What Went Wrong in Rhode Island With the COVID-19 Pandemic?
Saturday, December 05, 2020
The state of the COVID-19 pandemic in Rhode Island is undeniably one of the worst in the country. With 113.2/100,000 new cases/day (as of 12/3/2020), Rhode Island now has the second-highest infection rate in the U.S. – and climbing.
According to covidactnow.org, the non-profit organization of researchers from Georgetown University Center for Global Health Science and Security, Stanford University Clinical Excellence Research Center, and Harvard Global Health Institute, Rhode Island is the only state on the east coast rated as “Extreme – Severe Outbreak”.
For months, Rhode Island has had more severe infection rates than other New England states, and is currently projected to experience a total of 2,200,000 (two point two million) infections over the next 12 months -- it is obviously a number that can't be reached due to the state's population but demonstrates the uncontrolled spread.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTA Rhode Islander now becomes infected every minute, 24 hours a day. An average of 1,201 Rhode Islanders get infected each day. That rate is increasing. With a state population of 1.056 million, one way of looking at 2.2 million infections is that we each could have a 200% chance of getting infected over the next 12 months, or might each get infected twice.
There has been much speculation (and rationalization) as to why things are so horrendously bad in Rhode Island. This review tries to shed light on some possible causes, reasons why things have gone so terribly wrong here and what could be done about it.
This is not represented as a rigorous scientific study, and no statistical analyses were used. This is simply a very preliminary broad-brush look at the publicly available data, in hopes that more comprehensive work might be done by experts such as at the renowned Brown University School of Public Health.
Factors that have been mentioned as possible reasons for the horrific crisis in Rhode Island include an older population, a large nursing home population, and population density.
The following table summarizes population and some pandemic-related data across eight northeast states:
Age
Among 8 northeast states, Rhode Island has the 6th oldest population. Five other states all have both older average populations, and much lower infection rates. Age does not seem to be the explanation. The lowest infection rates are currently in Vermont and Maine, both of which have older populations than Rhode Island (Maine has the oldest in the country).
Nursing Home Population
Rhode Island does have a relatively larger nursing hope population than other northeast states. As a raw percentage, 0.72% of Rhode Island’s population are nursing home residents, compared to 0.38%-0.55% for the other seven states. COVID-19 deaths in nursing homes are disproportionate in Rhode Island, accounting for 46% of all COVID-19 deaths to date.
However, this does not explain the overall high infection rate in Rhode Island. COVID-19 cases in Rhode Island nursing homes represent about 4% of all cases, in line with the range of 2%-6% across other northeast states. As a crude raw measure, the 60,772 cases (as of 12/3/2020) in Rhode Island represent 5.8% of the total population of 1.06 million. Even excluding nursing home cases still results in a crude infected rate of 5.5% of the population, higher than any other northeast state.
Vermont and Maine stand out as notable exceptions. Those two states have the lowest infection rates in the country, and also have the lowest proportion of nursing home residents infected (5% and 7% respectively). In Rhode Island, 2,329 COVID-19 cases have been reported out of a total nursing home population of 7,558, a raw infection rate of 31% and similar to Massachusetts, Connecticut, and New Jersey. This suggests that Vermont and Maine are doing a better job of controlling COVID-19 in their nursing homes than Rhode Island or other northeast states are doing.
The population of nursing home residents -- and COVID-19 cases there -- also do not explain why Rhode Island has such a high overall infection rate.
Population Density
Rhode Island has the second-highest population density of all states. However, the 4 most densely populated states are all in the northeast. New Jersey has the highest population density, with Massachusetts third and Connecticut fourth.
Furthermore, the pandemic has been successfully contained in some of the most densely populated areas in the U.S. such as New York City, 30.1/100,000/day, and the San Francisco Bay area, 20.6/100,000/day. It has also been contained in many densely populated countries including Japan, South Korea, Taiwan, and China. Additionally, some of the highest infection rates are currently found in some of the lowest population density states in the country, including South Dakota, Wyoming, and North Dakota.
All of this makes it hard to point a finger at density as a major factor in Rhode Island’s pandemic catastrophe.
What went wrong in Rhode Island?
