As COVID-19 cases soar across the country and in New England, Maine’s top health officials are worried that the state could see a corresponding surge as the colder weather sets this fall and winter.

Case spikes in nearby states are “deeply concerning,” Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said in a media briefing Thursday.

“Maine is holding steady, but we can’t ignore what’s happening in our neighbor’s yards,” Shah said, referring to recent increases in cases around New England.

Maine reported 31 new cases of COVID-19 on Thursday and one additional death, a woman in her 90s in York County. After subtracting probable cases from previous days that turned out to be negative, the net increase was 20 cases.

The state’s average number of daily cases has climbed in recent weeks, with the seven-day daily average of new cases at 31.1 on Thursday, 31.4 a week ago and 28.4 a month ago. In early- to mid-August, the low point so far of the pandemic in Maine, the seven-day average of daily new cases was about 15.

In the past two weeks, the seven-day average of cases has surged by 112 percent in New Hampshire, doubled in Connecticut, and increased by 70 percent in Rhode Island and 25 percent in Massachusetts, Shah said.

Vermont’s cases are still very low, and Maine’s increase recently has been more of a gentle slope, but Shah said there are warning signs all around us.

Nationwide, new cases have increased from about 35,000 cases per day in September to about 50,000 per day, with the Upper Midwest, parts of the South and interior West hit particularly hard. The U.S. has recorded more than 220,000 deaths since the pandemic began and 8.1 million cases, according to the Worldometer website.

Stephen Kissler, a professor of immunology and infectious diseases at Harvard University, said that school reopenings, more indoor gatherings and virus dispersion from population centers to more rural parts of the country are helping to drive higher case counts.

“Part of the story is we are seeing the transmission trickle from major population hubs from the spring, like New York, into other parts of the country,” he said.

Although more research is needed, Kissler said it’s possible that colder, drier weather will make the virus transmit more easily, a warning sign for the upcoming winter.

A second coronavirus wave is also hitting Europe, as the European Union is now surpassing per-capita case counts in the U.S., with countries like France, Spain, the U.K. and the Netherlands being particularly hard hit this fall. France on Wednesday imposed a curfew in Paris and other major cities to try to tamp down COVID-19.

In New England, Shah said as the virus prevalence increases in nearby states, the odds rise that Mainers visiting friends and family in other states will bring COVID-19 back to Maine.

“We are concerned less about tourism than individuals from Maine traveling, going to see friends and family in nearby places and inadvertently picking up the virus,” Shah said. “We are not disconnected from the rest of the country.”

Dr. Laura Blaisdell, a pediatrician and infectious disease expert from South Portland, worries about complacency heading into seasons when people spend more time indoors, where the virus may be easier to transmit.

“We’ve been diligent, but we’ve also been lucky,” Blaisdell said.

Overall, Maine has recorded 5,836 cases of COVID-19, and 144 deaths.

People crowded Commercial Street in Portland on Sunday. Derek Davis/Staff Photographer

As the United States is experiencing a surge in cases this fall, Maine’s numbers also have increased, but not as much as the states with exponential growth of COVID-19. Maine’s virus prevalence is second-lowest in the country, at 2.3 cases per 100,000 people on a seven-day average, with Vermont the lowest at 1.5 cases per 100,000, according to the Harvard Global Health Institute.

Thirteen states – including Kansas, Tennessee, Wisconsin and Montana – are seeing uncontrolled exponential growth of COVID-19, with case counts of 25 per 100,000 or more, according to the institute. The states with the worst levels of virus prevalence, South Dakota and North Dakota, have more than 72 cases per 100,000 population.

One bright spot for Maine compared to most of the country is the state’s low positivity rate, the percentage of COVID-19 tests that come back positive. As testing capacity has surged in Maine, the percent positive reached a new low on Thursday, 0.42 percent over a seven-day period. Over the past month, Maine’s positivity rate has hovered around 0.5 to 0.6 percent, while the U.S. positivity rate is about 5 percent. A low positivity rate means public health workers have a better chance of isolating people who test positive before they infect others, reducing transmission and curtailing outbreaks.

“We have better visibility into what is truly going on in Maine,” Shah said. “We can see cases of COVID-19 when it’s just one or two people, which in turn allows our contact tracers and case investigators to in jump in to work with those who tested positive, and provide them with safe, supportive isolation really quickly.”

Community transmission, which means cases detected that are not part of an outbreak, is occurring in four of Maine’s 16 counties – York, Cumberland, Androscoggin and Penobscot. Hospitalizations in Maine remained low, with 11 currently hospitalized, and five in intensive care. Portland Public Schools reported its first case, one case of a student or staff member at Ocean Avenue Elementary School.

Blaisdell said she’s concerned about the reopening of bars on Nov. 2, although if done correctly the risk can be minimized. Rules put out by the state for bars – if followed – will transform them more into restaurants, with less mingling among patrons.

“There are ways to open safely, but will people choose to do it safely?” Blaisdell said. “Generally, I’m a little concerned. I just don’t think people appreciate how transmissible this virus is yet.”

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