Maine set another record Friday with 243 new COVID-19 cases, continuing a disturbing trend that has put pressure on hospitals, made contact tracing more challenging and prompted Gov. Janet Mills to eliminate Massachusetts from the states exempted from a mandatory quarantine or negative test.

“The surge we predicted has arrived,” Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said during a media briefing. “Now is the time for all of us to make sure we’re taking the necessary steps to keep a lid on things.”

Three more deaths also were reported Friday, bringing the state’s total to 162 since the pandemic began. Over the last two weeks, 16 people have died from COVID-19 complications, more than one per day. In the previous two-week period, there were none.

The additional deaths were a man in his 70s from Penobscot County, a man in his 70s from Androscoggin County and a woman in her 80s, also from Androscoggin County.

Hospitalizations have been rising rapidly, too, up to 66 on Friday, including 18 in critical care, the most since June. This time last month, just eight people were in the hospital.

Seen through the windshield of her vehicle parked under a red tent, Haylie Morris of Freeport uses a self-administered swab at a free drive-up COVID-19 testing at the Westbrook Public Safety building on Tuesday. Staff photo by Derek Davis

“I think we dodged a bullet with tourist season, but the public health people and scientists had talked about a fall surge since the beginning,” Maine Hospital Association President Steven Michaud said in an interview. “They were right, unfortunately.”

Friday marked the fifth consecutive day of at least 100 cases and the 10th time in the last 11 days the state has reached triple digits. The seven-day average of daily cases also rose to 171, the highest to date. One month ago, the seven-day average was 30 cases. Cases have been rising across the country, leaving state leaders in the unenviable position of considering, and in some cases imposing, additional lockdown measures.

Mills has resisted renewing strict lockdowns, although she has tightened some regulations – including the limit for indoor gatherings – and has strengthened the state’s mask mandate.

On Friday, Mills announced that beginning Monday visitors from Massachusetts would no longer be exempt from the state’s 14-day quarantine or proof of negative test requirement. Massachusetts’ rate of new cases is presently more than two times that of Maine’s. Mills already had removed New York, New Jersey and Connecticut from the list of exempt states. Only residents of New Hampshire and Vermont remain exempt.

“Like most people in Maine, I am extremely concerned about the spread of this virus as we head into the holiday season when we customarily gather with friends and family, often in neighboring states,” Mills said in a statement. “Some of our New England states, including Massachusetts, have demonstrated a concerning increase in the prevalence of the virus over the last two weeks.

“I recognize this will be an inconvenience for many, but it is in the interest of public health and can keep people, including our loved ones, healthy and safe this holiday season.”

Also Friday, Mills updated the state’s color-coding system for schools, moving Androscoggin County into the yellow designation, joining Knox, Franklin, Somerset and Washington counties. Under the yellow designation, schools should take extra precautions, such as limiting the number of people in school buildings at the same time, suspending extracurricular or co-curricular activities or other measures.

The remaining counties remain green, although the state is closely monitoring Cumberland, Hancock, Kennebec and York.

As cases climb, the state’s ability to effectively contact trace to help contain the spread is jeopardized. Some states have effectively given up trying to contact trace because the volume of new cases is too high to keep up with.

Shah said Friday that he’s not ready to “throw in the towel.” He said the CDC has been training people from other departments to assist with contact tracing, bringing the number of staff members up to 135.

Asked if there was a ceiling where the state would lose its ability to effectively contact trace, Shah said, “I don’t know.”

“We’re not there yet,” he added.

Although the increase in hospitalizations is a cause for concern, Maine’s rate of hospitalization, 4.6 per 100,000 people, remains well below the national rate of about 13.

And hospitals are in a better position now than they were in the spring, said Michaud, the hospital association president. At least for now.

Michaud said if things don’t change, the shortage of critical care beds will become acute in about a month. Many hospitals have the ability to convert some rooms, but that wouldn’t solve the problem.

“Then it’s really going to be managing patients and pushing back surgeries,” he said. “And alternative sites will be back on the table. It’s going to get real here pretty quick.”

“It’s still in our hands to control this,” he continued. “Flattening the curve back in the spring was to avoid overwhelming the hospitals. Thankfully that didn’t happen, but we were mostly shut down. If hospitals are overwhelmed now, we won’t have a choice but to shut down again.”

Another concern is hospital staffing. As cases increase, the number of health care workers who will either contract the virus or need to be quarantined because of exposure is certainly going to go up.

Additional cases were reported Friday in every county except Aroostook and Sagadahoc, a sign that community spread has taken hold in many cities and towns across the state – even rural areas that had largely been spared from the virus.

Androscoggin County, driven by the outbreak at the Russell Park Rehabilitation and Living Center in Lewiston, led with 68 new cases, and Cumberland (40), York (33) and Penobscot (27) also saw high numbers Friday. The Russell Park outbreak has infected 64 of the congregate care facility’s 94 residents, growing from 72 positive tests among staff and residents on Monday to 129 cases on Friday.

Health officials say the recent increase in cases nationwide has been driven more by smaller indoor gatherings where people aren’t always masked or distanced, rather than the larger gatherings that defined the early days of the pandemic.

In Maine, new cases also continue to significantly outpace recoveries, which has driven the number of active cases over 2,000 for the first time – three times what it was one month ago.

Many states have seen precipitous and even record-breaking rises in cases, hospitalizations and deaths over the last several weeks as the winter months approach and more people move indoors, where the risk of the virus spreading is greater. Despite Maine’s rapid rise, it still ranks low in the number of cases per 100,000 people and its test positivity rate of about 2.5 percent is much lower than the national average of 6 percent, a sign that testing capacity here is strong.

On Thursday, the United States set a record for the seventh time in the last nine days with more than 152,000 cases. According to Johns Hopkins University, there have been more than 10.8 million cases and more than 240,000 COVID-19 related deaths in the United States. Both are far and away the most of any country.

Maine Health and Human Services Commissioner Jeanne Lambrew, who appeared with Shah during Friday’s briefing, said the state is exploring all options for fighting the continued spread but said much of the battle comes down to personal behavior. Asked about the strict mask mandate, Lambrew said she doesn’t want businesses to have to be mask police but hopes that everyone complies.

Shah had the same message.

“Could things turn in a positive direction? The answer there is, absolutely yes,” he said. “The exquisite benefit of mask wearing, coupled with physical distancing, is the best set of tools we’ve got.

“What I feel most strongly about is: Where we go from here is up to us. The virus is going to spread opportunistically, but it need not be that way. We have the tools to cut off the virus at every pass.”

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