This State Is Getting the Vaccine—and a Surge of New Cases

PROVIDENCE, Rhode Island—A nurse wearing purple latex gloves, green scrubs and a surgical mask appeared through the backdoor of a medical building in downtown Providence this week hauling an overstuffed garbage bag full of discarded personal protective equipment.

Walking through what New Englanders call a “wintry mix”—something between hail and snow— she lobbed the bag over her shoulder and into a dumpster overflowing with cardboard boxes the gear had shipped in just a few days earlier.

From the highway exit down the road, an ambulance roared past, sirens blaring, skipping by the Ronald McDonald children’s rehabilitation home into Rhode Island Hospital’s adult emergency driveway. Nearby, men working in a local sandwich shop, boarded up and adorned with a “NO PUBLIC RESTROOM” sign, peered their heads around the corner during a smoke break to catch the view. For a moment, there was silence on the medical campus, a brief reprieve from the blaring horns that normally reverberate off the sides of the buildings on this street. All that could be heard was the creaking of the dumpster top slamming closed and shuffles of medical staff changing shifts, their face shields hanging from their wrists.

And then, another siren.

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It was the first week that anyone in the U.S.—where more than 300,000 people have died from the virus—received the novel COVID-19 vaccine. Doctors and nurses working in Providence were among the first to be immunized in the state. But when a small FedEx van arrived in front of one of the hospitals to drop off the vaccine, a delivery man hopped out and slowly removed a white box—the size of a toddler— from the back. Nurses didn’t dance in the driveway. There was no applause. A single hospital administrator offloaded the box onto a cart and rolled the package through the sliding doors, down the hallway and to the pharmacy where few if any looked up to see the vaccine’s arrival. Staff members who happened to be present took a few photos of the delivery box before one of them said: “Ok, now back to work!”

Frontline health-care workers here say they are relieved the vaccine has finally arrived. But there is little time for celebration. Rhode Island, more specifically Providence, is in the midst of battling its highest infection and hospitalization rates since the pandemic began. Like so many other healthcare workers across the country, the staff is overworked and exhausted.

The word tired has lost its meaning. There are simply too many cases to keep track of and too many patients to treat. It’s not just the new cases that keep medical workers here up at night. Deaths are rising, too. The situation is so busy at the Providence-based hospitals that health-care workers are being told to reuse masks and face shields in case of another surge. The rest of the gear—the gloves and the gowns—are being used and ditched faster than the waste management companies can clear the dumpsters.

And the worst of the virus may still be weeks away, doctors say.

“I am so unbelievably excited that the vaccine is here. But... we don't yet feel that we're out of the woods,” said Dr. Megan Ranney, a Brown University emergency doctor treating COVID-19 patients in Providence. “The number of community cases is so high right now. And I know that people have gotten together for Thanksgiving and are planning to get together for the holidays. So, I am not at all confident that we are going to see anything other than a continued surge in cases.”

The recent surge hasn’t just overwhelmed the state, it’s overrun it. In the last week alone, there’s been an average of 1,179 cases reported a day, an increase of 46 percent from the two weeks prior, according to data compiled by The New York Times. About 70 percent of those cases were reported in Providence—one of the most densely populated cities in the U.S. The day the vaccine arrived, Rhode Island reported 46 new deaths and 3,253 new cases for the past three days, meaning that one out of every 325 people in the state reported being infected during that period. In the state prison, the Adult Correctional Institutions, where more than 2,000 people are incarcerated, 771 people have tested positive for COVID-19. The number of hospitalizations in the state far surpasses those Rhode Island experienced in the spring. The recent uptick has forced the two largest health-care systems to open field hospitals last week to accommodate more patients.

For local officials, the looming question is whether to implement more social distancing restrictions even if its economy takes a hit, impacting a state that leans heavily on tourism and the food industry, among essential workers.

“When you look at our biggest employers, it's our schools … our hospital system and then tourism and the restaurant industry,” Ranney said. “And these are folks who can't by and large stay home and who are, by definition, going to be exposed to the public.”

