How Rhode Island Fell to the Coronavirus

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PROVIDENCE, R.I. — The numbers began ticking up in September. After a quiet summer, doctors at Rhode Island Hospital began seeing one or two patients with Covid-19 on each shift — and soon three. Then four.

Cases climbed steadily until early December, when Rhode Island earned the dubious distinction of having more cases and deaths per 100,000 people than any other state in the country. The case rate still puts it among the top five states.

Where did this tightly knit state go wrong? Former Gov. Gina Raimondo’s “pauses” on economic activity were short-lived and partial, leaving open indoor dining, shopping malls and bowling alleys. But the shutdowns were no patchier than those in many other states.

Until late summer, she was lauded for reining in the virus. Even now, few residents blame her for the bleak numbers. (Ms. Raimondo was sworn in as the secretary of commerce on Wednesday night.)

led to an outbreak of at least 29 employees and nine patients. It’s a phenomenon seen in hospitals throughout the United States.

The rules for patients don’t always accord with the science, said one nurse at Rhode Island Hospital. At first, the hospital did not allow anybody up from the E.R. until test results were back. But as the first surge ebbed, the rules became lax.

Patients were sent up with pending test results, potentially exposing other patients as well as the nurses who cared for them. After treating one such patient, at least nine nurses tested positive for the virus, the nurse said.

The policy at most hospitals in Rhode Island now is to have health care workers wear N95 respirators or similar reusable masks at all times, and to test anyone suspected of having Covid-19. But that does not account for patients who might be asymptomatic and who come in for other ailments.

Rhode Island has adopted one unusual approach: Officials are distributing vaccines to anyone who will take them in Central Falls, regardless of age. It’s a strategy that few other jurisdictions have tried.

“We decided to do that because of the horrific toll of the pandemic in those communities,” said Dr. Rodriguez, the vaccine committee member. Twenty percent of the adult residents have received at least one dose at local clinics, not including those who may have been immunized at work or elsewhere.

The state’s plan to immunize those at highest risk by age and geography, he added, “will put out the fire where it is burning the most intensely.”

In recent weeks, the number of cases in Rhode Island have fallen, as they have in the rest of the country. And fewer health care workers are getting sick because they have been immunized, so hospital shifts are better than they used to be, Dr. Ranney said.

But cases in the state are still the third highest per capita in the country. And doctors are continuing to see patients who have so-called long Covid, she said: “The trouble is that once patients get admitted, they don’t leave.”