RI COVID-19 vaccinations open for age 75-plus now, age 65-74 next week

COVID-19 vaccination reservations can now be made for everyone age 75 or older who lives, works, or goes to school in Rhode Island, the RI Department of Health (DoH) announced this morning. Actual vaccination appointments begin tomorrow, Thursday, February 18, at the two state-run points of dispensing (PODs), Dunkin Donuts Center POD, 1 La Salle Square, Providence, and Sockanosset POD, 100 Sockanosset Cross Road, Cranston.

Reservations for those age 65-74 will open Monday, February 22. In a press briefing this afternoon, RI DoH Director Nicole Alexander-Scott confirmed in response to a question from Motif that actual vaccinations for this age group would begin the following day, Tuesday, February 23.

Each eligible age group can schedule a vaccination appointment on the web – VaccinateRI.org – and, although the web is preferred, voice telephone is available for others – 844-930-1779 (weekdays 7:30am–7:00pm, weekends 8:00am–4:30pm) – unable to use the web. It is possible to make an appointment for oneself or for another eligible person using either system.

Alexander-Scott said that the website is a work in progress for which significant improvements are planned. “Another thing that I wanted to share is that the customer experience is going to be a little different today than it will be in the near future. Today, when you go into the system, you have to submit all your information. And then once you do that, you can see if any slots are available. We recognize that is not ideal, especially for someone who is going to be repeatedly looking in the system for an appointment. We are working to adjust that process so that it’s a little more user-friendly, wanting to get started first, and then we’ll continue to make the improvements as we go.”

“As of 12:30pm today [Wednesday, February 17], we have made 1,331 appointments, 86 of those over the phone and the rest of them online… at the two state-run sites we have activated,” Alexander-Scott said. “On the topic of the speed of vaccinating, another piece of good news is that we got a little bump in our allocation of vaccine. We had been at the mark of 16,000 doses a week, for the last few weeks. We found out yesterday that our weekly allocation from the feds is going to be increasing to 22,500 first doses. Part of this is an actual increase in Pfizer vaccine and part of it is that Pfizer made a change that allows six doses to be drawn from vials that we were previously getting five doses from. Again, very good news.”

The telephone system also is planned for improvement, Alexander-Scott said. “Right now when you call, the system is automated: You will be prompted to enter your phone number and then you will get a call back. Our goal is to get it set up so that when you call you get a live person right away; we expect to have this in place soon. Like everything with this pandemic, we’re looking forward and making improvements every step of the way as we go.”

“Appointments are currently open through February 27. Additional appointments may be added through the week as slots open. Appointments are expected to fill up quickly,” DoH said in a statement. In the next few weeks, RI expects to bring additional state-run sites into operation in the northern and southern regions, with a goal of doubling the daily capacity at state-run sites from 1,400 to 2,800.

The Dunkin Donuts Center POD is using the Pfizer vaccine and the Sockanosset POD is using the Moderna vaccine, both of which require two doses separated by 3 to 4 weeks: this is not important for first doses, but each recipient must get a second dose of the same type as their first dose. On the website, Alexander-Scott said, users are “signing up for the first dose as the starting point, and then as they are getting that first dose, we have as many steps in place as possible to help ensure that they enroll for the second dose right then and there, so that they’re able to come back.”

Screen capture of RI COVID-19 vaccine reservation web site for Sockanosset POD

Screen capture of RI COVID-19 vaccine reservation web site for Sockanosset POD

In addition to the two state-run PODs, vaccination is available from select retail pharmacies, and those 75 and older can schedule appointments at a retail pharmacy location: either CVS.com, using the CVS Pharmacy phone app, or calling 800-746-7287; or Walgreens.com/ScheduleVaccine or calling any local Walgreens. Municipalities are managing the scheduling process for additional local and regional clinics; contact each city or town directly.

Alexander-Scott said that the goal is to move eligibility in lock-step across all vaccination methods, opening up to each cohort at the same time. “We want to ensure that when we move to the next eligibility group, it is done consistently the same across all three channels from the pharmacies, as well as the local-regional approach, as well as the state run approach,” she said.

For those age 65 or older, Alexander-Scott recommends using the larger-capacity state-run PODs in order to reserve smaller-capacity local and regional for those age 75 or older who may have difficulty traveling or using the web. “I do want to encourage that for going to 65-plus, we really push people toward the larger volume sites with the state-run approach that is activated. Now, when that opens on Monday [for age 65 or older], it’s really ideal to go there because it is designed to move through hundreds of individuals with vaccinating. We want our local-regional approach – our municipalities have been doing a fantastic job – really catering to those 75 years of age and older, supporting them in accessing vaccine and being able to register as they need to, making sure that they can stay local and where they need to go. I just left the call with the municipal leaders where we’re continuing to say to keep that going, make sure that they are filling all of their 75-plus slots because they’ve done a great job getting vaccine out to them, and we really want to encourage those 65 and older to go to the state run sites. We’re activating it for high volume, we want to do it as quickly and as streamlined as possible,” Alexander-Scott said. DoH spokesman Joseph Wendelken said that the daily capacity at the Sockanosset POD is 900 doses and at the Dunkin Donuts Center POD is 500 doses.

It is not necessary to schedule more than one appointment because everyone scheduled is guaranteed to be vaccinated in their assigned time slot, so making multiple reservations disadvantages others eligible for access to the extremely limited supply of vaccine.

After those age 65 and older, vaccination will be available to everyone between 16 and 64 with an underlying health condition (kidney disease, heart disease, diabetes, lung disease, immuno-compromised) that puts them at high risk of complications from COVID-19 and then by age strata for otherwise healthy people. Everyone not immediately eligible to schedule a vaccination (that is, everyone 16 to 64) can sign up to be notified when they are eligible at portal.ri.gov – where many people already have an account if they previously signed up for COVID-19 testing.

Under the RI COVID-19 vaccination plan, persons age 75 or older are covered in the 5th and final sub-phase of Phase 1, and persons age 65-74 are covered in the 1st sub-phase of Phase 2. Moving into each sub-phase does not require completing any prior sub-phase; for example, persons age 65-74 will become eligible while some age 75 and older will not yet have been vaccinated.

In response to a question from Motif, Alexander-Scott said that for those younger than age 65, “Going to the next level should be sometime in March. We can certainly move that up as we continue to accelerate our ability to push vaccine out and have additional supply to be able to do that… So for right now we’re in that same mid-March time, but certainly with each day we’ll continue to assess as we’re pushing it out, we’ll hope to speed it up. So no updates yet, but we’ll certainly be making that known as we have it.”

Responding to criticism about the slow pace of vaccination compared to other states – as of yesterday, according to data from the US Centers for Disease Control and Prevention (CDC), RI is tied for 48th place in doses administered per 100,000 population – DoH in a statement said, “Phase 1 of Rhode Island’s vaccination campaign has been focused on preserving the healthcare system and reaching groups most likely to be hospitalized – nursing home and other congregate residents, people in high-density communities, and older Rhode Islanders. While targeting these high-risk groups took more time than opening appointments to the general population from the outset, it also had the intended effect of preventing more severe cases of COVID-19, more significantly decreasing hospitalizations, and speeding up the reopening of our economy. Over the past month, Rhode Island saw a 46% decrease in hospitalizations, compared to 32% nationally and 22% in our neighboring states. And the decrease is even more significant among those in targeted groups. Because of this positive impact from Phase 1, Rhode Island can now move into Phase 2 and begin vaccinating every Rhode Islander by age group. This will allow for a significantly faster pace of vaccination.”

