Milestone Recovery, a nonprofit shelter that deals with some of the most challenging cases of homelessness, appears to be the site of the latest COVID-19 outbreak in Cumberland County.

Milestone Recovery suspended its detoxification services, its 12-step programs and its Homeless Outreach Mobile Efforts in March because of concerns of coronavirus spread. Michael Kelley/The Forecaster

Executive Director Bob Fowler said the Portland-based shelter, which provides emergency services to people using alcohol, drugs and other substances, recorded its first confirmed case of COVID-19 last week and additional testing over the weekend has revealed another client and three staff members have been infected.

The Maine Center for Disease Control and Prevention recommends universal testing of everyone when a case is found in a congregate care setting. Fowler declined to provide details about the number of people who have been tested. But he suggested that not all of the 40 people identified as close contacts to the original case had been tested.

“We haven’t connected with all of the clients, all of the 40, that’s a process that’s still underway,” Fowler said. “They don’t always show up at the shelter when you do the testing. It’s a community effort to reach everyone that needs to be tested.”

The clients are recovering in respite shelters where they can safely isolate themselves. The state has secured hotels rooms for respite shelters, while another is being operated by the city of Portland but is available to other shelter operators.

So far, 16 homeless people in Portland have tested positive for COVID-19, including three from nonprofit shelters, according to the city. An additional three city shelter workers have tested positive. And at least 21 people have tested positive at the Hope House, a nonprofit shelter in Bangor.

Dr. Nirav Shah, the Maine CDC director, did not disclose the potential outbreak during his daily media briefing Wednesday, but Fowler said the agency was aware of the outbreak.

Maine CDC spokesman Robert Long said the state is investigating a possible outbreak at Milestone and whether the five cases are linked.

“Our case investigators are now determining whether at least three of the cases are epidemiologically linked, which would meet the definition of an outbreak,” Long said. “Testing support, personal protective equipment, and other services have been offered to Milestone.”

Fowler said his staff worked with Maine Medical Center in early March to adopt new policies and procedures to reduce the risk of the coronavirus being introduced into the India Street shelter. Those measures included reducing capacity from 41 to 34 people to provide additional space, screening clients and staff daily for symptoms and requiring everyone to wash their hands upon entry.

Fowler said he also worked with other shelter providers to keep track of the city’s known homeless population. They have assigned individuals to specific shelters to limit the likelihood that one person could introduce the disease into multiple shelters.

Staff have been following CDC guidelines, which have changed repeatedly over the last three months, he said. But he said it can be difficult to convince clients to wear masks when they are inside and the only enforcement mechanism is to kick them out.

“Our staff have been really vigilant about keeping themselves and others protected,” Fowler said. “So much of it is a balancing act when you’re working with people who have difficulty breathing, mental illness or are intoxicated.”

COVID-19 has torn through congregate settings with vulnerable populations nationwide, such as nursing homes and homeless shelters, and Fowler said he was pleased that they were able to keep COVID-19 out of Milestone for as long as they did.

“Generally we have had pretty remarkable success when you look at the rates in Portland compared to similar populations in other cities,” he said. “In general we have been feeling really pleased with how the infectious disease control efforts were going. This was obviously disappointing.”

Since testing was still underway, Fowler said it was too soon to say whether he was confident the illness had been contained.

“It’s an ongoing concern,” he said. “Even if everybody tested negative, we all know if you test negative today, you can test positive tomorrow. It’s a (situation) where there are no good answers.”