Rhode Island is currently in a “pause,” meaning residents have to limit their interactions with other households and refrain from gathering in large groups until Dec. 20. But restaurants are still allowed to serve people inside at up to 33 percent of each establishment’s capacity, which some doctors say indicates a continued failure to make the tough choices about the current surge in cases. They argue that all indoor dining should close through the holiday. Confusing the situation, Gov. Gina Raimondo, after pleading with residents to stay home except for essential activities, went to an event last Friday night in which she was pictured sitting nearby others without a mask, sipping red wine. Raimondo, a Democrat, is now quarantining because her director of public health tested positive for COVID.

“All I do is stay home,” one nurse working in Providence said, requesting anonymity for fear of losing her job. “I go to work and then I come home. It’s just me. No one else. That’s it. I guess some people get to do as they please. But I’ll say one thing, it’s not helping control this virus.”

A vaccine is supposed to start the healing process. It’s supposed to be the beginning to an end. But the end of the pandemic is nowhere in sight for the doctors and nurses here in Rhode Island. They don’t talk about what may be coming on the backend of the crisis or what their summer plans might look like. The constant wails of the ambulances and the bodies being rolled onto trays in the morgue muffle any long-term, lasting excitement a vaccine could offer.

Rhode Island is tiny, half the size of Delaware, the second smallest state in the U.S. It only takes about an hour to drive through Rhode Island making it one of the most densely populated states in America, according to data collected by the Census. A large portion of the population in the state resides in large, multigenerational homes. And while this is certainly not unique to Rhode Island, people who do not live with their family are often a close drive away.

“And people don’t stay away from their families,” Ranney said.

At least that’s what the state’s COVID-19 data shows. Here, transmission is happening within households, according to local officials and doctors.

“We have high-density communities and this virus is spreading from person to person in those settings,” said Dr. Jim McDonald, the medical director of the Rhode Island Department of Health. “There’s a percentage of people contracting it who live in the same household as someone who has the disease.”

Ranney said her department has seen more and more families coming into the hospital together, each reporting COVID-19 symptoms. “We are seeing a lot of husband, wife, or siblings that will come in together with both of them being sick at the same time,” Ranney said. “In fact, it is so common that we have specific protocols in the emergency room, because we don't want to make mistakes between patients. So we separate the patients into different areas of the emergency departments so we don't mix them up.”

When the pandemic first emerged in the U.S., doctors and nurses in Rhode Island say the state experienced an influx of patients like much of the East Coast. At the end of April, Rhode Island was recording just under 400 new cases a day. Over the summer, health-care workers say the situation improved. New positive case numbers declined as did hospitalizations and deaths. But with the beginning of the school year and as people began gathering indoors because of colder weather, health officials say the numbers slowly began to creep up again.

Part of the increase in cases can be attributed to a ramp-up in testing, officials here say. No one can point to one social gathering, wedding or event that led to an outbreak. But officials are sure that the Thanksgiving holiday exacerbated an increasingly dire situation. As the hospitals began to fill up, doctors and nurses were forced to send patients to either long-term care rehabilitation facilities—which doctors say many opted out of—or home, where their uninfected family members were waiting. And health-care workers here say they do not always test patients before discharging them and sending them back into large households where residents continue to resist the idea of wearing masks indoors.

“Changing a human being’s habit is really hard. Getting them to follow public health recs is really hard,” McDonald said. “And there’s a small part of the population that thinks personal liberty trumps public health guidance and that just isn’t helpful. At this point we’re telling people ‘you really need to wear a mask inside your home if there’s a positive case.’”

“It's hard,” added one home health-care nurse working in Providence. “I've had patients that I go to their house and they're like, ‘Oh, I shouldn't have to wear a mask. I'm at my house.’ People just don’t understand.”

While thousands of frontline health-care workers at the two largest hospital systems in Rhode Island received the vaccine this week, nurses like the one who works in home health care said they are uncertain when they will be eligible for immunization. And with the virus continuing to spread throughout the state, frontline health-care workers in alternate medical settings are growing more anxious.

“I was talking to my sister and she is getting her vaccine next week. All of their patients get tested when they come in the door. But I'm the first person who sees these patients when they get home,” the nurse said. “Some of the patients are positive and still having symptoms. And these patients, even if they are negative and aren’t having symptoms and are coming home to their husband or daughter… those people haven't gotten tested. I could be going into all these homes with all these positive people and I have no frickin’ idea.”