Greg Carson takes a break from his bike ride to admire Lake Auburn, Thursday, March 25, 2021 in Auburn. Credit: Andree Kehn / Sun Journal via AP

As coronavirus cases began to rise around him in early April, Auburn Fire Chief Robert Chase’s main concern was keeping his vaccinating staff and volunteers motivated.

Chase said he felt the state was nowhere near “the light at the end of the tunnel” when it came to beating back the pandemic, even as vaccination efforts accelerated in Maine. He was hearing about so-called “mask fatigue” and figured social events were increasing. He was aware of the situation at Bates College in Lewiston, where officials imposed a lockdown in early April after 50 cases were reported in a week.

But as a report a month ago from The New York Times that the Lewiston-Auburn area was seeing new COVID-19 cases increase at a faster rate per person than any other community in the U.S. with a population above 50,000 spurred renewed attention to the pandemic in Androscoggin County, Chase said he immediately began thinking of the best way to tell vaccinators that their efforts were not in vain.

“I felt like we really needed to [reinforce] that as long as we feel like we’re doing all we can, things will improve,” Chase, who is leading Auburn’s COVID-19 response, said. “I don’t know exactly what to attribute the rise in cases to, but it wasn’t for a lack of effort from people trying to get others vaccinated.”

It exemplifies the challenges that public health officials face in Androscoggin County, which has seen the highest case rate among Maine counties throughout the pandemic and exceeded the state’s average rate by 2 1/2 times as cases surged to an all-time high there in mid-April, according to Maine Center for Disease Control and Prevention data.

They have declined sharply since, though the county this week sat at nearly double a state rate at its lowest mark since March. Officials in the diverse urban communities and more rural areas say they are battling misinformation, hesitancy and confusion around public health guidelines. Though attention is focused on the cities, they have lower case rates than some nearby towns.

Ian McQueen pulls a sled full of ice fishing gear early Thursday, Jan. 14, 2021, across Martin’s Point in Sabattus, Maine. Credit: Daryn Slover / Sun Journal via AP

Half of the top 20 Maine zip codes with the highest rate of new infections in early May were in Androscoggin County, with Sabattus and Lisbon Falls holding the second and third spots, respectively, with 54 and 49 new cases per 10,000 people. Lewiston and Auburn held spots nine and 12, respectively, according to Maine CDC data.

The county is in the middle of the pack for vaccinations, with 44 percent of eligible residents receiving either their first dose or the Johnson & Johnson one-shot option, compared to the state average of 58 percent. The rate varies widely in the county, with Durham leading with 71 percent of residents fully vaccinated and Livermore Falls last at 40 percent. Auburn has the second-highest vaccination rate; Lewiston has the fourth-lowest.

Local officials have been touchy in public as cases rose and fell. Auburn Mayor Jason Levesque and City Manager Phil Crowell declined to comment, but the mayor criticized local coverage of the county’s cases to CBS 13 last month, saying it was only a snapshot, painted his city in a bad light and that the media was “picking and choosing” what data to focus on.

Lewiston Mayor Mark Cayer referred a reporter to Assistant City Manager Dale Doughty, who leads the city’s public health committee. Doughty said local coverage “didn’t tell us anything we didn’t already know” and the city would not change course because of it. It is trying to figure out where vaccine gaps are occurring and whether the issue is philosophical or access-based.

“The data will drive our efforts,” he said.

Abdulkerim Said, the executive director of the New Mainers Public Health Initiative, said it is hard to know how many cases are in the Lewiston immigrant community, but he has felt they were on the rise. The organization has partnered with health providers to get clinics and the Maine CDC assisted local religious leaders with vaccination efforts at two Lewiston mosques in May, said Maine Department of Health and Human Services spokesperson Jackie Farwell.

But Said continues to face the same challenges he said seen throughout the pandemic — a lack of trust in government guidance, misinformation around vaccines and a consistent need to educate people on the risks of gathering while unvaccinated.

Shifting public health guidelines pose a particular challenge for Said. He pointed to Gov. Janet Mills’ decision to lift indoor mask requirements for fully vaccinated people while requiring them for unvaccinated people in line with U.S. Centers for Disease Control and Prevention recommendations. Those nuances could be difficult for those integrating into the area, especially those mistrustful of officials. Said feared a rise in cases when the change takes effect on Monday.

“How can you explain that to the people who are not vaccinated yet?” he said. “It’s so hard. They will say, ‘If I’m doing well, I’m not sick, why should I be vaccinated?’”

Hesitancy challenges remain county-wide, said Dr. Michael Stadnicki, chief of primary care at Central Maine Healthcare in Lewiston. He said patients are generally not focused on the case rates in the county, but on vaccines. His efforts to convince unvaccinated people to get one have become “a little more strained and a little more difficult,” he said.

“Even this week, I had someone who was ready to up and leave the office over me even asking about the vaccine,” Stadnicki said.

Stadnicki said he eventually persuaded that person to be “on the fence” about a shot. He said the higher infection rates were not surprising. While Lewiston and Auburn have denser populations, people in more spread-out towns might think they are relatively safe and relax distancing efforts, he thought.

That could be the case in Sabattus, the town of 6,900 outside of Lewiston that has seen 26 cases per 10,000 residents between May 9 and May 16. The town’s new infection rate surprised Jean-Paul Curran, Sabattus’ head selectman, who said he generally believed people have been cautious and following masking and distancing recommendations.

“It’s no different than anywhere else,” he said. “There have been so many different versions of guidance from the CDC, you can’t blame some people for questioning the reality of things.”

BDN writer Jessica Piper contributed to this report.