A woman wearing a mask looks at her phone in Portland on Dec. 28, 2021. Credit: Troy R. Bennett / BDN

As the COVID-19 pandemic has worn on, Samantha Gilligan is starting to see patients fall through the cracks.

The nurse practitioner at the Seaport Community Health Center in Belfast is seeing patients who are struggling to afford healthy foods, or get to the doctor because their transportation has broken down. One woman with substance use problems she works with often relapses and stopped using medication during the pandemic after her car broke down.

Those are the Mainers are at risk of their health getting worse as the pandemic wears on. The secondary effects of the pandemic have been well-documented, including increased mental health issues and record overdose deaths in 2021. Maine is at a crucial juncture to address the problems before they get worse, Gilligan said.

‘It’s an entire system right now that is leading to poorer health outcomes,” she said.

The most recent illustration of the problem came in the form of a study from researchers at the University of Maine and the University of Vermont examining wider pandemic health changes released Wednesday. The study was conducted between March and June 2021, a period during which cases were declining while vaccines became widely available.

It found Mainers experiencing food insecurity were nine times more likely to experience higher stress in the pandemic and that 45 percent of respondents developed depression. Forty percent of Mainers gained weight during the pandemic. People in the LGBTQ community suffered four times more from mental health issues and hypertension. It was not surprising to researchers, as Maine has long had a reputation for being one of the hungriest states in the country.

While the virus poses immediate and ongoing threats to the state’s hospital capacities, the wider developing physical and mental health problems developing during the pandemic could create greater stresses and require more public investment once COVID-19 subsides.

“Hopefully, we can take the data that we have and use it to design policies that are automatic, and policies that are easy to use and that are accessible with no stigma,” said Jonathan Malacarne, a professor of agricultural economics at the University of Maine who worked on the study. “So that when things happen — because things will always continue to happen — people can rely on them and it’s already built into their strategy.”

The results show the cumulative weight of the emotional and mental stress caused by the pandemic, Malacarne said. Allocating tight resources is already a stressor, but doing so in a time when people were losing their jobs or children were staying home is even harder.

For Aspen Ruhlin, the results were sobering, but not surprising. A client advocate for the Mabel Wadsworth Center in Bangor, an independent health center in Bangor that provides LGBTQ-specific care, Ruhlin has seen the effect already higher-than-average health disparities had on their community before the pandemic.

“Food insecurity is not a failure of the individual, but of society at large,” Ruhlin said. “We have enough food for everyone, it’s just a matter of, ‘Do the people in power value people enough to make sure they have it?”

The state has been monitoring the secondary effects of the pandemic since it began, Maine Department of Health and Human Services Commissioner Jeanne Lambrew said on Wednesday. Those efforts are centered in programs like OPTIONS, meant to address substance misuse and StrengthenME, which focuses on behavioral health and resiliency in the pandemic. She did not anticipate an end to those efforts anytime soon.

“That work continued during the height of the pandemic, it continues to this date, and it certainly is on our horizon as well,” she said.

Correction: An earlier version this report Jonathan Malacarne’s title.