An employee works in the coronavirus unit at the Durgin Pines nursing home in Kittery in November 2020, when the nursing home was experiencing a COVID-19 outbreak. Outbreaks at long-term care facilities are rising again in April after two months of declines. Credit: Courtesy of Jabbar Fazeli

COVID-19 outbreaks at Maine long-term care facilities are on the rise again this month after declining through much of the winter.

The Maine Center for Disease Control and Prevention has opened 12 outbreak investigations at long-term care facilities across the state this month, from York to Aroostook counties. That’s more than the number it opened in February and March combined. Those April outbreaks — 10 of which are ongoing — have infected more than 90 residents and staff members, with staff members making up a majority of cases. Nobody in those outbreaks has died.

The Maine CDC opened just six outbreaks in February and five in March after an early winter that saw numerous outbreaks at long-term care facilities across the state. Thirty-six outbreaks began in January alone, infecting more than 700 and killing 36.

The new outbreaks may be a reflection of rising COVID-19 cases in Maine, as well as more infectious variants spreading across the state. In addition, nursing home staff members have been vaccinated at lower rates than the residents for whom they care.

Maine has seen the seventh-highest increase in COVID-19 cases of any U.S. state over the last two weeks despite having the highest rate of fully vaccinated people, according to the New York Times. It has also had the fifth-highest rate of new hospitalizations during that time.

The April outbreaks are likely the result of unvaccinated staff members bringing the virus into their workplace, said Dr. Peter Millard, former epidemiology staffer at the U.S. Centers for Disease Control and Prevention and an adjunct professor at the University of New England.

An unvaccinated person can infect several other people in a group living situation, including residents and staff who are fully vaccinated, he said. He cited a recent CDC study examining an outbreak at a skilled nursing facility in Kentucky, which appeared to begin when an unvaccinated employee who had COVID-19 brought it into the facility.

Eighteen fully vaccinated residents and 22 vaccinated staff members became infected, including one resident who died. However, vaccinated staff and residents had a far lower infection rate than their unvaccinated counterparts and were also far less likely to have symptoms of the virus.

“Nothing is 100 percent effective,” Millard said. “And if the staff are not vaccinated, they are going to bring it into the facility, and there will be future outbreaks.”

Millard said nursing home staff tend to be younger and less likely to see the urgency behind getting vaccinated.

At Madigan HealthCare in Houlton, where six staff members and one resident were infected as of April 23, several staff members decided to get vaccinated in the aftermath of the outbreak, administrator Jim Brown said in a Facebook post on April 20.

All Maine residents 16 and over have been eligible to receive the shot since April 7. About 37 percent of Mainers 16-49 had received one shot of the vaccine as of Monday compared with about 70 percent of those 50 and over.

After an initial burst of demand when vaccine eligibility widened earlier this month, vaccine appointments have become widely available across Maine. MaineHealth has begun walk-in appointments for vaccines in Farmington, a policy it plans to extend to the system’s other hospitals in southern and western Maine in the coming weeks.

The most effective solution is to vaccinate all staff and residents, Millard said. At this point, he said, the onus was on trusted community leaders, such as priests, doctors and political leaders, to persuade people that the vaccine is safe and effective, especially as vaccine demand appears to flag.

It would be difficult or impossible for long-term care facilities to require that staff become vaccinated, as it may cause some employees to quit from long-term care facilities that are already understaffed, Millard said.

Only one of the new outbreaks recorded this month had infection numbers in the double digits. MaineGeneral Rehabilitation & Long Term Care at Glenridge in Augusta has seen 39 infections (29 residents and 10 staff members) but zero deaths since the Maine CDC opened an outbreak investigation on April 13.

It is unclear who introduced COVID-19 to the center, where there is a high vaccination rate among staff and residents, MaineGeneral Health spokesperson Joy McKenna said. Some who were fully vaccinated had tested positive, she said, but few had shown symptoms.

Correction: An earlier version of this report misstated the infection numbers for the Madigan HealthCare outbreak.