Written by Judy Pasqualge   

A few weeks ago, in consideration of the most at risk of dying of COVID-19, I put the figure at a rough 40%. I was way off.

Almost every day I check to see notable figures in Maine, the US and globally; I do this without suggesting that others do the same; perhaps I am warped, but it helps me to look this situation in the face, and I am very afraid; it also serves to provide information that is unavailable in the mainstream media.

It is important to first stress that it is false to portray the choice as being protecting/reviving the economy vs. minimizing the number of deaths. The cost to the economy is usually calculated without suggesting possible new sources of income (even if temporary), such as increases in income taxes, imposition of a transaction tax on stock activity, consideration of offshore asset holdings, and special provisions that lessen corporate taxes. Nor do calculations of lost revenue and GDP incorporate a virus resurge that forces closures, and all the costs that have no monetary value. There is also little comment on the contradiction in putting workers back on the job in a context of lax enforcement of guidelines ‒ increasing risk to themselves and thus to everyone.

Normally I wouldn't be too quick to dig deeper. However, on May 5 a Yahoo article¹ cited a RAND Corporation model and compared data on several states, noting the strictness of measures, as compared to the estimated costs to a state under strict/moderate/no measures. From these state examples, dollar savings amounts were given if restrictions were lessened. However, the article was very misleading, and it is suggested that the reader go to RAND itself to see the important assumptions built into the model, especially regarding timing and definitions of restriction levels. (www.rand.org/pubs/tools/TLA173-1/tool.html#projected-effects)

Level 1: Close schools.

Level 2: Close schools, bars, and restaurants; and ban large events.

Level 3: Close schools, bars, and restaurants; ban large events; and close nonessential businesses.

Level 4: Close schools, bars, and restaurants; ban large events; close nonessential businesses; and issue a shelter-in-place order for the most vulnerable.

Level 5: Close schools, bars, and restaurants; ban large events; close nonessential businesses; and issue a shelter-in-place order for everyone but essential workers.

New normal: No intervention. Adjusted activity levels relative to the previous level of intervention.

Here is what RAND projected for Maine before May 8 (when the under-tested state had 1,330 cases and 62 deaths), assigning the most strict level 5.

IF:	deaths by Sep 1	ICU beds needed on Sep 1	hospital beds needed on Sep 1	cases by Sep 1	loss of income March 1-July 14
stay at level 5 going to new normal July 14	150	40	310	3,400	$2.24 b
go to level 3 from June 15, new normal July 14	220	72	540	4,400	$1.94 b
go to level 2 from June 15, new normal July 14	750	220	1,600	9,600	$1.89 b
go to level 1 from June 15, new normal on July 14	1,100	240	1,900	12,000	$1.85 b
go to level 1 from June 1, new normal on June 30	2,000	230	1,800	16,000	$1.56 b (to June 30)

On May 8 Maine Governor Mills announced that restrictions would be almost immediately relaxed on 12 of 16 counties (largely more rural), because no community spread was seen, and the state had just acquired increased testing capacity.

This policy change was reflected in new RAND projections on May 9, under a current level 2 restriction.

IF:	deaths by Sep 1	ICU beds needed on Sep 1	hospital beds needed on Sep 1	cases by Sep 1	loss of income
stay at level 2 , new normal 15 June	2,300	210	1,500	17,000	$1.24 b (Mar 1-June 13)
go to level 1 from 15 May, new normal June 13	2,900	200	1,500	19,000	$1.21 b (- June 13)
go to level 1 from June 1, new normal July 1	1,800	250	1,900	15,000	$1.56 b (- July 1)

Since measures followed by many states do not exactly conform to the RAND categories, AND the RAND model is limited as to choice of duration and end of a measure, AND it is not known if the RAND projections incorporate the addition of perhaps some tens of millions of summer visitors to Maine (the average is 29 million from May-August, sometimes more than 200,000 per day) ‒ and the percentage of them expected to adhere to the state-mandated 14-day quarantine requiring no contact with others ‒ it is best to not state firm projections.

Nonetheless, one can compare:

‒ staying at level 5, new normal July 14 (3,400 cases, 150 deaths, $2.24 b loss)

‒ staying at the new level 2, new normal June 15 (17,000 cases, 2,300 deaths, $1.24 b loss)

‒ going to level 1 on May 15, new normal on June 13 (19,000 cases, 2,900 deaths, $1.21 b loss)

‒ going to level 1 on June 1, new normal on July 1 (15,000 cases, 1,800 deaths, $1.56 b loss)

It is clear that minimizing the dollar loss means increasing the number of deaths; in particular: the low of 150 deaths would mean a $2.24 b loss; a high of 2,900 deaths would mean a $1.21 b loss. This is one estimate of the human cost of saving about $1 billion.

