Maine has emerged as a national hot spot for COVID-19 infections as New England – long the safest part of the country – has been hammered by the delta variant of the disease.

Delta has pushed the state’s health system to its limits even as a new wave of infections is expected in the coming weeks from the faster-spreading omicron variant, which was officially detected in Maine for the first time on Friday.

Maine had the country’s fourth-highest number of new cases per capita over the past week – a daily average of 78 per 100,000 people – a rate more than double the national average. The state also had the second-fastest rate of change – an increase of 148 percent over 14 days – after Connecticut, according to a national tracking database of statistics from state and local health agencies maintained by The New York Times.

The daunting trends are largely driven by an explosion in cases across western and northern Maine. On Friday, Aroostook County had the third-highest per capita new caseload of all 3,240 counties and county equivalents in the United States and U.S. territories at a staggering 149 daily infections per 100,000 people. Piscataquis County was ranked 15 and Penobscot, Franklin and Androscoggin were all in the top 50.

If Aroostook County were a country it would have had the third-highest rate on the planet Friday, according to the Times’s tracker.

The surge in cases comes on top of three months of unrelenting growth as the more contagious delta variant spread over Maine, pushing hospitalization levels for the disease to double the numbers seen during the worst pre-vaccination surge a year ago. Last week the state’s largest hospital, Maine Medical Center, had its worst burden of the entire pandemic, while most other hospitals coped with numbers higher than anything seen before delta – and now omicron – arrived on the scene.

Gov. Janet Mills deployed 38 members of the National Guard to 10 hospitals and long-term care facilities Monday to relieve stress on the medical system. The federal government also sent 15 medical professionals to Maine Med for the same purpose Dec. 11.

“It’s alarming,” Maine Center for Disease Control and Prevention Director Dr. Nirav Shah said of the state’s diminishing hospital capacity, which he said was aptly illustrated by a political cartoon he recently saw of a hospital patient in a bed in the middle of a swimming pool, being kept afloat by a struggling nurse. “Providers are literally keeping patients afloat, but at great cost to themselves.”

“It is not out of the realm of possibility that we will approach a time where ICU beds will not be available,” Shah warned. “Not just for COVID patients but for any patient. We have plans to avoid that and to deal with a two-hit situation like a big pileup on the highway but, oh boy.”

Dr. Laura Blaisdell, a pediatrician and vaccine policy expert, said that when the pandemic began Maine had a game plan: Use social distancing and masks to keep hospitalizations and deaths low until a vaccine was created and widely distributed.

“We in Maine won that first half of the game,” she said. “But I’m afraid we’re losing the second half and it’s the unvaccinated who are throwing our game.”

CHANGING PATTERNS

It’s not entirely clear why Maine and other New England states have been hit so hard in recent weeks, but it follows a seasonal pattern seen last year before vaccines and the more contagious variants arrived in the U.S. In both 2020 and 2021 the pandemic struck southern and western interior states hard in the summer, then turned its wrath on New England and the upper Midwest.

“With colder temperatures, especially in the Northeast and upper Midwest, there’s a lot more indoor gatherings,” says Dr. Thomas Tsai, a health policy researcher at Harvard University’s T.H. Chan School of Public Health. “In the South, in the hotter temperatures they tend to be more indoors with air conditioning, so that is definitely a factor.”

The early success of states like Maine and Vermont – which led the nation in vaccinations and in keeping the original version of the novel coronavirus in check – ironically may be contributing to the rapid spread of the new variants in both states now.

Maine has the oldest population in the country and got more people vaccinated back in the spring of 2021 than most states, meaning the efficacy of the vaccines has started to wane in people who have not received a third shot of the Pfizer or Moderna vaccine. Fewer people got sick in the early waves, so there is less non-vaccine “immunity” in rural pockets of Maine than in places like South Dakota or Georgia that had massive outbreaks in the first year of the crisis.

“Maine did so well that we just don’t have a lot of natural immunity in the background,” says Dr. Evangeline Thibodeau, an infectious disease expert at York Hospital in York. “If we have areas that haven’t had COVID before and where few people are vaccinated, that’s a recipe for delta to take hold and spread rapidly.”

GEOGRAPHIC AND POLITICAL DIVISIONS

What is clear is that COVID-19 is thriving in places with low vaccination rates and leaving places with high vaccination rates relatively unscathed.

