A man walks by the Calvary Baptist Church in Sanford. Credit: Troy R. Bennett | BDN

For the first five months of the coronavirus pandemic, COVID-19 spread in York County much as it did in the rest of the state. Maine’s southernmost county roughly followed state trends for daily numbers of new cases and active infections among its residents.

Then, a wedding happened on Aug. 7 more than 200 miles to the north.

Less than two weeks later, York County overtook neighboring Cumberland County — Maine’s most populous county, which has seen the state’s highest infection rate since the start of the pandemic — in its daily rate of new cases, and that rate has accelerated ever since.

Home to 15 percent of Maine’s population, York County has accounted for more than 40 percent of the state’s new virus cases since mid-August. The county was responsible for more than half of the state’s new cases for most of the past week. While York County started August with 70 active cases among residents, it had more than double that number — 156 — as of Thursday. It’s home to six of the state’s 13 active outbreaks.

Six months after Maine detected its first case of the coronavirus, York County is the part of the state with the most rapid spread of the virus after the Aug. 7 Katahdin-region wedding that’s now been linked to 161 infections. About half of those infections have been recorded in York County, and most of the wedding’s ripple effects are also being felt there while Katahdin-region case numbers have largely stabilized.

Some York County schools delayed the start of classes after the state issued a warning that in-person instruction would no longer be entirely safe there. In Sanford, the city council just passed an emergency ordinance requiring mask-wearing in public places, after the mayor sent out a stern letter asking residents to take the virus seriously.

And in York Hospital’s various medical facilities, frontline workers are now required to always wear eye protection on top of other protective gear, in case they’re treating a patient unknowingly infected with COVID-19.

Altogether, the flare-ups have prompted worries that the virus is spreading invisibly through the state’s southernmost county, even after the arrival of many out-of-state visitors in the coastal region during the summer vacation season did not appear to significantly drive up cases.

“I think the concern is the number of outbreaks and whether they’re related to each other or not,” said Dr. Evangeline Thibodeau, an infectious disease specialist at York Hospital. “It seems like some are linked to each other.”

Another “concerning” trend, she said, is that some of the new outbreaks have been tied more to “social” functions — including a wedding and funeral reception — rather than to essential industries such as nursing homes and factories where Maine saw earlier outbreaks.

With health experts fearing a resurgence of the virus as kids flock back to school and cooler weather forces people to spend more time indoors, its recent ascendance in York County has provided a slew of reminders about the need for established safety measures that can slow or stop the spread of COVID-19.

Masked people walk around the York County city of Sanford, Maine, on Sept. 9, 2020. Credit: Robert Bukaty / AP

Those measures were apparently ignored at key moments starting with the Aug. 7 wedding, to occasionally devastating effect. In addition to the cases in southern Maine, the wedding is also linked to one death of a woman in her 80s in the Millinocket area, who did not attend the wedding, and to a secondary outbreak at Maplecrest Rehabilitation and Living Center in Madison, where two other people have died.

While Maine is still doing “pretty well” at containing the virus, “the only problem is this one outbreak triggered by irresponsible behavior,” said Dr. Peter Millard, a former epidemiology staffer at the U.S. Centers for Disease Control and Prevention and an adjunct professor with the University of New England. “It may be an important lesson for Maine: If you do let your guard down, there are going to be more cases.”

For much of the spring and summer, Maine’s virus cases were most concentrated in Cumberland County, partly owing to some large outbreaks in long-term care facilities, manufacturing plants and other places around Portland.

Cumberland County’s daily rate of new cases was consistently double the statewide rate from April to early July, while York County’s rate roughly tracked the state’s, according to CDC data. (The daily rate is a seven-day rolling average of new cases per 10,000 people.)

But after Maine’s overall rate of new cases mostly dropped between June and early August, the two coastal counties essentially switched places. Since the Aug. 7 wedding, Cumberland County’s average rate of daily new cases has fallen by more than half — from about 0.2 new cases per 10,000 residents on Aug. 7 to about 0.1 on Thursday — while York County’s rate has grown more than four times larger, from 0.13 to 0.58.

Health officials have traced a large chunk of the recent uptick in York County to the Aug. 7 wedding in East Millinocket — and to some important missteps that began that day.

After the wedding, more than 60 guests packed into an inn on Millinocket Lake for a reception at which they didn’t wear face masks or sit at least six feet from each other, all in violation of the state’s restrictions on gatherings. The inn did check the guests’ temperatures, but Nirav Shah, director of the Maine CDC, now thinks that COVID-19 spread because a few guests were already sick but not showing symptoms yet.

Since then, at least two other institutions have also failed to adhere to established public health guidance.

The biggest of those failures may have been at the York County Jail, where a guest of the wedding was employed. Until the second week of August, the jail neglected to screen workers for virus symptoms or require them or inmates to wear face coverings, according to the state Department of Corrections. That’s despite the fact that respiratory infections can easily spread in congregate living facilities such as jails where it is impossible for inmates and officers to socially distance.

The York County Jail in Alfred. Credit: Troy R. Bennett | BDN

Now, COVID-19 has infected at least 74 people connected to the jail: 48 inmates, 18 employees and eight of their family members. Nine other family members are also suspected to have the disease, and the county has launched an inquiry into whether the facility failed to follow its own public health protocols.

On a smaller scale, the pastor who traveled to East Millinocket to officiate the Aug. 7 wedding has also continued to hold maskless services at Calvary Baptist Church in Sanford, where there is now a separate COVID-19 outbreak that has infected at least 10 congregants. The state is considering whether to sanction the Sanford church as Pastor Todd Bell keeps encouraging churchgoers to not wear masks.

The state has discovered at least three other smaller clusters of COVID-19 in Sanford, including four cases linked to the city’s fire department, four linked to a funeral reception at the American Legion T.W. Cole Post 19 and three linked to the private Lafayette Club.

Officials have still not determined whether those cases have any ties to the wedding outbreak, but regardless, they have concerned medical experts since they suggest the virus is traveling between people beyond the known outbreaks, in a process known as community transmission. It could also suggest that the people connected to those outbreaks are not following the necessary protocols, such as quarantining, keeping distance from others and wearing face coverings.

For now, York Hospital has not radically changed its operations given the outbreaks around the county, according to Thibodeau. That’s largely because the hospital has not seen an increase in the portion of its COVID-19 tests that are coming back positive, including for patients at the hospital’s outpatient clinic in Sanford.

The hospital has also not seen a significant change in the number of patients being admitted or treated for the disease, but “that can change quickly,” Thibodeau warned.

The only change for the hospital at this point has been a new requirement that frontline workers wear face shields or goggles in addition to their face masks and other gear, since people unknowingly infected with the virus could pass it through the mucous membrane of a provider’s eye.

Thibodeau said the new cases have been a reminder for hospital staff and the general public “to be very vigilant” about practices they adopted in the early days of the pandemic, such as stringent handwashing and mask wearing. In addition, she said the hospital now knows much more about how to handle the virus and has a greater supply of protective equipment.

“We are prepared for rising cases,” she said. “We’re prepared for little clusters of outbreaks. We’re going to have little upticks here and there.”

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