Alexander-Scott said at today’s press briefing, “We know that treatment with monoclonal antibodies is having a big impact. We know that our leadership with testing is an important component as well. But there is also clarity on the fact that our strategy is meeting the main objectives of the first portion of our vaccination campaign in Rhode Island. The first was to protect people in our nursing homes and other congregate settings, and the second was to make sure we have a health care workforce. Nursing homes are where we have seen the vast majority of our unfortunate deaths. And we need a healthcare workforce so that emergency care is there when you need it.”

State of the State: RI Gov. Raimondo cites “courage to lead” in valediction

The State of the State message on Wednesday, February 3, an annual tradition that usually provides the governor with an opportunity to lay out plans for the coming year, instead took on a valedictory tone for Gina Raimondo, expected to resign and be succeeded by Lieutenant Governor Dan McKee as soon as she is confirmed by the US Senate in a matter of days or weeks as Secretary of Commerce in the new administration of President Joe Biden. Her nomination was advanced earlier in the day on a bipartisan 21-3 vote in the US Senate Commerce Committee.

Due to pandemic precautions addressing a nearly empty House chamber occupied only by her immediate family and House speaker K. Joseph Shekarchi and Senate president Dominick Ruggerio, in the course of about 40 minutes Raimondo avoided most of the usual topics, not even mentioning the budget for the coming year that will now be the headache of McKee.

Considerable criticism has been directed at Raimondo who, presumably at the instructions of the Biden political team worried she would say something that could endanger her chances of Senate confirmation, has avoided public appearances and has not taken a question from the press for almost two months. The contrast between Raimondo’s accessibility at daily press conferences months ago earlier in the pandemic has caused some to describe her lately as “missing in action.” While that may not be entirely fair, the public perception is important.

RI Gov. Gina Raimondo enters the nearly empty House chamber to give her 2021 State of the State address
(Source: RI Capitol TV)

Raimondo in 2020, because of the pandemic that caused massive unemployment and economic contraction, faced the worst crisis of any Rhode Island governor in at least a century, and arguably since the Civil War of the 1860s. Acknowledging this, she emphasized that she was looking forward, saying “2021 will be our year of rebuilding.” Raimondo went out of her way to praise McKee, whom she has for years marginalized and excluded from any serious power or influence, at one point months ago responding to press questions about criticism of her from McKee by saying he was welcome to call her office like anybody else. She was far more conciliatory now: “There’s a lot of work to do, but I stand here confident that we have laid the foundation for a stronger and more equitable Rhode Island, and I know that Lt. Governor McKee is prepared to lead our state. He’s passionate, he’s experienced, he’s committed to public service, and he’s going to do a great job. I want you to know that there will be no disruption to our state’s COVID-19 response, and Lt. Governor McKee has committed to maintaining the entire statewide response team. I also want you to be reassured, as I am, that we are in a good, stable place.”

Raimondo repeatedly returned to the horrors of 2020, noting the families affected by deaths from the virus. “Let’s begin by recognizing the nearly 2,200 families across our state that have lost a loved one to COVID-19. This virus robbed so many of you of the chance to properly say goodbye.”

Acknowledging the shared pain, Raimondo said, “Every single day I heard from healthcare professionals working overnight shifts without a day off; parents balancing work with virtual learning; waiters, waitresses, cashiers and clerks out-of-work, surviving on unemployment insurance, worried about when, or whether, their jobs would come back; small business owners who wanted to stay open and make payroll but didn’t know how much longer they could hold on…”

Noting that much of the burden of the pandemic has fallen disproportionately on women and on racial and ethnic minorities, Raimondo quoted Biden’s campaign slogan – “Build Back Better” – in advocating that equity should focus economic recovery. “Rhode Island is prepared to meet this moment. I know that because of the work we have done together over the past six years to make our state stronger. We have made investments in Rhode Islanders – in skills and education, job creation, infrastructure, healthcare, equity and sustainability. On this foundation, we will build back better. And we’ll make sure that no one is left behind. It will take all of us to rebuild this economy, and that means everyone must reap the rewards.” Of course, Raimondo is not expected to be around when it comes time to realize those goals, so her words are effectively an exhortation to McKee and others.

Of her accomplishments in six years as governor, Raimondo emphasized educational policy. “We quadrupled the number of public Pre-K classes and made all-day kindergarten a reality for every child. We became the first state in America to teach computer science in every public school. We increased the number of high-quality career and technical training programs in our high schools by 60%… We took bold steps to make community college tuition-free for every high school graduate. At the time we did that, few states had taken this path. Now our country looks to us as a model. And since we started offering that scholarship to young people in Rhode Island, the two-year graduation rate at CCRI has tripled, and we’ve seen a 500% increase among students of color.”

One of the bigger political risks Raimondo took was asking voters to remove “Providence Plantations” from the official name of the state, narrowly passed in 2020 after being shot down in flames a decade earlier by a lopsided negative vote. “For too long, our state’s name was dragged down by a word so closely associated with the ugliest time in our history. We can’t change our past, but we must acknowledge it and commit to a more inclusive future. Last year, the people of Rhode Island came together and made history, voting to finally remove the word ‘plantations’ from the official name of our great state.”

To the surprise of no one, Raimondo made an almost obligatory farewell. “It is very difficult for me to leave Rhode Island. If I am confirmed as Commerce Secretary, it will be a privilege to serve in President Biden’s cabinet as we rebuild America and lift up those who have been left behind – a continuation of the work we have done together these past six years.”

As the first woman to serve as governor since Rhode Island was settled in 1636, Raimondo was conscious of her role for posterity. “I’d like to end tonight with a special message for girls and young women across Rhode Island. This world needs you. We need your voice. We need your ideas. We need you to lead. When I was first asked to serve as Commerce Secretary, I was unsure. But it was the women in my life – my mother, my sister, and even my teenage daughter – who gave me the push I needed. They told me it was okay to be nervous, but that I had to look within myself and summon the courage to lead. So, to all the young women out there, I want to leave you with their words. Look within yourself, and summon the courage to lead. There will be plenty of times when you’re unsure. In those moments, we need you to push aside your doubt and fear, and to say yes. Know that you can be anything you want to be. You are strong and smart and capable. And I’m looking forward to the day when one of you is our governor.”

Minority response

RI Senate minority whip Jessica de la Cruz gives the Republican response to the 2021 State of the State address
(Source: RI Capitol TV)

The Republican response, delivered by Senate minority whip (the second-ranking Republican) Jessica de la Cruz, in a quick eight minutes identified five key points. She said “the legislature’s refusal to reconvene or conduct basic oversight of the governor allowed continual, unilateral and unchecked power by the executive branch, which is tasked with enforcing the law, not making it.” She proposed a new law that will give family members the right to visit their relatives in nursing homes with appropriate medical protections, instead of the blanket visitation bans imposed a few months ago.

De la Cruz condemned restrictions or moratoriums on charter schools, an issue on which McKee, a strong advocate for charter schools, is likely to be sympathetic. “Whether it’s through school choice, educational freedom or an educational savings account, Republicans have repeatedly affirmed that access to a quality education is the civil rights issue of our time. We can no longer allow a child’s ZIP code or a family’s wealth to determine the quality of their education,” she said.

