As new COVID-19 cases reached a record for the third consecutive day in Maine, and as fears of uncontrolled community spread mount, a troubling question emerges: Is it too late to reverse course?

The short answer is no, but it will require vigilance.

“This is a war, we have to have a wartime mentality,” said Robert Horsburgh, an epidemiologist at Boston University. “We have to sacrifice, and we should be sacrificing equally. Without that, another lockdown is going to be the next step if things don’t improve.”

Dr. Thomas Tsai, assistant professor with the Harvard Global Health Institute, said Maine, and the nation, are on the “steep part of a sharply rising curve,” but public health strategies can still be effective. He said Maine has had a “very robust” public health response to the pandemic, and has a lot more tools at its disposal compared to the spring.

“We can act decisively to control it. A large basket of smaller interventions can be effective,” Tsai said. “This is within our control to suppress it.”

Cases are spiking everywhere. On Wednesday, the U.S. recorded more than 102,000 new infections – the first time it has gone over 100,000 since the pandemic began. The nationwide seven-day average is nearly 90,000, an increase of more than 100 percent in the last month, according to data from Johns Hopkins University. To date, more than 9.4 million Americans have been infected with COVID-19 and more than 233,000 have died.

But Maine does indeed have a lot going for it. Even though the state’s positivity rate – the percentage of tests that come back positive – has tripled in the last two weeks, it’s still just 1.5 percent, which is a sign that widespread testing is being conducted and not just on people who are strongly believed to have the virus. Other states have positivity rates of 10 percent or more.

Maine also has a governor, in Janet Mills, who has demonstrated over the last eight months that she’s willing to be aggressive with restrictions and safety measures – even in the face of criticism – and that she will prioritize public health over economic considerations. On Thursday, Mills strengthened her executive order on face coverings to require that they be worn in all public places, regardless of whether people can physically distance or not, following a similar order by Massachusetts Gov. Charlie Baker.

On Sunday, Mills postponed the reopening of bars and tasting rooms and dialed back the limit for indoor public gatherings. She also removed New York, New Jersey and Connecticut from the list of states whose residents are exempt from either a 14-day quarantine or negative test when they visit Maine.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, was not available for an interview Thursday, but at a briefing Wednesday, he was uncharacteristically somber about the direction Maine is headed. Afterward, he wrote on Twitter that he was “out of synonyms for concerning.”

On Thursday, he explained why: “This degree of community transmission means that face coverings and physical distancing are more important than ever,” he wrote on Twitter. “Why do I worry? Today’s community transmission can become tomorrow’s outbreaks in places like nursing homes. We all need to do our part to keep them safe.”

Hospitalizations and deaths often lag behind cases, and Maine already is seeing hospitalizations creep up. On Thursday, there were 38 people hospitalized, including 17 in intensive care units – the highest numbers since early June. One month ago, just nine people were hospitalized and only one in critical care.

Steven Michaud, president of the Maine Hospital Association, said hospitals are bracing for the worst. He said there are two positives now that weren’t true in the spring: We’ve learned how to manage the virus better and more younger people are contracting the virus and their cases typically don’t lead to hospitalizations.

“There is nothing else that’s good about it,” he said. “Give it a week and we could see the hospitalizations start to ratchet up.

“My biggest concern is, back at the beginning, the hospitals basically emptied themselves. They stopped taking everything that wasn’t an emergency procedure to create capacity. The surge never panned out and that’s great, but that led to major financial losses. We don’t have empty hospitals now, so if this gets going, the threat is that we could be overwhelmed a lot more quickly.”

Michaud also said he’s concerned about the impact on rural hospitals, since the recent surge in cases has hit rural areas harder than in the spring. Calais Regional Hospital, he said, recently had to transfer COVID-19 patients to Bangor.

Rick Erb and Nadine Grosso, president and vice president of the Maine Health Care Association, which represents nursing homes and long-term care facilities, shared Shah’s concerns about nursing homes.

“The greatest predictor of whether COVID-19 will appear in a facility is whether it’s in the community, so that’s the concern as we see this trend of higher cases,” Grosso said.

Erb said senior living facilities in Maine are in better shape than they were this spring. They have more personal protective equipment for staff and visitors, although there are still shortages from time to time. They have better access to testing. They are better equipped to isolate residents who may have been exposed to help limit the spread.

But residents of nursing homes remain among the highest risk individuals for complications or death if they contract COVID-19.

“Our members have really, to be honest, had the same consistent level of fear,” Erb said. “There’s not a day that goes by that our folks don’t worry about the virus getting in.”

Dr. Jabbar Fazeli, medical director for Durgin Pines in Kittery, is dealing with a second COVID-19 outbreak at that nursing home. The first was in May.

“The good part is that we’re more prepared now,” he said. “We have the supplies we need and access to testing, which wasn’t the case last time.”

Fazeli also said nursing homes are better equipped to catch cases earlier and to isolate people to limit spread.

“The goal is always to keep it out, but once it gets in, that shifts to containment,” he said.

Tsai, with the Harvard Global Health Institute, said two keys for Maine in the coming weeks will be compliance with mask mandates and the partnership between the state and Walgreens to roll out 15-minute antigen tests. The rapid tests are a better tool for states because they can more quickly capture asymptomatic cases, and more people can isolate when they are contagious.

Maine is receiving 400,000 rapid antigen tests by the end of the year, with 300,000 in Walgreens, where anyone who thinks they need a test can get one for free. Another 100,000 are being distributed to employers with essential workers, such as in health care facilities, schools, and police and fire departments. The rapid tests, which are manufactured by Illinois-based Abbott Laboratories – which has manufacturing plants and a lab in Maine – are being distributed nationwide.

“We are moving from a reactive testing strategy to a proactive one,” Tsai said. “The testing technology we have been waiting for has arrived. Through testing, we can now identify more people who are infectious and stop them from spreading the disease.”

One major concern about increased community spread in Maine is whether the state will be able to keep up with contact tracing, which helps identify close contacts of confirmed cases. Some states have all but abandoned contact tracing efforts and Shah has acknowledged major challenges, even as his agency has added more staff in recent weeks.

“There is a physical limit to how much contact tracing you can do, and some people haven’t been as forthright,” said Horsburgh, the Boston University epidemiologist.

In many cases, a feeling of pandemic fatigue has set in. People are tired or bored or even angry about the fact that things haven’t returned to normal. In Maine, which did so well over the summer to keep the virus from spreading, the recent trend could be another wake-up call.

“I think the point of no return is when you run out of space in hospitals,” Horsburgh said. “I’m afraid we’re headed in that direction. A vaccine is still a ways off. We need to hunker down and get through the winter.”

Michaud, the Maine hospital association president, said he travels a lot for his job and sees a lot of complacency in rural parts of the state, with masks especially.

“I feel like we’re on that cusp,” he said. “If we quit the gatherings, if we abide by the masking, I think we can keep this at bay. But we are kind of at that tipping point and we’re seeing how quickly and exponentially this can spread.”

Staff Writer Joe Lawlor contributed to this report.

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