Most people who are infected with hepatitis C virus have no early symptoms. A few might have jaundice; a rare few might have anorexia or abdominal pain, according to the Centers for Disease Control and Prevention. But unless those infected are tested and treated, many of them will slowly and un-knowingly develop chronic liver disease including, sometimes, cirrhosis of the liver. Maine is just beginning to understand the extent to which Hepatitis C has spread across the state, making a recent report on the subject from the Bureau of Health important and disturbing.

The report estimates that 15,000 Mainers have hepatitis C, but fewer than 2,000 are aware of it. The cost to Medicaid for just those who qualified within these 2,000 was more than $12 million last year, six times the amount of just four years ago. Not coincidentally, almost all of the identified carriers of this disease have emerged in just the last couple of years, meaning many more ad-vanced cases could be out there unidentified. As the report states, “Maine has arrived at a crucial juncture – a crossroads – in the hepatitis C epidemic in our state.”

Maine’s choices at this crossroads are to remain largely ignorant of the problem, expand testing to identify more carriers and then hope for the best or begin to establish a full range of medical testing, stress disease prevention, offer behavioral and social support and create a network supporting these services. As the report makes clear, the choice at this crossroads is really no choice at all. It would be irresponsible to ignore the findings of this work and pretend that what health officials are calling an epidemic is not happening.

The number of cases in Maine is not unusual, but the lack of knowledge here about the dangers of hepatitis C makes the state vulnerable to rapid increases in this disease. Populations at particular risk are drug abusers who share needles and other equipment; people who had blood transfusions or used blood products before 1992, when screening for hepatitis C began, and people infected with HIV, for whom it is the No. 1 killer. Alcohol can make any liver disease worse.

The health bureau performs a service just by alerting the public to the problem of hepatitis C, but the authors of the report further offer a half-dozen ways Maine can reduce and treat infection. They include more public awareness, more testing, better services and affordable, comprehensive care for people who are infected. It is a reasonable list, one that Maine could meet in a couple of years of effort.