Explicitly accusing Raimondo of misallocating federal pandemic relief funds, de la Cruz said, “The heart of Rhode Island’s economy has been shattered, with as many as 40% of Rhode Island small businesses closing last year. This represents lost wages, lost health insurance and broken dreams. Our state diverted federal monies to shore up the state budget instead of prioritizing these small businesses; Republicans will fight to make sure that any future federal relief monies are distributed to where they belong in our neighborhood small businesses.”

The state’s “ballooning budget is unsustainable,” de la Cruz said. “As businesses and nonprofits suffered great losses last year, Rhode Island’s outlandish budget grew to $13 billion. That’s $13,000 for every man, woman and child in our state. And while there are talks of new taxes, you can’t squeeze water from a rock. And you can’t squeeze more money out of Rhode Islanders and businesses beleaguered by taxes, fees and cumbersome regulations. Republicans call for state budget reform, we must end unsustainable spending practices, while still protecting core government services.”

Warwick Goes It Alone for Vaccine Reservations

Much to the apparent surprise of RI Department of Health (RI DoH) Director Dr Nicole Alexander-Scott, who was caught unaware on live television at her press conference at 1pm on Friday, January 28 – “RI Health Director Defends Vaccine Rollout”, Jan 28, by Michael Bilow – the City of Warwick opened a web page at 2pm to accept reservations for residents age 75 or older to be vaccinated against COVID-19. As Alexander-Scott was repeatedly saying that no action was required at this time to sign up, Warwick did exactly what she said would not happen.

RI COVID-19 vaccine Phase 1 progress
(Source: RI DoH)

According to Elizabeth Tufts, press secretary to Mayor Frank J. Picozzi, “Every municipality in the state was contacted by the Department of Health, literally yesterday [Thursday, January 27] saying, ‘Listen, we have some extra vaccines, we can start this rollout for 75-plus a little bit earlier, but we, depending on the size of your city or town, we’re going to give you a limited amount.’ So we got 390 doses, we were told literally yesterday, we had to come up with a plan how to get the word out. Unfortunately, with 75-plus… they’re not tech savvy. So we did what we could on social media with the news outlets. Also the mayor sent out a robo-call to let people know… We had to create a link and a registration form.”

The available 390 slots filled up within a half-hour of the web page opening, but Tufts said the state had told the city to expect thousands more doses later in February, allowing the entire population age 75 and older to be vaccinated. There are an estimated 8,000 people in the city in this age range, she said, but many have already been vaccinated, including residents of nursing homes and assisted living facilities.

The city is aware that a web page may not be well suited to the elderly population. Tufts said, “If they don’t have access to a computer, we’re asking family to help out or they can contact Senior Services [401-468-4073‬], there’ll be people on hand to help punch in their information to get them an appointment. I know, again, at 75 a lot of people don’t have access to a computer, but there’s no other way to do this because we can’t go door to door, we can’t have them start lining up outside of City Hall with COVID.”

Signing up on the web form is “just simply your name, your date of birth, your address and your phone number,” Tufts said. “They’re grabbing a spot. Tomorrow [Friday, January 29], we compile all this information. We have 10 to 12 volunteers calling them back” to provide specific appointment times. The Swift Community Center in East Greenwich is a regional vaccine point of dispensing (PoD), Tufts said, serving seven municipalities allocated vaccine for this round based upon population, with Warwick and Cranston receiving 390 doses each and East Greenwich receiving 80. “Once we [Warwick] get our time slots, we’re going to call them back and give them the day because we’re having a February 1st, 2nd, 3rd and then we’re going to say, ‘Okay, can you do Monday at 2pm?’ If they can’t, then they lose their spot because… they can’t pick and choose at this point because we don’t know what’s going to happen.” This specific clinic will be at this PoD because it was already set up to vaccinate first responders, Tufts said, but future clinics for Warwick residents will be in Warwick. “We just have to do it quickly because it’s the Moderna vaccine. We have to use it by a specific date, and we have it so that place was ready to go.”

It is not clear whether other cities and towns will follow the lead of Warwick in setting up their own vaccine reservation system instead of the state-run system contemplated by Alexander-Scott.

Cranston announced that “Residents interested in pre-registration are to call the Cranston Senior Services Center at 401-780-6000 on Friday, January 29, 2021 from 9:00am to 4:00pm. At this time, due to the limited allotment of doses available during this initial phase, the vaccine will be administered to Cranston residents according to their date of birth with the 390 oldest residents given priority. RIDoH regulations require resident email addresses in order to pre-register. A government issued ID and proof of residency are also required. Following pre-registration, qualifying applicants will be contacted by a city representative on Saturday, January 30, 2021 or Sunday, January 31, 2021 to schedule their first and second vaccination appointments.”

RI Health Director Defends Vaccine Rollout

On Friday, January 28, the regular weekly COVID-19 press conference conducted by Dr. Nicole Alexander-Scott, director of the RI Department of Health (RI DoH), was unusually chaotic.

RI COVID-19 vaccine Phase 1 progress
(Source: RI DoH)

In prepared remarks that were uncharacteristically defensive for the normally diplomatic Alexander-Scott, she avoided mentioning. but tacitly addressed, recent criticism in the media for what is widely seen as a slow rollout of the vaccination program in RI. In a Twitter exchange on January 25 involving several members of the press and the General Assembly, I said that the low ranking of RI by the US Centers for Disease Control and Prevention (CDC), 45th place among the states in percentage of doses administered out of doses received (then 45.28%), looked to be a data-reporting lag rather than a substantive problem; by January 28, three days later, RI had improved to 35th (52.16%). Alexander-Scott said, “A total of 86,315 doses have been administered in Rhode Island: 64,435 first doses and 21,880 second doses. As I have said in past weeks, we are overall in a good place and have a strong system in place. The CDC continues to publish rankings for states for doses administered, Rhode Island is close to the national average for total doses administered per capita. And we are just outside the top 10 nationally for second doses administered.” As of January 28, the CDC reports that RI has administered 7,565 doses per 100K population, exactly in 25th place among the states, and 1,752/100K second doses, in 9th place.

Alexander-Scott said there is a trade-off between getting doses out rapidly as opposed to getting them out most effectively. “While we all want as many doses as possible administered as quickly as possible, speed is only one of the measures of success we have prioritized. In addition to how many people you vaccinate, who you vaccinate matters… There are specific aims to the first phase of our vaccination campaign: ensuring the stability of the hospital and healthcare systems, and protecting the residents of nursing homes and other congregate living facilities. That means going to each nursing home and each assisted living facility in the state. That also means working through employers to get emergency medical services personnel and public safety workers scheduled for their shots. That also means getting very specific types of outpatient health care providers vaccinated.” Alexander-Scott credited the effectiveness of the system for keeping wasted vaccine doses very low, estimated at 0.2%.

