PROVIDENCE — Governor Dan McKee in recent weeks has repeatedly insisted that the state was “ramping down” on COVID in the lead-up to Thanksgiving. The state could have done things differently if it had a crystal ball, he said, but coming up on the late November holiday, issues like testing capacity weren’t even on the table.
A confidential internal state report obtained by The Boston Globe tells a different story: A little more than a week before Thanksgiving, the state’s own analysis warned that COVID-19 was spreading rapidly in Rhode Island.
“RI has recently experienced a considerable increase in daily cases,” the analysis, dated Nov. 16, says.
And though it’s true the state did not have a crystal ball, it did have internal modeling projections. Those projections showed that cases, hospitalizations and deaths would continue to rise into December.
That is exactly what happened, although the models understated how severe and prolonged the rise in cases would turn out to be: Rhode Island was recording 3,000 new cases a day at the end of 2021, roughly double the peak of winter 2020. The models on Nov. 16, before the world knew about the Omicron variant, only showed a peak of about 4,000 cases a week, and noted that the trend might actually lose steam. (The state’s health experts consider models more of an early warning system than an ironclad prediction, but they pay attention to what direction they’re pointing in. These were pointing up.)
In an emailed statement, his office said, he was referring to “ramping down” testing and vaccination because of lower demand, by transitioning to local and community-based sites starting in October. That was at the recommendation of the Department of Health, his office said, and recommendations like that can take months to complete.
“Fortunately, Rhode Island’s COVID-19 response system is agile enough to ramp up within hours to respond to changing circumstances,” the statement said.
The statement also said the Nov. 16 document “reflects only one set of data in a weekly and daily data set that is used to track and respond to the COVID-19 pandemic. Throughout the pandemic, the State has considered a percent positive of 5% a threshold for decision making. Rhode Island didn’t cross the 5% threshold until the week of 12/4.”
The report, called the “State of the Spread,” is regularly prepared by the state’s medical advisers and shared among its top officials, accompanied by a briefing where more details are shared. His public schedule later that day noted he’d be traveling out of state starting Nov. 17.
“[W]hile the Governor was out of state for 8 days — his first time leaving the state for personal time since taking the job 10 months ago — he received regular updates and was in close contact with his staff on COVID and other issues,” his office said Tuesday.
Though McKee’s office said he was referring to “ramping down” on COVID in a more limited fashion, the governor referred to it on multiple occasions in December as he addressed questions about the pace of the state’s response, including on Thursday.
“We were actually kind of ramping down this issue with the COVID prior to Thanksgiving, and now we’re ramping it back up,” McKee said in opening remarks.
When asked by a reporter why the state hadn’t increased testing sooner, before people got together for the holidays, McKee again pointed to Thanksgiving: “We always can look in the rear-view mirror on things, and perhaps if you had a crystal ball you could have done that. But remember, coming up on Thanksgiving, this issue was not on the table. Infection rates increased on December 4 and did again on December 11 and December 18, and we’ve been working on this for a couple of weeks.”
The state’s COVID infections rose in July into territory that the CDC considers high transmission and have remained there ever since. After a retreat in mid-October, they have been consistently rising since early November. They shot to unprecedented levels in the week between Christmas and New Years.
McKee said on Dec. 21 as he pledged to improve the state’s testing and vaccination, which were already among the top in the country: “I’d like to remind everyone that we were in a ramp-down strategy just before Thanksgiving. Things changed, and as a result of that, things are changing again.”
On Dec. 15, he said that “a lot has happened since Thanksgiving.”
“We were in the process of actually ramping down the COVID a week before Thanksgiving, but we have to react to what’s in front of us,” he said.
It wasn’t just confidential state documents that were sounding the alarm about COVID-19 in the week before Thanksgiving: At a news conference the same day as the confidential report, Dr. Nicole Alexander-Scott warned of increasing case numbers.
“Now is the time, get your masks ready, your high-grade, quality masks, and make sure you’re wearing them, particularly indoors,” she said.
McKee himself urged caution, but said steps like an indoor mask mandate weren’t necessary.
“I never discount anything, but at this moment in time we’ll proceed as we are with the masking policy, which is in the schools and hospitals and other areas like that,” McKee said. “But I’ve always said that we’re going to keep track of the numbers. If they warrant an action, we’ll take the action, but at this point in time, I don’t see that happening.”
By mid-December, after immense pressure — some officials in the Department of Health had been advocating for it for weeks, sources say — that changed. More steps followed, including liability waivers for hospitals and health care workers, ramping up testing, and tapping the state’s Emergency Management Agency director as coordinator of a renewed whole-of-government response to COVID.
With that, a governor who once stood in front of a banner touting 1 million COVID vaccines and a reopening economy now finds himself in the midst of a sharply rising case total and hospitals ill equipped to handle the strain. Omicron cases tend to be milder and the public has plenty of protection from vaccines and prior infections, but Alexander-Scott recently warned of a difficult January from the sheer volume.
The State of the Spread report from Nov. 16, in hindsight, now seems full of portents. Practically every data point in the “State of the Spread” presentation was flashing red: New cases were up 56 percent, hospital admissions were up 15 percent, the test positivity rate had gone from 2.1 to 3.4 percent.
The rate of reproduction was above 1, a significant figure because it means each person is infecting at least one other person. When the so-called R0 number is above 1, it means the virus is ramping up, not ramping down.
The Omicron variant was first reported by South Africa to the World Health Organization on Nov. 24. A little over a month later, Rhode Island health officials estimated it only accounted for about 10 percent of cases in the state right now.
Health officials say the Omicron variant is likely milder than other variants before it, and Rhode Island is well positioned with high levels of vaccination.
But the state’s health care system is creaking under the strain of two pandemic years and a staffing crisis that shows no signs of abating. That was also true on Nov. 16, when the presentation showed dangerous levels of overcrowding at several Rhode Island hospital emergency departments. At Rhode Island Hospital, 99 percent of hospital beds were occupied, and 95 percent of ICU beds were occupied, the report said.
By Dec. 14, the “State of the Spread” report showed a similar picture, illustrating that the COVID-19 wave might make the hospital crisis worse, but didn’t directly cause it.
Some doctors have expressed frustration with the pace and urgency of the state’s response. McKee said he understands their frustration, but insisted that the state is doing everything it can to address the crisis.
“I certainly disagree with individuals who think somehow there’s an easy answer to this, an easy response to this,” McKee said Thursday. “I don’t think they’re really paying attention to the work that we’re doing.”