In this March 2, 2021, file photo, pharmacy technician Hollie Maloney loads a syringe with Pfizer's COVID-19 vaccine at the Portland Expo in Portland. Credit: Robert F. Bukaty / AP

AUGUSTA, Maine — Maine saw the highest COVID-19 death rate in nursing homes of any U.S. state over four weeks in October and November, but boosters that were not available when initial outbreaks cropped up give reason for optimism entering the winter.

The summer surge driven by the delta variant has hammered Maine and other New England states that had seen fewer cases and deaths early in the pandemic. Cases rose to record highs here last week and hospitalizations hit yet another high at 330 on Tuesday.

The rise in infections hit long-term care facilities too. The Maine Center for Disease Control and Prevention went from opening just three outbreak investigations in July to 18 in August and 22 in September, according to state data. After reporting just nine deaths in all of July and August, Maine nursing homes reported more than 50 in September and October, federal data show. 

Boosters were approved for all nursing home residents on Sept. 24 as outbreaks — including several that would be deadly — ticked back up. For example, the Maine CDC began an outbreak investigation at Pinnacle South Portland three days after boosters were approved. Twelve residents died in the deadliest Maine nursing home outbreak to begin in 2021, state data show.

The regional surge in cases and consequent nursing home deaths were likely driven by several factors, including a population that was less immune to COVID-19 because of lower early transmission here and a long period of time between initial vaccinations and the surge, said Dr. Timothy Lahey, an infectious disease physician at the University of Vermont Medical Center in Burlington. Higher statewide infection rates made nursing home residents more vulnerable, regardless of vaccination status.

“When you look to see who isn’t perfectly protected, even among those who are vaccinated, it is typically people who are older or have some sort of medical vulnerability,” Lahey said.

Other New England states saw a similar trend, including Vermont, which for most of the pandemic maintained the lowest case and hospitalization rates of any continental U.S. state. While Maine saw the highest nursing home COVID-19 death rate of any U.S. state between Oct. 18 and Nov. 14, according to data reported by nursing homes to the federal government, Vermont was close behind. The data are preliminary and subject to revision.

The South Portland outbreak, plus another at Rumford Community Home that led to nine more deaths, accounted for roughly half of the 41 deaths reported in Maine during that period. Representatives for both homes did not return requests for comment on Tuesday.

The delta variant arrived in Maine at an especially bad time for nursing home residents. While boosters are now recommended for people older than 65 six months after receiving their two-course Pfizer or Moderna vaccines, people living in long-term care facilities who got vaccinated as soon as they could last winter were seven months past their second dose when the delta variant took off in New England in August and September.

The approval of boosters provided some relief for nursing homes and could be one factor contributing to the drop in nursing home outbreaks in October and November, even as overall virus cases in Maine have continued to rise.

The Maine Health Care Association said earlier this month that most of its members had already completed clinics or had them scheduled. The state’s immunization program put out a form for facilities to request assistance with boosters, receiving 20 responses, and was able to set up a clinic in each case, said Maine CDC spokesperson Robert Long. Others were able to set them up with pharmacies, he said, including more than 50 that worked with Walgreens or CVS.

Enthusiasm about boosters was high among already vaccinated people, said Joe Bruno, the CEO of Community Pharmacies, an Augusta-based chain. His company has mostly been administering boosters to residents of senior living housing and group homes, although they did one booster clinic in a nursing home alongside flu shots.

“People are very excited to get their boosters,” Bruno said.

BDN writer Caitlin Andrews contributed to this report.