The simple answer as to why things went so dreadfully wrong here is the mismanagement of the crisis by our political leaders. Rhode Island has the second-highest infection rate in the country and one of the fastest-growing. There is no getting around the fact that management of the pandemic here has been a complete, cataclysmic failure. We are rapidly becoming a humanitarian disaster.
Vermont and Maine continue to have the lowest infection rates in the country as well as the lowest infection rates in nursing homes. They are examples of best practices, with Rhode Island one of the worst.
Even from a cursory analysis, it is clear that Rhode Island followed much more lax guidelines both in putting containment measures in place, and subsequent reopenings. The following two graphs compare the timing of closures and reopenings in Rhode Island with Vermont and Maine, showing the per capita infection rates (per 100,000 population) over time and the dates some of the measures were put in place:
Rhode Island, Vermont, and Maine all experienced almost identical per capita infection rates in the first weeks of the pandemic – the numbers and the plotted lines overlap.
However, in both Vermont and Maine, closures started earlier (1-2 weeks) and lasted longer (4-6 weeks) than in Rhode Island. Both states also reopened more slowly and cautiously than Rhode Island. Both states also implemented new containment measures sooner than Rhode Island in the recent resurgences. Furthermore, some of Rhode Island’s measures are less rigorous and have a number of counter-productive exceptions. The current ‘Pause’ still allows indoor dining at restaurants, and nail salons, movie theaters, places of worship, big box stores, and other places to be open where large numbers of people can gather.
It is absolutely essential to act quickly and decisively in the pandemic. Delaying for even a week or two can allow infections to increase dramatically, and also then sets a course to grow even more. The experiences across the states also show the importance of keeping containment measures in place long enough, until infection rates are consistently and continuously low, and not reopening too soon.
A close-up look at the first three months of the pandemic clearly shows this:
Rhode Island’s delays in taking action allowed infection rates to get much higher here than in Vermont and Maine.
Rhode Island also started reopenings while infection rates were still high, much greater than in Vermont and Maine. Those two states waited until infection rates were reduced to very low levels and stayed down for several weeks before starting any reopening. Rhode Island started reopening when infection rates were beginning to trend down but were still at high levels, much higher than were seen at any time in Vermont or Maine.
The following table compares the infection rates across the three states at different points in time: when the first closures were made, when reopenings started, and recent containment measures:
Rhode Island waited too long to close, then started reopening too soon, and continued reopening too quickly. Combined with incomplete, half-hearted measures with nonsensical exceptions to closures, these seem to have been the drivers to infections becoming so appallingly bad here.
What to do?
The dramatically different experiences of Rhode Island vs. Vermont and Maine, as well as those of countries around the world where the pandemic has been successfully contained, prove the power of proper containment measures. The various small steps attempted in Rhode Island in recent months have all been too little, too late, and have not worked to bring down terrifyingly high infection rates.
Close downs work. They are the only thing that works in the pandemic, and especially when the situation has been allowed to get as totally out of control as it has in Rhode Island. They are good for reducing illness, and good for preventing deaths. They are also good for the economy, because economies thrive when people not only feel safe, but actually are safe to go out. If we close down now, properly, there will be so many more of us healthy, uninfected, and alive to get the vaccines when they arrive.
In any conflict between denial and reality, reality always wins. Every time. The virus doesn’t care about silly ‘exceptions’ or ridiculous things like allowing indoor dining at 33% of restaurant capacity. Pretending things aren’t the way they are won’t change them. Pretending didn’t help the 60,772 Rhode Islanders infected so far, or the 1,400 that have died. Pretending won’t help the rest of us. The way things are going, without major changes it’s likely most of us will become infected before we have a chance to get vaccinated.
Being elected to a position of leadership means you have to show it. Our elected leaders haven’t. They have failed us, and have abdicated their responsibilities and oaths of office. If you want to change things, then we all need to contact the Governor:
(401) 222-2080
and your local state Representative
http://www.rilin.state.ri.us/representatives/default.aspx
with a flood of calls and emails demanding leadership. Demand that they stop the illnesses and stop the deaths. The life you save may be your own, or someone you love.
Nick Landekic a retired scientist and biotechnology executive with over 35 years of experience in the pharmaceutical industry.
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