A group from visitors from Massachusetts at Old Orchard Beach last Saturday. Ben McCanna/Staff Photographer

With the state reopening, the summer tourism season under way and the coronavirus surging across much of the southern United States, many Mainers are anxious about the possibility that out-of-state visitors could spark a resurgence of COVID-19 here as well.

Those fears may be justified.

Updated figures from the Maine Center for Disease Control and Prevention on how many nonresidents have tested positive for the virus in Maine show a near quadrupling in the pace of new cases in the last 11 days of June compared to the previous period.

The CDC provided the data Thursday evening after previously claiming only two-week-old numbers were available. The updated data arrived several hours after the Press Herald published an earlier version of this story to its website reporting that it was difficult to determine what impact visitors were having because the state’s data was old.

Even before the CDC provided the data, there was anecdotal evidence of growing infections among nonresidents in Maine.

“We are seeing increasing numbers of out-of-state patients testing positive in our health system,” said Dr. Dora Anne Mills, chief health improvement officer at MaineHealth, the state’s largest hospital network. “We are seeing snowbirds, people visiting family, tourists, some of them admitted for something seemingly unrelated who then tested positive.”

In Castine, local officials learned June 23 that multiple guests and relatives of Premium Parking CEO Jim Huger of New Orleans had tested positive for the disease shortly after returning to Louisiana from Huger’s 38-acre estate on Nautilus Island, which faces the village from across the harbor. The difficulty ascertaining the facts of the incident illustrate the challenges facing local officials when cases are introduced by visitors.

Huger told the Castine Patriot newspaper that he couldn’t confirm the number of infected guests, but he said they included his son and his boat driver, and that the infection had originated in New Orleans. He did not know whether the infected guests had visited the mainland.

Town manager Shawn Blodgett issued a statement June 24 advising residents to remain calm, adding it would be “foolhardy to think that this is the last time this will happen.” Blodgett told the Press Herald via email that he had no additional information.

The Maine CDC said in a statement June 25 that it could not “confirm the outbreak,” but Dr. Nirav Shah, the agency’s director, told the Bangor Daily News that eight people linked to the group had tested positive, all of them nonresidents. Maine CDC spokesman Robert Long told the Press Herald on Friday that there are no confirmed cases among Maine residents who had contact with anyone at the Nautilus Island event.

MDI BUILDS OWN TESTING SYSTEM

The uncertain statewide situation has prompted Bar Harbor leaders to try to develop additional safeguards, including a pilot project to test 200 restaurant servers, hotel clerks, retail cashiers and other tourism workers six times each over the summer in an effort to catch new outbreaks before they get out of hand.

The effort started in late April and picked up speed when local officials realized Gov. Janet Mills’ quarantine rules for visitors might not be vigorously implemented or enforced, according to Rep. Brian Hubbell, the Bar Harbor Democrat who represents the island in the Legislature. (Mills announced Wednesday she was lifting all quarantine and pre-arrival testing requirements for residents of New York, New Jersey and Connecticut, having already done so for New Hampshire and Vermont.)

“We talked about what we would do irrespective of the quarantine requirements and whether they stayed in place, and in all cases the physicians in particular believed the two essential components were the widespread use of masks and some extent of baseline sentinel testing of asymptomatic employees,” Hubbell said. “It seemed pretty clear what the advantage would be of having early evidence of any sort of infection, given the influx of tourists and the tenfold population increase in the summer.”

Arthur Blank, president and CEO of Mount Desert Island Hospital and a member of the local task force working on the issue, helped secure bulk supplies of masks to distribute to local business owners and set up a system to gather test samples to send to the Maine CDC lab for processing.

“We’re very concerned that our population is changing minute to minute,” Blank said. “Our business community is working very hard to provide a safe environment for visitors, but we are concerned that we are entering a new phase.”

The scale of testing has been limited by a shortage of swabs, testing equipment, gowns and other items needed to perform the tests and preserve the samples until they can be processed, Blank said. “I don’t want to downplay all the different efforts made to increase the supply chain, but it’s all very much in development,” he added.

AN UNCERTAIN PROCESS

What will happen when a nonresident – whether a tourist or a seasonal worker – is found to be infected is unclear.

