An outbreak stemming from an Aug. 7, 2020, wedding in the Katahdin region has spread to the York County Jail in Alfred and the Maplecrest Rehabilitation and Living Center in Madison. Credit: Linda Coan O'Kresik | BDN, Troy R. Bennett | BDN, Rich Abrahamson | Central Maine Morning Sentinel via AP

While a couple’s decision to hold an Aug. 7 wedding in the Millinocket region may have started the state’s largest COVID-19 outbreak to date, the spread of the disease throughout the southern half of Maine has been magnified by the apparent failure of multiple institutions to follow practices that are now widely recognized to slow or stop its transmission.

At least one of those failures came on the wedding day, when an inn on Millinocket Lake hosted more than 60 guests for the reception, even though state coronavirus restrictions limit indoor gatherings to 50 people. The venue also didn’t force guests to wear face coverings or sit more than 6 feet apart.

From there, a nursing home in Somerset County and a jail more than 200 miles to the south in York County reportedly failed to screen employees for COVID-19 symptoms before suffering their own secondary outbreaks of the disease, which has driven the total number of cases tied to the Aug. 7 wedding to around 180. The jail also didn’t require its workers or inmates to wear face masks.

Now, as a growing number of additional outbreaks have emerged in York County, including at the Sanford church of the pastor who officiated the Aug. 7 wedding and at various private social clubs, officials are increasingly concerned that cases could keep growing if institutions and individuals don’t take the threat of the virus seriously.

The risk will be particularly great during fall and winter, when colder weather forces more people inside and flu season also hits.

Nirav Shah, director of the Maine Center for Disease Control and Prevention, said that the outbreaks at the wedding, nursing home and jail have demonstrated how rapidly COVID-19 can spread when people are gathered in close quarters for an extended period. He noted that limited mask-wearing appears to have fueled those outbreaks, given the “stark difference” in other “similar situations” where participants did wear them.

It’s now critical that people around Maine, and in particular York County, start to closely follow that guidance, because the virus can swiftly multiply from one case to two, then two to four, then four to eight, and so on, according to Shah.

“Exponential growth is one of the reasons why this situation went unchecked and has now resulted in approximately 180 cases,” he said. “That’s why we take low numbers so seriously. That’s why our concern level in situations like York County and Sanford is so high. If left unaddressed, it can quickly get out of hand and lead to the massive-scale outbreaks that we’ve seen.”

It’s likely that many Mainers developed a feeling of “complacency” in the months leading up to the Aug. 7 wedding outbreak, and that complacency probably extended to some businesses and organizations, too, according to Dr. Dora Anne Mills, the chief health improvement officer for the MaineHealth hospital group and a former head of the Maine CDC.

Over the summer, she noted, she frequently saw large groups of people barbecuing and gathering near her camp in rural western Maine, without any attention to mask-wearing or distancing, and sometimes with out-of-state cars parked in the driveway.

Some of that complacency could be related to the fact that Mainers had not heard of a COVID-19 super-spreading event happening in the state before the Aug. 7 wedding. “I think particularly since this virus hit the U.S. very hard in the spring, in New York and Boston, rural communities have felt somewhat protected,” she said.

Now, Mills is urging all Mainers to practice the “three Ws” — wearing masks, watching distances, washing hands — and avoid big indoor gatherings as much as possible this winter. Following those rules will be hard, particularly as the holiday season gets underway, but it will be essential until a COVID-19 vaccine is widely available, she said.

She noted that COVID-19 hospitalizations have been climbing at MaineHealth’s locations in Biddeford and Portland, with many of those patients from York County, and that the county’s cases are starting to spread beyond the Sanford area to workplaces in Ogunquit and Kittery.

Recently, Mills has become particularly worried by the spread of COVID-19 at private social clubs in Sanford. While larger institutions such as hospitals and schools have generally been able to prevent the virus from spreading inside their buildings, Mills said, it will be harder to convince the people who frequent more close-quartered clubs, churches and other organizations scattered around every corner of the state to change their habits.

“The strategies that need to be implemented are almost the antithesis of the mission of those groups, but I think they can adopt them,” Mills said. “Nobody wants to be the next Millinocket wedding.”

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