Based on national and Maine statistics on the most at risk (age, preexisting conditions, special circumstances, including type of work), one can get some idea about who may be most likely to die, as the number of deaths increases. (see a detailed chart on the US and Maine at the end of this article)

Because of the overlap in people with various and multiple health conditions and of various ages, it's hard to say how many of the 1.3 million Mainers are most at risk, but they do roughly include: 250,000 age 60+; 77,000 veterans age 55+, and 25,000 disabled veterans; 67,000 on disability insurance; 300,000 with adult obesity; 145,000 with asthma, incl. 30,000 kids; 70,000 with copd; 250,000 with arthritis; 100,000 with diabetes; 350,000 with hypertension; 74,000 with CHD; and 60,000 cancer survivors.

As for occupations, the very at risk include: some 40,000 in healthcare; 6,000 first responders; 5,000 postal workers; 8,000 in education; 5,000 in janitorial/cleaning; 45,000 in food service and drinking places; 17,000 in grocery stores; 5,000 in jail plus 1,700 staff ‒ coming to some 130,000. This figure does not include workers whose job might be otherwise 'safer' but have preexisting conditions. And it is not known how many workers are in very risky jobs AND have these conditions.

With the population of Maine at about 1.3 million, it is likely that in addition to the 250,000 people age 60+ who the state advises should continue to follow the stay-at-home policy, hundreds of thousands more who are younger than 60 would be advised to do the same ‒ in all, likely more than half of the population.

It is impossible to say what the effects of this would be due to the loss of consumption revenue. Also unclear is the impact on the image of Maine as a place to retire, or as a safe tourist destination.

This all, of course, says nothing about the experiences of perhaps 15,000 more people who get sick but don't die, and the effect if visitors to Maine get sick here, require hospitalization or die, or are seen to be prioritized.

Maine officials are clearly in a Catch-22, and, no matter what, they have to take a gamble; and it is true that the highest responsibility lies with the executive and legislative branches of the federal government. It is hard to gauge the political cost to Maine officials, in this day when standardized rationalizations are used to cover the expendability of so many people ‒ workers and nonworkers alike; but it may perhaps be more apparent in November and after.

Factors in the political cost may include:

‒ if the image of such actors as the Chamber of Commerce, the Retail Association of Maine and Democratic Party seems to coincide too closely with that of the current non-science policy of the Republican Party; already the state has chosen to not follow the federal CDC loosening guidelines, and has abruptly opened rural areas. It is unclear why one DP official, the speaker of the House of Representatives and candidate for US Senate, underestimated the number of people with preexisting conditions at 230,000³;

‒ if the state enforces its own regulations regarding physical distancing, use of face coverings, and the 14-day quarantine period for people coming into the state ‒ especially during the tourist season, and in light of reports already about lax enforcement (and the same currently regarding distancing and coverings);

‒ if the increase in testing is matched with contact tracing, and thus serves to do more than confirm cause of death;

‒ whether the two groups advising the Maine administration on loosening and on economic recovery are expanded to include people from all walks of life, including the most at risk, and evaluation considers nonmonetary factors;

‒ and whether a priority is seen to be given to providing new information, strengthening guidelines and laws, and upping services to protect those most at risk, at home or on the job ‒ over half of Mainers; or whether actions convey a requirement of calm silence in order to 'save' the economy.

For sure, confidence in government is falling, and what is going to happen will not be forgotten. I can see additional trouble if a scenario occurs that shows some 2,500 extra deaths, with an economic savings of $1 billion ‒ each death saving the state $400,000; or if, due to negligent tourism, the death toll is higher.

When a rural area turns into a hot spot, at the same time that tens of thousands of people come from outside, in a context of lax enforcement, and with pushback already to strict pandemic measures from the political Right, there is no doubt that one target of blame will be the outsiders. In short, some people who are against restrictions will blame outsiders for the rise in cases and deaths. I fear for Maine's minority community ‒ their number would add another 94,000 to the most at risk ‒ and for people with cars with out-of-state license plates.

Right now, I'm sitting here in Knox County, in beautiful midcoast Maine, a county that went to level 2, opened retail on May 11, and opens restaurants on May 18. Further lessening will come in June and July. The county population is 39,771. Just down the coast is Lincoln County, with 34,342, and just up the coast is Waldo County, with 39,694.² As of May 10, Knox had 18 cases, Lincoln 15, and Waldo 49; and the state total is rising, to 1,436. Waldo has had 13 deaths (many associated with a nursing home).

