State health officials reported 106 new cases of COVID-19 on Thursday – the biggest single-day total since late May – adding to the signs that Maine might be on the cusp of another surge.

Four additional deaths were reported as well.

The seven-day daily case average increased to 58, which is nearly three times what it was on average just two weeks ago. The average hasn’t been this high in about a month and a half.

York County appears to be a hot spot, with a case rate of 7.8 per 10,000 population over the past 14 days, compared to an average of 4.6 per 10,000 population statewide. Cumberland County, the state’s most populous and most-vaccinated, had a case rate of 4.1 per 10,000. Sagadahoc, which has one of the highest vaccination rates, has experienced the lowest COVID-19 prevalence during the past two weeks, with a rate of 1.39.

In another sign that the pandemic is worsening, the positivity rate – the percent of molecular COVID-19 tests that are returned positive – has increased from a pandemic low of 0.45 percent two weeks ago to 1.44 percent on Thursday.

Dr. Laura Blaisdell, a pediatrician from South Portland and an infectious disease expert, believes much of the increase in cases is caused by the more-transmissible delta variant. Even with Maine’s high vaccination rate, the delta variant is finding people to infect.

“Every exposure to the delta variant is a factor of two or three higher of infectivity,” Blaisdell said. “That means when the virus does find an unvaccinated person, that person is going to potentially infect at least double the number that they would have infected last year.”

However, Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said this week that he doesn’t believe the delta variant is dominant here yet. The state has tracked only five cases of the delta variant out of 4,631 positive COVID-19 cases that had been sequenced by labs for the Maine CDC as of July 3. Shah did acknowledge that the number of delta variant cases is certainly much higher.

Nevertheless, in the weeks and months ahead, Blaisdell said if the pandemic continues to worsen, Maine and other states may have to consider reimposing pandemic restrictions, such as indoor mask mandates and limits to gathering sizes.

“No one wants to go back to that,” she said. “We, as the public, have two choices before us. One is to get vaccinated and end the pandemic. The other choice is to go through continuous cycles of restrictions as the virus burns through the population.”

Shah said this week that his team will continue to monitor trends, but there are no plans to reimpose restrictions. He said watching cases is important, but it’s not the only metric. Many of the cases, especially breakthrough cases in vaccinated people, have been mild.

Dr. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, issued another plea Thursday for members of the public to get vaccinated if they haven’t already.

“If you are not vaccinated, please take the delta variant seriously. This virus has no incentive to let up, and it remains in search of the next vulnerable person to infect,” Walensky said during a White House briefing.

As for why York County has been experiencing higher case counts, Blaisdell said it could be related to more densely-packed Independence Day parties or popular tourist spots, such as Old Orchard Beach, that have drawn a lot of people since Maine ended its tourism and pandemic restrictions.

Jackie Farwell, spokeswoman for the Maine Department of Health and Human Services, said York County is “experiencing an increase in case counts because of sustained community transmission.

“We recommend that all Maine people, including those in York County, be vaccinated to avoid possible infection with COVID-19.”

There are still many places to get vaccinated, including at pharmacies, doctor’s offices and a walk-in clinic at the Portland International Jetport, from noon to 8 p.m., seven days per week.

Since the pandemic began, there have been 69,780 confirmed or probable cases of COVID-19 and 891 deaths, according to Maine CDC data.

There were 25 people hospitalized with COVID-19 as of Thursday, including 16 in critical care and six on ventilators. The number of hospitalizations here has been stable for more than a month, but that metric often lags behind case spikes.

Across the United States, new daily cases have nearly tripled over the last two weeks. States with lower vaccination rates are being particularly hard hit, but all states are seeing spikes.

As of Wednesday, the seven-day case average in the U.S. was 37,673, compared to 14,892 cases on average two weeks ago. Deaths have increased over that period from 164 per day to 237 per day, according to U.S. CDC data. Hospitalizations have reached their highest level since May, too, and are overwhelmingly among unvaccinated people.

In nearby Massachusetts, which like Maine has a high vaccination rate, daily cases have increased from 79 on average to 334 in two weeks, the length of one incubation period. New Hampshire’s daily cases have more than doubled, from 21 to 47 on average, in that time. Vermont, which has the highest vaccination rate of any state, has seen its average rise from 4 cases two weeks ago to 13 this week.

Other states are faring much worse. Florida, whose vaccination rate is 15 percentage points lower than Maine’s, has seen its average number of daily cases skyrocket from 2,476 to 8,107 in two weeks.

Maine remains stuck at 60 percent of all residents who have been fully vaccinated and 67 percent of eligible individuals age 12 and older, and there are still big disparities in vaccinations depending on age and geographic area.

Among Mainers 40 and older, 77 percent have been fully vaccinated, but for those between 12 and 39, the rate is just 52 percent.

There are five counties in Maine where the vaccination rate is at least 60 percent, led by Cumberland County at 71 percent. On the other end, two counties –Somerset and Piscataquis – have yet to reach the 50 percent threshold.

Blaisdell said vaccinations are no doubt helping to stem increases, but with a more contagious virus, it’s harder to stop the virus from spreading among unvaccinated populations.

She said with a more contagious variant circulating, it will take higher vaccination levels to reach herd immunity, which is when there are enough people vaccinated as a percentage of the population to stop the virus from spreading. Some earlier predictions estimated herd immunity could be reached with as low as 70 percent of the population vaccinated or with natural immunity, but Blaisdell said it now appears that vaccination levels need to be higher.

“We are going to have to have a lot more individuals in our communities vaccinated,” she said.

Blaisdell said that at some point vaccine mandates will be more likely at workplaces, and perhaps schools or other places where people gather. She sees vaccine mandates increasing when the FDA grants full approval to vaccines, which could happen as early as next month. The current vaccines have emergency use authorization.

“That (mandates) is probably where we are headed,” Blaisdell said. “The question is, who gets to hold who hostage? Who gets to decide whether our communal spaces are safe or not?”

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