With epidemiologists urging the importance of testing and contact tracing in combatting the coronavirus pandemic, Maine will need to increase both significantly in order to safely reopen. Currently, testing is prioritized for the most at-risk patients, but testing of everyone with symptoms along with randomized testing will be needed in order to understand how widespread the virus is in the state.
     The World Health Organization's director-general, Tedros Adhanom Ghebreyesus, recently stated, "We have a simple message for all countries: Test, test, test, every suspected case. To break the chains of transmission, countries must test for the disease and then isolate those who are infected."
     Robert Long, communications director for the Maine Center for Disease Control (CDC), says, "Increased testing capacity is one component of the current plan to gradually and safely reopen.

Maine businesses and gathering places."
     He notes that because testing is done at an increasing number of laboratories other than the Maine CDC lab in Augusta, a precise number for the state's testing capacity is not available. The CDC lab can currently process about 300 tests per day. Outside labs in Maine and in other states process tests for some Maine healthcare providers and are not required to report their capacity to Maine CDC. They do have to report test results, though. During the week of April 23, the total number of test results reported for Maine residents was roughly 2,900.
     Different models suggest different testing protocols for reopening businesses and gathering places. Dr. Nirav Shah, director of the Maine CDC, has said that the agency's goal is to double or triple the current testing capacity to a point at which every medical provider in Maine could order a COVID‑19 test for every patient who should be tested based on the provider's clinical judgment.
     As for why testing has not yet been ramped up in the state, Long says, "To date, the barriers have been shortages of testing materials, specifically those known as reagents. Maine CDC continues to work with partners in the federal government and the private sector to secure a reliable supply of reagents. There have also been occasional shortages of swabs used to collect samples for testing. Again, federal agencies and the private sector have worked to address the shortages."
    As for the newly developed devices and test kits by Abbott Laboratories that provide test results in minutes, Long notes that the devices are designed to be used for point‑of‑care testing by medical providers. The Maine CDC lab uses other testing processes. Test kits that allow for 23 patient tests each are required to test with the Abbott devices, and test kits were not readily available when the devices were delivered to Maine CDC for distribution, according to Long. As Abbott increases production of test kits, the capacity for providers to conduct more tests should increase. At present, the Abbott Labs devices have been given to care providers who serve vulnerable populations.

Contact tracing
     Another core strategy to prevent further spread of COVID-19 is contact tracing, according to the U.S. Centers for Disease Control and Prevention. In contact tracing, public health staff work with a patient to help them recall everyone with whom they have had close contact while they may have been infectious. Those contacts are then warned of their potential exposure and encouraged to stay home and maintain social distance from others until 14 days after their last exposure.
     While contact tracing has been going on in Maine since the first presumptive positive test, as it is part of the epidemiological response to every positive test result, the Maine CDC is expanding its contact tracing work to include tracing of probable cases, Long says. He states, "When the federal government last month issued new contact tracing guidelines that broadened the work to include tracing for probable cases, Maine CDC began recruiting and training new people to join the contact tracing team. If confirmed or probable cases were to spike in the future, it could pose a barrier" to being able to trace the contacts made by those who have been infected.
     As for privacy concerns in releasing information about who has been infected, Long says, "Privacy concerns and public health concerns are equally important. A pandemic does not negate the privacy rights of Maine people who seek medical care. The way that Maine CDC reports information on COVID‑19 aligns with the way information on other infectious diseases has been reported for years."
     Concerning the release of town-by-town information about confirmed numbers of cases, Long says, "Maine CDC would consider altering the way case information is reported if we could be certain that doing so would not violate the privacy rights of Maine residents who have sought medical care and if there was a clear public health reason for doing so."

Number of cases
     As of May 4, Maine had reported 1,205 confirmed and probable cases, with 720 people having recovered. There have been 57 deaths and 186 hospitalizations. The number of active cases was 428.
     In New Brunswick, as of May 4 there had been 118 confirmed cases, and all have recovered. There have been no deaths, and the province has not had any new cases for 16 consecutive days. However, Dr. Jennifer Russell, chief medical officer of health, said that although the curve has been flattened and everyone has recovered, there is still a need for caution. "Achieving this two‑week milestone is significant," says Russell. "But I cannot emphasize enough how important it is for us to continue practicing physical distancing, wearing face masks and staying home as much as possible."
     With Washington County having reported only two confirmed cases that have since recovered, Long says, "An important public health concern is that people in counties or communities with low case counts will develop a false sense of security and prematurely abandon the precautions that have helped Maine limit potential spread of the virus." With insufficient testing having been done and since people who have the virus can be asymptomatic, Dr. Shah has stated that everyone should be acting as though the virus is in their communities. "Absence of evidence of cases in your county is not evidence of absence of cases in your county," he has said, adding, "How you live your life today can affect how the people in your community live their life tomorrow."
     Even if the number of infections subsides, previous viral pandemics have shown that the virus can come back in succeeding waves. During the 1918 influenza pandemic, the second wave was the most deadly in the U.S. Concerning whether residents should be ready for another wave of infections after the number of active cases diminishes, Long states, "Some nations and states that eased physical distancing guidelines early experienced second waves. Maine CDC aims to avoid a similar situation here."