Estelle Pendleton, 81, looks up at her daughter, Ruthe Gray, as they talk on their phones and visit through the window of Estelle’s room at Tall Pines in Belfast on Wednesday.

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A nursing home that saw an early outbreak of the coronavirus was clear of active cases of the virus as of Tuesday, marking what the state’s top public health official called “an epidemiological milestone.”

But public health officials are encouraging caution. The Commons at Tall Pines skilled nursing facility in Belfast isn’t lifting restrictions on visitors or relaxing other precautions it’s taken against the spread of the coronavirus. And epidemiologists are watching for any new cases, said Maine Center for Disease Control and Prevention Director Nirav Shah.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

At the start of the month, Tall Pines had 43 cases of the coronavirus, with 32 residents and 11 staff members testing positive. Since then, 13 residents have died and the others have recovered. The last staff member was recently released from isolation, Shah said Tuesday.

It’s the first example of a major outbreak clearing in the state.

Residents at nursing homes and other long-term care facilities have been particularly vulnerable to the coronavirus because of their age, underlying health conditions and close living quarters. More than half of the state’s coronavirus deaths have been nursing home residents.

“What we want to do at this point is make sure that there is not a secondary spike in cases,” Shah said, adding that in-person visitations are still not allowed and that the CDC will continue to check on the facility’s supplies of personal protective equipment that staff members have had to wear to prevent infection.

Overall, 40 percent of infected residents at long-term care facilities have recovered from the virus, Shah said, adding that the CDC determines when a person is recovered. The U.S. CDC defines recovery from the virus as a decrease in fever or other symptoms without treatment, such as fever-reducing medications. It recommends that people remain isolated for at least 10 days after symptoms emerge, and three days after recovery.

It is difficult to determine how common recovery is at long-term care facilities in the country. A Kaiser Family Foundation analysis found that not all states report data on cases at nursing homes, and only 33 states reported deaths at those facilities. The data do not detail recoveries.

In Maine, it is unknown how many employees have recovered. Of the seven Maine nursing homes where outbreaks have been reported, one did not respond to a request for comment and two did not say how many recoveries have occurred.

The Cedars retirement community in Portland has seen five employees and eight residents recover out of 17 total cases, according to a Monday update. The Maine Veterans’ Homes facility in Scarborough saw its first case in late March when a staff member tested positive. Since then, 32 residents and 23 staff members have tested positive, and seven residents and 22 staff members have recovered, said spokesperson Joshua Scroggins.

Others say it is too early to tell if residents have recovered.

At the Springbrook Center in Westbrook, the facility is looking for two consecutive negative test results to determine if someone is recovered, said Richard Feifer, the chief medical officer for the center’s parent company, Genesis HealthCare.

Springbrook saw its first cases last week, and now has 25 cases overall. Feifer said the center expects to be able to begin testing for and tracking recoveries soon.

Mary Jane Richards, chief operating officer at North Country Associates, the parent company for Edgewood Rehabilitation and Living Center in Farmington, declined to say how many residents had recovered, citing privacy reasons. That facility had seen 13 residents and six staff members test positive as of Tuesday. One resident died, according to the Maine CDC.

Caring for older individuals at long-term care facilities comes with its own host of unique challenges due to the facilities’ layouts and their residents’ demographics, said Dr. Jabbar Fazeli, a geriatrician in southern Maine and vice president of the Maine Medical Directors Association, an organization representing nursing home medical directors.

Nursing homes have to be careful about the use of breathing aids, such as CPAP machines and nebulizers, because their use could result in the virus being transmitted through spray form, Fazeli said. In a congregate setting, that could lead to the virus infecting an entire unit, he said.

Patients with dementia also need special care, because a sick individual may inadvertently wander into another room and get someone else sick, Fazeli said. If they become delirious from the virus, normal medications may need to be altered so as not to make the symptoms worse.

Fazeli said he’s hoping the state’s expanded testing abilities announced last week will allow nursing homes to conduct more randomized testing of asymptomatic but high-risk individuals — such as health care workers and anyone they have come in contact with who has shown symptoms — as a preemptive step against more outbreaks.

Watch: Nirav Shah talks about 3 new outbreaks in Maine

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