Providence, RI – The numbers began in September. After a quiet summer, doctors at Rhode Island Hospital began seeing one or two Covid-19 patients on each shift – and soon three. Then four.
Cases continued to rise until early December, when Rhode Island had a dubious reputation of having more cases per 100,000 people than any other state in the country. The case rate still keeps it in the top five states.
Where did this tight-knit situation go wrong? Former government Gina Raymondo’s “pause” on economic activity was short-lived and partial, leaving open indoor dining, shopping malls and bowling alleys. But the shutdown was no more patchy than in many other states.
By the end of the summer, he was praised for infecting the virus. Even now, fewer residents blame him for his vague numbers. (Ms. Raymondo was sworn in as Secretary of Commerce on Wednesday night.)
Experts point to a myriad of other factors, all of which have played out elsewhere in the country, but have turned into a major crisis here.
The autumn cold sent people indoors, where the risk of the virus is highest, and the holidays bring people together. Rhode Island is small – you can pass it in 45 minutes. But those small-scale populations are a million people, second only to New Jersey for population density. If everyone in the world were connected by six degrees, the Rhode Islanders would probably be connected by two.
Central Falls, the epidemic center on Rhode Island, has a population density of 16,000 people per square mile, almost twice as much as Providence. “Just imagine, 16,000 people per square mile – I mean, it’s amazing,” said Drs. Said Pablo Rodriguez. “It doesn’t take much for the spark to erupt.”
In addition to its density, the percentage of elderly residents in nursing homes on Rhode Island is high, which is the leading cause of death. The state has multiple urbanized areas – Central Falls, Pocketcat, Providence – where language barriers, mistrust and jobs have made colonial families particularly vulnerable in multi-class homes. The state is also home to multiple colleges that close the chain of infection in early fall.
For months, the hospitals on Rhode Island were understaffed and overcrowded. Doctors and nurses were constantly trying to cope with the growing case load, with increasing guidance and their own protective devices stretching to the limit, without the necessary protective equipment.
Dr. Megan Rennie, a researcher and public health advocate, is also an emergency room physician at Rhode Island Hospital who has seen the full scope of the state’s crisis. What he saw in one shift provides a window into what happened.
Plow through it
One day in late December, when the crisis reached new heights, Dr. Runny made a long eight-hour shift. The sore behind his ear, where his spectacles and N95 bandages and surgical masks were dug, has not yet healed. But how can she complain, Dr. Rann Runny said, when her medical residents “eat, sleep, breathe covid” five days a week.
Among the patients it was bad, she knew. Anxious and scattered, they became more annoyed with the kedkaya and unfamiliar doctors and nurses running around them. D week. During her first week shift, she saw a broad spectrum: older people on a downward spiral, otherwise healthy young Latino men, Cape Verdean immigrants with a limited understanding of English.
Dr Ashish Zai, dean of Brown University’s School of Public Health in Providence, said Rhode Island was particularly vulnerable in part to this demographic: “It is definitely the poorest state in New England – so much poverty, and high poverty. “
Like most of the country, the Latino community is suffering from the epidemic. In Rhode Island, whites in Latinos are 6.7 times more likely to be hospitalized and 2.5 times more likely to die than whites.
In the days leading up to her relocation, Dr. Ran. Runny was working in a part of the hospital, intended to deal with a non-covid case. But people with other ailments, such as ankle fractures, turned out to be positive for the virus, she said.
He said, “I never knew how bad the day-to-day increase would be.” “I just have to dig through it.”
It turned out to be an extraordinarily busy day. “The ER is full, the hospital is full, the intensive care unit is full,” said Dr. Runny. “All of our units are moving as fast as they can, but patients keep coming.”
Each time she took off her mask during the shift, she risked contaminating herself. He had four cups of coffee before this shift, and then nothing.
The average age of the patients that day was about 70. An elderly woman who had difficulty breathing could not be separated because she lives with her children and grandchildren. At any rate, she arrived at the hospital 10 days after her illness, it was too late to separate anything.
Rhode Island epidemic has been devastating for immigrant families in multi-family homes. “How can you be different from someone when you have a bathroom?” Said Dr. Ran.Runny.
This is a problem in this different state. When 60-year-old Gigini Towers contracted the infection in July, she was willing to spend about 120 120 a night in a hotel – something many in her Cape Verdean community could not afford to keep apart from her frail 86-year-old father.
Even before the epidemic Ms. Towers was strict about hygiene, keeping wipes and cleaning supplies in the house at all times. She couldn’t imagine where she got the virus from. He was devastated by the loss of his Godmother and a friend of Kovid-19.
