Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine.

OBJECTIVE: Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. METHODS: We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. RESULTS: The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. CONCLUSION: Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.

Implementation of Universal School Meals during COVID-19 and beyond: Challenges and Benefits for School Meals Programs in Maine.

School meals play a major role in supporting children's diets and food security, and policies for universal school meals (USM) have the potential to contribute to positive child health outcomes. During the COVID-19 pandemic, schools provided free school meals to all students in the United States, but this national USM policy ended in school year (SY) 2022-2023; however, a few states have adopted policies to continue USM statewide for SY 2022-2023. Research examining the challenges and strategies for successful continuation of USM is essential, along with studying pandemic-related challenges that are likely to persist in schools. Therefore, we conducted a study in Maine (with a USM policy) to evaluate the impact of COVID-19 and the concurrent implementation of USM, as well as examine differences in implementation by school characteristics, throughout the state. A total of n = 43 school food authorities (SFAs) throughout Maine completed surveys. SFAs reported multiple benefits of USM including increased school meal participation; reductions in the perceived stigma for students from lower-income households and their families; and no longer experiencing unpaid meal charges and debt. SFAs also experienced challenges due to the COVID-19 pandemic, particularly regarding costs. When considering future challenges, most respondents were concerned with obtaining income information from families, product and ingredient availability, and the costs/financial sustainability of the school meal programs. Overall, USM may have multiple important benefits for students and schools, and other states should consider implementation of a USM policy.

Modeling the impact of the COVID-19 pandemic on speeding at rural roadway facilities in Maine using short-term speed and traffic count data.

The COVID-19 pandemic caused a significant change in traffic operations and safety. For instance, various U.S. states reported an increase in the rate of fatal and severe injury crashes over this duration. In April and May of 2020, comprehensive stay-at-home orders were issued across the country, including in Maine. These orders resulted in drastic reductions in traffic volume. Additionally, there is anecdotal evidence that speed enforcement had been reduced during pandemic. Drivers responded to these changes by increasing their speed. More importantly, data show that speeding continues to occur, even one year after the onset of the pandemic. This study develops statistical models to quantify the impact of the pandemic on speeding in Maine. We developed models for three rural facility types (i.e., major collectors, minor arterials, and principal arterials) using a mixed effect Binomial regression model and short duration speed and traffic count data collected at continuous count stations in Maine. Our results show that the odds of speeding by more than 15 mph increased by 34% for rural major collectors, 32% for rural minor arterials, and 51% for rural principal arterials (non-Interstates) during the stay-at-home order in April and May of 2020 compared to the same months in 2019. In addition, the odds of speeding by more than 15 mph, in April and May of 2021, one year after the order, were still 27% higher on rural major collectors and 17% higher on rural principal arterials compared to the same months in 2019.

The Impact of COVID-19 on Northeast and Appalachian Loggers.

OBJECTIVE: The Northeast Center for Occupational Health and Safety conducted a survey in December 2020 to understand the impact of the coronavirus disease 2019 (COVID-19) and the Androscoggin Mill explosion among loggers in six states: Maine, New Hampshire, Vermont, New York, Pennsylvania, and West Virginia. METHODS: Logger mailing addresses were aggregated with the assistance of state logging organizations. A paper survey, including a self-addressed return envelope was mailed to the loggers in December 2020. RESULTS: The mailed survey had a response rate of 13.3% and captured data on 484 loggers. The majority knew someone (including themselves) who tested positive for COVID-19 (71.9%). Less than half (43%) received employer training about COVID-19 prevention measures, though 73% received some form of COVID-19 personal protective equipment from their employers. The health department, Centers for Disease Control and Prevention (CDC), and health care providers were the most trusted sources of health information. Nearly half acknowledged significant change in their home lives and work responsibilities due to the pandemic. The explosion of the Androscoggin Mill affected the business of 80% of Maine loggers, and 18% of loggers that resided outside Maine. CONCLUSION: The lessons learned can be used to enhance trust in public health institutions and future public health response to this unique occupational group.

Exclusion of SARS-COV-2 From Two Maine Overnight Camps July-August 2020.

OBJECTIVES: Summer camp can positively affect self-esteem and social skills. Most United States summer camps did not open during 2020 because of concerns about severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Our objective is to describe exclusion strategies successfully used by 2 summer camps in Maine. METHODS: Before camp arrival, all attendees were asked to quarantine at home for 14 d and perform a daily symptom checklist. Salivary specimens were submitted by mail for SARS-COV-2 PCR testing 4 d before arrival, and again 4 d after arrival. At camp, multiple layers of nonpharmaceutical interventions (NPIs) were used. RESULTS: A total of 717 (96.7%) prospective attendees underwent remotely supervised saliva collection; 4 were positive and did not come to camp. Among the 20 who did not submit a sample, 3 did not come to camp; the other 17 underwent screening and a rapid antigen test for SARS-COV-2 immediately upon arrival and before reporting to communal living spaces; all were negative. All campers and staff were re-tested by salivary polymerase chain reaction 4 d after arrival, and all were negative. CONCLUSIONS: We demonstrate that it is possible to safely operate overnight camps during a pandemic, thus supporting the continued physical and socioemotional growth of children, using multiple layers of NPIs.

Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine - August 7-September 14, 2020.

