infection and death numbers since the pandemic reached Maine 10 months ago. Thursday marked the third time in eight days that new daily cases topped 700, after staying below 100 cases per day from mid-March to Oct. 30.

The 13 deaths also were the second-highest number in a single day, although reporting delays to the Maine CDC mean those likely occurred over multiple days. Meanwhile, state health officials say the near-record numbers likely do not include an anticipated spike linked to Christmas gatherings or travel, much less additional infections tied to the extended New Year’s holiday.

“Much of what we are seeing now is a function of more community transmission,” said Dr. Nirav Shah, director of the Maine CDC.

The seven-day rolling average of new daily cases stood at 427 on Thursday, down from the average of 476 new infections for the week ending Dec. 24. For comparison, Maine’s seven-day rolling average was 78 cases on Nov. 1.

To date, the Maine CDC has tracked 24,201 total cases of COVID-19 as well as 347 deaths linked to the virus, with more than half of those deaths occurring within the past two months. The vast majority of deaths have been among Maine residents over age 60, highlighting the significantly higher threat the virus poses to older residents.

There were 182 people hospitalized statewide with COVID-19 on Thursday – an increase of five from the previous day – which included 46 people being treated in critical care beds and 18 connected to ventilators. While Eastern Maine Medical Center saw its highest weekly admissions for COVID, patient numbers flattened at most hospitals around the state and the Maine CDC reported 100 available ICU beds as well as hundreds of available ventilators.

VACCINATIONS EXPANDING

Maine, however, is ramping up its 2 ½-week-old vaccination campaign.

As of Thursday morning, 27,122 individuals statewide had been injected with the first of the two required vaccine shots, an increase of roughly 3,500 since Wednesday.

The new vaccine order, when combined with the three previous weeks’ deliveries, will provide Maine with enough doses to give the first vaccination shot to 81,850 individuals, or roughly 6 percent of the state’s population.

This first step in Maine’s inoculation plan, known as Phase 1A, has largely targeted hospital emergency department and COVID ward staff or other personnel with potential exposure to the virus, first responders, and residents and workers at nursing homes. That circle began to expand this week to include some independent “outpatient providers” not affiliated with hospitals and will expand further next week to additional independent practitioners as well as assisted-living homes.

The distribution of the 17,075 doses Maine anticipates receiving next week includes:

• 7,000 additional doses to hospitals

• 2,500 doses to non-hospital outpatient groups, including urgent care facilities and Maine’s network of federally qualified health centers

• 4,875 doses to Walgreens and CVS pharmacies for administration to residents and staff at long-term care homes

• 2,500 doses to independent pharmacies for use within long-term care facilities

• 200 doses to emergency medical services agencies on top of 3,000 doses already sent to EMS providers

Private practice doctors and specialists have been raising concerns this week about when they would begin receiving vaccinations. Numerous primary care physicians as well as oncologists and others who serve high-risk patients have voiced frustration at seeing vaccines being administered to hospital staff who don’t have direct contact with patients or individuals with COVID-19.

Darcy Shargo, executive director of the Maine Primary Care Association that advocates for the state’s 20 federally qualified community health centers, said the prospects of vaccines arriving for staff next week “was a welcome relief in the unrelenting pressure of COVID” as well as “a sign of hope for 2021.” Community health centers are located in medically underserved communities and provide care to anyone, regardless of insurance coverage or their ability to pay.

“We have been working closely with Dr. Shah in recent weeks to try to get vaccines to the (federally qualified health centers) and we are extremely grateful that a solid plan has come together,” Shargo wrote in an email. “It’s an honor to serve the people of Maine and with a workforce that is now going to be  fortified with the vaccine, the health centers can continue that service and remain strong partners within our healthcare system.”

Shah reiterated Friday that the state’s rollout plan had always been to start with the larger hospital systems and gradually expand outward to private practitioners, dentists and other medical professionals outside of hospitals. This next stage of Phase 1A is more logistically challenging, Shah said, because many private or independent practices are too small to ship vaccines directly. Pfizer’s vaccines come in batches of 975 doses that must be kept in ultra-cold storage, while Moderna’s vaccines come in batches of 100 doses.

“We are moving toward these other circles faster” than anticipated, Shah said. “But to finish out the remainder of this 1A (phase) is probably going to take us out through January.”

The next phase of Maine’s vaccination plan, which Shah said appears likely to begin in early February, is expected to target Mainers age 75 or older, along with workers in higher-risk but “essential” front-line jobs, consistent with the most recent federal recommendations. Those include teachers, police officers, grocery store employees, postal workers, daycare staff and workers in food, agriculture or manufacturing jobs.

A handful of states are diverging from the federal recommendation by vaccinating a larger swath of residents age 65 or older, who have much higher hospitalization and death rates, ahead of essential workers who are not in health care fields.

Shah said that he was aware of those decisions in other states and that Maine health officials were still discussing the groups to be targeted during Phase 1B. But Shah also said that – unlike some of the large states not following the federal recommendations – he believes Maine could simultaneously vaccinate both individuals ages 75 or older and essential front-line workers.

“Right now, we are still razor-focused on (Phase) 1A and making sure health care providers of all stripes … can get vaccinated,” Shah said during Wednesday’s briefing on COVID-19. “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.”

Maine residents between the ages of 65 and 74, as well as younger individuals with underlying medical conditions, are currently slated for vaccination in Phase 1C, which is likely to begin in midwinter to spring. Widespread vaccination of the rest of the state’s population is not projected to begin until summer given the anticipated supplies of vaccines available nationally.

CONCERNING NUMBERS

Shah said he did not believe Thursday’s 702 cases– the third most reported in Maine on a single day – was part of a wave of new infections tied to Christmas travel or gatherings. Shah expects those to begin showing up next week, likely followed by higher numbers of hospitalizations and deaths.

Instead, Maine is experiencing sustained community transmission throughout the state. Shah expressed particular concern Thursday about Aroostook County, which he said is experiencing three “significant” outbreaks at long-term care facilities.

At least 179 of Maine’s 347 total deaths among those diagnosed with COVID-19 have occurred among residents of long-term care facilities, although the actual number is likely higher because there is often a days- or weekslong lag before facilities officially report deaths to the Maine CDC.

Shah said Wednesday that at least seven deaths had occurred within the past week in nursing homes in Aroostook County, which is experiencing a significant surge in the virus after maintaining low numbers for much of the pandemic.

Four of the 13 deaths reported on Thursday occurred in Aroostook: A man in his 80s as well as three women in their 60s, 70s or 90s. The other deaths were identified as: A woman in her 80s and two women in their 90s from Cumberland County; a woman in her 80s from Hancock County; a man in his 50s and two men in their 70s from Oxford County; and a man in his 80s and a man in his 90s from York County.

Gov. Janet Mills released a video Thursday urging Mainers to safely observe the New Year’s holiday at home by watching events on television, adding that “this crisis isn’t over.”

“Tonight, don’t let ‘fear of missing out’ cause you to do things against your better judgment,” Mills said. “Before you think about going out tonight, before you go to a party down the street, before you invite a bunch of people over, think about the first responders, the EMTs, the nurses, CNAs and doctors whose lives are constantly put on the line by so many people getting deathly sick with this virus.”

“We’re all eager to show 2020 the door and we very much want to join friends, go to parties and celebrate in the usual ways,” Mills said. “But the last thing any of us wants to do is to welcome in the New Year by getting sick, or making someone else sick, with a dangerous virus – one that is everywhere, all around us, invisible, and deadly.”

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