A study published Friday in a federal health journal says a large COVID-19 outbreak linked to a wedding in the Millinocket area highlights “the importance of adhering to recommended mitigation measures even in communities where transmission rates are low.”

The study, which was researched and written by the staff at the Maine Center for Disease Control and Prevention, recaps the sequence of events that led to Maine’s largest coronavirus outbreak to date. At least 177 people were sickened around the state and seven deaths were linked to the outbreak that began at the Aug. 7 wedding and subsequent reception in the Millinocket area where mask-wearing and physical distancing guidelines were not followed.

The report – published by the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report – also provides new, granular details on how and when the virus spread from Millinocket to a long-term care facility 100 miles away and a jail 200 miles away.

For instance, an attendee of the Aug. 7 wedding and reception worked five, eight-hour shifts at the York County Jail after first experiencing symptoms of COVID-19. The unidentified staff member first tested positive on Aug. 19, which was 12 days after the wedding and five days after first experiencing a cough, sore throat, loss of taste and other symptoms of COVID-19.

A total of 82 staff members and inmates at the York County Jail or household contacts of jail staff were eventually diagnosed with COVID-19, although there were no hospitalizations or deaths among that group.

The virus also spread from the Millinocket area to the Maplecrest Rehabilitation and Living Center, a long-term care facility in Madison. According to the Maine CDC study, an unidentified staff member at the facility apparently contracted the virus from a family member who attended the wedding. The staff member first began experiencing symptoms on Aug. 11, but worked that day and the following day before being tested on Aug. 13.

A total of 24 residents and 14 staff members at Maplecrest were diagnosed with COVID-19, and six residents (all of whom had underlying medical conditions) eventually died.

But the authors also noted that because the Maine CDC was not provided with a full list of wedding attendees, the agency “likely undercounted cases of illness that were linked to the event and the attack rate for the reception guests is thus a conservative estimate.” They also acknowledged, however, that it was not possible to definitively link the wedding to the outbreaks at the jail and long-term care facility without genomic sequencing of the virus.

“Community gatherings such as weddings, birthday parties, church events, and funerals have the potential to be (COVID-19) super-spreading events,” the authors wrote in conclusion. “Increased transmission risk at such events might result from failure to maintain physical distancing and inconsistent use of masks. Transmission risk is further increased when events are held indoors. Findings from this investigation also demonstrate that, in addition to asymptomatic and presymptomatic transmission, lack of adherence to CDC’s COVID-19 guidelines to stay home from work while symptomatic is an important contributor to spread of (the virus).”

Asked about the report during Friday’s daily briefing, Maine CDC Director Dr. Nirav Shah said he was proud of his team’s ability to put together the study for publication in the midst of a pandemic. Maine recorded a record 243 new COVID-19 cases Friday along with three additional deaths as the virus surges across the state and nation.

“It was published in the U.S. CDC’s flagship journal … and we did that for a couple of reasons, the first was we wanted to make sure that the other epidemiologists around the globe who are contending with COVID-19 have the benefit of understanding what we had uncovered with that outbreak,” Shah said. “The second was we wanted to draw attention to just how far and wide and quickly and silently the virus can spread.”

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