State and local governments have been front and center in the U.S. as we face the coronavirus pandemic. That is especially true because of inconsistent messaging from the Trump administration, and the fact that the federal government has not met states' needs for testing and medical equipment. So how has Maine responded since our first case of COVID-19, which was nearly two months ago?
All Things Considered host Nora Flaherty spoke with Maine Public health reporter Patty Wight and chief political correspondent Steve Mistler.
This interview has been edited for clarity.
Flaherty: Steve, Maine reported its first case of COVID-19 on March 12. We now have more than 1,200 cases, more than 60 people have died. How would you describe Gov. Janet Mills' response throughout this?
Mistler: I would describe it as cautious and permissive, especially when compared to some of the other governors in the Northeast. I mean, the early phases of the response began as recommendations-only that became mandates later on. And some municipalities actually moved quicker to shut down schools, and a couple were ahead of the state implementing stay-at-home orders. I'm talking about Portland and Brunswick.
There were also times early on when it looked like the state was leaning heavily on decisions made by the federal government, which were heavily criticized at the time and continue to be, as well as federal assistance, which in some instances never came, especially when it came to testing assistance. You know, we were the last state in New England to have a statewide stay-at-home order, and when one was put in place, it was relatively permissive when compared to some other states. There are actually more restrictive measures in Massachusetts and Vermont, which both have Republican governors.
Flaherty: And Patty, what about the public health response? How would you describe the actions that have been taken by the Maine CDC and Dr. Nirav Shah?
Wight: Well, in many ways, Dr. Shah has become the public face of the state's response and even before Maine identified its first case of COVID-19, he started to hold daily briefings to give updates on what the state was doing, and the state's actions have largely been guided by federal CDC recommendations. There have been a couple of instances when Maine has broken ahead of other states.
One example is in late March, Dr. Shah decided to elevate residents ofnursing homesto the top priority for testing. Maine was also among the first states toadopt universal testing in nursing homes as soon as an outbreak is detected — that's when there are at least three cases. And the idea behind those steps was to identify cases in these settings quickly, where in nursing homes COVID-19 can spread very rapidly. It's especially deadly in Maine, deaths in nursing homes from COVID-19 account for roughly half of all the deaths in the state.
But in addition to Dr. Shah talking about what actions the state's taking, he also talks about what our challenges are, and those have largely been focused on supplies. So things like personal protective equipment, or PPE, there's a global shortage and Maine is still grappling with that. Every time Dr. Shah gives an update he talks about the state's efforts to secure more PPE and where he's distributing it, where the state is distributing it. Testing is another area that's been an issue from the beginning, the demand for testing has outstripped capacity.
Flaherty: Steve, you reported pretty extensively on the testing situation. Is it still a problem?
Mistler: Yeah, I think it is in the sense that there are some questions about whether we still have enough capacity to open up doors and test enough people to track the virus, or get a sense of the outbreak as it stands right now. I mean, now we have — testing is done by the state. It really prioritizes two categories of people: health care workers and people in nursing homes, as Patty mentioned, and people already hospitalized by COVID-19. Now other people can ask their physician if they can get tested. But the results of those tests can take days, if not weeks. Additionally, we hear from people all the time that they are turned down for one reason or another.
And so even in the early going, there was a big backlog of testing for the priority groups that I just mentioned, and that was because of this nationwide shortage of reagents and supplies needed to conduct the tests. And that backlog also put pressure on the issue that Patty just discussed, which is the shortage of PPE for health care workers. Those workers are required to wear that equipment if someone is suspected of having COVID-19, so workers can end up using more PPE, even if someone is suspected of having COVID but can't get tested. In addition to squeezing off the supply of PPE, the feds have also shorted the state of new rapid tests by Abbott Labs. And even now with the governor's phased reopening of the economy, testing looms large and there are a lot of questions about whether we'll ever have enough of it to get a full picture of the outbreak or monitor it.
But the Maine CDC says it's working to boost capacity and apparently, that's enough for Gov. Mills to at least consider a timeline to restart parts of the Maine economy.
Flaherty: And more testing isn't the only thing that Maine needs as it starts to allow more public facing businesses to reopen. Patty, we also need contact tracers, right?
Wight: That's right, having enough contact tracers goes hand in hand with boosting testing. So you need testing to identify the individual who has COVID-19. You need the contact tracers to figure out who else around them has been exposed. And the idea behind this is to identify and isolate potential cases quickly to break the chain of transmission, which is especially important as Maine reopens its economy. And in terms of numbers, there have been figures put out there, or people have said that basically nationwide, the U.S. needs an army of contact tracers. And by some estimates in Maine, that would be about 400, given our population size. We currently have 30. That's double than what we had a few weeks ago, and Dr. Shah says we likely need to double that again to 60 if our case numbers kind of hold steady, but if they start to grow exponentially, we're going to need about 100 contact tracers, so it's really fluid, depending on how the outbreak unfolds in Maine.
Flaherty: Gov. Mills last week revealed her plan for reopening the economy, and we are actually a couple days into that first phase. Steve, you mentioned the protests and concerns by some businesses that the governor is not moving fast enough. How much of an issue is that? And how much of those concerns do you think are actually factoring into Mills' decision making?
Mistler: I think it's a huge consideration for the governor. I mean, remember that all of these shuttered businesses are not producing tax revenue to fill state coffers. We fully anticipate a massive budget shortfall in the near future, especially if Maine and other states can't get federal assistance. And that means that there could be cuts to state programs that the governor supports. So it's important to remember that, both in the context of the pressure she might be receiving from certain businesses, and also in the context of these protests, which sometimes suggest that the governor is deliberately trying to tank the economy.
The governor is trying to walk a very fine line here between allowing some economic activity and protecting public health. And she's doing it with very little assistance from the federal government. States are largely on their own here unless there's some federal aid package that will be able to help them out. You know, you might not hear it that much, but there are actually Democrats who worry she's moving too quickly to restart the economy. They're a little bit muted in their criticism, but it exists. And I think it's important to view her restart plan through that lens, while also evaluating whether the steps she's taking strike the right balance between protecting public health and curbing as much of the economic devastation as possible.
This interview is part of Maine Public's Deep Dive: Coronavirus. For more, visit mainepublic.org/coronavirus.
