Gov. Janet Mills announced her plan to gradually ease stay-at-home restrictions beginning May 1, but it remains unclear whether the plan will meet all the criteria that many public health experts say are necessary to ensure a safe reopening.

Those criteria include: at least a two-week decline in the number of positive tests and people hospitalized; widespread access to testing for the public; and a robust track-and-trace system capable of finding people who have had contact with an infected individual so they can be quarantined.

In her plan Tuesday, Mills said the Maine Center for Disease Control and Prevention would “monitor and report to the governor epidemiological data, such as case trends and hospitalization rates, as well as health care readiness and capacity, to inform decisions on the appropriateness of proceeding through stages and lifting restrictions.”

But she did not outline specific benchmarks she plans to use to quantify the decline in cases, testing capacity or track-and-trace capacity.

Maine CDC spokesman Robert Long said in an email Tuesday that the CDC is doubling its contact tracing staff from 15 to 30 and plans to add more. He also said the state ranks 23rd highest per capita in the nation for total tests completed and is “working aggressively” to improve that, including by “continuing to press the federal government to ensure that rural states like Maine receive adequate testing supplies.”

“These expanded capacities, along with progress on other metrics and the status of the virus, will be crucial to reopening Maine,” he said.


Mills said her new executive order, which she called a “safer at home” order, is not that different from the stay at home order that expires Friday. She said the state will continue to monitor all data through May to see if the next phase remains appropriate.

Maine CDC Director Dr. Nirav Shah also stressed that the state is not relying on any one metric.

“When we think about a potential rebound, we’re not just looking at any one criteria,” Shah said at a media briefing Tuesday. “We’re looking at all of them globally at once and making an overall holistic judgement about where things are and whether we might need to pump the brakes. It’s not driven by any one criteria.”

For weeks, state officials have said that they have not been able to conduct enough tests, in large part because of a shortage of supplies. Health care workers and those who are at high risk, such as residents of long-term care facilities, are the top priority for testing, but many others have not been tested.

Shah has not put a specific number on how much the state should be testing but said as early as last week that Maine could double or even triple its capacity.

One analysis of state-by-state testing published Monday by the Harvard Global Health Initiative and the medical news site STAT suggested Maine was running about 30 percent behind where it should be on daily tests. That analysis showed good news for Maine, too, as the state was performing better than other New England states and its positive rate of tests – 5.7 percent – was low and a sign that an adequate number of people are being tested.


The other piece that is often cited as essential before states can safely reopen is developing a robust system for tracking and tracing people who have tested positive or who are presumed positive. Shah said his team at the Maine CDC has been doing contact tracing since the beginning, and the agency said Tuesday that it’s doubling the number of tracers. It’s not clear, though, what number would be considered adequate or robust.

Tracking-and-tracing is critical in combating new outbreaks because it calls for isolating and quarantining when appropriate. But that also hinges on adequate testing.

A widely cited team of disease modelers at the University of Washington’s Institute for Health Metrics and Evaluation (IHME) recently analyzed each state by asking: What’s the maximum number of new infections that a state could handle with current testing and contact tracing capacity? The institute’s answer was 1 new infection per million people. Once a state reaches that level, it could reasonably keep outbreaks from happening even after some restrictions are lifted.

IHME’s team built a model to forecast when each state will reach its threshold of 1 new infection per million.

By May 10, only five states are projected to get there – Alaska, Hawaii, Montana, West Virginia and Vermont, according to a news release. Twenty states won’t reach the threshold until the beginning of June or later.

Maine should get there on May 19, according to IHME.

Over the last 10 days, the daily average of new confirmed cases has been 19.3. For the previous 10-day period, the average was 31. In addition, the number of active cases (all cases minus those who have recovered and those who have died) has leveled off over the last two weeks after steadily increasing for about a month.

Both Mills and Shah said Tuesday that while it appears Maine is successfully flattening the curve and that stay-at-home measures have been working to slow the spread, a spike, or several spikes, are still possible in the future.

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