A man walks by the Maine Center for Disease Control on water Street in Augusta on Thursday.

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As Maine’s public health agency works to increase its staffing, a key component of its disease tracking and health education team remains understaffed and not present in some of the state’s most rural areas.

The state’s corps of public health nurses fill a variety of jobs in the state’s response to the coronavirus pandemic. They answer questions from health care providers and help out with disease investigations to pinpoint how people became infected and find people to whom they might have spread the respiratory virus. They have been instrumental in slowing the spread of infectious disease in the state before, including during the last global pandemic.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

But the state is still operating on a reduced staff of public health nurses, almost three years after the Legislature passed a law requiring that the state fill all positions in the program. A supplemental budget the Legislature passed last month includes $352,000 in state funding for stipends for public health nurses, which the state’s Department of Health and Human Services hopes will help the state fill vacant positions and retain existing nurses, said spokesperson Jackie Farwell.

Some 37 of the public health nursing program’s 55 budgeted positions are currently filled, Farwell said. Twenty-six of those staff members are field nurses. Farwell said another field nurse is scheduled to start work in May, bringing staffing levels to 38 and leaving 17 vacancies in the program.

The nurses are deployed to eight districts around the state. The York and Cumberland County regions — where the virus has hit the state the hardest — have seven nurses combined. The Down East district, covering Hancock and Washington counties, have no nurses, according to the Maine Center for Disease Control and Prevention.

The lag in hiring concerns state Sen. Brownie Carson, D-Harpswell, who sponsored the 2017 law requiring that the state fill its public health nurse vacancies and was one of the three plaintiffs who sued the state when the LePage administration didn’t hire the required nurses.

It’s hard to tell how aggressively the state is working to fill the roles, he said.

“I had hoped that more would be done,” Carson said, adding that he has tried to get information from the state about its hiring practices since January, but has not always been successful. “…I know that there have been times in the past when the state has not advertised or actively recruited when I believe it should have been.”

Farwell said the Maine CDC’s hiring efforts have included radio advertisements on Bangor- and Presque Isle-area radio stations, an open house event at the Machias CareerCenter, and giving public health nurses palm cards with information on openings to distribute while on the job.

“While we have seen some staff retire and others move on to other employment during the past year, we have aggressively recruited for vacant positions since January 2019,” Farwell said.

While the program has vacancies, the current staff is larger than it was in late 2017 and throughout much of Gov. Paul LePage’s administration, which largely dismantled the program, eliminating office space for nurses, changing their responsibilities and refusing to fill vacant positions as nurses left.

Staffing had dwindled to fewer than 15 nurses in late 2017 from about 50 when LePage took office in 2011. His administration resisted hiring nurses even as the Legislature continued to fund about 50 public health nursing positions, passed special legislation requiring that the state fill the positions and a state senator, Carson, sued to enforce that law.

A superior court judge dismissed that lawsuit last July after she found Gov. Janet Mills’ administration was moving to hire nurses and “substantially complying” with the 2017 law requiring the hiring.

Janet Morrisette, who directed the program from 2005 to 2011 and has 26 years of experience in the field, said a nationwide nursing shortage has made hiring difficult and that the state struggles to compete with private hospitals. But she argued the program — which turns 100 this year — would thrive if the state worked actively to recruit participants.

“It’s just something you can’t neglect,” she said. “The previous administration did more than just ignore it — they made a downright effort to decimate it.”

When not responding to an all-consuming pandemic, public health nurses visit at-risk mothers and their infants in their homes, provide school nurse services in rural schools without their own nurses, work to contain infectious diseases such as tuberculosis, and assist in responses to public health emergencies such as small disease outbreaks.

During the last pandemic, the 2009 H1N1 influenza pandemic, Maine’s public health nurses helped to set up and staff 238 vaccination clinics across the state. They helped school nurses vaccinate students, and ensured vaccines were effectively distributed and safely stored. They educated others charged with vaccinating at-risk populations.

Nurses are also trained in contact tracing — the process by which public health investigators determine where an illness originated by interviewing an infected person to find out the people with whom they’ve been in contact — from their work with tuberculosis patients.

Contact tracing has helped shed light on the trajectory of the coronavirus in Maine and identified the source of some of the state’s early cases.

Watch: Nirav Shah on tracing the origins of coronavirus cases in Maine

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