York County Jail, the site of one of the county’s COVID-19 outbreaks. Shawn Patrick Ouellette/Staff Photographer

York County has emerged as the epicenter of COVID-19 in Maine over the past two weeks, as outbreaks associated with a now-infamous Millinocket wedding reception and the defiant Sanford pastor who officiated it threaten to undo the state’s impressive achievement in having safely hosted an entire summer tourism season in the midst of a worldwide pandemic.

Maine’s southernmost county has seen spikes in cases as the disease has spread from people who attended a wedding more than 200 miles away to the York County Jail and sheriff’s department and the families of staff working there. Active outbreaks at the Sanford fire department and within the Calvary Baptist Church have not been conclusively linked to the wedding reception, but the church’s pastor, Todd Bell, was the officiant of that wedding, and he has recently spread disinformation about the efficacy of masks from his pulpit and suggested that being required to wear them is an affront to his congregants’ personal liberty.

Driven by these outbreaks, York County’s active COVID-19 case count per capita Aug. 28 surged ahead of Cumberland County’s for the first time and on Thursday stood at 7.4 per 10,000 residents, compared to 6 for Cumberland and 5 for Androscoggin. The county’s seven-day rolling average of new confirmed cases hit an all-time high of 13 per day Thursday, a per capita rate nearly quadruple that of Cumberland County and far and away the highest in the state. On Friday the state downgraded York County’s readiness for school reopening because of the elevated risk of virus transmission, making it the only Maine county that is classified as yellow rather green under the color-coded system.

“Closely monitoring our internal data and the state’s data, we’re seeing evidence of continued expansions in pandemic activity in York County that are concerning,” said Dr. Dora Anne Mills, chief health improvement officer at the state’s largest medical network, MaineHealth. “We hope it’s not too late to put the pandemic genie back in the bottle.”

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, emphasized the seriousness of the situation there in his briefing Thursday, saying it was of deep concern because nearly half of the new cases confirmed in the previous 48 hours had not been linked to the known outbreaks, raising the possibility the disease is spreading undetected.  “When we look at when the individuals are getting sick, they are not telling us they got sick three or four weeks ago and just happened to get tested,” Shah said. “Instead they are telling us they got tested two or three or four days ago.”

“I am concerned that if we do not get a grip on what’s going on in York County, it has the potential to spiral and start affecting adjacent parts of the state in the not too distant future,” Shah said. He was not available for an interview for this story.

Todd Bell, pastor of the Calvary Baptist Church in Sanford, speaking to his congregation last Sunday. Image from YouTube video

Concerning trends in York County

The proportion of York County residents’ COVID-19 tests coming back positive – the positivity rate – has also been increasing. Shah said Thursday the 14-day rolling average rate had hit 1.8 percent, triple the statewide average, and Mills said MaineHealth had seen an increasing positivity trend of its own lab tests of patients not linked to the outbreaks.

For now, the problem appears most acute in inland York County. York Hospital, which primarily draws from the south coastal and near-coastal communities between Kittery and Kennebunk, has not seen a change in the positivity rate of surgical patients and others it regularly tests. For the week ending Aug. 29 it stood at 0.5 percent.

“Overall our positivity rate hasn’t really shown an uptick,” said Dr. Evangeline Thibodeau, an infectious disease specialist at the hospital. “Stay tuned, because I think it’s too early to tell, and we need to be vigilant with our control practices and masking and be prepared for increased cases.”

COVID-19 hospitalizations, which generally lag exposure by one to three weeks, also remain low in the county. Southern Maine Health Care Medical Center in Biddeford had just one inpatient for one day during the week ending Thursday, one of its quietest since the pandemic began. York Hospital had an average of 1.4 patients a day, its busiest week since April, but none on Wednesday or Thursday.

“So far it seems to be confined to the west of us and hasn’t spread to the seacoast area,” said Erich Fogg, York Hospital’s testing director. “But we’re watching the situation closely, as this is a classic example of the virulence of this virus.”

Successful summer effort imperiled

The epidemiological impact of the Aug. 7 Millinocket wedding reception – where 65 guests celebrated indoors at close quarters – threatens to undo what has been a remarkably successful effort by Mainers and summer visitors to keep the disease in check during the summer tourist season and ahead of the reopening of schools. As of Thursday, 147 cases and three deaths statewide had been linked to the wedding, not including the 10 cases at Bell’s church, or nearly half of the 357 cases recorded in the two weeks ending Thursday.

