A year of the coronavirus in Maine. Credit: Photo illustration by Natalie Williams / BDN

This story is part of the Bangor Daily News’ examination of the effects of the coronavirus in Maine, one year after the first case was detected in the state. Read all of our coronavirus coverage here.

AUGUSTA, Maine — The day the first coronavirus case was confirmed in Maine, a cluster of reporters gathered in Gov. Janet Mills’ office suite. Reporters packed closely together. Nobody wore masks or were familiar with the term “social distancing.”

Flanked by aides and a sign language interpreter, Mills announced limits on indoor gatherings and restrictions on travel for state employees. The governor’s goal was to prevent wide outbreaks with an approach “based on science and fact, not on fear.”

“On caution and compassion, and the hope that we as a community, as a state, as a team, can limit the impact of COVID-19 on the people of our state,” Mills said.

There would be many more news conferences in larger rooms and remotely via Zoom as precautions tightened. In the year since the first case was detected here, more than 46,000 Mainers have tested positive for the virus and 723 have died with COVID-19.

Despite the toll, Maine weathered the virus better than virtually everywhere else in America. It ranks third among states in per capita cases behind Vermont and Hawaii. While 3 of every 2,000 Americans alive at the start of the pandemic died from COVID-19, that ratio is 1 of 2,000 in Maine. Wide vaccinations give reason to believe the worst is behind the state and country.

The state’s rural geography — it was one of the last states to report a first case — and low population density helped limit transmission in the early going, experts said. A relatively high rate of mask wearing, plus travel restrictions and testing, have likely kept cases low. But even those measures were not enough to prevent the virus from infiltrating long-term care facilities or ward off wide winter spread that Maine has yet to fully recover from with cases flat.

“We know more now than we did then,” said John Gale, a University of Southern Maine researcher and president of the National Rural Health Association. “Even though we are not out of the woods yet, we know how to manage the disease and what the risk factors are. That makes decision making a lot easier than it was one year ago.”

The border crossing between the U.S. and Canada in Houlton is shown in this Oct. 20 file photo. Credit: Alexander MacDougall / Houlton Pioneer Times

Maine got an earlier jump on the pandemic because the virus was likely not widespread here before state officials knew it was here, said Robert Horsburgh, an epidemiology professor at Boston University. Other states were caught reacting to early outbreaks.

One conference in Boston in late February 2020 would be tied to more than 260,000 virus cases across the U.S., according to one study. While the virus almost certainly arrived in Maine before the first case was recorded on March 12 of last year, there is no evidence of superspreader events here in the early going.

Maine’s geographic remoteness gave the state an advantage, said Jennifer Tolbert, the director of state health reform for the Kaiser Family Foundation. Its border with Canada has been closed to non-essential travel since March 18 and only regional travel has been allowed for most of the past year without quarantine or a negative test.

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“We know now that when you control the flow of people across borders, you control the virus,” Tolbert said.

Nirav Shah, director of the Maine Center for Disease Control and Prevention, has often said the state’s preparation for the pandemic began months before the first case arrived here, when he heard from colleagues abroad about a virus taking hold in eastern China. His planning impressed state lawmakers and allowed Maine to begin distributing protective equipment.

Taco Trio in South Portland was among the Maine restaurants that had to close to dine-in service last year under coronavirus orders. It is pictured here in May 2020. Credit: Robert F. Bukaty / AP

Virus-related restrictions came down quickly after the first case was detected. Mills capped gathering sizes and required restaurants to switch to carry-out only before shuttering nonessential businesses in late March. As cases climbed, she signed an order in early April mandating a 14-day quarantine for visitors returning from out of state. Tolbert pointed to Maine’s quick adoption of mitigation policies as one reason for the state’s relative success.

“Maine closed its schools before New York state did and at the time, New York state was the second worst, or worst state in the country,” said Dr. James Jarvis, who leads Northern Light Health’s virus response. “We were very proactive, and I think it saved lives.”

In the spring of 2020, the Maine CDC studied several models for the pandemic’s possible course in Maine. In a worst-case scenario, the state could have seen thousands of new cases a day at the peak of the virus. Others were closer to the eventual trajectory of the virus here.

A masked boy runs along the sea wall at Spring Point in South Portland on Monday March 1, 2021. Credit: Troy R. Bennett / BDN

Early pandemic messaging emphasized “flattening the curve” — keeping virus cases low enough that hospitals would not be overwhelmed. Maine hospitals avoided capacity issues, and the state never had to use pop-up outdoor hospitals it planned for, though other states saw their health care resources overwhelmed at the peak of the pandemic.

Some of the changing policies had to do with increased understanding of the science behind the virus, including the role of airborne transmission. Maine began mandating face coverings effective May 1, before the U.S. Centers for Disease Control and Prevention had formally recommended them. The preceding period is now seen nationally as a missed opportunity.

