In this April 8, 2021, file photo, Kay Brown of Auburn fishes in the Little Androscoggin River in Minot with her family. Credit: Russ Dillingham / Sun Journal via AP

Maine’s recent rise in COVID-19 cases has disproportionately affected small towns outside of population centers in York and Androscoggin counties, challenging the state’s vaccine effort as well as assumptions about how the virus spreads.

Maine has seen some of the highest reported new case numbers in the last two days since January. Although the Maine Center for Disease Control and Prevention often reports large blocks of new cases at a time, reported cases have been on a steady upward creep over the last month as cases have risen nationally. It is occurring despite more available vaccines and 35 percent of Maine residents being fully vaccinated.

Androscoggin County, home to Lewiston, the second-largest city in the state, currently has the highest seven-day average among counties, with 50 people per 100,000 testing positive for the virus over the past week. Behind it is York and Kennebec counties, which each had roughly 43 people per 100,000 testing positive.

The top 20 zip codes with the highest infection rate in the last month are concentrated in York, Androscoggin, Kennebec and Oxford counties. Only three — Lewiston, Waterville and Sanford — are major urban areas. The highest case rates are occuring in relatively small towns. Health experts pegged the increases to possible fatigue from social distancing measures as the pandemic stretches into its 14th month in Maine, community transmission, more cases in younger adults and lower vaccination rates in those counties.

Parsonsfield, a York County town of about 2,100, saw the most dramatic increase, with 1.8 percent of its population sickened with 38 new cases recorded in the last month, according to Maine CDC data. It was followed by Norway in Oxford County and Mechanic Falls in Androscoggin County, where 1.6 percent of the population has been infected in the past month. Three other Androscoggin County towns — Livermore, Minot and Sabattus — have outpaced Lewiston during that period.

Parsonsfield, on the New Hampshire border, was a minor industrial center in the 1800s, but it now sits relatively far from population centers or health care hubs. Most people get care from the federally funded Sacopee Valley Health Center in Porter and are pretty good about social distancing, said Parsonsfield Select Board Chair Edward Bower.

For months, he said the town did not have one recorded virus case. He noted because the town is so small, even a few cases can have an outsized effect on the infection rate.

“I think it just caught up with us,” Bower said of the virus.

Art Cleaves, the director of the York County Emergency Management Agency, said the increase in rural York County was surprising, as he has noticed increased traffic in the more popular travel destinations along the coast.

He was not sure exactly what was causing numbers to go up, but thought it might be connected to school-related outbreaks, which can indicate greater community transmission. Of the 21 active outbreaks in York County, only one is not at a school, according to the Maine CDC. In Androscoggin County, only two of the 13 active outbreaks are not at a school.

“Sometimes it feels like people have started to go about their normal business,” Cleaves said.

The increases could be due to rural communities struggling with hesitancy and vaccine access, Gibson Parrish, a former U.S. Centers for Disease Control and Prevention epidemiologist who lives in Yarmouth, said. The former is a national issue, with only three in 10 rural residents saying they will get vaccinated as soon as possible, despite that group also outpacing urban and suburban residents in getting shots, according to the Kaiser Family Foundation.

About 22 percent of Androscoggin County adults are fully vaccinated, putting them last among Maine counties, according to the Maine CDC. York County is in the lower middle with 28 percent of adults having their final shot, despite being the second-most populous county.

Maine is attempting to close access barriers in rural regions, deploying a mobile clinic this week mostly frequenting towns with poverty and transportation issues, according to federal vulnerability indicators. Those plans may be hampered after the one-shot Johnson & Johnson vaccine was paused after six women among millions to get the vaccine in the U.S. developed rare blood clots, although the state is seeking two-shot doses to maintain appointments.

Doug Smith, the chief medical officer at St. Mary’s Health System in Lewiston, said his hospital started recording an uptick in positive cases a few weeks ago. He suspected “COVID-19 fatigue” for the increase, noting people may be becoming less vigilant as vaccines become more available.

Smith said increases in York and Androscoggin counties could be tied to the lower vaccination rates, noting large-scale vaccination sites, to which Maine has directed large portions of its federal allocations aiming to vaccinate many people as possible, rolled out unevenly. He pointed to a mass clinic in the Auburn Mall opening on March 17, two weeks after one opened in York County and more than a month after large clinics opened in Scarborough and Bangor.

“Unfortunately, of the three major metropolitan areas, we were later to the game in getting a high-throughput clinic set up,” he said.

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