Gov. Janet Mills on Tuesday extended a state of civil emergency through May 15, enabling her to continue using executive powers to enact or relax restrictions on businesses and Mainers’ social activities in response to the coronavirus pandemic.

The 30-day extension does not automatically lengthen the statewide stay-at-home order set to expire on April 30 but would allow the governor to extend it or impose new prohibitions should the virus continue to spread. Mills made the announcement on a day when confirmed cases of the COVID-19 disease topped 700 and Maine health officials reported the 20th death in the state.

Vital signs ICU beds: 312 total, 163 available Ventilators: 332 total, 280 available Alternative ventilators: 280 total and available

At the same time, Mills said she is talking with the governors of New Hampshire and Vermont about a collaborative approach to lifting restrictions, similar to other regional discussions happening elsewhere around the country. The timing of those decisions will depend, Mills said, on medical science and public health data.

“That is really the question of the hour and I cannot answer it because we are taking it day by day, hour by hour,” Mills said during an afternoon briefing. “And that is what all of the governors in our area are doing.”

CASES RISING

Maine had just seven confirmed COVID-19 cases when Mills proclaimed the civil state of emergency on March 15. The proclamation allows the governor to marshal additional resources – such as the Maine National Guard – or more easily tap into federal funding while also giving her the ability to impose quarantines, close businesses or order other restrictions in order to protect public health.

The number of cases has increased by a factor of one hundred in the month since the original proclamation, although infection rates and deaths remain far lower in Maine than in southern New England states and are a fraction of those seen in New York and New Jersey.

On Tuesday, the Maine CDC announced one additional death from COVID-19 – identified only as a woman in her 70s from York County – and 36 additional confirmed cases. To date, the Maine CDC has confirmed 734 cases of COVID-19 but nearly 40 percent of those individuals have already recovered from the disease and been released from isolation.

After accounting for deaths and recoveries, Maine CDC reported 422 active cases of COVID-19 on Tuesday, which was increase of 36 from Monday.

The virus has been documented in every county except Piscataquis, but is centered in Cumberland and York counties, which account for 331 and 152 cases, respectively.

State health officials warn that those figures only capture part of the outbreak in Maine, however, because of limited testing capacity and the fact that many people can carry the virus for a week or more after exposure without exhibiting symptoms.

“The cases are out there, we just haven’t documented all of them or confirmed all of them,” Mills said as she urged residents statewide to remain at home and maintain physical distancing when in public. “It is everywhere or we have to assume that it is everywhere.”

Nationwide, there were more than 570,000 confirmed COVID-19 cases and more than 23,000 deaths as of Tuesday, according to the coronavirus tracking system operated by Johns Hopkins University. The World Health Organization was reporting more than 1.8 million cases and 117,000 confirmed deaths from the disease around the globe.

NURSING HOME OUTBREAKS

Nursing homes and other long-term care facilities are a top concern and priority for state health officials. In recent days, the Maine CDC has disclosed several outbreaks of three or more infected residents or staff members, thereby triggering universal testing at the facilities.

“Although we are aware of at least three facilities in Maine where there are outbreaks and although we anticipated the likelihood of more, we are similarly aware of other facilities where there has been one case that did not flare up into an outbreak,” said Dr. Nirav Shah, director of the Maine CDC. “And that’s a good thing. It’s a testament to the fact that rapid, intensive infection control practices can prevent one case from turning into more cases.”

The Tall Pines retirement community in Belfast is reporting 19 residents and five staff members have tested positive for the disease. The Maine Veterans’ Home in Scarborough, meanwhile, saw its case count increase by six overnight to 38, while Augusta Center for Health and Rehabilitation added eight new cases, bringing its total to 63.

Shah said many of those new cases were among staff members who were tested upon returning to work after several days off.

Maine CDC staff are working with managers at each facility to put in place rigid infection-control regimens – such as “cohorting” infected residents away from non-infected individuals – and to ensure they have enough masks, gloves and other personal protective equipment, or PPE.

On Monday, the Maine CDC shipped more than 67,000 pieces of PPE to health care facilities around the state, with roughly two-thirds of that going to nursing homes or other “congregate care” settings.

DHHS officials are contacting all 93 long-term care facilities statewide this week to ensure that they have adequate emergency response plans for COVID-19 and, if not, quickly help bring them up to code with federal requirements. DHHS also planned to distribute an additional $8 million to long-term care facilities in the coming weeks.

‘ALTERNATIVE CARE’ SITES READIED

Among the other metrics closely tracked by Maine CDC, Shah said 37 people with COVID-19 were in regular hospital beds while 21 were being treated in intensive care units. Nine of those individuals were on ventilators.

Hospitals reported that 163 of the state’s 312 ICU beds were available as of Tuesday and that 280 of 332 total ventilators were available. Additionally, the state has 280 alternative ventilators that have been approved for use by federal regulators.

Shah and Maine CDC epidemiologists employ a combination of infectious disease modeling systems – each with its own strengths and limitations – to estimate potential needs for ICU beds, ventilators and technicians as the virus continues to spread.

One of those closely watched models, operated by the Institute for Health Metrics and Evaluation at the University of Washington, projected that Maine would experience peak demand for hospital services on Monday. The number of estimated deaths in Maine by early August declined further, from 115 to 63 since last week.

Asked about the estimate, Shah was careful to emphasize that it is just one of several models.

“We may not know for several weeks, several months whether today was the peak or was not the peak. In any outbreak, you really only know that in retrospect,” Shah said. “What I can tell you is that no matter which scenario we happen to find ourselves in, we in the state of Maine are ready for that from a resource perspective.”

One of those preparedness steps involves the launch of two “alternative care sites” – at the Cross Insurance Arena in Portland and the Cross Insurance Center in Bangor.

Jeanne Lambrew, commissioner of the Maine Department of Health and Human Services, said her department is moving forward with plans for those temporary sites.

The 100-bed Portland facility will care for COVID-19 patients who do not require intensive care, while the 50-bed Bangor site will focus on non-COVID patients in order to free up space in local hospitals.

Lambrew said beds have been moved to Portland, and DHHS is finalizing staffing arrangements. But with more than 160 critical beds available statewide as of Tuesday, the department has not activated either.

“Our goal is to keep people in hospitals wherever possible and we would only go to alternative care sites should we need to,” Lambrew said. “But at this moment, we don’t think we need to stand them up at this point. So we will continue to plan.”

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