RI DoH medical experts, notably Dr. Philip Chan, who is the consultant medical director for the vaccine program, have expressed disfavor about using large facilities, such as Massachusetts is doing at Gillette Stadium, both because it is difficult to get the people who most need vaccination to such a facility and there is risk of the vaccination process itself becoming a super-spreader event as a large number of people gather. Alexander-Scott said, “When you bring vaccine to people in congregate settings, and when you coordinate vaccination through people’s employers, that takes a little more time than just opening a large clinic at a public site somewhere, but we recognize that because it accomplishes our goal of making sure that we have a hospital and healthcare system for people when they need care. And it accomplishes our goal of protecting people in the congregate settings that have been most devastated by this pandemic. On the issue of timing and how quickly doses are administered, the good news is that we are very close to starting the portion of our vaccination campaign that will focus primarily on age. This approach is much less complicated and means vaccine will get administered more quickly.”

Alexander-Scott was obviously blindsided by the City of Warwick independently opening a web page to reserve vaccination appointments for persons age 75 and older. She outright said three times that no action was necessary at this time to schedule vaccinations, before being made aware of the Warwick situation by press questions. (See “Warwick Goes It Alone for Vaccine Reservations”, Jan 28, by Michael Bilow.) She said that the plan was to use an existing state website set up for those needing COVID-19 services to sign up for vaccination as they became eligible: “Starting this weekend, some limited vaccination will be happening for people who are 75 and older at our five regional clinic sites; that’s roughly 5,000 doses. We have an emergency registry at the Rhode Island Department of Health that people can sign up for to indicate that they need extra help during an emergency. That already existing list is primarily being used to do this initial vaccinating. The people in the registry will be getting contacted directly. We expect that within two weeks additional people who are 75 and older will be able to start registering.”

Near the end of the press conference, Alexander-Scott was directly asked, “Warwick is going to administer the vaccines in East Greenwich. Why is that? And is that then open to East Greenwich residents?” Her response, clearly having no idea about the Warwick situation, was simply, “We’ll get back to you on that detail.” (The answer is that the East Greenwich facility is regional, serving seven municipalities.)

There was good news, Alexander-Scott said, with continuing improvements in incidence measures. “We had 618 new cases to report from yesterday. That’s out of 18,678 tests. That means we had a test percent positivity of 3.3%. Our weekly percent positive number is 4.1%, which is down from 5% last week. This is very encouraging. It’s the exact direction that we need to go.”

Estimated timeline of COVID-19 vaccination in RI, from Jan 28, 2021, press conference.
(Source: RI DoH)

Much of Alexander-Scott’s prepared remarks described Phase 2 of COVID-19 vaccinations, expected to begin in a matter of weeks. As we extensively reported in detail last week – “Vaccine Phase 2 First Look”, Jan 22, by Michael Bilow – criteria for priority will be based upon age, high-risk medical conditions, and geography. Most people age 75 or older can expect to be vaccinated beginning in mid-February in Phase 1.5, the final sub-phase of Phase 1. Depending upon vaccine supply, Phase 2 is expected to begin vaccinating people age 65 or older in early March. Alexander-Scott said, “Our entire approach was developed based on the science and the data. Almost two-thirds of all our hospitalizations are among people who are older than 60, and 94% of our fatalities have been among people in this age group older than 60. So that’s where age is our primary consideration.”

US CDC risk factors for hospitalization
(Source: RI DoH)

RI COVID-19 risk factors for hospitalization
(Source: RI DoH)

The next cohort in late March or early April would include all people age 64 and younger who have one of five high-risk medical conditions as well as healthy people age 60 or older. “People who are 16 to 64 years of age who have kidney disease, heart disease, diabetes, lung disease, or who are immuno-compromised will have accelerated access to vaccine. People who are immuno-compromised include patients receiving chemotherapy for cancer. It includes patients on immuno-suppressant medications due to organ transplants, and includes pregnant women. People who have kidney disease, heart disease, diabetes, lung disease, or who are immuno-compromised will be able to be vaccinated at the same time as people who are 60 to 64 years of age,” Alexander-Scott said.

RI COVID-19 vaccine Phase 2 proposal
(Source: RI DoH)

Taking into account age, high-risk medical conditions and geography together is intended to serve the goal of minimizing hospitalization and death. “The last consideration in our next phase is geography. As I shared, the data here is clear. People in certain communities are at greater risk. It’s not because of genetics. It’s not because of anything particular to those individuals. It is connected to the environments and the conditions in those environments. Unfortunately, we have the example that the hospitalization rate in Central Falls is 67% higher than the statewide average. The hospitalization rate in Providence is 58% higher than the statewide average. Getting people in harder hit communities vaccinated quickly is the right thing to do. It’s the right thing to do ethically, and it’s the right thing to do to manage this pandemic most effectively,” Alexander-Scott said. “While the first phase of our campaign was focused on ensuring the stability of the healthcare system, making sure that we would not be overwhelmed and able to handle it, as well as protecting the residents of nursing homes and other congregate settings, the aims of this next phase are to protect those most at risk for hospitalizations and deaths from COVID-19. This is a critical point.”

COVID-19 hospitalization and death by age
(Source: US CDC)

The decision to not take occupation into account as a criterion for priority in Phase 2 has been frequently criticized, and Alexander-Scott addressed that specifically. “Something else to consider about our approach is that it is very broad. It captures many members of our various critical infrastructure occupations. Take teachers: Many teachers will get vaccinated early on using our framework that I’ve just shared; 58% of cases where teachers and staff are either 55 years of age or older, live in a community harder hit by COVID-19, or have one of the high risk conditions that I discussed. This is important news. Although the data make clear that schools are not higher risk environments, we all recognize how important it is to get teachers and all Rhode Islanders vaccinated as quickly as possible. What we want to do is do it as effectively as possible given the supply that we have.”

What was supposed to be the main news, that early closing restrictions for businesses would end effective Sunday, January 31, was almost lost amid criticism for not doing it immediately. One press questioner asked, “On the rollout with the restaurants, why not now? They will lose a whole weekend’s business.” As Alexander-Scott began to answer, the questioner pressed why the easing of restrictions required several days advance notice: “Restaurants are like, ‘Okay, 10:30.’ They don’t need to have a seminar to figure it out. Right?” As RI Commerce Secretary Stefan Pryor came to the lectern to respond, the questioner continued, “Why not tomorrow, Secretary? Give them another weekend, they’ve waited, this was supposed to be two weeks on a pause and it’s been two months. It’s thousands of dollars that they’re not getting reimbursed for.”

“It’s a fair point, we want to lift restrictions as soon as is feasible. I think it’s terrific that we have reached this point where we can roll back the early closure. It has affected an array of business categories. It’s not just the restaurants, of course, that have been affected. I just want to actually re-articulate the categories of business that are affected: restaurants, recreation and entertainment, historical and cultural sites, personal services, gyms and fitness centers, and sporting facilities,” Pryor said, noting that time was needed to coordinate with DoH and neighboring states. Concern has been expressed previously about the risk that people would cross state lines, possibly carrying the virus, to exploit different closing times. He also emphasized the importance of maintaining public health measures such as wearing face coverings and physical distancing regardless of expanded hours. “One of the things that our team has always emphasized is to communicate effectively and, quite frankly, the dialogue inside our team has been about the fact that people still need to exercise caution, they still need to observe all of the pre-existing rules. The pandemic isn’t over.”

Vaccine Phase 2 First Look

How to define eligibility for priority groups in Phase 2 of the state COVID-19 vaccination program was the subject of the regular weekly meeting of the Vaccine Sub-Committee at the RI Department of Health (DoH) on Friday, January 22. The goal is to have this clearly settled by the time Phase 2 is expected to begin in late March or early April.

