Maine will follow new federal guidance that recommends people resume wearing masks indoors in high or substantial COVID-19 transmission areas regardless of their vaccination status, Gov. Janet Mills announced Wednesday.

Additionally, Mills said the state will adopt guidance that all teachers, staff and students in public K-12 schools wear face coverings whether they are vaccinated or not.

But because the data is changing so rapidly, confusion is likely to persist around the new county-level guidance for the general public.

For instance, early Wednesday, York and Piscataquis counties were listed as having “substantial” levels of community transmission, meaning that individuals in those counties should wear face coverings in indoor public settings, regardless of vaccination status. Substantial transmission is defined as at least 50 new cases per 100,000 people in the last seven days.

By Wednesday afternoon, however, the U.S. Centers for Disease Control and Prevention updated its county map and York and Piscataquis were no longer categorized as seeing substantial transmission – but Waldo County was.

Maine CDC Director Dr. Nirav Shah said at a briefing before the county designations changed that this could happen and that officials would be watching things closely. CDC spokesman Robert Long said late Wednesday that the data changed after the governor’s announcement and media briefing, and that Maine would follow the most current designations.

All of Maine’s other counties currently have “moderate” levels of community transmission and are not subject to the new recommendation. But that could change. The U.S. CDC has said it expects to update its county map every week. In some southern and midwestern states, every county has high or substantial transmission.

In a statement from her office, Mills said the masking changes are recommendations not requirements, which she cannot impose now that the state of civil emergency has ended. But she urged Mainers to do their part, including getting vaccinated if they haven’t already.

Maine’s high vaccination rate “has helped us keep our rates of COVID low compared to the rest of the nation, but the delta variant remains a threat that we want to keep at bay as much as possible,” the governor said.

Robert Horsburgh Jr., an epidemiologist at Boston University, said states like Maine might be better off making statewide recommendations given how frequently things can change.

“The fact is that the spread isn’t everywhere, but it could move everywhere,” he said. “It’s going to happen in pockets, usually areas where you see a lot of visitors and areas of low vaccination.”

Asked why Maine didn’t just recommend everyone wear a mask indoors, Shah said officials wanted to strike a balance.

“The balance is giving people advice based on the risk in their area and in not making them feel like the vaccine they got was for naught,” he said.

Shah also said that even though Wednesday’s announcement is a recommendation, most Mainers have done the right thing when it comes to public health guidance and he hopes that will continue.

REACTIONS MOSTLY POSITIVE BUT CONCERN OVER CONFUSION

In downtown Biddeford on Wednesday, several people said they supported wearing masks indoors again, while some business owners were just digesting the new guidance and trying to figure out what it would mean for their employees and customers.

At Elements, a cafe and bookshop on Main Street, owner Katie Pinard said she and her business partner were discussing the new recommendations Wednesday and how they would communicate expectations to the public.

“If I have to tell you right now what I think we’ll do, I think it will be whatever is between voluntary and required,” she said. “I have to think through the messaging over the next few days, but if I had to guess, that’s the direction we’ll start with. This whole thing is a one-day-at-a-time reality.”

Barista Josh Powers wears a mask as he makes drinks at Elements in Biddeford on Wednesday. Shawn Patrick Ouellette/Staff Photographer

Pinard recently reopened Elements for indoor seating in June and has asked her staff, though vaccinated, to continue wearing masks. She hasn’t required masks for customers, though a sign on the front door encourages those who are unvaccinated to wear face coverings. As a small-business owner, she said keeping up with the evolution of the virus has been exhausting.

“There was like whiplash a couple months ago with, ‘We’re all vaccinated. We get to take our masks off,’” she said. “Now it feels like whiplash in the opposite direction. I’m not blaming the CDC. I know they’re taking things as they come. But it’s just exhausting to be pivoting again and not to know what timeline we’re looking at. I have no idea what to expect for the fall or winter. Are we bringing back plexiglass?”

Later in the day, after York County had moved back into moderate transmission classification, Pinard said she still would be taking time to review the recommendations and come up with the best approach for the café with the aim of creating a policy that would provide some long-term consistency for staff and customers.

“We want some kind of sustainability and consistency,” she said.  “I don’t really want to be flip-flopping for everyone’s sake. I’m hoping to find some middle ground on messaging that can get us through the next few months instead of like cases are up, cases are down.”

Outside, Melia Coletta and Lisa Frates were having drinks unmasked. The two said they support the new recommendations and plan to resume mask-wearing indoors in areas with substantial and high levels of community transmission.

“We’re so used to wearing masks at this point that putting them back on doesn’t seem like a huge inconvenience if it’s going to save lives,” said Frates, 44, of Arundel.

Melia Coletta of South Portland, left, and Lisa Frates of Arundel have a beverage outside Elements in Biddeford on Wednesday. Shawn Patrick Ouellette/Staff Photographer

“It’s about being respectful of our community, which includes people who may not be able to get the vaccine because they’re immunocompromised or have other things that don’t allow them to take it,” said Coletta, 26, of South Portland. “It’s about being there for the community and also for businesses so they don’t have to shut down again.”

Inside New Morning Natural Foods, a café and market, some shoppers wore masks while others didn’t Wednesday afternoon. Dianne Navarro, who works as a nurse, happily wore her mask as she checked out with a few groceries. “I’m happy to do it,” said Navarro, 61. “I’m not coming out until I feel like it’s all clear.”

Navarro said there has been a lot of mixed messaging about what’s safe and what’s not, so she has continued to wear a mask even though she is vaccinated. “I’m just going to wear it until we feel like this thing is over,” she said.