The Cape Verdeans are a bond-knit community, and not being able to mourn the dead has been painful. Towers said: “Culturally, I think that’s the reason we’re hurting more.”
On her shift, Dr. Reyni faced Kovid-19 patients who had a blood clot or heart problem, or who needed oxygen even weeks after diagnosis. Many patients were very careful – or said they were – but became infected after a family member brought the virus home.
The story is often told in Rhode Island. Abby Birchfield, 58, lost her mother and stepfather to Covid-19 in April at the Auxiliary Living Center in New Jersey. Destroyed and frightened, she and her family stayed away from restaurants, washed their hands frequently and tried to wear masks everywhere. That was not enough.
Ms. Birchfield’s youngest daughter, Lily, was infected at her college in Virginia on Aug. 21 and was hospitalized. Then, in late October, her husband, Jimmy, 58, contracted the virus from a co-worker who was infected, but did not wear a mask.
Ms. Despite Birchfield’s best efforts, she was also infected. He was admitted to the hospital after a sudden collapse in the family kitchen. She recovered, but her husband, who was also hospitalized, still had no taste, limited sense of smell and constant fatigue.
“Now my biggest fear is the protection of my eldest daughter,” Ms. Said Birchfield.
Exposure to the workplace has particularly hurt the Latino and Cape Verdean community, many of whom have jobs that cannot be done from home. But a state survey has found that 15 to 20 people have gout-infected people despite the spread of the virus, said Dr. Rodden, medical director of the Covid-19 unit of the Rhode Island Department of Health.
“People were not willing to live differently during the epidemic,” he said.
Dr .. Runny said there were several such cases in the emergency room that day.
“It is frustrating to see patients coming from car accidents or firearm injuries when patients are not wearing seatbelts because the firearm was not stored securely,” he said. “It’s like seeing people with covid.”
Masks were ‘disgusting’
Some nights in emergency medicine, the diagnosis and treatment are immediately clear.
But on this shift, Dr. Ran. Runny said, “there was very little that was straight or easy.” Numerous patients with substance abuse problems appeared, as well as people with mental illness, who became at risk for themselves. He said, “We are seeing a lot of people who are just alone.
Dr .. Ranny will be relieved, but many medical residents and nurses in Rhode Island were already burned to death. Some felt that the hospital administrators did not protect them.
At the onset of the epidemic, as in other parts of the country, most health care workers in Rhode Island did not have N95 masks. The masks are single-use, but when the nurses each got an N95 they were told to put it in a paper bag at the end of their shift and put it back on the next day.
“They were stunned, they were thin, they were disgusting. They broke your face, “said a nurse at Rhode Island Hospital, who spoke on condition of anonymity because the hospital had instructed staff not to speak to the news media.
If a strap is broken, the mask will be returned to the new strap with a stall. The nurse said, “The chief will dig in your face.
Many nurses received only 40 hours of sick time a year, which translated into approximately three 12-hour shifts; Will probably be reprimanded for the fourth day.
Because of this, many nurses were not tested, and some came to work despite being ill. At the Eleanor Slater Hospital in Cranston, RI, at least 29 staff and nine patients broke out in the wake of sick staff members. It is a phenomenon seen in hospitals in the United States.
“The rules for patients are not always consistent with science,” said a nurse at Rhode Island Hospital. Initially, the hospital did not allow anyone to leave the ER until the test results were returned. But, with the first boom, the rules became loose.
Patients were sent with the remaining test results, exposing potential other patients as well as the nurses caring for them. After treating one such patient, at least nine nurses tested positive for the virus, the nurse said.
The policy of most hospitals in Rhode Island is for health care workers to always wear N95 respirators or similar reusable masks and to test anyone suspected of being Covid-19. But it is not responsible for patients who may have congenital and other ailments.
Rhode Island has taken an unusual approach: officials are distributing vaccines to anyone who will take them to Central Falls, regardless of age. It is a strategy that some other jurisdictions have tried.
“We decided to do that because of the horrific toll of epidemics in those communities,” said Drs. Rodriguez said. Twenty percent of the adult population has received at least one dose at local clinics, not including those who have been vaccinated at work or elsewhere.
The state’s plan to vaccinate those most at risk by age and geography, he added, would “cut down fires where they are burning very intensely.”
In recent weeks, the number of cases in Rhode Island has dropped, as it has in the rest of the country. “Fewer health care workers are getting sick because they have been vaccinated, so it’s better to be shifted to a hospital than before,” said Dr. Runny.
But the state still has the third highest number of cases per capita in the country. And doctors continue to see patients who have so-called long covids, she said: “The problem is that once patients are admitted, then they don’t leave.”