RI COVID-19 vaccine Phase 1 progress
(Source: RI DoH)

The supply of vaccine, currently about 14,000 doses per week, is not expected to increase for the foreseeable future, Alysia Mihalakos of DoH told the sub-committee. Phase 1 began in December with the most high-risk groups, frontline health care providers and nursing home residents and staff in Phase 1.1, moved on to frontline professionals in critical infrastructure such as firefighters and law enforcement in Phase 1.3, and will conclude with all persons 75 years of age or older in Phase 1.5.

RI COVID-19 vaccine Phase 2 proposal
(Source: RI DoH)

The main challenge, according to meeting facilitator Mckenzie Morton, is to specify eligibility criteria that can be “operationalized,” meaning that the state can readily deploy resources in accordance to match and verify eligibility. As a result, the principal criterion proposed is age, which is known to correspond to risk of hospitalization and death, so that Phase 2 would begin with all persons age 65 or older. After that, all adults with medical conditions that put them at high risk would become immediately eligible, and other adults without such medical conditions become sequentially eligible by age strata 60-64, 50-59, 40-49, and finally 16-39.

COVID-19 hospitalization and death by age
(Source: US CDC)

No vaccine is yet approved by the US Food and Drug Administration (FDA) for persons younger than 16 because clinical trials are still in progress, so there is as yet no data on safety and efficacy. As of last week, a national trial had recruited 800 of a needed 3,000 volunteer test subjects ages 12 to 17.

Social Vulnerability Index (SVI) by census tract, more vulnerable is darker, centered on Central Falls
(Source: US CDC)

Although age can be checked with commonly available identity documents, geography is also known to correlate with greater risk of infection, and the proposal is to prioritize in part using the Social Vulnerability Index (SVI) published by the US Centers for Disease Control and Prevention (CDC) that measures “potential negative effects on communities caused by external stresses on human health” with census tract granularity. Exactly how “geography” would be defined for vaccination was not discussed, leaving open such questions as, for example, how a teacher who works in Central Falls and lives in Exeter would be classified.

US CDC risk factors for hospitalization
(Source: RI DoH)

Although the CDC lists medical conditions known to be associated with increased risk of hospitalization and death from COVID-19, several sub-committee members pointed out problems with the CDC list. Relatively rare conditions, such as amyotrophic lateral sclerosis (ALS), which is commonly called Lou Gehrig’s disease, and Ehlers–Danlos syndrome, probably did not make the list only because of their rarity. It was observed that other conditions on the CDC list may be secondary in risk, such as Down syndrome that is often correlated with heart disease that is also on the CDC list. It was also suggested that substance abuse disorders can result in severe alcohol disease such as cirrhosis, which would put a patient at high risk, but this is not on the CDC list although a history of smoking is on the list. Mental health disorders can result in patients being unable to access reliable physical health care, putting them at higher risk from COVID-19 and also presenting difficulties in making sure they receive a required second dose of vaccine after the first.

RI COVID-19 risk factors for hospitalization
(Source: RI DoH)

Some conditions listed as high-risk by the CDC are so common that they provide little help in prioritizing vaccination, such as high blood pressure, high cholesterol, and obesity that each affect over 30% of the entire population of RI. Nor are such conditions grossly disproportionately reflected in hospital admissions: obesity is present in 25% of hospital admissions for COVID-19 in RI, less than its 30% prevalence. As a result, the proposal focuses on four specific conditions of known prevalence that account for a disproportionate number of hospital admissions in RI at least triple their prevalence: renal disease (22% of admissions, 2%/20,000 prevalence), cardiac disease (30% of admissions, 4%/34,000 prevalence), lung disease (19% of admissions, 7%/59,000 prevalence), and diabetes (30% of admissions, 10%/89,000 prevalence). The proposal also includes those who are immuno-compromised, either because of another medical condition such as HIV positivity or because they are on suppressive drugs as would be the case for organ transplant recipients, accounting for 9% of admissions but of unknown prevalence. (Some patients have more than one condition.)

While there was some concern about people claiming to have high-risk conditions due to anxiety to be vaccinated, DoH Director Nicole Alexander-Scott said that her preference was to follow a “self-attestation” model, essentially putting people on the honor system, especially because the eventual goal is to vaccinate everybody. If there are too many barriers requiring proof of eligibility, the concern is not only would this discourage people in legitimate medical need, but would likely disproportionately discourage the most vulnerable who may not even have a primary care practitioner (PCP).

RI COVID-19 vaccine Phase 2 principles
(Source: RI DoH)

Consistent with the frequently emphasized goal of equity, several members of the sub-committee raised the concern that COVID-19 has radically disparate effects by race and ethnicity, citing as an example a study that showed infected Black patients in their 50s have a risk of death comparable to those in their 70s among the general population. Rather than take race into account explicitly, the proposal intends the combination of geography and medical conditions to subsume race, as these factors are believed to be significant likely causes of racial disparity in health outcomes.

The proposal avoids distinguishing by occupation in Phase 2, which would be operationally difficult as well as requiring selections among, for example, teachers and grocery store workers, effectively putting different occupations in competition with each other for vaccine. Alexander-Scott said that more than half of teachers would qualify based upon age and medical condition alone, even before taking geography into account, reducing the need to prioritize teachers specifically. Jonathan Brice, a school superintendent representing educational interests, said that he would prioritize teachers who work with students unable practice mask wearing and physical distancing, either because they are very young, in his example kindergarten through second grade, or because they have special needs. It is possible that the federal government may make additional vaccine supply available and earmark it for specific groups such as teachers, Mihalakos said, but at this point there is nothing definite.

One of the main advantages to the proposed structure for Phase 2 is that it would allow communicating to the public approximately when any given adult could expect to be vaccinated, based upon the known supply of doses, one of the most frequently asked questions to DoH, Mihalakos said. If the supply increased, as is expected from additional vaccines being authorized by the FDA and greater production of vaccines already approved, it would be simple to recalculate the improved time estimate.

RI COVID-19 vaccine Phases 1 to 3 overview
(Source: RI DoH)

The final Phase 3 would cover children younger than 16 and all others not previously vaccinated.

Granting Immunity: COVID vaccine roll-out stymied by lack of supply

“We’ve crossed the 30,000 doses mark… as of 9am,” said Dr. Philip Chan of the RI Department of Health (DoH) in a press briefing late in the afternoon on Friday, January 8. “This morning, 31,541 doses have been administered and 1,798 people were fully immunized, meaning they received their second and final dose of the COVID-19 vaccine.”

Vaccine Phase 1 eligible groups
(Source: RI DoH)

Currently, RI is in Phase 1 of its vaccination plan, having begun the first three of five sub-phases. New sub-phases begin before the prior sub-phase has completed, so for example Phase 1.1 that includes nursing home staff and residents is still in progress although Phase 1.3 that includes firefighters, police officers, and hardest-hit communities has started. Phase 1.4 that includes dentists, dialysis center staff, and funeral home workers, is expected to start the week of January 25. Phase 1.5, otherwise healthy people at least 75 years old, is expected to start in February or March. The limiting factor is vaccine supply.

