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(Portland Phoenix/Rebecca Reinhart)
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With the omicron variant surge of COVID-19 abating and hospitalizations returning to levels last seen months ago, mask mandates are disappearing and experts are optimistic about what lies ahead for public health and the economy.

But two years after COVID-19 was declared pandemic, they remain worried about the unknowns that may lie ahead from possible new variants or the effects of long COVID – and particularly the long-term mental health challenges posed by the coronavirus.

Even if COVID-19 does retreat in the next few months, Dr. Dora Anne Mills, chief health improvement officer at MaineHealth, said health care systems will continue to be strained for the foreseeable future. 

Malory Shaughnessy
Malory Shaughnessy, executive director of the Maine Alliance for Addiction and Mental Health Services.

Additional strains on health care facilities have picked up in Maine already, with an influx of patients struggling with psychiatric issues. Malory Shaughnessy, executive director of Maine’s Alliance for Addiction and Mental Health Services, said “we went from hospitals being full of COVID patients to hospitals being full of people in mental health crisis.”

Emergency departments have been overtaken by patients struggling with COVID-related mental health issues, Shaughnessy said, and there are not enough community facilities available to accept them.

She said workers have left community-care jobs due to the pandemic, leaving those facilities ill-equipped to handle the volume of patients. She said she doesn’t see this resolving anytime soon, and historical evidence suggests the mental health need is only going to worsen.

Risks of ‘a new normal’

Disruptions that alter life in major ways, like Hurricane Katrina along the Gulf Coast, can have long-term repercussions that reverberate for years, Shaughnessy said. But past disasters can also provide insight into what might follow as the coronavirus changes from pandemic to endemic. 

Dr. Dora Anne Mills
Dr. Dora Anne Mills, chief health improvement officer at MaineHealth.

Mills said Katrina produced an increase in several health problems, including depression, anxiety, addiction, cardiovascular disease, and cancer, which lingered as long as 10 years after the disaster. Similarly, she said COVID-19 infection seems to trigger chronic symptoms (“long-haul COVID”) as well as heart disease and strokes.

The implications of the pandemic as a stressor event – increased rates of anxiety, depression, and substance abuse – are already noticeable in Maine, Shaughnessy said. She said substance use, alcohol use, and the number of people seeking therapy or going into mental health crises are spiking and are likely to continue to increase for at least the next few years.

Mental health and substance abuse problems can worsen when transitions back to a sense of normality begin. When that transition is apparent, and then people begin to realize it’s “not the normal you were hoping to get back to,” Shaughnessy said, the repercussions on peoples’ mental health can be even worse.

Greg Marley, clinical director and director of suicide prevention for the National Alliance on Mental Illness in Maine, said so many people have been holding on and trying to survive throughout the pandemic that once a relaxation period comes along, more mental health issues will appear.

Greg Marley of NAMI Maine
Greg Marley, clinical director and director of suicide prevention for NAMI Maine.

Marley said he’s concerned that suicide rates could increase, and noted there has been an increase in middle-aged suicides.

Living with COVID-19

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, warned the public against a “quest for normalcy.” In an email, he said people need to accept the reality of living with COVID-19.

“We’re not out of this pandemic yet,” Shah said, “so my team remains focused on what we can do each day to reduce the risk for Maine people and provide them with the information they need to make informed choices about how they live their lives with COVID in their midst.”

Shah noted the availability of vaccines and general resilience in the people of Maine as reasons for optimism. The risk of serious illness or death from COVID-19 is lower than in past years, he said, because most people in the state – 82 percent of those eligible – have been fully vaccinated. 

Dr. Nirav Shah of Maine CDC
Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention.

“Maine can be proud of how we’ve rallied together and supported each other to become one of the most vaccinated states in the country, Shah said, ” thereby limiting the tragic impact of this virus. But our work is not done.”

Mills said she remains optimistic based on how many COVID-19 prevention tools are now available but isn’t ruling out the possibility that the disease could surge again. 

“As overstretched as we were with 436 (hospitalizations at the peak in January), I can’t imagine if we’d had that many more hospitalized,” she said. “But we’ve learned a great deal, and we’re better prepared for whatever the pandemic throws at us.”