Large indoor gatherings pose a high risk for transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), and have the potential to be super-spreading events (1,2). Such events are associated with explosive growth, followed by sustained transmission (3). During August 7-September 14, 2020, the Maine Center for Disease Control and Prevention (MeCDC) investigated a COVID-19 outbreak linked to a wedding reception attended by 55 persons in a rural Maine town. In addition to the community outbreak, secondary and tertiary transmission led to outbreaks at a long-term care facility 100 miles away and at a correctional facility approximately 200 miles away. Overall, 177 COVID-19 cases were epidemiologically linked to the event, including seven hospitalizations and seven deaths (four in hospitalized persons). Investigation revealed noncompliance with CDC's recommended mitigation measures. To reduce transmission, persons should avoid large gatherings, practice physical distancing, wear masks, stay home when ill, and self-quarantine after exposure to a person with confirmed SARS-CoV-2 infection. Persons can work with local health officials to increase COVID-19 awareness and determine the best policies for organizing social events to prevent outbreaks in their communities.

Preventing and Mitigating SARS-CoV-2 Transmission - Four Overnight Camps, Maine, June-August 2020.

The World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020.* Shortly thereafter, closures of 124,000 U.S. public and private schools affected at least 55.1 million students through the end of the 2019-20 school year.† During the summer of 2020, approximately 82% of 8,947 U.S. overnight camps did not operate.§ In Maine, only approximately 20% of 100 overnight camps opened.¶ An overnight camp in Georgia recently reported SARS-CoV-2, the virus that causes COVID-19, transmission among campers and staff members when nonpharmaceutical interventions (NPIs) were not strictly followed (1); however, NPIs have been successfully used to mitigate SARS-CoV-2 transmission among military basic trainees (2). During June-August 2020, four overnight camps in Maine implemented several NPIs to prevent and mitigate the transmission of SARS-CoV-2, including prearrival quarantine, pre- and postarrival testing and symptom screening, cohorting, use of face coverings, physical distancing, enhanced hygiene measures, cleaning and disinfecting, and maximal outdoor programming. During the camp sessions, testing and symptom screening enabled early and rapid identification and isolation of attendees with COVID-19. Among the 1,022 attendees (staff members and campers) from 41 states, one territory, and six international locations, 1,010 were tested before arrival; 12 attendees who had completed a period of isolation after receiving a diagnosis of COVID-19 2 months before arrival were not tested. Four (0.4%) asymptomatic attendees received positive SARS-CoV-2 test results before arrival; these persons delayed their arrival, completed 10 days of isolation at home, remained asymptomatic, and did not receive any further testing before arrival or for the duration of camp attendance. Approximately 1 week after camp arrival, all 1,006 attendees without a previous diagnosis of COVID-19 were tested, and three asymptomatic cases were identified. Following isolation of these persons and quarantine of their contacts, no secondary transmission of SARS-CoV-2 occurred. These findings can inform similar multilayered public health strategies to prevent and mitigate the introduction and transmission of SARS-CoV-2 among children, adolescents, and adults in congregate settings, such as overnight camps, residential schools, and colleges.

Tall Pines Healthcare COVID-19 Outbreak Experience in Rural Waldo County, Maine, April 2020.

As a family physician and a family nurse practitioner in a Federally Qualified Health Center in rural Maine, we experienced a COVID-19 outbreak at our local long-term care facility, which involved 32 patient cases, 11 staff cases, 19 recovered cases, and 13 deaths over 34 days in April 2020. There were many lessons to be learned that may inform and guide others or help prevent facilities from facing some predictable challenges.

Pandemic Notes From a Maine Direct Primary Care Practice.

The effects of coronavirus disease-2019 (COVID-19) pandemic fear and its economic impact in rural primary care are still being felt, as they have affected demand for office visits and how we deliver care. Our finances and our ability to sustainably deliver this care, however, have not yet changed significantly due to the nature of our business model as a direct primary care practice.

Characteristics and Outcomes of Contacts of COVID-19 Patients Monitored Using an Automated Symptom Monitoring Tool - Maine, May-June 2020.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is spread from person to person (1-3). Quarantine of exposed persons (contacts) for 14 days following their exposure reduces transmission (4-7). Contact tracing provides an opportunity to identify contacts, inform them of quarantine recommendations, and monitor their symptoms to promptly identify secondary COVID-19 cases (7,8). On March 12, 2020, Maine Center for Disease Control and Prevention (Maine CDC) identified the first case of COVID-19 in the state. Because of resource constraints, including staffing, Maine CDC could not consistently monitor contacts, and automated technological solutions for monitoring contacts were explored. On May 14, 2020, Maine CDC began enrolling contacts of patients with reported COVID-19 into Sara Alert (MITRE Corporation, 2020),* an automated, web-based, symptom monitoring tool. After initial communication with Maine CDC staff members, enrolled contacts automatically received daily symptom questionnaires via their choice of e-mailed weblink, text message, texted weblink, or telephone call until completion of their quarantine. Epidemiologic investigations were conducted for enrollees who reported symptoms or received a positive SARS-CoV-2 test result. During May 14-June 26, Maine CDC enrolled 1,622 contacts of 614 COVID-19 patients; 190 (11.7%) eventually developed COVID-19, highlighting the importance of identifying, quarantining, and monitoring contacts of COVID-19 patients to limit spread. In Maine, symptom monitoring was not feasible without the use of an automated symptom monitoring tool. Using a tool that permitted enrollees to specify a method of symptom monitoring was well received, because the majority of persons monitored (96.4%) agreed to report using this system.