The ND Paper mill in Rumford is pictured on Aug. 20. The mill is among eight places in Maine that have seen repeat outbreaks of the coronavirus after seeing outbreaks earlier in the pandemic. Credit: Natalie Williams / BDN

The coronavirus has been circulating in Maine for so long now, and is spreading so intensely this fall, that some nursing homes and other places that saw infectious outbreaks earlier in the pandemic are now facing them again. In some cases, their repeat bouts with the virus have been more dire.

Five elder care centers have now had repeat outbreaks, which state public health officials define as three or more related cases. Two of them — Durgin Pines in Kittery and Clover Health Care in Auburn — have had particularly severe outbreaks this fall compared to the ones they surmounted last spring.

The Maine Correctional Center in Windham, the ND Paper mill in Rumford and Bath Iron Works have also seen the virus return in recent weeks after earlier outbreaks.

More than anything, their experiences highlight the increasing risk that workers across Maine can catch the coronavirus now that it has surged to record levels across the whole state. Unlike in the spring, the virus is no longer concentrated in the most populous southern counties. That makes it more likely people will catch the virus going about their daily lives, then bring it with them when they report to work.

Adding to the danger, people infected with the virus may be contagious even if they are not showing symptoms, which can make it hard to detect even in workplaces that are vigilantly working to keep it out, according to Dr. Jabbar Fazeli, the medical director of Durgin Pines, the 81-bed nursing home in Kittery.

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Durgin Pines initially saw a flareup of coronavirus infections in the middle of May, when two residents and four workers were infected, according to the Maine Center for Disease Control and Prevention. No one died in that outbreak, which was detected after a resident developed a fever a couple weeks after leaving the hospital for an unrelated medical issue.

But this fall, the facility experienced a more severe outbreak beginning in late October, which has now infected 22 staff and 47 residents, 11 of whom have died, according to Maine CDC data from the beginning of this week.

The biggest difference in the second outbreak was that there were multiple ways the virus may have come in and “silently” spread among people not showing symptoms before it was eventually detected during the facility’s normal course of testing, according to Fazeli.

Dr. Jabbar Fazeli works at the Durgin Pines nursing home in Kittery recently, where he is the medical director. Credit: Courtesy of Jabbar Fazeli

The only clear source of outside transmission was an employee who eventually tested positive after being exposed to someone out in the community who had the infection, Fazeli said. But there were two other possible sources: another employee who may have been exposed to an infected person outside of work, and a resident receiving end-of-life care who received visits from relatives one or two weeks before testing positive.

“There were multiple sources of exposure happening because of the community transmission,” he said. “The fewer sources of transmission you have, the more chance you have of containing it early.”

The second outbreak also may have spread more quickly because it started among people connected to Durgin Pines’ dementia unit, where residents are less able to follow precautions such as social distancing. “The dementia patient can’t remember to stay away from others,” Fazeli said. “That multiplies transmision.”

Durgin Pines was better equipped to handle the second outbreak because of its experience with the first, which gave Fazeli more experience and understanding of how to treat COVID-19 patients. About 80 percent of the infected residents have recovered after the facility worked to contain the virus’ spread and provide many of the same medical services a hospital would, according to Fazeli, who caught the virus while treating the patients during the second outbreak. There were just three remaining active cases as of Wednesday.

The prison and two manufacturing operations that have suffered repeat outbreaks all said they have followed Maine CDC guidelines throughout the pandemic and that their first outbreaks were instructive in how to respond to the second.

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Anna Black, a spokesperson for the Maine Department of Corrections, which runs the Maine Correctional Center in Windham, said the prison was able to test for the virus more rapidly in November through the use of point-of-care testing systems — as opposed to sending samples to the Maine CDC lab — that weren’t available during the first flareup last May that infected four people.

The isolation of infected inmates into separate units, known as cohorting, also helped limit the second outbreak, which had infected 154 people through the start of this week, Black said. The facility had 469 inmates in its general population as of May, according to the Department of Corrections.

“While the number of infected residents at MCC was high, the facility was able to keep the virus contained within two units,” Black said of the second outbreak. “This is a result of the cohorting and testing procedures.”

While it’s always difficult to respond to a coronavirus outbreak, facilities such as Durgin Pines that have done it more than once are “more aware of the cadence of what needs to happen, what happens next, what the next steps are,” said Maine CDC Director Nirav Shah. “That allows for both us as well as them to do more advanced planning on day one, anticipating, for example, how many testing supplies would be needed, how the increase of an outbreak will change the demand for” personal protective equipment.

An employee works in the coronavirus unit at the Durgin Pines nursing home in Kittery. It’s one of a few Maine elder care facilities that have now experienced two outbreaks of COVID-19. Credit: Courtesy of Jabbar Fazeli

Long-term care facilities are particularly vulnerable to COVID-19 outbreaks, as staff must provide hands-on services to residents who live in close quarters where the virus can rapidly spread, and because residents are generally at higher risk of death from the virus due to their age and health. One of the biggest threats is that workers may catch the virus outside of work or at another job, then bring it back into the nursing home or assisted living center.

Fazeli also serves as the chief medical officer for the parent company of Clover Health Care, the 109-bed nursing home in Auburn that suffered a second outbreak in mid-November that has become more serious than the one last spring, with 63 residents and 35 staff confirmed to have infections as of earlier this week and seven deaths among residents, according to the Maine CDC.

As with Durgin Pines, that outbreak was made worse by the ongoing spread of COVID-19 in the surrounding community — Androscoggin County now has Maine’s highest infection rate — and by the fact that some of its initial spread was in a dementia unit, according to Fazeli.

The three other long-term care facilities that have seen repeat outbreaks during the pandemic are Seal Rock Health Care in Saco, the Mooring on Foreside in Cumberland Foreside and the Barron Center in Portland.

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Representatives for Seal Rock, which reportedly had three deaths in its second outbreak, and the Mooring, which had none, didn’t respond to requests for comment.

The Barron Center, a 219-bed facility run by the city of Portland, had just four cases during its first outbreak in the spring and three in the one that the state began investigating in late November. No deaths have resulted from the small outbreaks.

During the second outbreak, two cases have been in residents and one in a visiting hospice worker, according to Administrator Rebecca Gagnon. It’s not clear how those people, who were all asymptomatic and revealed to have the virus through regular testing, contracted the virus.

The Barron Center’s response to coronavirus infections has been consistent throughout the pandemic, according to Gagnon. The center’s success is clear from the fact that just three cases have been detected out of more than 350 staff and residents who were tested as part of the second outbreak, especially with the virus circulating widely in the Portland area.

Part of that success, Gagnon said, is that the Barron Center has not brought in outside workers from staffing agencies, who may be at greater risk of carrying the virus because they spend time in multiple different locations.

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