For months after he stepped into his role as Rhode Island’s chief executive, Governor Dan McKee got to be the bearer of good news on the COVID-19 crisis.
You can take off your masks now if you’re vaccinated. You can go back to full-capacity restaurants, attend music festivals, dance at nightclubs, and drink at bars. Vaccines are widely available, no appointments necessary. He often stood in the shadow of a huge banner that touted 1 million shots in arms by May, a banner that read, “Protecting Rhode Islanders. Reopening the economy.” And by the way, here’s a truckload of cash from the federal government.
But those hopes for a carefree, post-virus end to summer have been dashed by the Delta variant. And McKee, who has been reluctant to reimpose any restrictions on residents and businesses, this week ordered health care workers to get vaccinated or face twice-weekly testing.
His mandate highlighted the situation Rhode Island finds itself in: Infections have been rising for weeks, from 12 per 100,000 residents during the week of July 3 to 145 this week. There were just 18 people in the hospital with COVID-19 on July 21; two days ago there were 79. On July 3, just 0.4 percent of people tested were positive for the virus; now it’s up to 3.3 percent.
Rhode Island is hardly alone, especially compared to some southern states where outbreaks are swamping ICUs. The highly contagious Delta variant has caused an increase in infections in every state of the union.
The question is what comes next.
On Tuesday, for the first time in weeks, McKee held a news conference to address Rhode Island’s COVID-19 situation. McKee, the former lieutenant governor who took over the top spot when Gina Raimondo left in March to join the Biden administration, announced that the state will now mandate COVID-19 vaccines for health care workers in state-licensed health care facilities, ranging from nursing homes to private and public hospitals. In the state’s own public hospital, less than half of the employees were vaccinated as of July.
He also said the state was working on guidelines for its own workers to mask up — but he did not wear a mask himself at the news conference, and relayed an anecdote of a store asking him to put one on recently. The Centers for Disease Control and Prevention now recommends that even fully vaccinated people wear masks in public indoor settings if they’re in an area of substantial or high spread of COVID-19, which right now includes Rhode Island.
“You or your family need to know the risk of the Delta variant, and then if you are vaccinated, make the decision that’s best for you,” McKee said, brandishing a mask in his hand — but never at any point putting it on his face. “If you want to wear a mask in public, wear a mask in public.”
McKee was joined by two top Department of Health officials and Lt. Gov. Sabina Matos, who all wore masks when they weren’t speaking. Dr. Nicole Alexander-Scott, the director of the Department of Health, said she was making the personal decision to start wearing a mask indoors in public places again.
“Why not use one of the additional tools we have to help protect yourself and your loved ones?” Alexander-Scott told reporters gathered in a Capitol Hill conference room.
McKee’s resistance to sterner measures stands in contrast to states like Washington, where the governor has ordered government workers to get vaccinated or face losing their jobs, and Maine, which has expressly recommended people wear masks indoors in certain high-transmission areas even if they’re vaccinated.
The Rhode Island increase is showing up in hospital wards and in state infection trends, where more than 75 percent of new cases are estimated to be caused by the Delta variant.
“We really thought the worst was over, but as with many things in science, it’s not that straightforward,” said Dr. Oliver Mayorga, the chief medical officer of Westerly Hospital. “This Delta is really throwing us for a loop.”
The situation at Westerly Hospital is one local example of how the Delta variant is playing out in a state where, despite being among the highest vaccinated in the state, still has nearly 200,000 holdouts.
In the quiet summer months before the Delta spike, if Westerly Hospital had any patients at all, it would have one at a time. That was down from a peak of 22 in December. As of Monday, there were eight patients with COVID-19, including three in intensive care.
All of them are unvaccinated.
It’s not unheard of for fully vaccinated people to need care for COVID-19 at Westerly Hospital, Mayorga said, but they are in the minority, at much lower risk of death than people who are not vaccinated.
Even though the Delta variant is spreading in the face of high vaccination rates, “I would say as a physician, [the vaccine] still prevents death significantly, and it prevents hospitalizations,” Mayorga said.
Some health experts, meanwhile, say Rhode Island should be doing more to address the rise in COVID-19 cases.
