Maine’s backlog of 46,000 positive COVID-19 tests has artificially lowered its official case statistics in recent weeks, causing federal authorities to reduce the state’s share of a lifesaving drug treatment given to infected high-risk people.

For much of the past week, Maine’s official per capita new confirmed case numbers have been the lowest in the country. But those numbers don’t account for the 46,000 positive tests awaiting official screening by the Maine Center for Disease Control and Prevention, which weeds out occasional duplicate tests involving the same person. As a result, Maine CDC director Dr. Nirav Shah has cautioned, the daily new case number is “not the metric of the moment.”

The artificial lowering of the state’s new case data has a critical ripple effect: It has reduced Maine’s share of the scarce monoclonal antibody treatment sotrovimab, one of the few medicines effective in reducing the severity of omicron variant COVID-19.

The drug is rationed out to states each week by the U.S. Department of Health and Human Services based on their shares of the hospitalizations and new cases over the previous seven days. Because Maine’s official data has it as the safest place in the country for new cases, the state’s allocation has been low in recent weeks.

Compare Maine and New Hampshire, which have nearly the same population – about 1.3 million – and on Friday had exactly the same seven-day per capita rate of hospitalizations: 33 per 100,000 people, according to the New York Times’ tracker. Last week Maine received 72 doses of sotrovimab. New Hampshire received 180.

Vermont has less than half as many people as Maine and a significantly lower per capita hospitalization rate of 20 per 100,000 people, but received 96 doses.

“From a supply side standpoint we are still in a time of scarcity, that’s for sure, and that’s a situation shared by all health care providers in the state,” said Matt Marston, vice president of pharmacy at Northern Light Health, the state’s second largest hospital network. “There is definitely an unmet need, hence the need for prioritization of patients based on need.”

Before supplies became constrained last month, Northern Light providers were administering doses to three times as many patients as they are able to now, Marston said.

The only silver lining that has emerged over the past two weeks, as the highly contagious omicron variant has driven hospitalizations to record numbers, is that a smaller share of the newly sick have become critically ill, though the absolute numbers of acute patients has remained high.

Shah on Thursday acknowledged the disparity between Maine and New Hampshire’s sotrovimab allocations but expressed doubt that it was due to the backlog, arguing that there was something amiss in the way DHHS was allocating the drug.

“The allocations have been quite strange,” Shah said. “My sense is that hospitalizations is what they are using.”

DHHS’s website clearly states the formula it uses for determining each state’s allocation. The agency “looks at the past 7-day incident hospitalizations and case counts for each state/territory and the case counts for the entire country,” it explains. “A state or territory’s percentage of the country’s 7-day incident hospitalizations and weighted 7-day incident case counts equals that state’s percentage of the available amount of (each of the monoclonal antibody treatments) for distribution this week.”

Responding by email to follow-up questions Friday, Maine CDC spokesman Robert Long said: “The posted HHS formula may seem clear, but allocations have not conformed to the formula.” He said Shah – who is also president of the national Association of State and Territorial Health Officers – has been in regular contact with DHHS officials seeking “equitable distribution of COVID-19 therapeutics to all states.”

The DHHS did not respond to inquiries about whether it is following its stated allocation formula.

Maine is not the only state with a backlog of positive test results awaiting official confirmation, but the scale of the backlog appears unusual on a per capita basis. There is no repository for this data, but as omicron has surged across the country over the past month, such backlogs have made the news only in a few states.

The most high-profile backlog has been in Ohio, where authorities warned of an artificial new case spike as they confirmed and reported their backlog of positive tests. But officials described the backlog – which has now been cleared – as being “tens of thousands” of cases. With 11.7 million people, Ohio has a population nine times the size of Maine’s, so to have a comparable backlog it would have had to have hundreds of thousands of cases.

Dan Pelletier, a pharmacy technician for MaineHealth, holds up a vial of monoclonal antibodies. Derek Davis/Staff Photographer

In Idaho, authorities alerted the public to a backlog of 16,000 cases Jan. 14. Idaho has 1.7 million people compared to Maine’s 1.3 million. In Minnesota a computer glitch resulted in a backlog this month, but that involved only about 17,000 positive tests in a state with a population of more than 5.6 million.

On Wednesday, Shah said Maine’s backlog had occurred because of the “tsunami’ of new omicron cases. He said staff would look for ways to address the backlog but did not offer specifics.

The state has had backlogs before but nothing on this scale. Over the week ending Friday, the CDC received a daily average of 3,172 positive tests to confirm, more than triple the daily average from just three weeks ago. At-home tests are not reflected in the official numbers.

Monocolonal antibodies, laboratory-produced versions of a natural protein, are designed to attack the coronavirus that causes COVID-19. They are generally prescribed to COVID-19 patients ages 60 and older and younger people with high-risk conditions, such as obesity, diabetes or conditions that suppress the immune system, shortly after they test positive, to reduce the chance they become acutely sick. Sotrovimab is the only type of monoclonal antibody known to be effective against the omicron variant.

In December the U.S. Food and Drug Administration approved the use of another treatment, an antiviral pill called Paxlovid, that also appears effective at fighting omicron cases. But its supplies also have been severely depleted in Maine and nationally.  Another therapy, the antiviral remdesivir, is not in short supply but is harder to administer to outpatients because it requires three injections on three consecutive days, which can be difficult for people with work, parenting or transportation challenges.

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