Shah has said repeatedly in his briefings that nonresident cases of COVID-19 detected in Maine are referred to the person’s state of origin, where public health officials are supposed to take up the job of tracing everyone they came in contact with while infectious so they all can be tested. But asked repeatedly this week how effective this process had been so far, agency spokesman Long said via email that “Maine CDC already does contact tracing for out-of-state residents associated with outbreaks,” citing the investigation into the May outbreak at a Cianbro construction site in Augusta, where 19 people from multiple states were investigated.

“We also collaborate with public health officials from other states when their work can benefit from our knowledge or proximity to affected individuals,” Long added.

MDI Hospital’s Blank said there is no way to know how well contact tracing of nonresidents is being handled, especially when being coordinated by public health officials in a different state.

“If we have a positive case we report it to the Maine CDC and they communicate directly with the public health officials in that person’s state, and any communication that goes on with the patient is between them,” he said. “So our concern is that there is no real way of knowing what the quality of that tracing is.”

“The obvious reality is that it is more difficult for anybody to do contact tracing with someone who is hundreds of miles away,” Blank added.

The Mount Desert task force – which also includes the local chamber of commerce, town managers, state Sen. Louis Luchini, the Acadia National Park supervisor and Healthy Acadia, the public health partnership for the area – has been lobbying for the Maine CDC to create systems to contact trace seasonal residents and other out-of-state visitors using local resources and volunteers.

“We haven’t gotten any commitment from Maine CDC about pursuing that, and I guess it would come to a head once there were a significant number of nonresidents who had received a positive test,” Hubbell said.

Dora Anne Mills, a former Maine CDC director and sister of Gov. Janet Mills, said the national protocols by which contact tracing of infected individuals is done by their home state’s health departments envisioned diseases like HIV and tuberculosis that are much less contagious and where far fewer people were affected.

“It’s a national conundrum,” Mills said. “People across the country are saying: Does it really make sense for another state to do the contact tracing?”

During the April surge of the disease in New York and Massachusetts, Mills said MaineHealth had patients from those states who had tested positive for the disease.

“There was just no way at that time that anybody in New York City and Boston was going to pay attention to a case in Maine at that time,” she said. “Now we have all these states that are in the middle of a surge, and those health departments probably have very few capabilities to divert to contact tracing of someone in Maine.”

DATA TRENDING UPWARD

Asked for an updated count of confirmed cases among nonresidents in Maine, Long initially said the Maine CDC’s most recent data available ended June 19. He said the agency had previously deemed monthly tallies sufficient but that “with travel now increasing in Maine and nationally, Maine CDC will tally case transfers weekly.”

The agency’s figures on nonresidents have been released only sporadically since the pandemic began, often in response to media requests.

Thursday evening, hours after the Press Herald published an earlier version of this story to its website, Long disclosed cumulative figures as of June 30 showing that 107 nonresidents had tested positive for the disease in Maine – 26 of them since June 19, a rate of 2.4 new cases per day for this 11-day timespan.

This represented a substantial increase since the previous available period, May 11 to June 19, when there were also 26 new cases, but over a longer timeframe, for a rate of 0.66 new cases per day.

That was a substantial slowing in pace compared to the previous reporting period, April 20 to May 11, when there were 18 new cases and an average of 0.86 per day; and the one before that, April 9 to 20, when there were 20 new cases, an average of 1.8 per day; On April 9, the first day the state reported data on nonresident cases, Maine CDC reported 17 cases.

As of June 19, Maine had transferred a total of 81 COVID-19 investigations to health authorities in other states, according to the agency, a move made when a case turns out to involve an out-of-state resident. The majority of those cases were from New Hampshire (with 23 such cases) and Massachusetts (with 19), Long said.

By comparison, between May 11 and June 19, 1,451 Maine residents tested positive for the disease, meaning the nonresident share has remained tiny.

Not all of the transferred cases involved people who had set foot in Maine, Long said. Some were New Hampshire residents whose health care providers sent their tests to Maine for processing, he said, and a few were students residing elsewhere who had listed their parent’s Maine addresses for billing purposes.

Maine is particularly vulnerable to out-of-state infection vectors, as tourism is its biggest industry and the state has the highest proportion of vacation homes in the country at 19 percent of the housing stock.

Two other states with large numbers of seasonal residents – Hawaii and Florida – post information on nonresident cases on a daily basis, and Florida provides the numbers by county on its website. Maine, by contrast, doesn’t disclose the information on any regular schedule and only began doing so at all on April 9, the morning after the Press Herald had asked for the information.