“Unfortunately, unless we see fairly strong action from the state, I’m expecting the number of preventable deaths to go up,” said Dr. Michael Fine, a former director of the state Department of Health.
Though McKee has often noted that deaths are still at a low level, if the state waits until deaths start to rise, it will be too late, Fine said. The state should offer even more robust testing than the program that already is among the nation’s leaders. People over 65 with chronic diseases should be encouraged to stay at home, and there are good reasons to wear a mask indoors -- starting not now, but three weeks ago, Fine said.
“I know it’s unpopular; I hate masking too,” Fine said. “And I’m a big fan of dive bars. But I’ve only been at the Ocean Mist once in the last year. And I haven’t been to Nick-A-Nees.”
For infectious disease experts, the rise in infections comes as no surprise after highly vaccinated places, including the United Kingdom and Israel, saw increases amid the Delta variant before the US did.
“A wave is building,” Dr. Eleftherios Mylonakis, chief of infectious diseases at Lifespan’s Rhode Island Hospital and the Miriam Hospital. “With vaccines, the wave is going to be moderated, but how long the plateau is going to be is going to be crucial.”
There are still some open questions, like whether vaccine protection may fade over time, Mylonakis said. What will come next? That part is pretty well settled, Mylonakis said. We should expect to see a real increase in cases in a month, and then increases in hospitalizations two or three weeks after that.
Should we expect deaths to increase along with that?
“We don’t expect it,” Mylonakis said. “We know it.”
But more good news about the vaccines: On Monday, only one of the system’s 11 admitted COVID-19 patients was vaccinated, Mylonakis said.
A similar trend is on display at Care New England’s Kent Hospital in Warwick, where people are still coming in sick with COVID-19 — but mostly unvaccinated. The high numbers of vaccinated people should help the state avoid the worst of the surge of winter 2020-2021, which resulted in Rhode Island opening field hospitals.
“There are two things everybody should do,” said Dr. Jinen Thakkar, a hospitalist who helped run Care New England’s field hospital. “Mask indoors, and get vaccinated if you have not.”
South County Health in Wakefield has also seen an increase in the number of patients presenting with COVID-like symptoms, according to Anitra Galmore, the system’s chief nursing officer and chief operations officer. Galmore said in an email that “a surge in COVID cases is anticipated in mid- to late October,” and because of that, people who are vaccinated or unvaccinated should still wear face masks.
“We will continue to watch the data with respect to the number and severity of new cases,” Galmore said. “The general hope is that as more people get the COVID vaccine, the number of new cases will decrease.”
Even as worries about the new surge abound — particularly with an exhausted health care workforce facing a shortage of nurses — there are reasons for hope, according to leading doctors. Rhode Island is still not seeing major problems in its nursing homes, where infections ravaged the elderly and frail populations, said Dr. John Stoukides, chief of geriatrics and palliative medicine and vice chairman of medicine at Roger Williams Medical Center. Right now, it is a “pandemic of the unvaccinated,” Stoukides said, echoing a phrase that’s been used on the national stage.
State data bears out Stoukides’ observations. For weeks now, the only COVID cases in Rhode Island nursing homes were sporadic, if they happened at all. Sometimes in entire weeks-long stretches earlier this summer, not a single resident was infected.
On Wednesday, that changed: State data showed Alpine Nursing Home in Coventry had at least five new resident cases in the past two weeks, the first such cluster in some time.
But behind that number are more encouraging trends: All seven of the residents who have tested positive have mild symptoms, akin to a cold, owner and operator Rod Gauvin said. All of them are vaccinated, as is upward of 80 percent of the staff, Gauvin said. Three staffers, all vaccinated, tested positive for COVID and had mild to moderate symptoms, which is how it may have gotten in, Gauvin said.
Everyone else at the 60-bed facility came back with negative test results. That’s a much better outcome than the devastating winter surge the home experienced, when three quarters of the staff and the entire resident population was infected as the virus swept through the facility like wildfire. Fourteen residents died during the weeks-long winter surge. Even more may have died if some weren’t treated with monoclonal antibodies.
With protection from vaccines and prior infections, things are easier to handle this time around at the 60-bed facility, and things are stabilizing, Gauvin said.
“The vaccine is doing what it’s supposed to do,” Gauvin said.