A sign on the door to a Portland building instructs visitors to wear a mask on Tuesday Dec. 22, 2020. Credit: Troy R. Bennett / BDN

The coronavirus is again hammering Maine’s nursing homes and assisted living facilities, causing some of the deadliest outbreaks in elder care centers since the start of the pandemic and also reaching a wider range of places.

When the coronavirus first surged in Maine last spring, much of its transmission was driven by outbreaks at long-term care facilities in more populated sections of southern Maine and along the coast.

The surge this fall and early winter has been different, reaching every corner of the state as it spreads like wildfire among people in virtually every community and breaks new records for infections, hospitalizations and deaths.

That rampant spread also seems to have left Maine’s long-term care facilities more vulnerable than ever to outbreaks, even as those facilities are poised to gain more protection from the coronavirus vaccines being rolled out across the state and country.

Of the more than 70 outbreaks that have emerged in Maine long-term care centers — defined as three or more linked cases — more than a third have been detected just in December, and more than half have been discovered since the start of November.

Those new outbreaks are now emerging everywhere from the Portland suburbs to northern Aroostook County, where four different nursing homes have suffered outbreaks this month.

Many of the new outbreaks are also some of the most severe since the start of the pandemic. Since late October, Maine has discovered its four largest outbreaks at elder care facilities, defined by the total number of infected residents and staff, according to state data from last week.

Five of the 10 deadliest outbreaks at Maine long-term care facilities have also been reported in that timeframe, including at Island Nursing Home in Deer Isle, Durgin Pines in Kittery, Clover Health Care in Auburn and Gray Birch in Augusta, which have all resulted in at least a dozen resident deaths.

State officials have attributed the new uptick in nursing home outbreaks to the increasing prevalence of the virus across Maine as more people gather indoors during colder weather.

Even though nursing homes have learned many best practices for keeping the virus out or containing its spread, staff are more likely to catch it themselves while picking kids up from daycare or going shopping, then bringing it into work before they start showing symptoms, according to those officials.

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From there, nursing homes are uniquely vulnerable to outbreaks because staff must deliver hands-on care to residents who live in close proximity and whose poor health makes them more susceptible to the worst effects of COVID-19.

“Where there are high rates of community transmission, there are likely to be outbreaks in nursing facilities, and where there are increasing rates, for example in Aroostook County, we anticipate seeing more,” said Nirav Shah, director of the Maine Center for Disease Control and Prevention.

“I think what this tells me is just how insidious the virus is. Even in highly controlled situations where [protective equipment] is commonplace, where infection control is the norm, outbreaks have still happened within nursing facilities. It’s just an indication of how difficult this virus is to control, and why it’s all the more important for the rest of us to take” protective measures, he said.

Dr. Jabbar Fazeli, a spokesperson for the Maine Medical Directors Association — a group that represents the medical directors of the state’s nursing homes — agreed that increased community transmission is driving the greater number of outbreaks.

Fazeli serves as the medical director of Durgin Pines, the Kittery nursing home that had a serious outbreak of COVID-19 this fall after overcoming a smaller one last spring. Durgin Pines staff were well-protected with respirator masks and other supplies as they worked to contain the second outbreak, Fazeli said, but it still sickened more than 50 residents and 28 staff, including Fazeli himself.

Maine has partnered with the Jackson Laboratory to identify the variants of coronavirus spreading in Maine, but so far the state does not have any evidence that the state’s mutations of the virus are more contagious or that the variant from England has shown up here, according to Shah.

Matthew Trombley, executive director of Island Nursing Home in Deer Isle, said there was little more he and his staff could have done to prevent COVID-19 from reaching the facility.

Throughout the pandemic, they have done frequent testing and temperature checks and widely used protective equipment. After the outbreak started, they worked to contain the virus by barricading residents into three cohorts: those who had tested positive for COVID-19, those who had not tested positive but showed symptoms and those who were negative and did not show symptoms.

The facility has now seen nearly 100 cases among staff and residents since its first case in mid-November, with 14 of the 61 infected residents dying, but it has not had a new positive case since Dec. 9.

The outbreak took a heavy toll on staff and residents, who were offered counseling. “The emotional aspect is not always something you can prepare for,” Trombley said. He also expressed concern that Mainers holding indoor gatherings over the Christmas holiday may lead to even more community spread and a greater risk of outbreaks forming in nursing homes.

If there has been some consolation to Maine nursing home officials in recent months, it’s that the growing availability of coronavirus vaccines from Moderna and Pfizer/BioNTech will help protect staff and residents from the worst health effects of COVID-19.

At Island Nursing Home, staff and residents will be vaccinated on Jan. 5, Trombley said.

Fazeli hopes that all of Maine nursing homes and assisted living facilities will be able to complete the vaccinations of their residents and staff by March. After that, he hopes the state can roll out the vaccines to the family members of staff and the general population by June.

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