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A coronavirus surge made worse by inequity

Poverty, a lack of affordable housing, and jobs that can’t be done remotely make Central Falls a horrible hot spot for COVID-19 infections in Rhode Island

Central Falls health ambassador Elvin Toro, left, hands out a package of information and face masks on Thursday as part of the city's attempt to curb the spread of the coronavirus.Pat Greenhouse/Globe Staff

CENTRAL FALLS, R.I. — As he tries to keep a massive coronavirus outbreak at bay in tiny Central Falls, Dr. Michael Fine, the city’s chief health strategist, sees the inequity up close.

He sees how colleges throughout New England can afford to test students and staff as often as twice a week, while the residents of this impoverished, 1.29-square-mile city wait for five days or more to schedule a test as the case count skyrockets.

He sees how the region’s factories, meat packing plants, and fish processing plants remain open, forcing many of the city’s low-income workers to spend hours in crowded buildings while white-collar workers stay safely at home, logging into Zoom conferences.


He sees how infected family members stay stuck in cramped triple-deckers while the city searches in vain for hotel rooms or other safe spots for people to isolate so they don’t spread the virus.

“If we were serious about approaching health equity, we would be doing for our poorest residents what we are doing for our college students, and we are not even close,” Fine said. “The inequality is outrageous.”

Fine, who served as director of the state Department of Health from 2011 to 2015, was greeted this week by grim statistics showing the city’s COVID-19 infection rate has shot up to 1,058 per 100,000 people – more than double the statewide rate.

Dr. Michael Fine, chief health strategist for the City of Central Falls, R.I.Tia Thuong/Snicca Photography

Since March, Central Falls has been a hot spot for the virus in Rhode Island, and while the initial outbreak subsided in late summer, the past three weeks have been brutal, with 152 cases reported the last week of October, 141 cases reported the first week of November, and 205 cases reported the second week of November, the latest state Department of Health data show.

In an interview, Fine said he is “incredibly disappointed” in how the nation has responded to the pandemic.


“We have failed on testing, we have failed on contact tracing, we have failed on enforcement of isolation, and the consequence of our failure is widespread dissemination of the virus,” he said. “With so many people sick, it is compounding the underlying inequities caused by race and income.”

On Thursday, Governor Gina M. Raimondo announced a “two-week pause,” beginning Nov. 30, to try to curb the virus in the state.

The new measures include closing gyms and casinos, asking most high school students to learn from home, and closing offices “when possible.” The state is immediately lowering social gathering limits to individual households.

Fine said he realizes the governor must balance competing interests, including the state economy and public education, but he fears the latest state action might be too little, too late.

“We are bringing an eye dropper to a forest fire,” he said.

Fine said he thinks the state should have taken action “to limit movement” three or four weeks ago. And he noted that the “two-week pause” doesn’t take effect until Nov. 30 — which means the virus could spread rapidly until then.

Rhode Island Department of Health spokesman Joseph Wendelken said there is no doubt that communities such as Central Falls have been disproportionately impacted by COVID-19.

“This is a wrong that we’re focused on every single day,” he said. “Within the state response, we have a whole unit that is focused on health equity and our more densely populated communities. However, we absolutely know that more needs to be done.”


So far, the state has invested $834,500 of federal CARES Act funds in Pawtucket and Central Falls, he said. That money has supported the “Beat COVID-19″ hotline, support for families in quarantine and isolation, outreach and mask distribution, and funding for community-based organizations providing direct support to people.

“These are essential services that need to not only be maintained, but expanded,” he said.

But meanwhile, if factories in Rhode Island and fish processing plants in New Bedford stay open, “then essentially you are condemning the people of Central Falls to this kind of rapid spread of disease,” Fine said. “You are discriminating in favor of those people who can stay at home and earn a living.”

Many city residents get tested for COVID-19 at a state-run site in nearby Pawtucket. Fine said that site is testing 125 to 150 people a day, while the city would need to test thousands of people per day to keep up with colleges.

He said he is thankful that a Central Falls pediatrician, Dr. Beata Nelken, is testing 75 to 100 people per day in her private office across from City Hall. “She is everybody’s hero,” he said.

On Thursday, Raimondo announced plans to open additional testing sites at McCoy Stadium in Pawtucket, South Road Elementary School in South Kingstown, and the Stop & Shop store in Greenville, and will expand testing at the Wickford Junction train station.


But Fine wonders if it’s too late for additional testing to make a difference.

Testing is only effective if those who test positive are able to isolate immediately and if those who have come in close contact with an infected person can be traced and tested quickly, he said. At this point, the state’s contact tracing system is overwhelmed, he said — an issue confirmed by Raimondo in recent weeks. And in a community as densely populated as Central Falls, finding a place to isolate is easier said than done.

City Hall in Central Falls, Rhode Island.Pat Greenhouse/Globe Staff

“If you live in Barrington in a home with five bedrooms and three bathrooms, you can move into one wing of the house and isolate and maybe prevent that transmission,” Fine said. “That ain’t happening in Central Falls. You might have a two-bedroom apartment with six, seven, eight, nine people living there, and one bathroom.”

Wendelken acknowledged that the lack of affordable housing is one of the “structural inequities” driving health disparities in COVID-19. “We also need to address the issue of housing in the long-term and the short-term to support families in this moment, and in the future,” he said.

While they wait for the state to help, Central Falls is doing what it can to curb the virus, Fine said.

He praised Central Falls Mayor James A. Diossa for issuing an executive order Monday that limits the city’s bars and restaurants to takeout and delivery service.

“Think of the courage it took for the mayor to do that when no one else in the state has done it,” he said. “We want to take care of all the businesses in the city, but we want to make sure it is safe so people can feel safe and can use the businesses.”


On Thursday, Raimondo announced that bars in the state will close beginning Nov. 30, and restaurants will be limited to 33 percent capacity, with a one-household-per-table requirement. That means restaurants can remain open for Thanksgiving and the night after Thanksgiving – typically one of the busiest nights of the year in the service industry.

Fine also praised the work of the Central Falls “health ambassadors” – 22 people who wear bright yellow vests and orange hoodies as they distribute face masks and remind residents and business owners about the importance of flu shots, social distancing, and other public health protocols.

Central Falls health ambassadors Elvin Toro, left, and Yanina Zuniga walk around the city, passing out coronavirus information and face masks.Pat Greenhouse/Globe Staff

All of the ambassadors are local residents, and many of them speak Spanish or Creole — a necessity in this majority-Latino city with a significant Cape Verdean population. “Instead of spending money on outside consultants, we are spending money on people from Central Falls, many of whom were out of work because of the pandemic,” he said.

Each day, the ambassadors measure how many city residents are wearing face masks, Fine said. On Friday, the “masking percentage” was 95 percent, on Thursday it was 85 percent, and on Wednesday before it was 45 percent. While the number can vary widely, it averages 70 to 75 percent, he said.

“We want it at 90 percent consistently because the evidence suggests that if you did that, you will reduce viral transmission by 60 percent,” Fine said. “We are trying to do what works.”

He said if everyone wore a mask, that would help curb spread of the virus until a vaccines arrives. But he said he is concerned about groups of people getting together on Thanksgiving Day, and he is worried that the virus will spread as people line up at big box retailers the day after Thanksgiving.

“Hopefully,” Fine said, “the disease will be under control by next Thanksgiving.”

Edward Fitzpatrick can be reached at Follow him @FitzProv.