October 2020 COVID Update

Dear Friends,

There was frost in the garden a few mornings ago and while the fall colors are now past peak in most of Maine, the colors along the coast are sublime. Life with COVID continues to be a challenge and it seems like years ago rather than just seven months ago that all our lives were upended. 

As in previous updates we are focusing in on the pandemic’s effects in Maine. Overall, Maine continues to be steady with challenges, stable but fragile. 
First the good news: We have made huge strides in testing and Maine is one of 11 states, almost all in the Northeast, that are testing and contact tracing at a rate high enough to suppress rather than mitigate the virus. Nationally the testing rate is only 67% of what is needed. There is continued progress in testing availability and sources of testing are regularly updated at https://get-tested-covid19.org/.  The models we most closely follow, one developed by the founders of Instagram and the other from the MITRE institute, both show the pandemic in Maine is stable. Overall, Maine is rated at medium risk.  Our new case rate is 2.1 per 100,000 population. Our positivity rate seven-day average is 0.55% (goal is less than 3%).Our death rate is flat.

Our hospitals have capacity.  Our R0, while relatively stable holding at just under .96 to .99.  To move to a declining rate of infection we need the rate to be less than 0.8. A rate greater than 1.0 shows the infection is spreading. Our telehealth capacity, use, and quality are high and improving. Our schools are open and all but two of our counties are in the Department of Education’s ‘green’ coding although individual schools have challenges. 

On the more challenging front:
Social mobility, as measured by aggregate cell phone patterns, remains static as compared to February which is good for our economy but challenging to maintain low COVID new cases. Our anxiety and depression measures have not declined over the past six months. We still have 4 times the unemployment as compared to pre-pandemic.

It is still early in the school year and as we move inside the safety of our students will be a challenge. We continue to have community transmission, especially in our southernmost counties. As recent outbreaks highlighted in the news both in Maine and nationally illustrate, challenges can increase quickly.  As the weather changes more of our activities are moving inside. The most significant challenge is non-adherence to universal masking and maintaining social distancing as we encounter asymptomatic and pre-symptomatic people around us. 

The other new significant challenge we face is the onset of influenza season and the potential of a “twindemic.” At LifeFlight we are already encountering critically ill patients positive for influenza also with COVID-suggesting clinical presentations.  As it is a coronavirus similar to the common cold there are a lot of unknowns around SARS Co-V-2 (the official name of COVID-19). We do not know much about short- and long-term immunity and there is increasing research showing significant long-term deleterious neurologic and cardiac sequalae from COVID infection. This is not a disease you want to catch. 

LifeFlight, as always, is there when needed and we continue to care for critically ill and injured patients with respiratory failure, sepsis, gastrointestinal bleeds, multi-organ failure and complications of cardiovascular events—heart attacks and strokes. All of these clinical presentations correlate with potential COVID, and as we have shared previously, every patient we care for is treated as positive for infection.  

With a lot of experience gained over the past months we know that PPE works, masks work, handwashing works, and constant vigilance is required. To date we have had no staff incur an unprotected exposure requiring isolation or quarantine and thankfully no one has become ill. 

COVID has been an incredible disruptor upending all our lives. Only collective effort and vigilance will keep it at bay until there are more effective treatments and a vaccine hopefully by mid-2021.  

As we have noted the biggest challenge and risk of COVID is our individual actions and behaviors. We are all fatigued from masks and maintaining our physical as well as social distance from each other. Fatigue is palpable, real, and a risk. It is our positive actions that will keep us from becoming COVID positive. Remember:  If you have not already, get your annual flu shot. Protect your family by keeping your family “bubbles” small. Wear a mask whenever social distancing outside is not possible and at all times in public places inside. Wash hands.  Outside is safer than inside and we must be more careful as the fall turns to winter.  
We continue the journey and we are all in this together. LifeFlight is there for you when needed. Please help us keep Maine safe. Maine, stable but fragile.

On behalf of the LifeFlight team, 
Thomas Judge, ParamedicExecutive DirectorNorm Dinerman, MD, FACEPMedical Director