Vaccination progress as of Jan 5
(Source: RI DoH)

“We wish there was more vaccine available to people in Rhode Island right now, where we’re efficiently distributing what’s been given to us by the federal government and we’re limited by the doses that we’re getting nationally,” Chan said. “Currently, though, we are getting enough vaccine to vaccinate roughly 1.5% of the entire population of Rhode Island a week. It’s not a lot, but it’s definitely some and we’re getting there. We are hopeful that the supply will open up soon, and there’s some evidence that this may happen in the near future.”

Vaccination timeline Phases 1-2
(Source: RI DoH)

Both of the two vaccines currently authorized, from Pfizer and Moderna, require two doses administered 3 to 4 weeks apart for full immunity. The Trump administration has been holding back half of the vaccine supply to make sure there are sufficient second doses, but the incoming Biden administration has been discussing a change in policy to ship out all vaccine as quickly as possible in hopes that production will increase in time to meet demand for second doses. The Strategic Advisory Group of Experts (SAGE) within the World Heath Organization (WHO) last week strongly cautioned against skipping second doses, a suggestion that has been made by some as a means of extending the supply, citing the absence of clinical data for extending the time between doses beyond six weeks. (There is no maximum interval, and if an individual misses the six-week window then they should still get the second dose as soon as possible.) The UK has contemplated making a 12-week interval standard, but there is no clinical data to support this.

Criteria for vaccine priority
(Source: RI DoH)

RI has not yet specified eligibility for Phase 2. With the current supply of slightly fewer than 14,000 doses per week, it will take more than 21 weeks to fully vaccinate with two doses the estimated 150,000 people in Phase 1, implying a timeline extending into May or June without a substantial increase in supply. The RI DoH Vaccine Sub-Committee at the regular meeting on the morning of Friday, January 8, discussed the principles by which Phase 2 priorities could be allocated, taking into account age, occupation and geography. A number of members pointed out that the Social Vulnerability Index (SVI) is already calculated by the CDC by census tract, and would provide direct socio-economic risk data rather than using geography as a proxy for it.

Social Vulnerability Index (SVI) by census tract, more vulnerable is darker, centered on Central Falls
(Source: US CDC)

RI stands in 13th place among the states in percentage of vaccine first doses administered out of those received, 30,264 of 72,175 (41.9%), as of Thursday, January 8, according to data from the US Centers for Disease Control and Prevention (CDC). RI is also in 13th place for number of vaccinations administered per capita, 2,857 per 100,000 population. While RI is well ahead of the nation as a whole, which has administered 6,688,231 of 22,137,350 first doses (30.2%), the state lags most of its New England neighbors in per capita first doses per 100,000 population, behind Vermont (4th, 3,579), Connecticut (7th, 3,261), Maine (8th, 3,082), and New Hampshire (9th, 3,079), but ahead of Massachusetts (22nd, 2,197). By contrast, states in the Deep South (Georgia, Mississippi, Alabama, South Carolina, Arkansas) at the bottom of the list have both utilization rates of their supplied doses and per capita vaccination rates less than half that of RI.

A major concern throughout RI DoH is the need to get accurate and authoritative information out to the public. “We’re starting to get reports and have been getting reports from across the country, including here in Rhode Island, of simply inaccurate and false information related to vaccines and other aspects of COVID-19… I do want to, again, encourage people to seek out information from reliable sources, like your primary care provider, and not from social media or other sources that can really be questionable,” Chan said. “I want to again reiterate to people that myself along with my other physician colleagues, nurse practitioners, health care professionals, have taken an oath to keep people healthy. Literally our job is your health, and we base our actions and advice on science and evidence.”

New Treatment Available: Monoclonal antibody treatments for all eligible RI patients

A new treatment for COVID-19 patients is available in RI to anyone who tests positive and is age 65 or older, or has an underlying health condition: a one-shot infusion of monoclonal antibodies. It is most effective when administered as soon as possible after testing positive, and it is hoped that it can reduce severity of sickness and prevent hospitalization.

Monoclonal antibodies are one of the then-experimental treatments given to Donald Trump when he contracted the virus and was hospitalized several months ago, as we reported (“Trump has COVID-19 and it’s not ‘karma’ at all”, by Michael Bilow, Oct 2, 2020): “The AP also reported he received an ‘experimental antibody cocktail’ which The New York Times reported contains Regeneron, an experimental bio-engineered drug made by Eli Lilly, which is in a class of ‘monoclonal antibodies’ that can be designed against a wide range of specific targets, including viruses, cancers and autoimmune diseases.”

At the Department of Health (DoH) press briefing on Friday, January 8, Director Nicole Alexander-Scott said, “Rhode Island now has a doctor-recommended treatment for COVID-19 that is extremely effective at preventing people from developing severe disease and from being hospitalized because of COVID-19. The key, though, is starting early: The earlier you start treatment after testing positive, the better and more effective this can be. After completing a simple infusion, intravenously, of this treatment, many people with COVID-19 start feeling better as early as the next day. The treatment does not require hospitalization, and it’s intended to help prevent people from actually having to be hospitalized.”

Dr. Alexander-Scott has repeatedly emphasized her strategic priority of reducing hospitalizations to protect health care services from being overwhelmed, and this is a major reason the state is pushing the new monoclonal antibody treatment as a matter of policy in addition to its significant benefit to individual patients. Treatment for infection is the third major prong of the state’s pandemic response, along with testing and vaccination.

The goal is to give this monoclonal antibody infusion to as many eligible patients as possible by making the eligibility criteria automatic. Dr. Alexander-Scott said, “If you test positive for COVID-19 and are 65 years of age and older, or you have an underlying health condition, immediately call a health care provider and ask about treatments for COVID-19 you should start with your health care provider.” Patients who do not have a health care provider can access TeleCARE at Brown Emergency Medicine – brownemtelecare.org – to get this treatment, she said, and general information about treatments is available from the DoH website – covid.ri.gov/treatment – directly. “So remember, as we’re expanding testing and you’re getting tested, if you test positive and you qualify, access the treatment that’s available. It makes a difference.”

Dr. Alexander-Scott strongly encouraged the use of the new treatment. “It’s available right away now for everyone who is positive and who qualifies. It has to be ordered by a provider, so your provider has the information. We’ve worked closely with our providers to make sure they know where the resources are, where the infusion sites are, how to get their patient connected, and then we also have the Brown Emergency Medicine TeleCARE option that was described so that you could call and speak to a provider online: That provider can order it for you, get you connected immediately with an infusion site.”

Eventually, the plan is to have infusion sites co-located with larger testing sites, so that eligible patients can get the new treatment immediately after testing positive by a rapid test. “We’re working to build out as many different infusion sites as possible, particularly at places where there is a lot of testing already occurring, so that you can just go to the next room if you’re at one of our testing sites that’s able to accommodate this and get access to the treatment. We want to get at every element,” Dr. Alexander-Scott said. “Thank you to some of our local clinical sites also that are partnering with us to make sure that this treatment can be available in all of the different environments that would work well.”

On the Dotted Line: RI likely unaffected by delay in federal pandemic relief

President Donald Trump signed the combined $900 billion pandemic relief bill and $1.4 trillion omnibus funding bill around 8pm on Sunday, December 27, after almost a week of issuing implied threats that he might not do so. The delay already allowed critical unemployment insurance (UI) provisions to lapse the prior day, although the bill provides that the programs would be restored retroactively should such a gap occur, so that recipients will receive the same amount of payments. The two main UI programs at issue extend the time of eligibility beyond that provided by state programs and make gig workers and freelancers eligible when they otherwise would not be.