At the urging of a friend, I looked up the word 'genocide' in Webster's 7^th: "the deliberate and systematic destruction of a racial, political, or cultural group." Perhaps the addition of some 15,000 new cases and perhaps 2,500 deaths by September 1 ‒ to save about $1 billion ‒ is only collateral damage, or perhaps the at-risk COVIDs constitute a new cultural group.

Boy, I sure wish that the state had some pull with Jeff Bezos or Bill Gates, or with the Bush or Rockefeller families who summer up here, and that the federal legislative branch took its responsibility seriously.

What are your predictions for Maine come, say, mid-September, as the tourism season ends? Stay tuned.

¹ https://www.yahoo.com/finance/news/the-cost-of-reopening-the-economy-in-lives-201007725.html.

² https://worldpopulationreview.com/states/maine-population.

³ Candidate Sarah Gideon, in campaign TV ad at the end of April (29^th?), https://www.facebook.com/ SaraGideonME/videos/230000/557629544885911/?__so__=permalink&__rv__=related_videos.

 

Some of the Most at Risk of Death due to COVID-19 in the US and Maine (compiled by Judy Pasqualge)

	US	Maine
economic indicators GDP (2019) budget (2020-2021) tourist spending (reported Apr 2019) critical care beds ventilizers Pen Bay Medical Center, Rockport, Knox County: beds		$67,518,600,00026 $7.98 b27 at least $6 b 28828 308 + 413 alternative vent.s   total  16529 acute care  81, ICU  630
total population	329,064,916 (2019)1	1,344,212 (2019)3
age 60 and above	73,710,539 (22.4%)1	c. 250,023 (18.6%)4
0-19 20+		c. 352,184 (26.2%)4 c. 992,028 (73.8%)4
minority groups		94,0953 African American  1.6%  21,507 Native American  0.7%  9,409 Asian  1.2%  16,131 Hispanic  1.7%  22,852 2 or more races  1.8%  24,196
Social Security recipients
Old-Age and Survivors Insurance	52.7 m (2018)2	277,2742
Disability Insurance (for workers)	10.2 m (2018)2	67,2082
Supplemental Security Income (for aged, blind, disabled with limited income)	8,128,652 (2018)2	36,875 (2018)2 blind 212, disabled 34,923, aged 1,740
autoimmune conditions (rheumatoid arthritis, lupus, IBD, MS, Type 1 diabetes, psoriasis, graves disease, MG, Hashimoto's thyroiditis, Guillain-Barre)25	› 23.5 m5	arthritis c. 250,000 cases (est. 2010  290,329; 2030  248,703)6
diabetes     Type 1 prediabetes	34.2 m (2018) (10.5%)7 7.3 m undiagnosed 14.3 m seniors (65 and older) 1.6 m, including 187,000 under 18 88 m (age 18 and above)	adult  10.5% (2018) c. 104,1636
heart disease coronary artery disease   heart attack	leading cause of death 18.2 m (20 and above)8 1/5 of deaths in adults under age 65 805,000 per year	adult hypertension  34.8%6 (2017) c. 345,226   CHD adults 7.5%  (2009)9 c. 74,400
chronic obstructive pulmonary disease chronic bronchitis emphysema	16 m10   › 8.9 m (2016), 75% in over age 45 3.5 m, › 90% in over age 45	adults 6.9%   68,450 (20+)11 18–44    3.4%    15,813+ 45–54    8.1       16,441 55–64    11.4     14,864 65–74    13.2     13,308 ≥75                         13.4     12,248   asthma  146,95012 adults (11.7%) c. 116,067 children (9.1%) c. 32,049
cancer	1,735,350 new cases (2018)13 15.5 m cancer survivors (2016) (minimum 4.7%)	8,920 new cases (2019)14 obesity-related c. 45,0006 cancer survivors c. 63,178 (at US rate)13
adult obesity severe obesity	42.4% (2017-2018)15 9.2%	30.4% (2018) 301,5776 age 10-17  14.9%6
Labor
Total number of jobs	161,037,700 (2018)16	615,27517
Healthcare physicians and surgeons physician assistants RNs nurse practitioners licensed practical/vocational nurses pharmacists pharmacy aides	756,800 118,800 3,059,800 189,100 728,900 314,300 37,000	offices of physicians  10,551   nursing and residential care 23,685   pharmacy  2,842
home health aides nurse assistants orderlies	831,800 1,513,200 51,000	4,425
EMT and paramedics ambulance drivers and attendants	262,100 15,600	1,632
social workers	707,400
fire police security guards	332,400 691,600 1,143,800	1,424 4,512
bus drivers taxi/chauffeurs subway/streetcar drivers	681,400 370,400 9,200	transit/ground transport passenger  2,686 taxi and limo  321
post office clerks post office carriers	75,700 328,700	federal clerks/carriers  3,273 couriers and messengers  2,287
education, training and library	9,647,400	educational services  8,383
janitors and cleaners refuse and recyclable materials collectors	2,404,400 133,000	3,520 1,310
waiters bar tenders fast food and counter	2,634,600 644,100 4,184,400	food service and drinking places    46,788
butchers and other meat, poultry and fish processors	377,700	animal slaughtering/processing 471
retail cashiers	3,671,100	grocery store  17,319 supermarkets  15,736 convenience  1,583
veterans	17,964,242 (2018)18 pre-SWW only  4,83219 SWW only  435,538 Korean War only  1,145,773 SWW and Korea  32,776 Vietnam War only  5,909,320 Korea and Vietnam War  111,040 1st Gulf War only  2,231,804 Vietnam and 1st Gulf War  282,708 2nd Guld War only  2,474,807 1st and 2nd Gulf War  1,224,886   disabled (2018) (disability rating)20 70% or more  1,527,220 50 or 60%  574,119 30 or 40%  678,590 10 or 20%  1,174,469 no rating  13,615,186	107,09121 18-34: 6,115 35-54: 23,441 55-64: 20,589 65-74: 30,437 75+: 26,509   disabled (age 21-64) 24.9%22 (2017)
in jail   state prisons federal prisons and jails local jails correctional officers and jailers	2.3 m, including 44,000 youth and 42,000 in immigration detention21 1,291,000 226,000 (166,000 convicted) 631,000 (161,000 convicted) 434,300	5,000, including 80 youth24   2,400 630 1,800 1,726

