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'Unprecedented surge' in COVID-19 cases leads to 'difficult' changes in Maine CDC's approach to case investigations

The sustained increase in new cases and new lab reports has outpaced Maine CDC's ability to continue the approach used thus far, Dr. Shah explained.

AUGUSTA, Maine — On Monday, Maine CDC Director Dr. Nirav Shah painted a grim, but necessary picture of where Maine stands in the fight against COVID-19.

The seven-day moving average of new cases in Maine now stands at 291. Just one week ago, it was 168. That's a 73 percent increase just in one week, Shah explained during the coronavirus briefing Monday.

One week ago, 139 people were in the hospital with COVID-19. Currently, there are 170 in the hospital—a 22 percent increase in hospitalizations just in the past seven days.

A week ago, the positivity rate was about 3.95 percent; today it's 4.7 percent.

And just in the past seven days, 33 people have died with COVID-19.

The sustained increase in new cases and new lab reports has outpaced Maine CDC's ability to continue the approach that has taken us where we are right now, Shah says. And the surge is causing a backlog in the Maine CDC’s case investigation system–a system that relies on accuracy.

Shah explains the Maine CDC is facing interrelated concerns: the rapidly growing number of lab reports that must be reviewed every day and the need to assign them for investigation to ensure the focus is on the highest risk, most vulnerable individuals.

"We foresaw that this increase was coming and we believed we could keep up with it," Shah said. "But the surge on top of the surge that we saw last week challenged that process."

Shah explained that each and every positive test result is reported to the Maine CDC and is then reviewed by someone. That someone has to review whether it's a new case of COVID-19 or an existing person who has already been logged in the system. He said the Maine CDC needs to make sure when they're getting a lab result that they're not duplicating cases.

They also need to make sure the test results themselves are not duplicates, because Maine is what is called a dual reporting state, meaning the Maine CDC often gets two versions of the same lab report—one might come from the lab and another might come from the person's doctor.

Every one of the lab reports the Maine CDC gets has to go through a process to ensure it's not a duplicate.

"All of that requires a thorough review to ensure that when we have a case, it is a new case, not an existing case," Shah said. "Accuracy matters in this process, because what's at stake is an accurate daily case count."

Shah says in recent days, the Maine CDC has developed a gap–the number of new lab reports that have been coming into the Maine CDC has been exceeding their ability to do that review process on a daily basis. For example, on Friday alone, the Maine CDC received 650 reports.

As of Monday morning, the number of lab results awaiting review had grown to over 4,000.

Shah says, however, the number of cases the Maine CDC still has to review does not affect things like positivity rate or the number of people in the hospital. All the same, the Maine CDC faced this issue and knew they needed to make some changes.

With a focus of preserving the ability to address the needs of the highest-risk individuals in Maine as well as those who they care for or who care for them, Shah said their “discussions and decisions were extremely difficult and they were unpalatable, but they were also necessary in these times of an unprecedented surge."

Until now, every person who tested positive for COVID-19 received a case investigation from the Maine CDC. But in light of the increasing number of new cases, this will no longer be the case.

Maine CDC will continue to conduct case investigations of the following groups:

  • People age 18 and younger
  • People age 65 and older
  • People who are hospitalized
  • People identified on the lab report as a minority 
  • People identified as having a disability   
  • People identified on the lab report as a health care worker or first responder  
  • People known to be living or working in congregate settings including:  
  • Health care facilities
  • Nursing facilities  
  • Homeless shelters  
  • Group homes
  • Correctional facilities 
  • People known to be associated with schools or childcare facilities   

This means if you test positive for COVID-19 but do not fall into one of those high-priority groups, you will not be assigned a "case investigator" to go through the contact tracing process; you will be responsible for identifying your own close contacts and contacting them yourself. But there is a third option available now through Maine DHHS, which will give you a notification of your positive result and will offer support and guidance.

RELATED: Maine DHHS redeploys team of call center staff to support people who test positive for COVID-19

In light of the changes, Shah says if you test positive for COVID-19 the first thing you should do is promptly isolate to lower the risk of spread, and then work on contacting people you’ve been in close contact with as soon as possible since the Maine CDC will no longer be taking these actions for you.

"These choices are incredibly difficult," Shah said. “But we're in a position where there are no easy options in front of us. We at the state will continue to do everything we can to continue the processes, bring more people on, to hire more, to continue staying on top of the virus as much as we can. But sadly, we're in a situation where, just like at the emergency room, some difficult decisions have to be made."

Watch Monday's coronavirus briefing here:

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