Seven deaths related to COVID-19 have now been linked to an Aug. 7 wedding and reception in the Millinocket area, and the state’s top infectious disease official expressed concern Tuesday that Maine’s coronavirus numbers are worsening.

“The trends we’ve seen over the last two weeks tell us things are getting worse or not getting better,” said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention. “COVID-19 is not on the other side of the fence. It’s in our yards.”

The agency said Tuesday that the deaths all were related to secondary spread of the disease after the wedding, with six occurring at Maplecrest Rehabilitation and Living Center in Madison. The state had previously linked five deaths to the wedding and reception. One of the new deaths was reported Tuesday, and the second will be reflected in the official case count on Wednesday.

“None of those individuals attended the wedding or the reception itself,” said Shah in a news briefing.

The super-spreading event emanating from the wedding has now sickened 176 people across the state, including a major outbreak at the York County Jail. The pastor who officiated the Aug. 7 wedding, Todd Bell, is the pastor at Calvary Baptist Church in Sanford, where 10 people have contracted COVID-19, although the Maine CDC has not established an epidemiological link between the wedding and the outbreak at the Sanford church.

Shah said that overall, “things right now in Maine are in a challenging situation” and he asked Mainers to “do their part” by wearing masks, following physical distancing and size-gathering rules, and other measures to curb the pandemic.

There are currently 501 active cases of COVID-19 in Maine, up from 423 on Sept. 8.

On the positive side, the University of Maine System reported Tuesday that there are no active cases of COVID-19 in the system, after 13 people previously tested positive out of nearly 15,000 tests given as part of the university’s screening and testing program.

Shah said while no decisions have been made, the Maine CDC is aware of research by the U.S. CDC released last week that draws a correlation between restaurant dining and increased likelihood of contracting COVID-19. The U.S. CDC said someone who had COVID-19 was twice as likely to have reported dining at a restaurant within the previous 14 days as someone who had not fallen ill.

Many states, including Maine, have at certain points in the pandemic banned indoor dining at restaurants, although most states now have reopened indoor restaurant service. Maine reopened indoor dining at restaurants this summer but encouraged outdoor seating and never reopened bars, which have been linked to super-spreading events in other states.

“As we go into the winter, the fall months, there’s going to be increased pressure on all sorts of hospitality-based industries to have people indoors,” Shah said. “We know now just how much higher the risk is from activities like dining.”

But Shah said that rather than implementing new statewide restrictions on restaurants, the first step should be improved mask-wearing and physical distancing in communities.

Shah also said no decisions have been made regarding trick-or-treating recommendations for Halloween, but that likely recommendations will include more physical distancing among groups of trick-or-treaters.

Maine reported a total of 18 new cases of COVID-19 on Tuesday. While that is lower than recent trends, the state has experienced four days in the past week with 30 or more cases, driven by a surge in cases in York County, which had nine of the 18 cases reported Tuesday. Cumberland County, Maine’s most populous county, had two cases.

The seven-day average of daily new cases has increased from 25 on Sept. 8 to 30.2 on Tuesday.

The state’s citation of the Big Moose Inn near Millinocket, which hosted a wedding reception that caused a COVID-19 outbreak, says a health inspector found that employees were not wearing face coverings, tables were not at least 6 feet apart and there was no social distancing. Linda Coan O’Kresik/The Bangor Daily News via AP

The York County outbreaks include at the jail, Calvary Baptist Church in Sanford, the Sanford Fire Department, the Lafayette Club and the Sanford American Legion.

On Monday, the Maine CDC announced that the number of cases connected to the wedding and reception in the Millinocket area had risen to 176, after more cases were discovered at the Maplecrest Rehabilitation and Living Center.

Retesting at the Madison nursing home found another 11 cases of COVID-19, which increased the case count for that outbreak investigation to 39, including 24 residents and 15 staff, Robert Long, Maine CDC spokesman, said in a statement.

Since the pandemic began, 4,918 COVID-19 cases have been reported in Maine and 137 deaths.

Also on Tuesday, the Maine CDC announced an outbreak at ND Paper in Rumford, where four cases have been confirmed.

In response to the York County outbreaks, the University of Maine System is ramping up testing and screening efforts at its facilities. The system anticipates testing about 700 students and employees at five southern Maine locations, including 400 at University of Southern Maine campuses in Portland and Gorham and the University of Maine School of Law in Portland. The testing is part of a previously approved $6 million effort devoted to strategies to prevent the spread of COVID-19 on system campuses.

The expanded testing also will be conducted at the University of Maine Cooperative Extension’s Springvale office and the University of Maine at Augusta’s Saco center.

Statewide hospitalizations remained low, with 10 people in the hospital, including five in intensive care units.