Nurses at a drive-up COVID-19 coronavirus testing station set up by the University of Washington Medical Center wear protective gear as they wait under a heater next to a tent Friday, March 13, 2020, in Seattle. Credit: Ted S. Warren | AP

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After Maine announced its first two presumed cases of the coronavirus between Thursday and Friday, some officials are expressing concern that the actual number of cases in the state could be far greater because of delays by the federal government that have made it hard for states to begin testing for COVID-19, the disease caused by the virus.

Only last week did the federal government give physicians more leeway to start sampling patients for the virus. And only late last week did Maine receive and start using its first batch of testing materials from the U.S. Centers for Disease Control and Prevention, which state officials have said will allow it to test about 1,000 individuals.

Now, a dam seems to have broken in the state’s surveillance for the illness: more than 100 people in Maine were tested in the past week, after just one was tested prior to last week. What’s more, a number of independent health care systems are working to boost those numbers by either processing tests themselves or streamlining the ability of patients to be sampled.

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The two positive cases announced this week were a Navy reservist in her 50s from Androscoggin County who traveled to Italy on a training mission, and an employee of Portland’s India Street Public Health Center who came into contact with 30 other staff and volunteers.

While it’s good that Mainers are now being more widely tested, some doctors are concerned that the capacity has not been adequate given the chance that COVID-19 has been spreading among people who did not meet the previous testing criteria issued by the U.S. CDC that included visiting a country heavily hit by the coronavirus, such as China or Italy, or being exposed to someone who was known to have COVID-19.

There is a strong chance the disease has already been spreading among people who didn’t meet those limited criteria, according to Dr. Jay Mullen, a Brunswick-based emergency room doctor who co-chairs the legislative committee of the Maine Medical Association.

“My concern is that we may be responding too slowly to the community spread, and because of that, we’re not testing widely enough,” said Mullen, who leads BlueWater Health, a company that provides staffing to hospitals in Maine, Massachusetts and Vermont. “We’re essentially playing catchup, which is making it difficult for us to get out ahead of the community spread.”

[Interactive map: The number of confirmed coronavirus cases in each state]

Mullen said that he’s heard from a Maine hospital that struggled early last week to authorize a COVID-19 test for a patient who had flu-like symptoms, had traveled outside the country and had tested negative for influenza, but who had not been to one of the few countries flagged by the federal testing guidelines. The person’s results eventually came back negative, but those were strong indicators that they may have had the virus, according to Mullen.

Only later last week did the U.S. CDC loosen its requirements to allow doctors to use their judgement to test patients who exhibited symptoms including fever, coughing or shortness of breath. Also last week, Maine was finally able to start using the testing kits provided to it by the U.S. CDC.

Mullen said that he has been impressed by the guidance coming from Dr. Nirav Shah, the director of the Maine CDC, to help health care providers navigate the slow action and changing guidelines from the federal government, but he faulted the federal response.

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“There have to be cases here where the physician thought the test had to be done, but it couldn’t get done,” said Mullen, who now thinks there could be a “dramatic” surge of new testing and positive cases in Maine.

U.S. Sen. Susan Collins, a Republican, offered similar criticism Friday. Besides arguing that President Donald Trump should “step back” from publicly responding to the pandemic, she also raised concerns about the limited testing for the virus.

According to data from the federal Centers for Disease Control, more than 13,600 people in the U.S. had been tested for the virus as of Thursday, putting the U.S. behind every other developed country in per-capita COVID-19 testing.

Some of Maine’s numbers are getting a boost from independent efforts. MaineHealth, a Portland-based group of hospitals, also developed the ability to process tests in its laboratories this week. A second health care system, Brewer-based Northern Light Health, also hopes to begin processing the tests in the next few weeks, according to a spokesperson.

[Here’s what has been canceled or postponed in Maine due to coronavirus]

Other health care organizations have been trying to streamline how their patients can be tested for the virus in other ways.

For example, Central Maine Healthcare has set up satellite testing for the coronavirus in tents at its three hospitals in Lewiston, Rumford and Bridgton. InterMed, a Portland-based group of primary care physicians, has begun offering outdoor, drive-through, appointment-only swab tests, per an email sent to clients by a chief medical officer late Friday afternoon obtained by the BDN.

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