 

¹ https://www.populationpyramid.net/united-states-of-america/2019/.

² https://www.ssa.gov/policy/docs/statcomps/supplement/2019/supplement19.pdf.

³ https://www.census.gov/quickfacts/ME.

⁴ percentage rate from: https://www.infoplease.com/us/comprehensive-census-data-state/demographic-statistics-25; applied to 2019 population.

⁵ https://www.womenshealth.gov/a-z-topics/autoimmune-diseases.

⁶ https://stateofchildhoodobesity.org/states/me/.

⁷ https://www.diabetes.org/resources/statistics/statistics-about-diabetes.

⁸ https://www.cdc.gov/heartdisease/facts.htm.

⁹ https://www.maine.gov/dhhs/mecdc/population-health/hmp/mcvhp/documents/burden-of-cardiovascular-disease-2012.pdf.

¹⁰ htttps:// www.healthline.com/health/copd/facts-statistics-infographic#4.

¹¹ https://www.cdc.gov/copd/maps/docs/pdf/ME_COPDFactSheet.pdf.

¹² https://www.maine.gov/dhhs/mecdc/population-health/mat/information-and-publications/2014%20Factsheets/Statewide_factsheet%202-8-16.pdf.

¹³ https://www.cancer.gov/about-cancer/understanding/statistics.

¹⁴ https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html.

¹⁵ https://www.cdc.gov/obesity/data/adult.html.

¹⁶ all US employment figures, except as noted: https://www.bls.gov/emp/tables/emp-by-detailed-occupation.htm.

¹⁷ all Maine employment figures, except as noted: https://www.maine.gov/labor/cwri/qcew.html, Maine_Employment_and_Wages.xlsx.

¹⁸ https://www.statista.com/statistics/25027/us-veteans-by-gender.

¹⁹ https://www.statista.com/statistics/250279/us-veterans-by-period-of-military-service.

²⁰ https://www.statista.com/statistics/250316/us-veterans-by-disability-status.

²¹ https://worldpopulationreview.com/states/maine-population/.

²² https://www.statista.com/statistics/521377/american-civilian-veterans-service-related-disability-share-by-state.

²³ https://www.prisonpolicy.org/reports/pie2020.

²⁴ https://www.prisonpolicy.org/profiles/ME.

²⁵ https://www.web.com/a-to-z-guides/autoimmune-diseases.

²⁶ https://fred.stlouisfed.org/series/MENGSP.

²⁷ https://www.google.com/search?client=firefox-b-d&q=maine+budget+2019.

²⁸ https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus.shtml (May 10, 2020).

²⁹ https://www.ahd.com › free_profile › Rockport › Maine.

³⁰ https://www.leapfroggroup.org › hospital › profile › Pen+Bay.^.

³¹ https://www.pressherald.com/2019/04/10/tourist-visition-trends-down-in-maine-for-second-year/.