Another 13 people have died of COVID-19 in Maine, health officials reported on Thursday, continuing a surge in deaths statewide over the past five weeks. Nationally, the U.S. totaled a record number of deaths on Wednesday as the pandemic continues to ravage the country.

Overall, 27,625 people in Maine have tested positive for COVID-19 – including 535 new cases reported Thursday – with 385 deaths. The United States had a record 3,964 COVID deaths on Wednesday, and more than 360,000 since the pandemic began.

Deaths – which lag increases in cases and hospitalizations – have spiked in Maine since Dec. 1, nearly doubling the statewide total. Since the end of November, Maine’s cumulative death toll has climbed from 194 to 385, an increase of 191. Maine has recorded 34 deaths since the start of the new year.

Dr. John Alexander, chief medical officer at Central Maine Healthcare in Lewiston, said he is concerned. “Unfortunately, we are going to see this upward trend for some time.”

“One leads to another. Cases leads to hospitalizations and then subsequently result in deaths,” Alexander said

For those who suffer from severe COVID-19, deaths typically occur two to five weeks after contracting the virus. Although treatments have improved since the spring, leading to better survivability among patients, COVID-19 is about five times more deadly than the flu for hospitalized patients, according to the U.S. Centers for Disease Control and Prevention.

Alexander said treatments are improving, such as the use of monoclonal antibodies to help avoid hospitalizations, but the bottom line is when there’s a surge in cases, that will later lead to more deaths.

With high case counts continuing, the U.S. CDC is predicting a deadly January even while vaccinations are starting.

In Maine, cases and hospitalizations are no longer climbing precipitously, plateauing somewhat over the past two weeks. For instance, the seven-day average of daily new cases was 490 on Thursday, compared to 447.3 on Dec. 18, an increase but not as steep as the previous two weeks.

The seven-day average was 168.1 on Dec. 1, surging to more than 400 cases by Dec. 16.

Dr. Dora Anne Mills, chief health improvement officer for MaineHealth, the parent company of Maine Medical Center, said that another worry is if the new COVID-19 variant arrives in Maine before large numbers of people are vaccinated, it could cause another huge spike in cases, eventually leading to more deaths. The variant, although not more deadly, is more contagious. The variant has not yet been detected in Maine, but is has been found in New York, Connecticut, Colorado and California.

Hospitalizations in Maine reached a new peak on Thursday. A record 202 people were hospitalized with COVID-19, with 55 in intensive care. Since mid-December, hospitalizations have fluctuated between 180 and 200. That compares to daily hospital populations in the 80s in mid-November, with increases to more than 160 by early December.

Meanwhile, the rollout of the state’s immunization program continues, but not at a pace that will allow for significant expansion, said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, on Wednesday.

Shah said in a media briefing that the state is expecting another shipment of about 17,000 vaccine doses next week, roughly the same weekly supply the state has been receiving since the vaccines started being shipped to states in late December. But Shah said without those shipments growing, the pace of the immunization program will be constrained.

“Right now we are receiving nowhere near the vaccine we need,” Shah said.

Maine is currently in the middle of vaccinating for Phase 1A, which includes health care workers, staff and residents of nursing homes, and paramedics, a total of about 130,000 people. The next phase, 200,000 in Phase 1B, would include seniors 75 and older and front-line essential workers, which will likely consist of teachers, police officers, grocery store clerks and postal workers, among others.

But exactly who will be first in line when Maine starts immunizing in Phase 1B – expected to begin in February – is under discussion. Groups are jockeying to be as high on the list as possible. Shah said no decisions have been made, but the state is looking to prioritize among Phase 1B to vaccinate those who are most vulnerable and at risk of transmitting the disease.

So far, 38,065 vaccine doses have been given in Maine.

The deaths on Thursday included a man in his 80s from Aroostook County; a man in his 40s from Aroostook County; a woman in her 60s from Cumberland County; a man in his 60s from Hancock County; two women in their 90s from Hancock County; a woman in her 70s from Kennebec County; a man in his 60s from Oxford County; a woman in her 80s from Oxford County; two men in their 80s from York County; a woman in her 90s from York County; and a man in his 70s from York County.

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