COVID-19 contributed to the death of an inmate who tested positive for the virus during an outbreak at the York County Jail, the state Medical Examiner’s Office said.

The office said this week that a stroke was the primary cause of 47-year-old Jason Daigle’s death last month, but an exam and a review of his medical records identified coronavirus as a significant condition. That finding differs from comments made at the time by Maine’s top public health official, who said the death was not related to the virus.

Jason Daigle Photo courtesy of Daigle family

Meanwhile, the Maine Center for Disease Control and Prevention declared the outbreak at the York County Jail to be over last week. Nearly half the inmates and staff tested positive for the disease, which also spread to their family members and contributed to a spike in cases in York County. Interviews and an internal document revealed the jail had failed to follow safety protocols, even denying inmates masks and discouraging corrections officers from wearing them.

“Government officials should be held accountable when they endanger people’s lives unnecessarily,” Meaghan Sway, policy director for the American Civil Liberties Union of Maine, said Friday. “Mr. Daigle and his family deserve accountability. Members of the York County community, who elect these officials and who are also endangered by these failures, deserve accountability.”

Daigle, who lived in Berwick, died Sept. 20 at a local hospital after experiencing what officials had previously only described as “a medical issue” at the jail. The medical examiner’s office released his final cause of death this week: cerebrovascular accident, or stroke, due to hypertensive cardiovascular disease.

The office also listed what it called two significant conditions in addition to that cause: hemophilia, which is a genetic disorder that prevents blood from clotting normally, and COVID-19. An administrator said she could not discuss specific diagnoses, but that description includes any medical condition that contributed to a person’s death but was not the immediate cause.

The Portland Press Herald requested a copy of the office’s full report but had not yet received it Friday.

State and county officials previously said Daigle was among dozens of inmates who contracted the virus during an outbreak at the jail. But Dr. Nirav Shah, director of the Maine CDC, said last month that the man’s death was not related to COVID-19 because he had recovered and was no longer in isolation.

“In addition to that, the clinical features surrounding that individual’s passing were not related to COVID-19,” Shah said at the time, without further explanation.

A spokesman said Friday that the agency has not changed that classification based on the medical examiner’s determination.

“As Dr. Shah stated when this individual’s death was reported, Maine CDC’s review of medical records determined that the death did not meet Maine CDC’s criteria to be classified as related to COVID-19,” Robert Long wrote in an email. “Maine CDC classifies deaths as related to COVID-19 as part of its public health surveillance and data collection efforts, and does not make determinations about cause of death.”

In an email Saturday, Long clarified there have been instances since April when new information has caused the agency to reclassify a death as related to COVID-19, even though it did not originally fit the criteria. He also said the Maine CDC has not received any information that would prompt that change in this case.

Long did not respond to questions about any connection between strokes and the virus.

Medical experts are studying the association between COVID-19 and stroke. Doctors began to raise that alarm last spring when they noticed more reports of strokes in young and middle-aged people who had tested positive for the virus. Dr. Babak Navi, an associate professor of neurology and neuroscience at Weill Cornell Medicine and medical director of the Weill Cornell Stroke Center in New York, wrote a blog post for patients about that connection in August.

“I believe there is a link, which needs to be confirmed in large, high-quality studies,” Navi wrote. “I suspect the association is driven by multiple factors. First, infections and inflammation increase the risk of stroke. COVID-19 is an infection that produces a strong inflammatory reaction from the body. Second, COVID-19 seems to trigger cardiac events: heart attack, dangerous heart rhythms, etc. All of these factors can lead to a stroke. Third, COVID-19 causes a severe critical illness, which can lead to multi-organ failure, including kidney failure. Being critically ill and having multiple organs fail can place patients at a higher risk for stroke. The last potential explanation is how COVID-19 affects the body’s clotting system. It seems to promote clot formation, as evidenced by laboratory studies, but we don’t know exactly how.”

Daigle’s family has not responded to an interview request through the Medical Examiner’s Office.

A background check shows Daigle had never been convicted of a crime in Maine. He was arrested in June and charged with unlawful trafficking of scheduled drugs. A judge set his bail at $2,500 cash.

Defense attorney Nathan Hitchcock, who represented Daigle at the time of his death, has described him as “an honest, caring man.”

“During a pandemic, the stakes are literally life and death,” Hitchcock said. “Jason Daigle lost his opportunity at a second shot in life.”

Sway, from the ACLU of Maine, described “a series of failures.”

“The medical examiner’s report appears to show that Mr. Daigle had COVID when he died,” she said in an email. “Whether or not COVID was the ultimate cause of death, Mr. Daigle should not have been exposed to it. More tragically, Mr. Daigle should not have died in jail, alone and far from the people who cared about him.

“A series of failures resulted in this tragic circumstance. The first failure: a criminal legal system that continues discredited policies from the war on drugs. The second failure: the District Attorney’s decision to charge Mr. Daigle and set unaffordable bail, keeping him locked up during a highly contagious and deadly pandemic. The final failure: a sheriff’s office that did not implement basic COVID precautions in the York County jail. The sheriff needlessly exposed staff and people in his custody to a deadly disease.”

The outbreak was among the largest single-site outbreaks so far in Maine and the largest by far at a correctional facility. A jail employee attended an Aug. 7 wedding in the Millinocket region that is now considered a superspreader event linked to more than 170 cases statewide.

By the time the first person in the jail tested positive for the virus two weeks later, nearly half of inmates and correctional officers were infected. The Maine CDC said the total number of cases associated with the jail outbreak was 87. That included 48 inmates, 19 people who work in the building and 20 household contacts of employees. Interviews and an email to jail staff showed that most inmates were not allowed to wear masks, and guards were discouraged from wearing them to avoid creating panic.

York County Manager Greg Zinser did not respond to an email or a message at his office Friday.

In a news release earlier in the day, Zinser announced that the Maine CDC had closed the outbreak at the jail, which means no new cases had been associated with the jail for 28 days. The county manager also said that no inmates are currently receiving medical treatment related to COVID-19, and all staff have returned to duty.

“Since the jail outbreak occurred in August, we have worked closely with our staff and the CDC to stop the spread of infection, doing everything possible to help inmates and members of our team who have been impacted to return to health,” Zinser said.

The county asked an outside attorney to conduct an inquiry into the outbreak but shared few details so far. The news release said that process is still ongoing. Zinser also said the jail is following best practices for personal protective equipment, social distancing and testing.

“We’re committed to doing everything we can to ensure all safety protocols are being followed and to prevent any future outbreaks,” York County Commissioner Michael Cote said in the news release.

Editor’s note: This story was updated at 10:25 a.m. on Oct. 24 to clarify that there have been instances when the Maine CDC has reclassified deaths as related to COVID-19 upon receiving new information, after those cases did not originally fit the criteria. An earlier version of the story said an agency spokesman did not answer a question about how the CDC counts COVID-19-related deaths when someone is beyond that recovery period.