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Rhode Island leads the country in rate of new COVID-19 cases, and officials fear things could get worse

Population density, the change in weather, and some residents dropping their guard appear to be among the driving factors in the recent spike

Under the supervision of the state National Guard, drivers waited in line for COVID-19 testing at the Rhode Island Convention Center in Providence.John Tlumacki/Globe Staff

PROVIDENCE — As Rhode Island’s public schools prepared to reopen in early September, Governor Gina Raimondo sounded as upbeat as she had at any point during the pandemic.

She told residents on Sept. 9 that fewer than 2 percent of all COVID-19 tests were coming back positive, a stark contrast from other states that were still seeing positive rates in the double digits. She praised businesses for remaining compliant during the Labor Day weekend, and assured families that the state was prepared for in-person learning to begin.

But now, Rhode Island leads the country with an average daily case rate of 122.9 per 100,000 people, according to data published by the Centers for Disease Control and Prevention. That’s among the highest numbers in the world, according to The Financial Times. By comparison, neighboring Connecticut and Massachusetts have positive rates of 74.2 and 65.6 per 100,000, respectively.


The state reported 982 new cases on Monday, and 22 more deaths, bringing the total number of fatalities in Rhode Island to 1,470 since March. The 444 residents in the hospital are the most at any time during the pandemic, and the state has been forced to open two field hospitals to provide open beds.

Cases continued to rise even as the governor imposed a two-week “pause” on the economy. The Department of Health is issuing temporary licenses to health care workers who are still completing their training programs, and the governor is pleading for retired or unemployed health care workers to volunteer to help in hospitals.

As the weather has gotten colder, people have spent more time inside. Experts say that, plus a little more complacency around social gatherings and a little less vigilance about protocols like hand-washing and mask-wearing, likely magnified the impact of the second wave of infections that hit the state.


“The air is dry, our hearts are warm, but viruses love dry air,” said Dr. James McDonald, the medical director at the Department of Health.

The virus has spared no community — for the last week of November, only Block Island and South Kingstown reported positive rates below 100 per 100,000 residents — but cities, and especially those with large Latino communities, have been hit the hardest. In recent weeks, the test-positive rate among those who identify as Latino has been three times higher than for white residents, which has sent cases soaring in Central Falls, Pawtucket, and Providence.

Rhode Island is among the most densely populated states in the country, which McDonald said is one of the driving factors when it comes to community spread. During the first wave of the virus, in April and May, the state also posted some of the highest positive rates in the country.

McDonald said population density, the change in weather, and some residents dropping their guard appear to be among the driving factors in the recent spike. He said he looks at the virus and the public as opposing teams, and the virus is a formidable opponent.

“Team Virus never gets tired and always knows what it’s doing,” McDonald said. “Team Human gets tired, we’re in denial, and quite frankly, we just don’t care anymore. And we’re scared.”

Dr. Megan Ranney, an emergency room physician at Rhode Island Hospital, took to Twitter Tuesday to lay out several potential causes for the state’s rising cases. She said density, high levels of poverty, and too many family gatherings that become “super-speader events” could be among the reasons. She also noted that a high concentration of college students and the large amount of testing that is occurring could be factors.


“At the end of the day, regardless of the reason, our hospitals are overwhelmed & everyone knows someone who’s sick,” Ranney tweeted. “We are calling for retired [health care workers] to volunteer, while allowing people to eat in-person at Denny’s. We are, frankly, in a very bad spot. With no sign of slowing.”

Rhode Island is in the second week of what Raimondo calls a two-week pause of the economy, which deeply limited the in-person dining capacity at restaurants and closed recreational facilities like gyms and casinos. The state has also restricted gatherings to single households, which means residents were not supposed to eat Thanksgiving dinner with anyone they don’t live with.

The state has also given high schools the OK to move to distance learning, but Raimondo has said she wants elementary and middle schools to remain open as long as possible. Still, Cranston, the state’s second-largest school district, announced Monday that it will move to distance learning for at least the rest of 2020.

With the pause ending Sunday, Raimondo is expected to announce later this week whether she’ll extend the restrictions. During a weekly interview on WPRI-TV Tuesday evening, she said it’s too soon to say whether social gatherings will be limited for Christmas.


“It’s my hope that I can get a handle on it and reduce our test positivity,” Raimondo said.

While the governor has faced criticism for not implementing tighter restrictions prior to Thanksgiving, McDonald defended the state for trying to balance its approach between health guidance and keeping businesses open.

“You can always do something sooner,” McDonald said. “What’s hard about that is, does sooner necessarily mean better?”

Both McDonald and Raimondo say they are closely monitoring hospitalizations, even more so the daily number of positive cases. In November, the average daily number of new hospitalizations was 46, up from 19 in October. In the first few days of December, the average is 60 hospitalizations a day.

McDonald said he’s hopeful that Rhode Island will continue to receive doses of monoclonal antibodies to help treat high-risk COVID-19 patients, and he noted that a vaccine is expected to be widely available during the first half of 2021.

McDonald said he believes Rhode Island still has the ability to control the disease, but he warned that things could also get worse if the existing restrictions aren’t followed.

“As bad as it is now, only about 10 percent of Rhode Islanders have had it,” he said. “You’re looking at a susceptible population of close to 90 percent.”

Dan McGowan can be reached at dan.mcgowan@globe.com. Follow him on Twitter at @danmcgowan.