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Rhode Island’s top doctor steps up to the podium amid the epidemic

Dr. Nicole Alexander-Scott, director of the state Department of Health, is an infectious disease expert and an advocate for health equity

Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health, briefed reporters on the coronavirus outbreak last month as Governor Gina Raimondo listened.
Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health, briefed reporters on the coronavirus outbreak last month as Governor Gina Raimondo listened.Steven Senne/Associated Press

PROVIDENCE — For more than a month now, Dr. Nicole Alexander-Scott has been a near-daily presence in the lives of many Rhode Islanders, as familiar locally as Dr. Anthony Fauci is nationally.

As director of the state Department of Health, she stands alongside Governor Gina M. Raimondo during each day’s televised updates on the coronavirus crisis, providing the latest data on deaths, positive tests, and hospitalized patients.

She details the directives aimed at slowing the spread of the disease, reminding us to wash our hands with warm soap and water, sanitize high-touch surfaces, and recently, to cover the lower part of our faces with scarves, T-shirts, or bandanas.

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So who is the person behind the podium?

For one thing, she is a specialist in infectious diseases for children and adults — expertise in high demand now that the state has 1,727 confirmed cases of the coronavirus and a death toll of 43.

She is the first African-American to lead the Department of Health and an advocate for health equity — committed to ensuring “that a person’s health does not depend on his or her ZIP code.”

And she is the mother of an infant son. At earlier news conferences, she wore a splint on her wrist for inflammation from holding the baby.

Alexander-Scott describes her son as “our miracle,” saying, “He helps remind us what life is about.” And she calls her husband “my absolute hero:” “Without him, none of what I am doing would be possible.”

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For some, Alexander-Scott is more than just an expert helping to lead the state’s battle against a deadly virus. She’s a role model, a symbol of possibility.

“As a fellow woman of color, it’s greatly gratifying to think of all those little girls and boys in communities of color” who are watching Alexander-Scott, said Secretary of State Nellie M. Gorbea, who is the first Hispanic person elected to statewide office in New England.

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Rhode Islanders are lucky to have Alexander-Scott heading the health department during the epidemic, Gorbea said, “not only because of her expertise in infectious diseases, but because of her character and commitment." And she has found a way to make it all work even with a baby at home, she said.

Often in the past, high-profile leadership positions have been held by white men, Gorbea noted.

“So for me, what’s been really special is to see these two women change the way people see leadership,” she said, referring to Alexander-Scott and Raimondo. “Rhode Islanders are now able to see women who are strong, competent, effective leaders.”

Raimondo described Alexander-Scott as “brilliant, hardworking, and thoughtful" as well as "a devoted mother, a supportive and empathetic boss, and a great friend.”

She has remained “unflappable and decisive” during the crisis, the governor said. “Rhode Islanders are incredibly fortunate to have her expertise guiding us through one of the most difficult times in our state’s history."

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Alexander-Scott grew up in the Park Slope section of Brooklyn, the daughter of a mother who worked as a nurse and a father who died when she was 11, but who often told people that his daughter was going to grow up to be a doctor.

She graduated from Cornell University before going to medical school at the State University of New York Upstate Medical University at Syracuse. After completing a combined internal medicine-pediatrics residency at SUNY Stony Brook University Hospital, she finished a four-year combined fellowship in adult and pediatric infectious diseases at Brown University.

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She received a master’s degree in public health from Brown University in 2011 and became an assistant professor at Brown University’s Warren Alpert Medical School in the pediatric and adult infectious diseases divisions. She served as a consultant to the Rhode Island Department of Health during the H1N1 pandemic in 2009 and 2010.

Alexander-Scott, 44, who lives in Providence, became director of the Department of Health in April 2015. She earns about $143,000 a year.

Alexander-Scott’s specialty in infectious diseases has focused on health care for both the very young and the very old — a focus that has helped in the current crisis because the coronavirus is hitting Rhode Islanders of a wide range of ages.

In fact, the state’s first case stemmed from a school trip sponsored by Saint Raphael Academy, a Catholic high school in Pawtucket; now many of the deaths associated with the coronavirus have been in an older population in nursing homes in North Providence and Pawtucket.

Alexander-Scott said her infectious disease training helped hone investigatory skills needed to figure out how people become exposed to viruses, she said: “Infectious disease doctors are often known as the Inspector Gadgets."

And she said her master’s degree in public health helped her focus on matters of health equity — how health problems can have a disproportionate impact on vulnerable populations.

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The Globe recently reported that Boston appears to have high infection rates of COVID-19, the respiratory illness caused by the virus, in Black, Latino, and immigrant communities in the city neighborhoods of Hyde Park, Mattapan, and East Boston.

And a Washington Post analysis found that counties that are majority Black have three times the rate of infections and almost six times the rate of deaths as counties where white residents are in the majority.

Alexander-Scott said Rhode Island is still compiling data on the outbreak’s impact on specific demographic groups. “We are continuing to investigate that,” she said.

But, she said, “We do know that, certainly, environmental, social, and economic factors make certain people more vulnerable. We talk often about how your health should not depend on the ZIP code you are from.”

The disparities seen with coronavirus cases in places such as Chicago and Louisiana underscore health disparities that existed long before the outbreak, Alexander-Scott said.

“It really exposes what we talk about all the time in non-pandemic situations,” she said. “This virus clearly does not have predilections for groups, but when you see groups disproportionately impacted, it allows you to recognize and bring attention to that fact that folks experience social and environmental and economic conditions that put them more at risk.”

Those conditions can include a lack of health insurance, economic instability, a lack of access to fresh fruits and vegetables, the prevalence of underlying conditions such as diabetes, unstable housing conditions, and the inability to stay at home if you must work, Alexander-Scott said.

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“When we start to rebuild, we need to be conscious of these kinds of structural inequities,” she said.

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So what has been the best and worst parts of overseeing Rhode Island’s response to the epidemic?

Alexander-Scott said the highlight has been the “amazing heart, determination, resilience, and compassion” of state health officials who are working weekends, putting in long hours. “My heroes have been my colleagues here at the department," she said.

The worst part has been seeing families lose relatives to the virus, including those who have died in nursing homes. “Those are grandparents, aunts, and uncles who are loved,” she said.

Alexander-Scott urged Rhode Islanders to adhere to the stay-at-home and social-distancing directives aimed at keeping the virus at bay.

“If we keep following the instructions,” she said, “we will get through this together.”


Edward Fitzpatrick can be reached at edward.fitzpatrick@globe.com