Millinocket Regional Hospital has expanded hours for COVID-19 testing and is conducting those tests away from its main campus at the walk-in clinic in East Millinocket. A healthcare provider works out of a truck in the clinic's parking lot on Tuesday. Credit: Linda Coan O'Kresik | BDN

Businesses and offices around Millinocket have been closing their doors for the last week out of concern that the coronavirus could be spreading locally after at least 60 people were sickened in connection with a wedding and reception held in the area on Aug. 7.

But one institution, Millinocket Regional Hospital, has been forced to do almost the opposite. While many rural Maine hospitals have resumed something closer to their normal operations since the COVID-19 surge last spring, the Millinocket facility has reimposed a number of safety measures meant to keep the virus from spreading while rallying its workers and ramping up testing.

While the local hospital has delayed a number of nonessential services for now, its providers had to quadruple the average number of COVID-19 tests they were conducting each day during the early part of the outbreak, from between 20 and 25 to 100.

In driving rain and hot weather, they have now done more than 400 tests in connection with the outbreak at an outdoor drive-through site at the hospital’s walk-in clinic in East Millinocket.

And while most people infected in the Katahdin-area outbreak have been able to isolate and recover at home, the hospital has had to admit “several” patients who were so sick that they needed emergency care, including one woman who died late last week, according to hospital CEO Robert Peterson.

State health officials said Tuesday that the wedding outbreak has now been connected with two other COVID-19 outbreaks elsewhere in the state — at a nursing home in Madison and the York County Jail in Alfred. Most of those who have become infected didn’t attend the wedding, according to the Maine Center for Disease Control and Prevention, including the woman who died.

For now, the hospital says it is up to the task of handling any possible surge of patients, with adequate supplies of protective equipment and an agreement to send critically ill patients to Northern Light Eastern Maine Center in Bangor if necessary, Peterson said in a statement.

But just as the outbreak has shown that rural communities are not immune from the deadly pandemic despite Maine’s relatively low rates of COVID-19, the hospital’s response offers a reminder of how new outbreaks will affect all kinds of businesses and organizations that simply can’t operate at their normal levels when the disease is circulating.

The small hospital could face new challenges if any of its workers become infected, since it does not have a deep bench of employees to call on.

And despite its work to contain the outbreak, Millinocket Regional Hospital now expects to lose at least half of its expected patient revenue for as long as its nonessential services are on hold. That comes after hospitals all across Maine suffered major revenue shortfalls last spring when they had to pause those same services while paying more for resources to handle the pandemic.

Millinocket Regional Hospital, a 25-bed critical access facility, has already suffered many financial challenges familiar to hospitals in rural America. Although hospitals in Maine have avoided the closures that have hit other parts of the country, two of them — Penobscot Valley Hospital in nearby Lincoln and Calais Regional Hospital — are in the midst of bankruptcy proceedings, and said earlier in the pandemic that they would have to shut their doors without more government aid.

The Millinocket hospital ended every year between 2012 and 2018 with a negative operating margin, according to the most recent data from the Maine Health Data Organization. The greatest of those losses came just recently, in 2018, when the hospital lost $5.8 million.

Since then, the hospital made “significant operational changes” and was “financially stable” through the first nine months of the 2020 fiscal year, which started in July 2019, according to Peterson. Now, the hospital is in “no danger of closure or even bankruptcy,” due in part to funding from the federal Paycheck Protection Program, Peterson said.

But, he said, “This will have a significant impact on cash flow in the weeks to come. We will manage, but it is an unenviable position to be placed in.

The Maine Center for Disease Control and Prevention says that about 65 people attended the wedding reception at the Big Moose Inn, which has now received an “imminent health hazard” citation for violating a state coronavirus restriction limiting indoor gatherings to 50 people. The ceremony was held beforehand at Tri Town Baptist Church in East Millinocket, but the state has not said whether it will cite that venue.

Echoing guidance from state health officials, Peterson had a warning for anyone who still thinks that Maine’s relatively low COVID-19 rates are reason to stop social distancing, wearing face masks in public, avoiding large gatherings and taking other preventive measures.

“Due to our low positivity rate in Maine and our ‘flattened curve,’ many Maine residents have become complacent with the safety measures mandatory in other parts of the country,” Peterson said. “What we are going through in the Katahdin region is a stark reminder that this pandemic is certainly not over and that this virus is extremely virulent and dangerous. Lapses in safety measures lead to dire consequences and we have been dealing with these consequences firsthand for the last ten days.”