Katherine Holt of Portland leaves the CVS store Sunday on Congress Street in Portland, where a sign says face coverings are required for entry. Ben McCanna/Staff Photographer

State health officials reported 26 additional cases of COVID-19 and one new death on Monday as Maine continues to see an increase in the number of active cases.

The Maine Center for Disease Control and Prevention said there have now been 1,462 confirmed or probable cases of COVID-19, the disease caused by the coronavirus, although the actual number of infected individuals is believed to be much higher.

To date, 65 Maine residents have died after contracting COVID-19, the latest being a man in his 70s from Cumberland County. After accounting for those deaths and the 872 people who have recovered from the disease, Maine CDC was reporting 525 active cases of the disease on Monday – an increase of 14 since Sunday.

Additionally, Maine CDC Director Dr. Nirav Shah said his agency is tracking small outbreaks at three more congregate settings: four cases at a Residential and Community Support Service facility in Sanford, six at a Granite Bay Care home in Brunswick and three cases affiliated with Maple House in Portland run by Spurwink, which provides behavioral health and education services to children and adults.

The Maine CDC did not immediately provide additional information on the cases. But in the case of Maple House, Shah said it is “part of a series of other homes that are in the area.”

“We are trying to figure out if it is a singular, discrete outbreak or part of an existing outbreak affiliated with some other centers in the area,” Shah said.

Spurwink officials declined Monday to provide additional information on the cases.

One client and three staff members at a single-resident home run by Sanford-based Residential and Community Support Services have tested positive. Angie Marquis, director of programming at RCSS, said the resident and staff are recovering.

“RCSS was proactive in our planning,” Marquis wrote in an email. “All of our homes have adequate PPE and disinfecting products. We are also checking staff temperatures upon arrival on shift and during their shift. All residents’ temperatures are also being checked and we have educated our staff on symptoms of COVID 19.”

To date, there have been 389 confirmed COVID-19 cases at congregate settings, a category that includes everything from nursing homes and homeless shelters to large workplaces such as the Tyson Foods poultry processing plant in Portland.

The number of active cases in Maine has risen most days since last Wednesday, which means new infections are outpacing recoveries.

After hovering in the high-300s to low-400s for roughly two weeks, the number of active cases jumped from 426 on Wednesday to 481 on Thursday – an increase of roughly 13 percent – largely because of outbreaks discovered at the Tyson Foods poultry processing plant in Portland and the Springbrook Center skilled nursing facility in Westbrook. Active cases dipped slightly the following day but have risen each of the three days since.

The Maine CDC has been heavily focused on detecting potential outbreaks at nursing homes and other congregate settings and then recommending testing of all residents and staff of those facilities. That has led to spikes in active case numbers, at times, as new outbreaks are detected.

And Shah has cautioned that the anticipated ramp-up of testing capacity at the Maine CDC lab later this week will likely lead to additional cases as it becomes easier for doctors to order tests for patients with symptoms.

Shah said the number of active cases is just one measure his team examines – along with daily hospitalization rates, hospital capacity, geographic distribution of cases and the percent of tests that come back positive – as they make recommendations to Gov. Janet Mills.

“Given where we are in the outbreak right now, day-to-day variations are interesting, but really what we base our policy decision-making on is much more of a seven-day or 14-day average,” Shah said. “That really gives us a better sense of what has transpired, not just in the past 24 hours but over the seven-day period.”

The number of Mainers with COVID-19 who were hospitalized increased from 36 to 37 on Monday while the figure for individuals being treated in intensive care units held steady at 17. There were nine people hooked to ventilators because of respiratory failure. Maine had 157 ICU beds, 224 ventilators and 413 alternative ventilators available statewide on Monday, indicating that demand for those critical health services is still well below capacity.

Many public health experts say the conditions for a safe economic reopening must include: a two-week decline in cases, deaths and hospitalizations; widespread access to testing for the public; and a robust track-and-trace system for identifying and monitoring people who have been exposed.

The Maine CDC requested information over the weekend from the federal government about whether Maine will receive a supply of the anti-viral drug remdesivir that has shown some promise in treating critically ill COVID-19 patients. Federal officials have begun distributing the drug nationwide, but there are concerns about how and when the distribution is taking place.

“We haven’t received a final delivery date, if at all yet,” Shah said.

Shah said any additional supplies of remdesivir will likely be allocated to hospitals that have been treating critically ill patients but with the hope that, if needed, hospitals with excess supplies will share the drug with those with immediate needs.

The uptick in numbers comes on the first day that additional retail stores throughout much of rural Maine were allowed to reopen their doors to in-store customers for the first time in more than five weeks, as long as they comply with a list of health and safety guidelines.

Gov. Janet Mills accelerated the reopening schedule for retail stores as well as fitness centers – on a restricted basis – starting Monday in Aroostook, Piscataquis, Washington, Hancock, Somerset, Franklin, Oxford, Kennebec, Waldo, Knox, Lincoln and Sagadahoc counties. Restaurants in those dozen counties are slated to resume dine-in service on May 18 as long as operators limit capacity, allow for physical distancing and take other steps to reduce the risks of customers or employees transmitting the disease.

Mills announced her rural reopening plan after the administration negotiated a deal with Westbrook-based Idexx Laboratories that will allow the Maine CDC’s lab to more than triple testing capacity. Maine has, to date, not seen the levels of infection experienced in southern New England and mid-Atlantic states.

Mills’ rural reopening plan does not apply to businesses in Cumberland, York, Androscoggin and Penobscot counties, where Maine CDC epidemiologists have determined that community transmission is occurring. Retail stores and other businesses not already exempt from the closure mandates are slated to reopen on June 1.

Shah stressed again on Monday that the Maine CDC will be closely monitoring cases in those 12 counties as testing capacity expands. He added that this is not a “one-way ratchet” and that restrictions could be reimposed if the Maine CDC observes a spike in areas.

“It’s important, I think, to recognize that the complexion of the outbreak across the state of Maine has been different in rural areas versus more densely populated areas,” Shah said.

The largest outbreak to date at a business other than a health care or long-term care facility has been at the Tyson Foods plant in Portland. There have been 51 confirmed cases among the more than 400 employees and contractors who were tested, a figure that has not changed since late last week.

According to the company, 31 of those 51 individuals were not exhibiting any symptoms – a fact that underscores the public health challenge of combating what appears to be a highly transmissible virus. The poultry processing plant was closed for sanitization several days last week while testing was ongoing, and protective improvements – such as physical barriers between work stations – were installed.

Additionally, the company is now requiring temperature checks of all employees before their shifts and providing face masks to all employees. Tyson’s Portland facility is one of more than 30 nationwide where the company is adding more on-site medical care, screening and testing.

“As it is doing in Portland, Tyson will disclose verified test results at other plants to health and government officials, team members and stakeholders as they become available as part of its efforts to help affected communities where it operates better understand the coronavirus and the protective measures that can be taken to help prevent its spread,” the company said in a news release.

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