“If we had known that even a month earlier and started the campaigns for people initially to wear face coverings, or wear masks, I think that would have been a tremendous asset to us,” Jarvis said. “But we really didn’t know how this virus spread.”

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Shah said that mandate followed a call where federal infectious disease specialists presented early data about how the virus spreads. A strict mask-wearing rule was important as a public health initiative and a signal to residents that Maine would be taking the virus seriously, he said.

Understanding how the virus worked also encouraged Maine to speed up the widespread availability of testing, Shah said. The state abandoned its testing priority strategy when it partnered with IDEXX Laboratories in early May to triple capacity. Maine is now eighth in the U.S. in volume of testing per capita, according to the Kaiser Family Foundation, but it was not until September that anyone could get a test regardless of whether a doctor recommended it.

As case levels remained low in some rural areas last spring, Maine loosened restrictions, allowing for indoor dining and nonessential businesses to reopen as long as they met social distancing requirements. Many states were rolling back restrictions at that time, although Maine had a significantly lower case count than most when it allowed businesses to reopen.

In June, Mills allowed visitors from a handful of neighboring states to come here without quarantining and — as testing became more widespread — allowed visitors to use a negative test as an alternative to the isolation period. Although tourism rebounded by more than expected, drops were still significant and hammered the economy. While full data are not yet available, the popular Acadia National Park saw 22 percent fewer visitors in 2020 compared to 2019.

Small groups of people remain socially distanced on Old Orchard Beach on July 7, 2020. Credit: Troy R. Bennett / BDN

Maine’s relative geographic isolation also meant the state was less likely to face repercussions for poor management of the virus elsewhere. Tolbert pointed to a motorcycle rally in South Dakota last August linked to an estimated 250,000 virus cases in at least 20 states.

But Maine’s closest neighbors were more effective than most in preventing the spread of the virus. Although neighboring New Hampshire had more cases than Maine, it still limited transmission better than all but a handful of states, according to a New York Times tracker.

The first COVID-19 case here — a U.S. Navy reservist from Androscoggin County who had traveled to Italy — drove home the reality that geography and good planning would not spare Maine from the virus. But Shah points to the The Commons at Tall Pines in Belfast’s first outbreak in April 2020 as the moment that “crystallized” the pandemic situation in Maine.

“From an epidemiological perspective, it also had several hallmarks and concerns,” he said. “It was in a relatively rural part of the state, Waldo County, not Portland, not Bangor, not Lewiston.”

A road was closed on March 16, 2020 at Oceanview at Falmouth, a retirement community, after a resident in his 80s and his spouse tested positive for the coronavirus. A resident of the facility was the first Mainer to die with the coronavirus. Credit: Troy R. Bennett / BDN

A long-term care facility in Falmouth had already seen the first outbreak in Maine and the first death. But the outbreak in Belfast, a city of fewer than 7,000 people in a county with only seven confirmed cases then, showed the virus was far more prevalent than testing indicated. It also showed workers were going to be the main cause of the virus entering long-term care facilities, which influenced the state’s emphasis on employee testing and mask fitting, Shah said.

Since the Tall Pines outbreak, dozens of other nursing homes and congregate living settings in Maine have seen cases of the virus. Long-term care facilities account for less than 10 percent of Maine’s virus cases but just over half of the deaths, according to state data.

Maine saw several other notable outbreaks in workplaces including a Tyson Food plant in Portland that was one of the drivers of transmission among Maine’s immigrant communities. Maine saw among the greatest racial disparities in virus cases in the U.S. early in the pandemic. The gap has narrowed since, though inequities remain.

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Conditions have changed since Maine first implemented — and then lifted — many virus-related restrictions last year. When Mills ordered nonessential businesses to close in March 2020, the state had 118 total confirmed cases. New case counts that high are still reported nearly every day. Bars and tasting rooms, the one category of businesses forced to stay closed last year, will be able to reopen indoors on March 26, a year and two days after Mills ordered them closed.

Maine CDC Director Nirav Shah gives his daily COVID-19 press briefing in Augusta on March 23, 2020 inside the Maine Emergency Management Agency. Regan Thibodeau interpreted. Credit: Troy R. Bennett / BDN

Shah acknowledged Maine is far from out of the woods. But he characterized the approval of three vaccines as a game changer. Health officials are hopeful that case numbers will gradually go down as more people get vaccinated. As of this week, the state has distributed more than 460,000 vaccine doses, with 1 in 8 Mainers considered fully vaccinated.

More contagious variants of the virus could pose a challenge, but the state’s current prevention measures should keep them from derailing its plans, Shah said. He argues Maine should not let the possibility of a resurgence prevent it from seeking a return to some type of normal.

“If you let … the theoretical possibility of a variant — one month, six months from now — be the sole decision maker [on reopening], then what’s your theory of coming out of the pandemic?” Shah said. “Because there was always going to be a variant on the horizon.

“There is always going to be something on the horizon.”