Those tools include vaccinations, high-quality masks, and knowledge about better indoor ventilation. Conversations about a second booster shot have started, but the FDA isn’t ready to recommend one yet, according to Dr. Peter Marks, who heads the FDA’s vaccine division.

A chance to bounce back

Economically, there is hope, in particular, for a boom in Maine’s hospitality industry if public health restrictions remain minimal this summer. Even though staffing challenges may persist, Matt Lewis, president of HospitalityMaine, said there’s potential to equal or beat last year’s numbers, which were “outstanding.”

Kate Snyder
Portland Mayor Kate Snyder.

Mayor Kate Snyder shared optimism about opening up in Portland when the weather permits, especially thanks to the city’s large vaccinated population. 

“As the weather warms and omicron recedes I expect Portland to come alive with outdoor (and indoor) dining, events, concerts, and activities. I know we’re all eager to regain the ability to move more freely through the days, with less fear, and more optimism,” Snyder wrote in an email.

Still, she urged the public to remain alert to CDC guidance and believes living with COVID-19 will become a part of daily life, similar to the way we exist with illnesses such as influenza.

Lodging businesses in Maine saw a 27 percent increase in revenue in 2021 compared with 2019 (2020 being a low outlier due to the initial pandemic impact), according to Greg Dugal of HospitalityMaine. Restaurants didn’t see the same growth, but with restrictions loosening, he said this summer could be better than last.

Lewis said there’s no doubt in his mind that people are comfortable with getting back out and visiting Maine. He said Maine economic data shows people wanted to visit the state before vaccines were available and the desire only increased as restrictions were lifted.

Matt Lewis of Hospitality Maine
Matt Lewis, president of Hospitality Maine.

He said there’s a silver lining in what the hospitality industry has learned over the past two years: Employers are more mindful about addressing the personal health and wellness of their workers, acknowledging the importance and value of vacation time, benefits, and mental health support.

The realization of how important it is to take care of employees in the hospitality industry, particularly in terms of mental well-being, is also an example of how the pandemic has helped make the public more accepting and aware of mental illness and mental health struggles.

If anything, Malory Shaughnessy said, these last two life-altering years have made people realize that anyone can be affected by mental health issues, or find themselves in crisis.

Greg Marley agreed and said he’s noticed a “renewed recognition of the need to focus on mental illness and mental health,” particularly how it can impact anyone. So many people have been battling with their mental health, or have been close to someone who has, he said, that it’s reducing the stigma.

But an unfortunate side effect of the increased recognition has been the inability to access outpatient mental health care, with people facing waits as long as six to eight months to receive therapy, Shaugnessy said.

Marley said he’s been trying to emphasize the importance of people working to build more hope and resilience within themselves. It’s also important to keep conversations open with loved ones, he said, to help support each other and cope with whatever lies ahead with the pandemic.

What’s next?

After the CDC updated its framework for determining the level of COVID-19 risk a community faces on Feb. 25, Dr. Greta Massetti of the agency’s COVID-19 Incident Management Team said the new framework provides a picture of COVID-19 in the community while also identifying the potential strain on that community’s health care systems.

As of March 1, most of Maine, including Cumberland County, was still considered to have a high level of community transmission – although that could be a result of the new emphasis on hospital capacity rather than an indication of new hospitalizations or cases, which were down significantly from the end of January.

The lifting of mask recommendations and the end of a requirement that vaccinated individuals quarantine after contact with a positive case opens up further possibilities for economic recovery, particularly with the return of warm weather. 

But an air of caution remains for unvaccinated people: Experts still encourage those who aren’t vaccinated – about a quarter of all Mainers – to get the first dose available to them.

And while optimism surrounds the recent decline of the virus, experts like Dr. Shah of the Maine CDC and Dr. Mills of MaineHealth remain wary about possible long-lasting implications. With plenty to learn about long COVID and the repercussions the pandemic will have on mental health, there are still more difficult days to come, they said, and caution remains key.

“I think it will be less of a matter of bouncing ‘back’ and more of a case of being resilient and nimble as we adapt to the stress that COVID will continue to exert,” Shah said.

“Even a butterfly emerging from the cocoon flutters its wings for a while before it fully flies,” Mills wrote on Feb. 21. “Yes, this stage of the emergence from the surge seems like the right time to be fluttering, not yet for a full flight.”