It’s been four years since Maine recorded its first case of COVID-19, and far more is known today about the coronavirus that causes the disease and how to contain it.

“We have come a long way since that first case in Maine,” said Dr. Puthiery Va, director of the Maine Center for Disease Control and Prevention. “We had minimal understanding of what the virus did and how it spread. We didn’t have vaccines or treatment.”

But much is still not known about why some patients develop chronic symptoms and about how to treat them. And health experts continue to warn that vaccination is the best defense.

As the coronavirus spread into Maine in March 2020, much of the world was shutting down, with limits on gatherings and mask mandates among a suite of pandemic restrictions and closures that followed. Widespread immunization began in Maine in early 2021, and more than 80% of Maine people received at least one dose of the life-saving vaccine. Restrictions were lifted over time, with the federal government ending the public health emergency last May.

Over the four years, more than 9,000 Maine people have been hospitalized with COVID-19 and 3,356 have died.

Hospitalizations and deaths still occur, but with widespread vaccination and more overall immunity in the population, they happen at a much lower rate. There were typically 50-100 people hospitalized with COVID-19 in Maine during the past few months, compared to a peak of 436 patients hospitalized statewide on Jan. 13, 2022. There were 440 deaths in Maine in 2023, compared to 1,272 deaths in 2022, according to the Maine CDC.

“We have effective vaccines and treatments,” Va said. “The shift happened because we now have the tools. It’s made COVID-19 more on par with flu in terms of hospitalizations and death.”

Everyone 5 years old or older should get the updated 2023-24 vaccine if they have not already, according to the U.S. Centers for Disease Control and Prevention. People 65 and older who have not had a dose in four months or longer are recommended to receive another dose of the updated vaccine. Children between 6 months and 5 years old are eligible for one or two doses depending on previous vaccine doses.

The reduced impact of the virus is part of what led the U.S. CDC last week to eliminate isolation guidelines for those who have tested positive for COVID-19.

The agency eliminated the recommended five days of isolation for those with COVID-19 symptoms and now urges “that people stay home and away from others until at least 24 hours after both their symptoms are getting better overall, and they have not had a fever (and are not using fever-reducing medication).”

“We can now be a little bit more flexible with COVID-19,” Va said. “If you are not feeling well, you should still be staying home.”

LONG COVID REMAINS A PROBLEM

But while the world is in a better place in responding to COVID-19, long COVID remains a persistent problem. For some, COVID-19 symptoms remain long after the initial infection.

Dr. Clifford Rosen, principal investigator for the MaineHealth RECOVER program, which is part of a national effort to research long COVID, said about 10% of people who were infected with COVID-19 before the 2022 omicron wave developed long COVID symptoms, while about 5% to 8% of those who got infected more recently are contracting long COVID.

Symptoms of long COVID include brain fog, fatigue, post-exertional malaise, dizziness, heart palpitations, loss of smell or taste, and chest pain.

“We are making progress, but it’s slow and people are impatient,” Rosen said. “But no one should doubt that this is a real condition.”

Rosen said one of the most important ways people can protect themselves against long COVID is to remain updated with their COVID-19 vaccines.

Treatments are still being researched, and Rosen said his research group is currently examining whether Paxlovid is an effective treatment for long COVID. Primary care doctors should consider prescribing Paxlovid for those with long COVID, Rosen said.

Other medications undergoing study include metformin, which is used to treat diabetes, and Immulina, a supplement that boosts the immune system.

Rosen said a proposal by Sen. Susan Collins, R-Maine, if successful, could help improve access to treatment for long COVID patients, by spending at least $5 million to establish COVID-19 Centers for Excellence. If the funding is approved, Maine could be one of the Centers for Excellence.