Down the street at Dizzy Birds Rotisserie, owner Tom Peacock said he wasn’t sure how his restaurant would be navigating the new recommendations. Peacock isn’t currently asking staff or patrons to wear masks, though he said those who are unvaccinated should.

“I need to understand more, but our primary concern is that our employees are protected and our customers are comfortable doing what they feel is right,” Peacock said.

DELTA VARIANT ‘FORMIDABLE’

Shah said the delta variant has proven to be “more wily and more formidable,” than any other strain of coronavirus. At least 47 percent of new cases in Maine are the delta variant and the number is likely higher than that, he said.

“This change in recommendation from the U.S. CDC is for many of you unexpected,” Shah said. “This is a reminder that we’re still in the pandemic, but it’s also a reminder that this is science and this is what science does. Recommendations we make to keep you safe evolve … that’s what good science does and that’s what’s happening here.”

Maine’s Department of Health and Human Services and Department of Education also announced a plan Wednesday to support vaccination among school staff and students ahead of the fall school year. That plan includes partnering with schools to host free clinics, promoting vaccine education and collecting and posting online the vaccination rates for each school beginning Sept. 1.

DHHS Commissioner Jeanne Lambrew said the mask guidance in schools preserves the rights of local districts to make their own decisions, but she said it provides “an extra layer of protection.”

CASES, HOSPITALIZATIONS RISING

State health officials reported 65 new cases of COVID-19 on Wednesday. One additional death was reported as well, and the number of hospitalizations rose to 41, the highest daily total since mid-June.

With Wednesday’s cases, the state’s seven-day daily case average now sits at 68, up from 24 cases on average two weeks ago and from 21 cases this time last month.

Since the pandemic began, there have been 70,141 confirmed or probable cases and 899 people have died. The 41 people hospitalized with COVID-19 Wednesday is eight more than Tuesday and the highest daily total since June 12. Of those hospitalized, 16 are in critical care and nine are on ventilators.

There are 596 breakthrough cases among fully vaccinated people in Maine out of the more than 808,000 people who have gotten their shots. Shah said at least 60 percent of the breakthrough cases were asymptomatic and discovered through routine testing.

Tom Peacock, owner of Dizzy Birds in Biddeford, discusses the new mask guidelines with a reporter on Wednesday. Shawn Patrick Ouellette/Staff Photographer

Although the risk of serious illness or death for vaccinated people remains extremely low, there is research that suggests vaccinated people who are infected with the delta variant carry the same viral load as those who are unvaccinated. That means even though vaccinated individuals are far less likely to get sick, they can still transmit the virus easily.

But Shah said fully vaccinated people should not be overly worried, even if they might need to wear a mask again.

“Most spread around the country is among unvaccinated individuals and in low vaccination states,” he said.

Shah also said the risk of exponential growth is far lower now than it was last year, in large part because of Maine’s high vaccination rate. The question mark, he said, is whether another variant emerges that is resistant to the approved vaccines.

Horsburgh, the Boston University epidemiologist, said the resumption of mask wearing makes sense because there is no way for anyone in public to know who else around them is vaccinated or not. The mask is a sign that others are safe regardless.

VACCINES STILL THE MOST IMPORTANT TOOL

Cases, hospitalizations and deaths have been rising across the country amid lagging vaccination rates. According to the U.S. CDC, the seven-day daily case average is now nearly 57,000. This time last month, the average was just 12,600 and people went into the Fourth of July holiday with a feeling that the pandemic might finally be ending. The average number of daily deaths in the U.S. from COVID-19 has risen to 280 after bottoming out at about 165 deaths per day on July 11.

In Maine and across the country, those who are dying or being hospitalized are overwhelmingly unvaccinated. The recent surge has created some new demand for vaccinations, but the country is still well short of reaching any level of herd immunity and many who are unvaccinated say nothing will change their mind, polls have suggested.

Roughly 63 percent of all counties in the United States have either high or substantial virus transmission over the last seven days, the threshold the U.S. CDC set for areas where masking should resume. Four states – Louisiana, Arkansas and Missouri and Alabama – are in the top six in both highest seven-day case rate per 100,000 people and lowest vaccination rate.

Barber Nate Foran of Apex Barber Shop on Main Street in Biddeford discusses the new mask recommendations outside his barbershop Wednesday. Shawn Patrick Ouellette/Staff Photographer

Some Republican governors, even in states where cases are spiking the most, have criticized the new CDC guidance on masking. Democratic governors have come out in support.

Maine’s vaccination rate still ranks third behind only Vermont and Massachusetts, but has been stuck around 60 percent for all residents and about 68 percent for eligible individuals age 12 and older. In many rural counties, rates are much lower.

Health officials, though, continue to encourage people to get vaccinated, and there are small signs that things might be picking up slightly. For the week that ended Saturday, Maine averaged 1,299 shots per day, which is an increase from 1,164 shots per day on average the previous week.

“The most important thing that has not changed is the role of vaccines in getting us out of this pandemic,” Shah said.

Lambrew said state officials are closely watching what other states are doing in terms of incentives and mandates for employees and said Maine could adopt some of those strategies going forward.

Asked whether he thinks the new guidance might move more people toward vaccinations, Horsburgh said it’s possible.

“Some in that group can be persuaded,” he said. “But I think it comes down more to whether someone you know has gotten sick. If no one you know got sick from COVID, you just aren’t going to think about it the same way.”

Staff Writer Rachel Ohm contributed to this report.