Medical personnel discuss patients that had been admitted for testing for the coronavirus at the entrance Central Maine Medical Center on Friday, March 13, 2020, in Lewiston, Maine. Gov. Janet Mills announced Monday that anyone suspected of having the virus is eligible for a test with a doctor’s order. Credit: Robert F. Bukaty | AP

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Confirmed coronavirus cases in Maine have climbed steadily as the state expands testing and reopens businesses, though flat hospitalizations and lower positive test rates suggest that the changes so far mostly reflect increased detection of the virus rather than its spread.

Maine is resuming many economic activities, with retail establishments and restaurants already allowed to open in 12 counties and more businesses cleared to open June 1. The shift toward reopening comes — not coincidentally — as the state increases coronavirus testing.

Gov. Janet Mills announced Monday that anyone suspected of having the virus is eligible for a test with a doctor’s order, putting an end to a prioritization system that reserved tests for health care workers, residents of congregate living facilities and patients who were at high risk due to age or preexisting medical conditions.

As Maine expands testing, case counts are likely to increase due to better detection, but there is also risk that resuming economic activities could increase transmission of the virus. The Bangor Daily News will continue to monitor these statistics in the coming weeks in an effort to evaluate how Maine’s economic reopening affects the spread of the coronavirus.

Testing dramatically affects the number of confirmed cases. That makes the case count a difficult figure to evaluate. An increase in confirmed coronavirus cases might signal the disease is spreading, or it might indicate the state is detecting more cases that already existed.

More than 7,500 tests were performed in Maine in the past week, compared to an average of a bit over 4,000 tests performed in previous weeks, according to data from the Maine Center for Disease Control and Prevention.

Maine also saw its biggest single-day jump in cases on Wednesday, with 78 new cases, days after the state formally ended the testing prioritization system. Maine CDC Director Nirav Shah said the increase was “not a surprise,” citing the increased testing.

Increasing testing was one of the pillars supporting Maine’s reopening plan, though public health experts have provided different estimates for how many tests the state should be conducting. One study from the Harvard Institute of Global Health suggested Maine needs 583 tests per day to resume economic activities, though researchers said the estimate was a lower bound.

A second report from the Safra Center for Ethics at Harvard said states should aim to test at least 2 percent of their populations each day in order to account for asymptomatic carriers of the virus. That would translate to nearly 27,000 daily tests in Maine, meaning the state would have to increase current capacity by 27 times to meet that higher standard.

Hospitalizations have stayed relatively flat even as cases have trended upward. Hospitalizations can be one indicator of the seriousness of the virus, based on the assumption that patients with severe cases will usually end up in the hospital regardless of how much testing occurs in the general population.

Since the Maine CDC began providing daily data in April, the number of people hospitalized with coronavirus has declined even as cases rose, though hospitalizations ticked slightly upward in the last week. They have not gone over 45 on any one day since more than a month ago.

Some variation is inevitable, but a significant increase in hospitalizations as Maine reopens could indicate that the disease is circulating more widely in the community than previously known. This would be especially concerning because hospitalizations are a lagging indicator — a person who is hospitalized with COVID-19 likely caught the virus days or even weeks earlier.

The share of positive tests is decreasing the more Maine tests, which is a good sign. The positivity rate is usually calculated as the percent of tests that come back positive. Experts say it is a good sign if the positivity rate is less than 10 percent. In some New York City neighborhoods, the rate was more than 50 percent at the height of the outbreak.

In Maine, it has been significantly lower than that since the state resumed providing that kind of data on testing in mid-April. It declined slightly over the past few weeks, sitting at 5.4 percent as of Wednesday, Shah said.

“We still have a fair amount of road ahead of us with respect to getting that positivity rate down, but just in the past week we’ve driven it down in statistical terms by 10 percent, from about 6 percent to down to 5.4 percent” Shah said. “We’ve still got more work to do.”