The geographic disparities in Maine are stark. In Cumberland County on Friday, 81 percent of all residents were fully vaccinated and the densely populated county had the lowest new case loads in the state. In hard-hit Franklin, Piscataquis, Aroostook and Somerset counties, the vaccination rate is just 57 percent to 63 percent, according to the Maine CDC.

In Cumberland County, 26 percent of all 5- to 11-year-olds have been fully vaccinated. In Franklin that figure is 15 percent, in Aroostook 14, and in Somerset just 8.6.

“This is really the story of the two Maines,” says former Maine CDC Director Dr. Dora Anne Mills, chief health improvement officer at Maine Med’s parent entity, MaineHealth, who is originally from Farmington in hard-hit Franklin County and visits the area regularly. “If you go to Whole Foods in Portland, everyone is masked and if you go to Hannaford in Farmington almost nobody is, except the employees.”

The cleavages on vaccines and new cases mirror the state’s historic divides between the “rim counties” that border on Canada and the rest of the coast and Kennebec and Androscoggin Valley towns. The Maine CDC’s latest ZIP-code level data on vaccination rates – dated through Dec. 13 – shows relatively high vaccination rates in every town bordering on the ocean (save Kittery and Machias). Low vaccination communities – those with a population-wide rate under 75 percent – are clustered in the interior from Eliot and the Berwicks in York County to Presque Isle and Fort Kent in the far north.

The geographic disparities in vaccination rates don’t neatly correspond to rural versus urban. Portland’s rate is a healthy 83 percent of all residents, but Bangor’s is only 71, and Lewiston’s just 66. Some rural towns have very high rates like Whiting in far eastern Maine (91 percent) or Eagle Lake in the far north (92), according to the Maine CDC. But rates are low in the places where most residents of Franklin, Somerset, Oxford, Piscataquis, Penobscot and Androscoggin counties live.

Shah said he is concerned that the decision to get vaccinated is becoming driven by political-cultural identities, putting tens of thousands of Mainers and millions of Americans at unnecessary risk.

“I think it has gone beyond a simple scientific belief and is now becoming part of someone’s identity,” he said. “You see very readily people on social media proud of where they have been boosted or vaccinated or proud of not being vaccinated at all. This has a huge implication from a messaging and convincing standpoint because we are essentially asking a large swath of the population to change their identity on this.”

Mills said that for this reason the messengers bearing public health and vaccination facts are extremely important.

“We very strongly need people from conservative circles – religious, faith and business – to really stand up and promote vaccination,” she said. “We desperately need them to do this to save our health care system and to save lives. I am very worried about the coming weeks.”

CAPACITY TESTED IN HEALTH CARE FACILITIES

The stress of the building surge is already hitting hospitals hard.

In the early months of the pandemic, public health authorities were prepared to open field hospitals at the arenas in Portland and Bangor. In a sense, Maine has again reached the point where those would have kicked in.

Shah said last week’s National Guard deployment was in effect facilitating the creation of new crisis hospital capacity to relieve stress on the state’s large medical centers. But instead of field hospitals, the idea is to create surge capacity within existing medical facilities.

With the Guard’s help, the 10-hospital MaineHealth network is setting up new capacity at the St. Joseph’s Manor rehabilitation center in Portland in order to open up space at MaineMed. Eastern Maine Medical Center is relying on a facility in Waterville.

“That’s structurally the same model, but smaller and with a city-by-city approach rather than having a giant tent hospital in Bangor,” Shah said. “It’s effectively an alternate care site, but smaller and more replaceable.”

With the holidays coming and even more contagious omicron variant presumed to be circulating in the state, experts expect the situation to get worse before it gets better. And previous assumptions that masks and social distancing could be dropped as vaccination rates exceeded 70 or 80 percent are now outdated, given the new variant’s ability to spread faster and challenge vaccine defenses.

“We know what we need to do – nothing has changed in mitigation strategies,” Dr. Thibodeau said. “Stay home if you’re sick. Practice social distancing. Get vaccinated and get boosted.”

Dr. Blaisdell agrees. “I think we know how to do masking, distancing and testing – all these things work, but I’m really looking forward to life getting back to normal,” she said. “And the way we get back to living a normal life during the pandemic is through high vaccination rates.”