Maine’s newly expanded capability to test and trace people who have tested positive for COVID-19 substantially alters how the state responds to the pandemic and gives it a better chance to reopen safely, public health experts say.

“This is a really important step, and gives Maine the one-two punch that it needs to stay one step ahead of the pandemic,” said Jennifer Kates, senior vice president and director of global health at the Kaiser Family Foundation, a national health policy think tank.

Kates said with the improved testing and tracing capability, Maine is now one of the best-positioned states in the nation to fight the virus, perhaps only second to Rhode Island. Much of the country is still struggling with testing capacity, although capacity has improved nationwide within the past few weeks.

The Mills administration, a day after announcing the testing surge on Thursday, released a revised reopening plan that allows for faster reopening in rural areas of the state starting Monday with retail stores and, a week later, restaurants. The gradual reopening of the state is occurring in stages, with more relaxed restrictions monthly, at the beginning of June, July and August, envisioning a near-full reopening in September.

But threats remain, especially with tourist season coming up and the potential for throngs of people to gather in places like Portland’s Old Port, Old Orchard Beach and Bar Harbor.

“Tourism is a real quandary,” Kates said. “There’s going to be a lot of pent-up demand.”

Maine has several weeks to employ its newly amped-up testing strategy before the deluge of tourists descends upon Maine in July and August. Out-of-state visitors must quarantine for 14 days upon arriving in Maine, even in July and August, although the Mills administration has discussed whether to relax those rules.

Maine’s testing capability has more than doubled under a partnership with Idexx, a Westbrook company. The state will increase volume by an additional 5,000 tests per week, bringing its total capacity to about 1,100 tests per day – and the new testing capability should be on line by the end of this week. Maine is expanding the people who can be tested from mostly health care workers, hospitalized patients and those living in congregate care settings to just about anyone who needs a test.

“Our doors are open for testing,” said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention.

Meanwhile, the number of contact tracers – the disease detectives who track close contacts of those who have fallen ill with COVID-19 to isolate them as well – has already more than doubled and could grow to about 100.

Testing and then tracing close contacts means Maine can be less reliant on social distancing measures to control the pandemic, public health experts say, and state officials concur, as the pace of the reopening plan has already quickened.

Widespread “testing and tracing” is the strategy employed in other countries that have successfully contained the novel coronavirus, such as South Korea and Germany.

With the strategy, state health workers can be proactive and find where the virus is circulating, isolate patients and close contacts to stop the spread, as opposed to reacting to outbreaks.

Dr. Dora Anne Mills, vice president of community health for MaineHealth, the parent company of Maine Medical Center, said that expanded testing and the ability to trace contacts can help stamp out and prevent outbreaks.

“We know when surges are not detected early enough, this virus has a tremendous ability to explode,” said Mills, who is Gov. Janet Mills’ sister. “But this allows us to be a lot more targeted.”

DOES MAINE HAVE ENOUGH CAPACITY?

Even with the announcement of Maine’s new testing capacity, it’s not a given that the state has enough tests for an effective strategy and would not be overwhelmed.

There’s no way to know for sure in advance, as the pandemic is unpredictable, but there are encouraging signs.

One marker in Maine’s favor is the “percent positive rate,” which is the percentage of total COVID-19 tests performed that come back positive. The higher the percentage, the more likely it is that the virus is unconstrained and spreading rapidly through the population.

Maine’s percent positive rate has held steady at about 5 to 6 percent, according to state data. The national average is about 17 percent positive, according to the COVID-19 Tracking Project website.

South Korea’s percent positive rate is about 2 percent, a benchmark that Shah said Maine will try to meet. South Korea is considered a model for the testing and tracing strategy, and by using those methods early on has avoided mass casualties and overrun hospitals. South Korea has had five deaths per 1 million population, compared to 236 deaths per 1 million population in the United States.

But Maine has been relatively spared, with 64 deaths so far and at 1,408, the sixth-lowest number of cases per capita in the nation.

