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AUGUSTA, Maine — It has been only a week since Maine reported its first cases of the new coronavirus. The number of positive tests has steadily increased since then, allowing the state to have some idea of what to expect and how Mainers can “flatten the curve.”
That term is being used by health officials as a call to the public to slow the spread of the highly contagious virus by practicing “social distancing” during the global pandemic. It means leaving the house for only essential reasons such as work or grocery shopping, washing hands frequently and staying six feet from people outside your household.
Cases in Maine are so far concentrated in Cumberland County, which accounted for 25 of the 52 positive tests reported as of Wednesday by the Maine Center for Disease Control and Prevention. All four of the people hospitalized for the virus as of Tuesday were in that county.
To get an idea of what to expect in southern Maine, the Bangor Daily News used a model developed by the University of Pennsylvania Health System aimed at helping hospitals prepare for the virus. The numbers look dire under certain circumstances, but they affirm that Mainers can stem the spread of the virus — and save lives — by making lifestyle changes now.
Maine’s biggest hospital could be completely overwhelmed by the virus in weeks. It will not be if people in the region hunker down significantly. We used the Penn model to examine Maine Medical Center, which had 596 beds as of 2018. It is the biggest hospital in the most populated region in the state and plays a dominant role in the health care system in Cumberland and York counties with more than half of all hospital beds.
If there were no reduction in social contact at all, the model projects that about 90 percent of residents of the two counties would eventually contract the coronavirus. The model uses the number of hospitalizations to estimate the number of cases in the community, which is likely higher than the number of positive tests. A study in the journal Science estimated that, at one point, 86 percent of the coronavirus cases in China were undiagnosed.
Under a scenario with no social distancing, more than a quarter of the two counties’ populations would be simultaneously infected with the virus at its peak, with 4,700 requiring hospitalization at Maine Medical Center — requiring eight times more beds than the hospital has and more than double the total that all hospitals have in the two counties.
Social distancing, however, significantly slows the transmission of the disease. If there were a 55 percent decline in social contact, for example, the number of cases would climb gradually, and the total number of people infected with the virus at the same time would top out at around nine percent of the counties’ combined population.
Under this scenario, the number of patients simultaneously needing to be hospitalized at Maine Medical Center peaked at 294. It would still be a dramatic drain on the hospitals, but one that is far less likely to overwhelm it.
It is worth noting that all of this could be conservative or could change if the U.S. developed new treatment protocols. We told the model to assume that 10 percent of coronavirus cases would require hospitalization — on the low end of estimates — and that average stays for most patients would be seven days. Maine’s older population is also more susceptible to serious illness from the virus than any state but West Virginia, according to the Kaiser Family Foundation.
The state has taken steps to reduce social contacts. Mainers need to follow through. In an executive order on Wednesday, Gov. Janet Mills banned public gatherings with more than 10 people and barred restaurants from offering dine-in services, while urging many other private businesses to close.
Schools and colleges across the state have also shut down, but some social contacts are much harder to reduce. Grocery store clerks still interact with hundreds of customers. Employees of businesses that remain open will come into contact with their coworkers. Many Mainers will still have contact with their family members.
That is why public health officials say it is important that individuals take steps to reduce their likelihood of catching and transmitting the disease, as a young, healthy person who became infected with coronavirus at a social gathering could go on to infect many others.
Maine CDC Director Nirav Shah said Thursday that it was “too soon to tell” whether the state was effectively flattening the curve. He reiterated that there is ample evidence to support that social distancing can help mitigate an epidemic, though it’s most effective before there is widespread community transmission.
“If everyone complies, you do well,” said Dora Mills, chief health improvement officer for MaineHealth, the parent of Maine Medical Center, a former Maine CDC director and the governor’s sister. “But it only takes a few who are not compliant to explode the epidemic.”