Two weeks ago, hospitals in southern Maine were bracing for a spike in COVID-19 admissions as the national death count surged.
Instead, the steadily rising tide of coronavirus hospitalizations has crested, flattened or gently receded over the past week, the first solid indication that the sacrifices Mainers have made to limit the spread of the disease and protect the state’s hospitals from being overwhelmed are working.
The data, which the Portland Press Herald collected directly from the hospitals, shows the same encouraging signs at hospitals in western and midcoast Maine, though most of these smaller facilities have had few if any patients, because the big hospitals are better equipped to care for them. In eastern Maine, where the pandemic arrived later, hospitalizations are still ticking upward, albeit from a low level.
“It’s very encouraging, and it shows that the actions and social distancing restrictions our city and state officials put into effect relatively early on have really helped keep the curve flat and keep it flat,” said John Alexander, chief medical officer for Lewiston-based Central Maine Healthcare. “The cautionary part of this is that we know we are staying flat because of the measures we’ve put in place and we don’t know what will happen when we start to lift some of those measures.”
The flattening of the hospitalization curve will likely spare Maine from one of the worst outcomes of the pandemic: the overwhelming of hospitals and an exhaustion of their acute care resources and the personal protective gear that protect their staff, such as happened in Northern Italy and New York City. Hospital leaders and public health experts said Maine should avoid worst-case scenarios in terms of running out of ventilators or ICU beds.
“Social distancing is working, and we are not seeing the surge that would have inevitably occurred if we hadn’t taken action,” said Mical Raz, a physician and public policy and health professor at the University of Rochester, who has seen a similar pattern at the upstate New York hospital where she practices. “But this slow and more linear increase means that we will see steady numbers of COVID patients in the coming weeks and even months, making it a long and slow process.”
Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said the flattening is reassuring for the state’s ventilator capacity. On Friday, when eight COVID-19 patients were relying on them, Maine had 309 conventional and alternative ventilators available.
“It suggests a high degree of cushion,” Shah said Friday evening in a telephone interview. “With personal protective equipment, it’s a little more concerning. I would describe it as OK. We need more.”
But the development comes at the same time Maine is witnessing a tragic situation at long-term care facilities across the state, with sobering implications for the lifting of the social distancing measures that have helped protect Maine from the worst outcomes. Stringent protective measures have failed to prevent serious outbreaks and a spike in deaths, many of which have occurred outside of hospitals and thus are not reflected in the hospitalization data.
“The long-term care outbreaks are a big lesson for us, because it shows what happens when you cannot fully socially distance,” said Dr. Dora Anne Mills, a former Maine CDC director who is now MaineHealth’s chief health improvement officer. “They have taken tremendous precautions, and yet this virus, when it sneaks into a long-term care facility, it has spread like a brush fire.”
“These places that have had these outbreaks were doing everything they were ever asked to do,” added Mills, whose sister is Gov. Janet Mills. “It shows you what could happen if a lot of the social distancing mandates were lifted right now, which is quite frightening.”
Shah agreed. “We look at these LTCs as microcosms of what could happen if we were to leave the physical distancing requirements too early or in the wrong manner,” he said. “It’s a good case study of why we’ve got to be really cautious going forward.”
Shah added that what keeps him up at night is not just the long-term care facility outbreaks “but the possibility that significant numbers of those men and women could need to be transported to hospitals in short order,” he said.
Health care workers leave Maine Medical Center on Friday. A flattening of the hospitalization curve will likely spare Maine from one of the worst outcomes of the pandemic: the overwhelming of hospitals. Derek Davis/Staff Photographer
The Press Herald sought to gather statewide data on confirmed daily COVID-19 hospitalizations back to the start of the outbreak here. Unlike the case counts highlighted by state authorities, the numbers are not dependent on how many tests have been conducted, a major analytical obstacle given the nationwide shortage of testing chemicals, kits and laboratory capacity. The state’s three largest hospital groups – MaineHealth, Northern Light Health, and Central Maine Healthcare – provided their daily data by hospital, providing a comprehensive picture of COVID-19 hospitalization trends in most of the state.
Maine Medical Center in Portland has consistently had the lion’s share of the state’s COVID-19 patients, typically about half of the total. Between March 15 and April 7 its patient count steadily increased from two to 35, but since then it has fallen and stood at 27 Friday. Southern Maine Health in Biddeford, the state’s second most impacted hospital, has had between six and eight COVID-19 patients each day since April 4. Mid Coast Hospital in Brunswick had four or five such patients a day from April 2 to 15, and just two on Friday. CMMC in Lewiston has had between two and five every day since its first admission March 28.
Portland’s Mercy Hospital peaked at six admissions on March 27, had a steady decrease, and had no COVID-19 patients at all Wednesday and Thursday. Three smaller hospitals, in Farmington, Pittsfield and Waterville, each had one to three patients for a few days in late March or early April but have had none since.
Only at Bangor’s Eastern Maine Medical Center have the numbers been moving in the opposite direction, slowly growing from one on April 4 to four on Thursday. The numbers are consistent with available evidence that the virus arrived later in eastern Maine. Penobscot County, where EMMC is located, wasn’t declared by the state CDC to have community transmission taking place until April 10, nearly four weeks after Cumberland County.
In all cases, hospitalizations can end three ways: recovery, death or transfer to another facility.
Efforts to determine the trends in central Maine were confounded by the refusal of the biggest provider in that region – Maine General – to share the data. Maine General spokesperson Joy McKenna would only provide the daily count for April 16 – five patients – the same number who were hospitalized at its north Augusta hospital April 8, the day the Kennebec Journal happened to have last asked for such information.
The Maine CDC did not begin asking hospitals for daily COVID-19 hospitalization counts until March 31 and could only provide statewide numbers back to April 9. Between then and Friday, the statewide count fell from 87 COVID-19 hospitalizations to 55, with a low of 46 on Thursday.
Health experts said that while the flattening of pandemic hospitalizations is encouraging, the path ahead for returning to anything approaching normal is a long one and fraught with dangers. Nobody knows what the seasonal effects of the novel coronavirus are, if and for how long people who recover are immune, or how long it will take to develop an effective, widely available vaccine.
“It allows for cautious optimism, but we need to be prepared for the long haul,” said the University of Rochester’s Raz. “This is not a one-and-done event. This disease will be with us for a long time, until an effective vaccine is available, and our lives are likely never going to be quite the same.”
Giving up social distancing prematurely, she added, could bring a second wave of illness, which is what happened in the 1918 influenza pandemic, which ultimately killed 50 million people, including 675,000 Americans.
“We’re going to be dealing with this for a while,” Mills agreed. “That’s why its important to make sure we have the workforce in place to take this on, that we have plenty of personal protective equipment, and the testing capabilities – the tools we need to be prepared for additional surges.”
Alexander, Central Maine Healthcare’s chief medical officer, expressed gratitude to the people of Maine for abiding by social distancing recommendations to help flatten the infection curve. It has allowed medical providers the breathing room to look after patients with chronic conditions and other medical problems, and he encouraged Mainers who need medical care to seek it.
“Because we’ve had a relatively low burden of disease in our region, I want to caution people that if they feel they need to access health care resources they should access those,” he said. “We want to make sure you receive care.”
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