Before the Millinocket infections began to be detected, Maine was vying day to day with Vermont for having the fewest new cases per capita in the country as tabulated by trackers at The New York Times, with a seven-day averaged rate of around eight daily cases per 100,000. On Friday that metric stood at 15, placing Maine third best in the country behind New Hampshire and Vermont.  The state still has among the fewest deaths per capita (45th) and deaths over the past seven days per capita (tied for 49th).

The Big Moose Inn in Millinocket, the site of an Aug. 7 wedding reception that has been linked to more than 140 COVID-19 cases and three deaths. Linda Coan O’Kresik/The Bangor Daily News via AP

The summer tourist season appears to have concluded without an epidemiological hitch. There is no evidence of out-of-state visitors triggering any outbreaks among Maine residents.

The Portland Press Herald/Maine Sunday Telegram has been tracking the statewide positivity rate for COVID-19 tests given to nonresidents: It fell from 3.2 percent in July to 1.8 percent in August as the testing volume more than doubled. Mount Desert Island Hospital in Bar Harbor, which has been at the center of a communitywide effort to test front-line employees and distribute masks to the public, hasn’t had a positive case, nonresident or otherwise, since Aug. 18.

“I’m pleased from a public health perspective that we’ve fared as well as we have,” said MDI Hospital’s CEO, Art Blank. “It’s been truly amazing the degree of cooperation that I’ve seen throughout the island.”

Coastal York County, whose beaches are in easy day-trip range of Greater Boston, hasn’t seen nonresident spikes either. York Hospital’s drive-thru COVID-19 testing site on Route 1 in York – where 65 to 70 percent of customers have been from other states – saw its seven-day rolling average positivity rate fall to 0.2 percent last week, the lowest rate of the summer.

The epidemiologically successful tourist season appears to have been the result of broad compliance with mask wearing and other public health advice by Mainers, visitors and business owners. In mid-August, southern Maine business owners and law enforcement officials reported increasing compliance across the board, and reporters visiting downtown Damariscotta, Belfast, Bar Harbor, Southwest Harbor and other tourism centers in midcoast and Down East Maine in late August also saw broad compliance by customers and business owners alike.

“This didn’t just happen because people wanted it to happen. A ton of money was invested in this by the hospitality sector,” said Steve Hewins, president and CEO of Hospitality Maine, which represents restaurants and lodging establishments. “All these little inns and restaurants across the state – even in backwoods areas like Eustis and Great Pond – invested money in everything from Plexiglas to PPE to training people, and they gave up a lot by limiting capacity. I hope people will look back and say that’s one of the reasons the state remained safe.”

ZIP code level and college pandemic trends

Since the pandemic began here in March, the brunt of the harm has been felt in and around the population centers of southern Maine, but the sparsely populated Katahdin region around Millinocket has also been among the hardest hit.

As of Aug. 30, the most recent data available from Maine CDC, downtown Portland (04101) was the hardest hit ZIP code per capita, with 16.3 cases per 1,000 since the pandemic began. Westbrook and Falmouth were second and third at 13.6 and 13.3 respectively, followed by Millinocket-East Millinocket (12.3), Portland’s other mainland ZIP codes, 04102 (11.6) and 04103 (11), and Lewiston (10). Cape Elizabeth, with 9.2 cases per 1,000 residents, Medway, near Millinocket (8.9) and South Portland (8.1) rounded out the top 10.

By comparison, York County’s hardest-hit community per capita, Acton, had a rate of 6.6.

People waiting to be tested for COVID-19 at the University of Southern Maine on Aug. 26. Ben McCanna/Staff Photographer

Maine’s colleges are in the midst of reopening, and are regularly testing students and staff for COVID-19. As of Friday, four have had outbreaks, defined as three or more cases: the University of Maine in Orono (with 15 infected students); the University of New England in Biddeford (nine students and one staff member); Colby College in Waterville (six students, two staff); and Maine Maritime Academy in Castine (three students, one staff.) The University of Southern Maine has reported four student positives; Bates College, two; Bowdoin, University of Maine Law School and the University of Maine at Fort Kent, one each.

The generally benign statewide trends this summer have been encouraging to health officials.

“I think it reinforces for us that having multi-stakeholder support for a safe environment and a safe culture does allow us to do things like entertain visitors and, hopefully, allow more and more people to return to work and return to school,” said MDI Hospital’s Blank. “The world won’t be ‘normal’ until there’s a vaccine, but that doesn’t mean that we can’t find ways of supporting each other and finding different ways to enjoy our lives and maintain the kind of social contacts that are endemic to being the social animals that we are.”