nn Enderle, R.N., checks on a COVID-19 patient in the intensive care unit at St. Luke's Boise Medical Center in Boise in August. Credit: Kyle Green / AP

Penobscot County has the fullest hospitals in Maine, and it’s in the top 8 percent of counties nationwide for its percentage of occupied inpatient beds, federal data from the U.S. Department of Health and Human Services show.

Patients filled nearly nine out of 10 inpatient beds in Penobscot County as of Friday. Out of the more than 2,400-plus counties and county-equivalents with hospitals in the United States, only around 180 reported a higher rate of hospitalizations than Penobscot. Just three counties in New England have fuller hospitals: Merrimack and Sullivan counties in New Hampshire and Newport County in Rhode Island.

Record numbers of patients hospitalized with the coronavirus in Maine are contributing, but they’re not the only factor responsible. Limited capacity at long-term care facilities has made it difficult to discharge many patients and unhealthy behavioral changes brought on by the pandemic could be responsible for some hospitalizations.

COVID-19 patients had taken 10 percent of Penobscot County’s inpatient beds as of last Friday while those who don’t have the virus are using another 79 percent of them. About 11 percent of inpatient beds are vacant.

Penobscot County’s patients were scattered across 573 beds at Northern Light Eastern Maine Medical Center and St. Joseph Hospital in Bangor, Millinocket Regional Hospital and Penobscot Valley Hospital in Lincoln. Licensed for 411 inpatient beds, EMMC is the largest of those, while St. Joseph has 112, and Millinocket Regional and Penobscot Valley have 25 each.

The numbers are not surprising, since EMMC draws patients from all of Maine north of Augusta, Northern Light Health spokesperson Suzanne Spruce said. That’s an area where more than 500,000 people live.

A lack of available beds at other hospitals and long-term care facilities across the state, combined with a rise in COVID-19 patients, have likely resulted in a high number of hospitalizations, Spruce said.

Some medical experts have also pointed to a potential rise in indirect COVID-19 hospitalizations — people who are not hospitalized with the coronavirus but with ailments that have emerged due to behavioral changes brought on by the pandemic.

People have gained weight and drunk alcohol more during the pandemic. National cigarette sales also increased for the first time in 20 years. Increasing numbers of patients are also being treated for drug overdoses, heart disease and psychiatric needs, Dr. Dora Mills, MaineHealth’s chief health improvement officer, said last month.

Spruce was unsure if behavioral changes had played as significant a role in new hospitalizations.

“While behaviors certainly play a role in both acute and chronic conditions requiring hospitalizations, it is difficult to point to a direct link with changes due to the pandemic versus other factors,” Spruce said.

Most counties with similar hospitalization rates nationally — 88 to 90 percent occupancy — have far lower vaccination rates than Penobscot. While 65.7 percent of Penobscot County residents are fully vaccinated against COVID-19, according to the data, the average is 49.5 percent in those other counties.

While it was reasonably common for EMMC to have bed occupancy of more than 85 or 90 in 2019 and before, that has become more common during the pandemic, Spruce said.

That is due to increased length of stay and the greater care required of COVID-19 patients, a lack of long-term care beds and an influx of patients from regional hospitals who need higher levels of care, she said.