While some states warned that delay in approving the bill might interrupt the weekly flow of payments to beneficiaries, RI expects to accommodate the extension of benefits with no trouble within a few days margin of safety. In response to our inquiry, Department of Labor and Training press liaison Margaux Fontaine on Wednesday, December 23, told Motif, “Since payments will still go out next week [for the prior week] regardless, we have some time. Extending the date of the programs is a relatively quick fix, so as long as it’s signed by mid to late next week, we wouldn’t expect most claimants to see an interruption.”

UPDATE: Fontaine clarified on Tuesday, December 29, “Under the law, and per US [Department of Labor], the first payable week for the extra $300 is week ending 1/2/21. Payments for that week go out [the] next week.”

The combined bill on pandemic relief and omnibus funding was agreed after seven months of on-again-off-again negotiations by Congress late on the night of Sunday, December 20, as we reported. In addition to extension of UI eligibility periods and supplementing UI payments by $300 weekly above state benefit amounts through March 14, the bill provides for $600 stimulus payments to nearly every American earning less than $75,000 annually, initiates a new round of aid to small business, extends the federal eviction moratorium until January 31, expands the Supplemental Nutritional Assistance Program (SNAP, commonly still called “food stamps”), and provides funds to state and local governments for support of schools and health care, including the cost of administering the new COVID-19 vaccines. As we reported earlier, the bill includes the “Save Our Stages” provisions advocated by IATSE (the theatrical worker trade labor union) and the National Independent Venue Association, authorizing $15 billion in dedicated funding for live venues, independent movie theaters, and cultural institutions.

Trump’s approval of the bill ends nearly a week of chaos caused by his surprise four-minute video statement released late on the night of Tuesday, December 22, that we reported at the time – facebook.com/motifri/posts/3585321644880532 – contained numerous inaccuracies and falsehoods, criticizing the inclusion of items unrelated to pandemic relief. “Trump conflates two separate bills, one $900 billion for COVID-19 relief and the other $1.4 trillion ‘omnibus’ funding bill that keeps most aspects of the federal government running, which is why everything from foreign aid to fisheries is included,” we explained.

Trump’s video statement also picked up untrue right-wing media talking points. We wrote, “Some of the claims Trump asserts in this video are false, especially that undocumented immigrants are eligible for stimulus payments, when in fact only persons legally present in the US, either as citizens or permanent residents (Green Card holders), are eligible for the stimulus payments. What is different in this latest bill is that mixed-status households, such as a US citizen married to an undocumented immigrant with a US citizen child, were completely not eligible for the stimulus round months ago, but would be eligible for the stimulus round now, provided that only those in the household with legal status, such as the US citizen spouse and child, are eligible for the payments.”

The main objection Trump raised in the video, that the $600 stimulus payments were too low and should be raised to $2,000, was seen as especially bizarre because Treasury Secretary Steven Mnuchin, representing the White House in negotiations with Congress, had repeatedly fought Democrats trying to increase the amount, and the $600 number was a compromise between $2,000 wanted by the Democratically-controlled House and zero wanted by the Republican-controlled Senate. In a rare session on Thursday, December 24 – Christmas Eve – House Speaker Nancy Pelosi called for a vote on increasing the payments to $2,000, but the short notice required unanimous consent under the rules and Minority Leader Kevin McCarthy objected on behalf of the Republican caucus.

US Sen. Jack Reed (D-RI)
(Photo: US Senate)

Democrats have said they will hold the vote on increasing the stimulus payments to $2,000 on Monday, December 28, when Congress will reconvene after the holiday break in order to consider overriding Trump’s veto of the National Defense Authorization Act (NDAA), the annual appropriation of funds for the Department of Defense. Trump objected that the NDAA would allow changing the names of military bases currently bearing the names of Confederate soldiers, as well as Congress refusing his demand to repeal Section 230 of the Communications Decency Act of 1996 that provides “safe harbor” immunity for online forums, such as Facebook and Twitter, so they are not subject to paying damages from libel and slander claims arising from unmoderated posts by their users. Trump also claimed the NDAA was not tough enough on China.

RI Sen. Jack Reed, who served with the 82nd Airborne Division as an alumnus of West Point where he later served as a professor, and who is now the ranking minority member on the Senate Armed Services Committee, said “President Trump clearly hasn’t read the [NDAA] bill, nor does he understand what’s in it. There are several bipartisan provisions in here that get tougher on China than the Trump Administration has ever been.”

Even if the increase to $2,000 passes the House, it is widely considered dead-on-arrival in the Senate, unlikely even to be called up for a vote.

Don’t Panic: Explaining coronavirus mutations

Coronavirus — Don’t Panic

In the last few days, there has been a near-panic reaction to the discovery of a mutation of the SARS-CoV-2 virus that causes COVID-19. The mutated lineage – in virology, a “lineage” suggests a variant somewhat closer to its immediate ancestors than a “strain” – is now named “Variant of Concern 202012/01,” having been referenced as “Variant Under Investigation 202012/01” and “B.1.1.7” earlier. (The VOC nomenclature is simply “year 2020, month 12, variant 01.)

Worries about the new variant focus on four main issues:

  • Does it spread more easily?
  • Does it cause more severe sickness or greater likelihood of death?
  • Does it have resistance to vaccines just approved for use?
  • Does it have the ability to escape detection by widely deployed PCR tests?

Mutations occur fairly often in the course of virus replication, essentially just inevitable errors making copies of copies of copies, but the vast majority have no meaningful effect. By random chance, very rarely a mutation gives an evolutionary reproductive advantage to the virus, which is how SARS-CoV-2 arose in the first place, probably many years ago in an animal reservoir, such as bats, until a spillover occurred to humans. Like every virus, this virus continues to mutate, and some random variations could boost the mutated lineage in epidemic risk. Thousands of such mutations have been observed and recorded in SARS-CoV-2; by one estimate about 12,000 distinct variants so far, but most do not seem to do anything different.

As the Global Initiative on Sharing Avian Influenza Data (GISAID) explained in a statement, “Mutations are naturally expected for viruses and are most often simply neutral regional markers useful for contact tracing. The changes seen have rarely affected viral fitness and almost never affected clinical outcome… Changes in the spike protein have relevance for potential effects on both host receptor as well as antibody binding with possible consequences for infectivity, transmission potential and antibody and vaccine escape. Actual effects need to be measured and verified experimentally.”

According to an advisory from the World Health Organization (WHO), by December 13 there were 1,108 known infections with this new variant in the UK. Ordinary COVID-19 testing is not intended to distinguish between variants, but in the UK between 5% and 10% of samples are routinely sent for genomic analysis that can distinguish between variants, and 4% of samples in southeastern England are sent for genomic analysis. The new variant accounts for over half of COVID-19 infections in southeastern England, after having been first seen in September in Kent, and is disproportionately more likely to be seen in young rather than old patients.

