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PROVIDENCE -- In its “best estimate," a state model predicts that Rhode Island will see the COVID-19 outbreak peak on May 3 and will claim 2,120 lives by October.

But if residents fail to follow social distancing directives, the peak could come on April 27 and be much higher, with 4,015 deaths by October, Governor Gina M. Raimondo announced Thursday.

“The single most important variable in the model is the degree of effectiveness of social distancing," Raimondo said. “Social distancing makes a difference. It’s real lives.”

She unveiled the model as state health officials reported 18 more deaths associated with COVID-19, marking the highest single-day total and bringing the state death toll to 105.

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Another 309 Rhode Islanders have tested positive, bringing the statewide total to 3,838 cases, according to state Department of Health data. The state now has 245 people hospitalized with the respiratory illness, 61 in intensive care units, and 43 on ventilators, according to the data.

“I wish we were out of the woods," Raimondo said. "We are not quite out of the woods yet.”

The next two weeks will be critical, she said, urging people to continue following stay-at-home and social distancing directives.

Raimondo had been holding off on publicly projecting COVID-19′s destructive course in Rhode Island.

“I have been reluctant to share a model because it is still not a perfect model," she said. “It is not a perfect predictor of where we are going.”

For example, she said it’s only been a couple of weeks since she put a “stay at home” order in place, and it takes at least 10 days to see how that affects the hospitalization rate, she said.

But she said a 12-member team -- which includes epidemiologists, economists, toxicologists, and data scientists -- has been working on the state model, and the Department of Health has been collaborating with Brown University on the projection. The model is based on a framework from Johns Hopkins University, and officials consulted counterparts at the University of Washington, which has produced a widely cited model for the disease’s progression.

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So while any projection is somewhat imprecise, Raimondo considers this model “directionally correct.”

The model includes a “best estimate” that the state will need a peak of 2,250 hospital beds on May 3. A “higher scenario” shows the state needing a peak of 4,300 hospital beds on April 27.

Governor Gina M. Raimondo released this model projecting Rhode Island hospitalizations stemming from COVID-19 based on a "best estimate" and a "higher scenario."
Governor Gina M. Raimondo released this model projecting Rhode Island hospitalizations stemming from COVID-19 based on a "best estimate" and a "higher scenario."Rhode Island Department of Health

Under the “best estimate,” the state’s existing hospitals could handle the peak without having to turn to the field hospitals that are being set up at the Rhode Island Convention Center in Providence, a former Citizens Bank building in Cranston, and an old Lowe’s hardware store in North Kingstown.

“It will be very difficult,” Raimondo said. “But it is possible.”

The “higher scenario” reflects what would happen if Rhode Islanders stop taking social distancing directives seriously, she said. Right now, the state does not have the 4,300 hospital beds that would be required at the peak under that scenario, but it’s working to try to have that much capacity if needed, she said.

“For those of you who wonder does (social distancing) really matter -- it really matters,” Raimondo said. “We are talking about double the number of deaths, double the number hospital beds, determined by what we do together as a community right now in the next couple of weeks.”

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A week ago, the “higher scenario” looked a lot worse -- the peak was a lot higher, she said. But she said she does not expect to see that higher scenario become a reality.

“I hope in a couple of weeks I could come back to you with a different set of lines and say 'Way to go, Rhode Island, our system is not overwhelmed and we see real light at the end of the tunnel,” she said.

Raimondo said she will hold off until next week to make an announcement about whether school buildings will reopen during the remainder of the school year. Distance learning will continue at least through the rest of April. “This is a huge decision” that affects 142,000 students, she said.

“The model shows things are changing,” she said. “I need a little more time to look at the evidence and facts. I’m not willing to throw in the towel and say no more school for the rest of the year.”

Dr. Nicole Alexander-Scott, director of the state Department of Health, said all 18 of the new fatalities involved people who lived in nursing homes or other congregate care settings. Of the 18, seven people were in their 70s, seven were in their 80s, and four were in their 90s, she said.

Some of the 18 fatalities occurred earlier but were only reported now because of factors such as a lag in COVID-19 test results, she said.

Alexander-Scott detailed plans for the Oak Hill Center for Rehabilitation and Nursing, in Pawtucket, to serve as a central facility to accept patients being discharged from the hospital with COVID-19. That will allow patients to receive specialized rehabilitation and post-acute care, she said. People in other nursing homes with the illness will remain where they are, she said.

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About 45 percent of COVID-19 cases are among Latino Rhode Islanders, meaning Latinos are “significantly over-represented in those who have tested positive,” Alexander-Scott said.

She said the state is working to set up testing sites in core cities and trying to ensure that “regardless of zip code people get the services they need in good times and in bad times.”

On Wednesday, Dr. Deborah Birx, the response coordinator for the White House Coronavirus Task Force, said Rhode Island continues to see a rise in coronavirus cases in part because it’s trapped in between “two incredible hotspots” in New York and Boston.

When asked about those comments Thursday, Alexander-Scott said Raimondo set up a conversation on Wednesday between her and Birx to talk about Rhode Island’s needs in responding to the outbreak. “(Birx) acknowledged the tremendous work going on here and the density of our population adds a level of challenge to what we need to do,” she said.

Raimondo said she let Birx know that Rhode Island was struggling to get test kits and reagents. “She was responsive,” she said. “It has not always been easy to get everything we needed, but she was on it” and Birx realizes this region “is being hit especially hard.”

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Raimondo said state officials are trying to figure out what restrictions to put in place in restaurants and other businesses once the economy begins to reopen.

“It will be things like regular schedules of sanitizing, fewer people allowed in restaurants at any one time, changes to the way we work in shifts, continued wearing of masks, temperature checking before you go into public work places,” she said.

Until a treatment or a vaccine is developed, the country will face the possibility of another spike in COVID-19 cases, so the state will try to identify measure to avoid new surges, she said.


Edward Fitzpatrick can be reached at edward.fitzpatrick@globe.com. Follow him on Twitter @FitzProv.