Kates said with Maine’s low population density and so far low numbers of cases, starting up a robust test and trace program now should be a lot more effective than after huge outbreaks like what is happening in New York, New Jersey and Massachusetts.

“Transmission, when it happens, can be quickly interrupted when you have a strong testing and tracing program,” Kates said.

As Maine tests more, daily cases may initially go up, but the percent positive rate may stay the same or start to decline. If the strategy works well, case numbers would start to drop sharply as isolation prevents the spread of the disease.

Many models and estimates have been drawn up of how much testing a state needs to reopen. One model by the Harvard Global Health Institute projects that Maine would need about 583 tests daily, well below the capacity for 1,000 daily tests that Maine will achieve with the Idexx agreement.

But the 1,000 daily tests fall short of the 2,400 daily tests needed in Maine in a projection by the Center for American Progress, a left-leaning national think tank on health policy. The center estimates that states need enough testing for 2 percent of the total population in order to control outbreaks, said Topher Spiro, vice president of health policy for the center.

Shah said he anticipates the Maine CDC will now have enough testing to find where the virus is circulating.

“We want to cast the biggest and broadest net possible, and leave no stone unturned,” he said.

The Johns Hopkins School of Public Health estimates the United States would need about 100,000 additional contact tracers nationwide. How many that would mean for Maine is unclear. But the Johns Hopkins analysis pointed to Massachusetts, which has hired 1,000 contact tracers. To have a comparable amount of tracers as Massachusetts on a per capita basis, Maine would need to have about 200 contact tracers. But Massachusetts – with more than 72,000 cases and one of the hot spots for COVID-19 in the country – has about 55 times more cases per capita than Maine.

The Maine CDC has about 50 contact tracers on staff, and may ramp up to 100, depending on demand, Shah said.

Currently “we are able to do full contact tracings on each and every positive case,” he said.

Contact tracing – performed by what Shah calls “disease detectives” – involves identifying the close contacts, usually relatives and friends, of people who test positive for COVID-19, during the two days prior to symptoms appearing and up to the day the patient began isolation. A person who had fleeting contact with an infected individual may not be advised to take any special precautions, but if someone was in close proximity to the COVID-19 patient for hours, that person may be required to quarantine for 14 days. If the close contact has symptoms, he or she will likely be tested, especially now with expanded testing available.

RISKS OF REOPENING

Reopening brings with it a new set of risks from a public health standpoint, as people socialize, travel and go out more, and come into contact with others, giving the virus more opportunities to spread.

On June 1, the number of people who can gather together will increase from 10 to 50, and stores, restaurants and other businesses in all counties will be able to reopen, with some restrictions. If the state does relax the 14-day quarantine for nonresidents, crowds of much larger than 50 may gather all over Maine’s favorite tourist locations.

“Tourism is a major wild card,” said Dr. Mills. “Anything that relies on travel and large group gatherings is the antithesis to pandemic control.”

Schools reopening this fall would be another risk factor, but Mills said if Maine goes into the fall in good shape, the testing and tracing strategy could also be used at schools rather than keeping them closed. Targeted quarantines for students who are ill or close contacts to others who have contracted COVID-19 could prevent closures of entire schools or districts, she said.

Kates said school reopenings will be a significant risk, and public health experts are grappling with that topic now. She said one possibility is schools reopening in stages at the beginning of the year, perhaps by staggering attendance every other day and spreading students physically.

Matt Weed, senior vice president and chief strategy officer at Northern Light Health in Brewer, who has done disease modeling for the hospital network, said that Maine has so far “dodged a bullet,” but tourist season and reopening schools will be major risks. Testing and contact tracing will be important, but Mainers shouldn’t expect society to return to pre-pandemic times soon.

“This was probably the best we could have hoped for, but I don’t see us quite getting back to normal until we get a vaccine,” Weed said. A year or more is likely to pass before a vaccine becomes available.

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