It is not clear why the variant is significantly more prevalent in the affected area, but one possible explanation is that the mutation makes the virus more transmissible from person to person, and if so this would be a major concern. The WHO warns, “Preliminary reports by the United Kingdom are that this variant is more transmissible than previous circulating viruses, with an estimated increase of between 40% and 70% in transmissibility (adding 0.4 to the basic reproduction number R0, bringing it to a range of 1.5 to 1.7).” On the other hand, according to a news article in Science, generally considered the most prestigious scientific journal in the US, “Scientists, meanwhile, are hard at work trying to figure out whether B.1.1.7 is really more adept at human-to-human transmission – not everyone is convinced yet – and if so, why.”

Sometimes increased prevalence is a result of a biological property of the virus, but this is not always so. It is widely known that the lineages of infections in the US toward the West Coast tend to be genetically closer to those found in Asia while the lineages of infections in the US toward the East Coast tend to be genetically closer to those found in Europe, but that almost certainly reflects patterns in airline travel rather than any intrinsic property of the mutations in the lineages. Likewise, the higher prevalence of the new variant in the UK could reflect human behavior, such as young people being more likely than old people to transmit infections in bars or restaurants, rather than any biological underpinning.

SARS-CoV-2 receptor binding domain (RBD)
(Source: Global Initiative on Sharing Avian Influenza Data (GISAID))

The new variant is characterized primarily by three distinct mutations, labeled “N501Y,” “P681H,” and “69-70del.” The detection of the new variant in the UK is a coincidence because a common commercial PCR test, known as TaqPath, consists of a three-part panel of subtests, one of which looks for the component of the virus that goes missing in the 69-70del mutation; as a result, a positive indication on the other two subtests and a negative indication on that subtest allowed the UK to go back over their existing test data and estimate the prevalence of the new variant.

While the 69-70del mutation can cause anomalous results in some PCR tests, it is the other two mutations that are of real concern, modifying the receptor-binding domain (RBD) that controls how the virus infects hosts cells. This could give the variant an advantage invading host cells, increasing ease of transmission from person to person, as the WHO fears. One indication of this possibility is that the N501Y mutation has been seen elsewhere in the world, with a few dozen cases known in Australia and Africa. In fact, it was the University of KwaZulu-Natal in South Africa that first identified the N501Y mutation in a separate lineage and made the UK aware of its potential importance. The independent evolution of this same mutation in different parts of the world strongly suggests that the mutation gives the virus some reproductive advantage and is therefore favored by natural selection. Whether this is true and if so to what extent is unknown pending further study.

So far, there is no evidence that the new variant causes more severe sickness or increased likelihood of death, even if it does have an advantage in being able to infect the host and therefore spread more easily. There is no known biological reason to expect a change in the RBD of the virus to result in worse sickness.

It’s too early to know whether the new variant is more resistant to immunity, whether acquired through recovered infection or vaccine, but theoretical models strongly suggest that the mechanisms of action by immune antibodies will be just as effective and are not affected by the particular mutations that characterize the new variant. Eventually, although SARS-CoV-2 mutates relatively slowly, it may be necessary to formulate a slightly modified vaccine periodically, similar to seasonal influenza vaccines that must be given annually.

Is the new variant in the US, or even in RI? Experts believe it almost certainly is, but there has been no testing for it until extremely recently, so it is impossible to know for certain. We asked that question, and Joseph Wendelken, spokesman for the RI Department of Health, told Motif, “Rhode Island participates in a CDC initiative to sequence SARS-CoV-2 from throughout the USA by regularly submitting positive specimens collected from Rhode Island residents. We are not aware of any such specimens being confirmed as the UK mutant strain. The State Health Laboratories (SHL) is also currently working with Rhode Island scientists on sequencing SARS-CoV-2 positive specimens at time points throughout the pandemic and in a sampling of isolates collected in March through August none were the UK mutant strain. These efforts are continuing.” However, as Wendelken made clear, at this point data more recent than August is not yet available, a month before the new variant was first detected in the UK. Motif asked the CDC directly, but so far they have not replied.

Wendelken was confident, however, that PCR testing accuracy in RI should not be affected if encountering the new variant. “Rhode Island clinical laboratories utilize a diversity of molecular amplification detection methods and many have multiple tests online – the SHL alone currently has five different ‘PCR’ tests. Each test uses different virus gene targets for detection and many use a multi-target approach. For this reason, if virus mutations in one area affect detection of a certain gene, the built-in redundancy would detect the other virus gene targets, thus lessening the potential for a ‘false negative’ result for the UK mutant strain.”

No Holiday for Death at the ACI

A second inmate has died from COVID-19 at the Adult Correctional Institution (ACI), according to a statement from the RI Department of Corrections (DoC) on the afternoon of Friday, December 25. Motif previously reported the first inmate death on Saturday, December 19, and the first staff death on Monday, December 14.

“The inmate requested ‘Comfort Measures Only’ and that no extraordinary measures be taken to keep him alive. He was 79 years old,” the DoC said. “The inmate had other serious complicating health conditions that contributed to his death. He was being treated at Rhode Island Hospital for complications of COVID-19. The inmate was housed in the Medium Security facility of the ACI, where he was serving a life sentence for murder, and a concurrent expired sentence for manslaughter. The inmate’s family has been notified.” As is customary for DoC, the name of the deceased was withheld, citing “medical privacy laws.”

RI Department of Corrections COVID-19 counts as of Dec 17, 2020.
(Source: RI DoC)

Although DoC usually releases an update every Friday via their official Facebook page of the number of cases and deaths as of the prior day, it appears to be delayed this week due to the holiday. The most recent weekly report published by DoC as of December 17 listed 1,098 total COVID-19 cases, of which 808 are among incarcerated persons and 290 among staff.

The RI Decarcerate NOW Coalition – https://www.facebook.com/RI-COVID-Response-Decarcerate-NOW-102918301434589 – an umbrella organization that includes Direct Action for Rights and Equality (DARE), Black and Pink Providence, Formerly Incarcerated Union of Rhode Island, AMOR RI – Alianza para Movilizar Nuestra Resistencia, and other community members has been vocally critical for months about conditions at the ACI. The group recently held a protest rally outside the weekly press conference by Gov. Gina Raimondo on Tuesday, December 22, without incident.

Code Black RI, “a coalition of medical professionals, healthcare workers and trainees taking a stand against racism and racist systems,” held a protest rally in front of the governor’s residence on Wednesday, December 23, resulting in at least five arrests, that was broadcast via Facebook Live by UpriseRI. The group published a statement that evening on UpriseRI, saying “Mass incarceration is a threat to health equity and a public health crisis. As of December 17, greater than 90% of the inmates in Maximum Security tested positive for COVID. Cases are rising at the surrounding facilities. None of these outcomes are due to happenstance. Since March, the Decarcerate NOW Coalition and many others have called for the state to halt arrests; release as many incarcerated people as possible on parole and into community confinement – centering elderly and medically vulnerable people; and provide adequate PPE and universal testing to incarcerated people. These measures were not taken, or taken in half-measure.”

DoC Director Patricia A. Coyne-Fague said in today’s announcement of the second inmate death, “Any loss of life is very painful for friends and families, especially around the holidays, and we are keeping all who have lost relatives and loved ones in our thoughts during this difficult time. We are doing everything we can to keep people as safe as possible – no one wants to see more people die as a result of this virus that has claimed already too many lives in our state, and the rest of the world.”