The Big Moose Inn on Millinocket Lake is seen in this Aug. 18, 2020, photo. Credit: Linda Coan O'Kresik / BDN

The first sign that the coronavirus had been spreading at an Aug. 7 wedding reception on Millinocket Lake came just one day after the event, when a Maine resident who was at the reception developed a fever, runny nose, cough and fatigue.

Over the coming week, a total of 24 people who attended the reception tested positive for the virus. From there, the outbreak continued to infect people all over Maine, including in a Somerset County nursing home and, more than 200 miles to the south, at the York County Jail.

Eight people died in connection with the event, and seven were hospitalized, none of whom actually attended.

At least 177 cases of COVID-19 were eventually linked to the now-infamous wedding in northern Maine, according to a new scientific article from staffers at the Maine Center for Disease Control and Prevention that was published this week on the website of their agency’s federal counterpart. 

The article in the U.S. CDC’s Morbidity and Mortality Weekly Report includes many of the details the state has already shared with the public. It also sheds some new light on how the coronavirus spread following the wedding reception and some of the challenges Maine CDC investigators faced in piecing together the disparate parts of the outbreak, which spanned at least four counties.

Among the new details in the report:

  • The bride, groom and groom’s family came to the wedding from California the day before the wedding, Aug. 6, and received negative coronavirus tests before traveling, allowing them to avoid the two-week quarantine Maine otherwise requires of out-of-state travelers.
  • The “index patient” — the first patient known to have come down with COVID-19 as a result of the wedding reception — was a Maine resident.
  • The initial round of infections from the reception also included an employee of the Big Moose Inn, a vendor who was there, and a diner at the inn who was unconnected to the wedding.
  • The York County Jail employee who attended the wedding reception and subsequently spread the virus to the jail worked daily eight-hour shifts from Aug. 15-19 in two separate jail units while showing coronavirus symptoms.
  • Maine CDC investigators never obtained a wedding guest list, which led the state agency to likely undercount the number of cases ultimately connected to the wedding outbreak.
A diagram published in the U.S. CDC’s Mortality and Morbidity Weekly Report illustrates how the coronavirus spread following an Aug. 7 wedding reception in the Millinocket region. The reception led to Maine’s largest COVID-19 outbreak to date. Credit: Courtesy of the U.S. CDC

The article in the CDC’s weekly epidemiology publication does not specifically mention the location or other geographical details about the outbreak, but it notes that the outbreak began with an Aug. 7 wedding reception before spreading to a nursing home and county jail. Maine CDC Director Nirav Shah has previously told the BDN that such an article was due to be published.

The 177 cases linked to the wedding reception — which included 27 of the 55 wedding reception guests — are likely an undercount, the Maine CDC staffers wrote in the article, because state case investigators never received a list of reception guests, and likely missed some who became infected.

“Robust case investigation and contact tracing allowed seemingly disparate outbreaks to be epidemiologically linked to the event,” the Maine CDC staffers write in the article.

The staffers also note the various lapses in compliance with state COVID-19 rules that allowed the virus to spread so extensively. Those included the fact that 55 people attended the wedding reception, in violation of a 50-person limit on indoor gatherings, and didn’t wear masks. Staff at the inn that hosted the reception wore masks and checked guests’ temperatures, but didn’t enforce mask-wearing among guests and did not collect guests’ contact information to help with a potential outbreak investigation.

Following the reception, the jail and nursing home employees worked shifts while showing symptoms, allowing the virus to spread to inmates, nursing home residents and the employees’ colleagues.

At Maplecrest Rehabilitation and Living Center in Madison, a certified nursing assistant — identified as the parent of a wedding guest in the U.S. CDC report — was allowed to work an overnight shift on Aug. 11 even after she wrote in a symptom screening log that she had a sore throat, cough, chills and muscle aches. That went against the nursing home’s protocols and federal nursing home rules meant to prevent the spread of COVID-19. Twenty-five residents and 15 employees ultimately tested positive, and seven residents died.

At the York County Jail, the CDC staffers’ article notes that no symptom screening was in place for employees, and that mask-wearing wasn’t enforced. More than 80 people connected to the jail tested positive, making it Maine’s largest outbreak in a correctional facility at that time. (An ongoing outbreak at the Maine Correctional Center in Windham has now surpassed it.)

York County later said it was launching a probe into the jail outbreak. The Maine Department of Corrections found following the York County outbreak that three other county jails in the state weren’t requiring all to wear masks and one other didn’t screen staff members for symptoms.

Without the list of wedding guests, the Maine CDC staffers wrote, case investigators linked more cases to the wedding reception “by backward tracing” — interviewing people with newly diagnosed cases of the disease, and asking them whether they had attended events or been in contact with known cases before testing positive themselves.

Closer to Millinocket, the article notes that one attendee at the wedding reported the onset of a cough on Aug. 10 and attended an in-person school meeting the same day. Two other school staff members then tested positive, prompting schools in the area to delay their openings by two weeks.

East Millinocket school Superintendent Eric Steeves said at the time that six school department employees and two students ultimately tested positive following the wedding, including a staff member who was hired as a musician at the wedding. Steeves also tested positive, though he didn’t attend the wedding.

The delayed start of the school year was one of a number of ripple effects in the Millinocket area after the wedding. Businesses closed down, the local hospital ramped up virus testing and postponed nonessential procedures, and area residents stepped up mask wearing. As of the beginning of October, Millinocket, East Millinocket and Medway had gone more than a month without recording a new case.

On Thursday, Maine CDC Director Shah said that the agency published its finding on the wedding outbreak to provide more evidence of how the virus can spread across multiple communities when mask-wearing and social distancing are not followed.

Shah also said that the outbreak demonstrated the importance of thorough investigation and contact tracing. That message could become even more relevant as the virus keeps surging in Maine and potentially overwhelms the 125 or so people now doing that work. 

“Given the large number of people affected in disparate parts of the state and the ability of our contact tracers to piece those things together to produce the picture that we now have, that to me was a reason to not only publish that so other state health departments can learn from that, but also to demonstrate what is possible through good and careful contact tracing,” Shah said.

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