The Hope House Health and Living Center on Corporate Drive in Bangor, Maine.

This story was updated on May 5 to reflect more current case counts at the homeless shelter.

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There is now an outbreak of COVID-19 among people who visited the Hope House Health and Living Center in Bangor. Twenty homeless shelter residents and staff have tested positive for the virus, the shelter said.

The shelter initially announced on April 29 that 21 people had tested positive, but one case was later determined to be a false positive, a shelter spokesman said.

As of Friday, April 24, the shelter had confirmed two cases of the virus among its residents. But when a third person tested positive the following Monday, it followed guidelines from the Maine Center for Disease Control and Prevention to test everyone who visited the shelter within the previous two weeks.

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

As of Wednesday afternoon on April 29, 17 additional people had tested positive — four staff members and 13 clients — said Dan Cashman, a shelter spokesman.

Homeless residents are now being quarantined at a local hotel, according to Noah Nesin, chief medical officer of Penobscot Community Health Care, which oversees the Hope House.

Hope has been screening all visitors to the shelter for COVID-19 symptoms, meaning that all of the new cases revealed by widespread testing involved people who were not showing symptoms, Nesin said. It shows how the virus can spread before people show signs of illness, if they ever do.

“Once the decision was made to go to universal testing for shelter guests and staff, [the Maine CDC] returned results in a rapid manner that allowed us to make nimbler decisions to maintain the safety of our staff and guests,” he said.

An outbreak is considered three or more confirmed cases of the virus affiliated with a congregate living setting, such as a homeless shelter, within a two-week period, according to the Maine CDC. It is also the threshold by which the state recommends universal testing. So far in Maine, outbreaks have mostly occurred in nursing homes.

“Obviously if we had unlimited testing capacity, we might be doing things differently in every setting, not just people experiencing homelessness,” Nesin said. A national shortage in testing supplies has forced public health officials to ration and prioritize.

In Bangor, officials have known that homeless shelters were vulnerable to rapid spread of the virus among guests sleeping in close quarters. In mid-March, days after the state’s first reported case, the Bangor Area Homeless Shelter reduced its overall capacity to achieve the recommended 6 feet of distance between sleeping cots.

It took longer for the Hope House on Corporate Drive to spread out its beds, as the 54-bed shelter hit obstacles in its search for an offsite location to move about half of its residents. On April 14, the shelter transferred 20 people to the Columbia Street Baptist Church, which had been prepared as a quarantine space in the event a shelter client tested positive.

Less than a week later, on April 18, a client tested positive. Without a designated quarantine space, the Hope House isolated the guest at a local hotel. It found another hotel room when a second client tested positive later that week, though the shelter said it didn’t believe the two cases were connected.

When a third person tested positive on April 27, the shelter began testing everyone who visited the shelter, not just those who had reported close contact with an infected guest. About 100 tests were conducted that afternoon and another 49 the following morning, said Cashman, the shelter spokesman.

Someone who was tested prior to the shelter beginning its universal testing policy was also confirmed positive, bringing the total number of infected staff and guests to 20 as of May 5.

“I am proud of the work done by our dedicated Hope House staff, who followed the plan and immediately took steps to [reach out] to every person who accessed Hope House services within the past two weeks, including folks located at the temporary shelter at Columbia Street Baptist Church,” said Lori Dwyer, president and CEO of Penobscot Community Health Care.

Prior to the outbreak, the shelter signed a contract with a local hotel to quarantine exposed and infected guests, she said. Everyone whom the shelter has asked has agreed to get tested, she added.

“They are, like all the rest of us, anxious, nervous and very concerned for their health and safety,” she said. “Because they don’t have their own home to isolate, in that way, it’s even more anxiety-inducing.”

As of April 29, two guests who fell ill had been hospitalized, and one had been released, Nesin said. Another person had recovered and was cleared to leave quarantine.

The shelter has and will continue to take safety precautions at its Corporate Drive location and at the Columbia Street Baptist Church.

In addition to being asked to abide by social distancing guidelines, both inside and outside the shelter walls, all guests are required to wear a face mask upon entering the buildings. Staff are providing education around handwashing and hygiene. They are also screening guests twice a day for symptoms, including by taking temperatures.