Dena Holmes, an employee at the Hampton Inn in Presque Isle, gets her temperature checked to test for COVID-19 symptoms before clocking in. Credit: David Marino Jr. / BDN

PRESQUE ISLE, Maine — At the end of September, there was not a single active COVID-19 case in Aroostook County, a vast region the size of Connecticut and Rhode Island combined.

The County experience was a far cry from what residents had heard about the pandemic’s effect on the rest of the country. People gathered without social distancing at events — from weddings to parties — with little worry. Face coverings sometimes drew scorn or ridicule, especially in smaller rural communities, where masks were associated with liberalism and the “other Maine.” It was as if the pandemic had not made its way to Maine’s north.

That has changed rapidly in recent days. From Dec. 1 to Dec. 10, Aroostook County saw 105 new cases, more than the 79 it saw in the whole month of November, according to data from the Maine Center for Disease Control and Prevention. And the 17 new cases on both Dec. 7 and Dec. 8 represented dubious daily records for The County. The County has also seen a rising portion of its COVID-19 tests coming back positive, another sign of the virus’ widening spread.

Aroostook’s active case rate pales in comparison to the rest of the state, let alone the country.

Yet, new cases have been rising rapidly. And in a region with an aging community, an aversion by many to face coverings and a rural hospital infrastructure, there are several risks to Aroostook County as it enters the next stage of the pandemic.

Though COVID-19 can have adverse effects for those in any age bracket, the vast majority of deaths from the virus have occurred in those older than 65. About 25 percent of The County’s residents are older than 65, higher than both the state’s and the nation’s populations — 21 and 16 percent respectively.

Poverty is also more rife in The County than the rest of Maine: 16 percent live below the poverty line, compared to 11 percent statewide, making it more difficult for residents to afford treatment for COVID-19. About 12 percent of residents do not have health insurance.

And while Aroostook County has several hospitals, including Northern Light A.R. Gould in Presque Isle, Cary Medical Center in Caribou, Houlton Regional Hospital and Northern Maine Medical Center in Fort Kent, they are far less equipped than their urban counterparts to handle a surge in cases.

From left (clockwise): Alban Bouchard of Fort Kent visits his wife of more than 60 years, Rita Bouchard on her birthday at Crosswinds Residential Care; Houlton girls soccer coach Marina Cameron cheers on her team during the Sept. 22  season-opening soccer match against Southern Aroostook; In order to comply with social distancing requirements, students at the Caribou Community School are grouped by their grade level; Josh Caler, a graduating senior at Hodgdon Middle-High School, pops a confetti container at the conclusion of the school’s commencement ceremony Friday, June 5. Credit: Chris Bouchard | Aroostook Republican & News; Joseph Cyr | Houlton Pioneer Times

Aroostook County had its first known COVID-19 case on April 2 after a patient at Houlton Regional Hospital tested positive for the virus. Aroostook was the third last of Maine’s 16 counties to see the coronavirus reach its borders. Only Washington and Piscataquis counties saw their first cases later.

There have since been five outbreaks in The County, including three in the last two weeks alone: an outbreak of 13 residents and 12 staff members at a Presque Isle nursing home, and outbreaks of five cases at Zippel Elementary School in Presque Isle and four at Presque Isle High School, both announced on Thursday.

On Wednesday, nursing home officials announced that two residents of the center had died of the virus. They announced a third resident had died on Friday, bringing Aroostook County’s death toll from COVID-19 to five.

Though two previous summer outbreaks made ripples, word of the nursing home outbreak quickly spread. Mask usage became noticeably more common in Presque Isle-area stores, though many in the region’s more rural areas have continued to go maskless in public places.

Enforcement of face mask-wearing and social distancing varies, often the prerogative of individual business owners.

As of Dec. 11, state officials had issued imminent health hazard citations to three Aroostook businesses for violating COVID-19 rules: the Littleton Pit Stop (for numerous infractions, including staff and patrons not wearing masks), Eureka Hall in Stockholm (for employees not wearing masks and a lack of mask signage) and Teresa’s Corner Cafe in Presque Isle (for tables not being 6 feet apart and no barrier at counter service).

Personal mask use often falls along political lines. Joseph Underwood, a Republican who won a seat representing Presque Isle in the Maine House in November, has repeatedly said that wearing a mask should be an individual choice, and he prefers not to wear one.

Conversely, Rep. David McCrea, D-Fort Fairfield, who won reelection to the Maine House in November, has said he believes wearing face coverings is a common-sense solution to stemming the spread of the virus.

As of Dec. 6, the hardest-hit area in The County has been the Houlton region: Houlton itself has had 45 cases, an increase of 12 in a week. Caribou (with 29 cases), Presque Isle (17), Fort Kent (14), Madawaska (10) and Fort Fairfield (six) had all seen their case counts grow in the past week.

With community spread now occurring in The County, Cary Medical Center Chief Medical Officer Regen Gallagher said that her staff was treating all patients as if they had COVID-19, using PPE at a “very rapid rate.”

Gallagher said the hospital — which currently is treating one patient known to have COVID-19 — has six ICU beds with plans to increase that number if necessary. She said the potential for running out of ICU beds was always present, especially as the hospital treats non-COVID ailments and if downstate hospitals it often transfers to fill up with COVID-19 patients.

Northern Light A.R. Gould President Greg LaFrancois said his hospital had the capacity to treat the increased number of COVID-19 patients it had seen in recent days and had contingency plans in the event of a larger surge.

He said the rise across Maine is emblematic of a “post-Thanksgiving” surge health officials expected as people traveled for the holiday. He and Gallagher did not expect this increase to halt in the coming weeks.

“We all need to take steps to protect the people around us,” LaFrancois said. “It is more important than ever to wear a mask, physically distance and take all of the steps necessary to slow the spread of COVID-19.”

Correction: A previous version of this article misgendered County Medical Center Chief Medical Officer Regen Gallagher, who uses “she/her” pronouns.

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