As the holiday season approaches during the state’s worst surge of COVID-19, Maine health experts say testing is one of a variety of ways to stay safe, but rapid at-home tests remain expensive and difficult to find.

Dr. Dora Anne Mills, chief health improvement officer for MaineHealth and former director of the Maine Center for Disease Control and Prevention, laid out five layers of protective measures, which she equated to wearing layers of warm weather gear. 

The thickest layer — the down coat of COVID-19 protection — is the vaccine, Mills said. The next layers are masking, distancing and ventilation.

“Then the last layer is testing, which very few can really do,” she said.

Rapid at-home tests can be purchased at drug stores like Walgreens and are available online. But they cost an average of $24 and can be sold out.

During recent media appearances, Dr. Nirav Shah, director of the Maine CDC, also pointed to testing as one way for Mainers to stay safe during the holidays, particularly when gatherings include unvaccinated people.

“The more you can test folks — before they get in the car, before they hop on that plane, before they walk in — the safer the gathering will be,” Shah said on Maine Public Radio’s Maine Calling program. “Now these rapid tests, they’re still a little bit tough to find. I acknowledge that. But they are available.”

The state this month also opened a new testing program in Calais and is working to expand hours at state-funded testing sites, Maine CDC spokesman Robert Long said.

Mainers who have COVID-19 symptoms, have been exposed to someone with COVID-19 or meet other criteria can schedule testing at various locations. More information is available on the Maine CDC website.

The bigger picture

The Biden administration in recent months approved spending $3 billion to purchase at-home testing kits, which is expected to quadruple available tests by December.

But national public health experts say the United States remains far behind other countries when it comes to available and affordable rapid tests.

Michael Mina, assistant professor of epidemiology at Harvard T.H. Chan School of Public Health, has been outspoken throughout the pandemic about the importance of testing as a public health measure.

In many other countries, rapid tests are inexpensive or free, Mina told Harvard Magazine this month. But in the U.S., demand has outpaced supply, primarily because only a few companies are approved to make the tests.

“We’re starting to see capacity build, and we’re starting to get some more of the companies that are selling for less expensive overseas now driving the prices in the United States down,” Mina said. “This could have happened last year, unfortunately, in 2020. It didn’t. And you know, I don’t really see it happening before 2022.”

Biden’s efforts to ramp up production should make the tests more available and affordable, Mills said. “But it has been a dilemma and a struggle since the beginning, that it’s hard to get easy access to a test.”

Lack of access to testing also could hinder promising solutions. Oral antiviral medication could be approved next month, but the pill has to be taken within 3-5 days of the onset of symptoms, which requires early testing, Mills said. Similarly, monoclonal antibodies can reduce the chance of hospitalization, but should be taken within five days of the onset of symptoms.

“We’re finding a lot of people are not able to or don’t get tested until it’s too late. Then they get admitted to the hospital,” Mills said.

Safe holidays

While testing can be limited, there are a number of other ways Mainers can protect themselves and others during the holidays. And Thanksgiving doesn’t need to be quite as restrictive as last year.

“We had probably four people at Thanksgiving last year. And two years ago it was 40,” Mills said. “This year we’re not doing 40 and we’re not doing four. We’re doing something in between, probably 10 to 12.”

Both Mills and Shah said the most important measure is making sure everyone who is eligible is vaccinated. While it can be uncomfortable to talk to family members about their vaccination status, Mills said she would explain that she’s trying to make sure older and vulnerable family members can be safe.

“Personally, I would not be going indoors and spending the holiday with people who are eligible and not vaccinated,” she said. “I wouldn’t feel safe. There’s so much disease right now.”

The remaining layers of protection depend on the attendees and the circumstances, Mills said. And the methods can be dialed up and down depending on the situation.

It’s a good idea to be outside as much as possible, she said. When indoors and with people from other households, wear masks and open windows for ventilation. When masks are off while eating indoors, space out separate households from each other.

“I do think it’s important for people to get together,” Mills said, “but it’s important to be doing it safely.”

Maine is in the middle of its worst surge of the pandemic, she said, driven primarily by unvaccinated people.

Despite a high statewide vaccination rate, Maine this week  set records for new COVID-19 cases, hospitalizations and the positivity rate.

Shah has said part of the explanation is that Maine didn’t experience the same spikes as other states earlier in the pandemic and thus doesn’t have the same background immunity. Therefore, the virus is able to rip through unvaccinated parts of the state.

Mills said it’s “discouraging” to watch the COVID-19 numbers continue to rise. Yet some unvaccinated patients still insist they don’t have COVID-19, even when they go on ventilators, she said.

“I’ve never seen anything like this before in my entire life,” she said.

Maine is in a “surge within a surge,” so it’s important to be careful during family gatherings.

“Hospitals are full. We are over-full. We are overstretched. I don’t know how else to say it. We can’t afford to have another surge after Thanksgiving.”