RI COVID-19 Daily Press Conference: April 3, 2020

Cloth-based face coverings

RI Department of Health (DoH) Director Nicole Alexander-Scott, following new federal guidance, advised everyone to wear cloth-based face coverings, such as bandannas, that cover the mouth and nose. Face coverings can be hand-sewn or improvised from T-shirts and scarves. These are not intended to protect the wearer but to prevent the wearer, if infected, from expelling virus droplets into the air when coughing, sneezing or speaking, thereby protecting others from the wearer. Such cloth-based coverings should be either discarded or laundered after use, and if laundered should be dried on highest heat. She advised hand-washing immediately after handling cloth-based coverings.

The main reason for the change in guidance is that as the science develops it is becoming clear that many infected people have either no symptoms or very mild symptoms, and therefore are unaware that they are infected and can infect others, so spread of the virus can be slowed if these people wear cloth-based face coverings. Symptoms vary greatly between different infected individuals, Alexander-Scott said, and, although this is now well established, the reasons and extent are not yet understood.

Medical-grade masks, especially N95-rated masks, are desperately needed by healthcare workers who are expected to come into contact with infected patients as a matter of course and should be reserved for them, as they are not needed by the public.

Daily Patient Census

RI Governor Gina Raimondo reported that since yesterday there had been two new deaths, for a total so far of 14, and 54 new cases, for a total so far of 711, of which 72 are currently hospitalized. This is a “rapid spread scenario” that means social distancing is becoming more important, even “life saving.”

Alexander-Scott said nursing homes are major challenges because they are congregate living facilities that inherently promote spreading the virus and house a particularly vulnerable population. Orders were previously issued for nursing homes to clean like hospitals, every four hours with special attention to high-touch surfaces such as doorknobs. “Aggressive measures” have been ordered, such as isolating patients suspected of infection, isolating all of their roommates into a “cohort” who remain kept together, and having a very limited number of staff, ideally the same staff member, provide services to these people.

Of the two new deaths, one was in a nursing home and the other was not. There are 12 nursing homes in the state with at least one infected case, but only three with more than one case. The majority of deaths have involved co-morbid underlying health conditions, Alexander-Scott said, and 57% have involved persons in congregate living situations such as nursing homes. DoH is working with the Department of Human Services (DHS) to assist families of deceased patients, she said.

Getting Ready for the Surge

Gov. Raimondo has been sounding the same theme since her first press conference a month ago on the then-emerging threat from the coronavirus, even before “flattening the curve” became a meme: the state is in a race to have enough hospital capacity — beds, personal protective equipment (PPE), ventilators, and trained medical personnel — ready for a predicted surge in demand that is expected from and typical of exponential growth in cases of epidemic respiratory infections.

In what was described as a “Herculean effort,” she tasked the state adjutant general, Major General Christopher Callahan, who spoke briefly at the press conference, with setting up temporary hospital facilities in order to expand net capacity by 1,000 beds, an effective doubling of existing capacity. In cooperation with the US Army Corps of Engineers, three facilities have been identified: the RI Convention Center in Providence, the Citizens Bank office in Cranston, and the former Lowe’s store in Quonset (North Kingstown). Already operating hospitals have a goal of 10-20% expansion of capacity.

The National Guard, Callahan said, has activated over 700 and can activate 300 more in what he called their “largest ever response to a domestic crisis.” Soldiers are conducting health screenings (including at the airport and train station), and are picking up and transporting donated medical supplies and are managing warehouse operations.

Gov. Raimondo promised next Monday there would be more details available about the mathematical prediction models the state is using to forecast the timing and size of the coming demand surge for medical resources, but emphasized that the most important variable determining the results was the degree of compliance with social distancing and stay-at-home orders she has issued. The state is not ready for the surge this week or even next week, but it would be ready in time if the people of the state follow the rules intended to slow the spread of the virus. Compliance is “life-saving,” she said, expressing concern that RI has measured that people have cut down on movement by 36% but the national average is 41%, so RI has to be better.

The state is on track to have the necessary equipment to meet the surge, she said, but the most acute shortage is trained medical personnel. Anyone with professional medical training — including doctors, nurses, CNAs and even students — if they have available time due to retirement or other reasons can sign-up at RIresponds.org. These are paid positions, she said.

Testing

Because of the increased supply of tests, guidance is now changed, Alexander-Scott said, and all Rhode Islanders who have symptoms consistent with COVID-19 are encouraged to get tested by calling their primary care provider (PCP) and scheduling a test at one of the three drive-through testing facilities opened this week, located at the CCRI campus in Warwick, the RIC campus in Providence and the URI campus in Kingston (South Kingstown) (“Drive-Thru for COVID-19 Test”, by Maureen O’Gorman, Apr 1). No one who believes they may have COVID-19 should just show up at a health care facility of any sort without making an appointment in advance by telephone, it was strongly emphasized. If someone does not have a PCP, they can call an urgent care facility (if they have health insurance) or a community health center (if they do not have health insurance).

Symptoms of COVID-19 include any of: fever, cough, shortness of breath, muscle aches (myalgias), chills, runny nose or stuffy nose, sore throat, headache, or diarrhea. Each infected person may experience any combination of different symptoms, or even no symptoms, Alexander-Scott said.

In an ideal world it would be possible to test everybody often, but in the real, resource-constrained world there is now enough capacity to test everybody with symptoms: this is the testing needed if not all the testing wanted. The governor said the state was promised 15 new rapid testing machines, but they have not yet arrived.

Anyone needing advice on any COVID-19 matter including testing can contact the RI Department of Health by telephone 401-222-8022 (every day including weekends, 8:30am-4:30pm), 211 (after hours), or by e-mail to RIDOH.COVID19Questions@health.ri.gov.

Child Care

The governor extended the closure of all child care facilities through the end of April, apologizing that she is still looking for some safe solution for first responders, medical personnel and other essential workers left with few options. At this time, she said she unfortunately has no alternatives.

Small Business Loans

The new Paycheck Protection Program authorized by recent federal stimulus legislation came into force effective 3am today, the governor said. Although backed by the US Small Business Administration (SBA), the application process requires businesses to go through their bank (or any bank). These will be handled in the order received and, in the face of expected overwhelming demand, the governor encouraged filing “as soon as possible.” Call RI Commerce at 401-521-HELP or e-mail info@commerceri.com. for assistance.

Food Security

Anyone in need of food who cannot get it for themselves can contact RIdelivers.com or telephone either 211 or the Point at 401-462-4444 in English or Spanish. Roch’s market is offering delivery anywhere in the state in addition to many other ordinary delivery services listed on the website, but the governor encouraged anyone who can get their own groceries to do so in order to reserve delivery capacity for those in quarantine or who, due to age or disability, need delivery. Do not break quarantine to go shopping, the governor emphasized, saying, “We’ll take care of you.”

The special service being provided to the state by Roch’s market is receiving 40,000 requests per day, so if you are young and healthy, the governor said, not only should you get your own groceries but you should offer to help family, friends and neighbors who cannot. Designate one person from each household to go grocery shopping rather than a group, the governor said, to minimize possible exposure to and spread of the virus.

The state added a bonus to many EBT cards used to access Supplemental Nutrition Assistance Program (SNAP) benefits, still commonly known as “food stamps.” In response to a question about obtaining WIC-eligible products that are out of stock at stores, the governor recommended calling 211 or contacting Family Service of RI.

Mental Health Services

This is a trying time for everyone, the governor said she understands, but there are support services for those who feel stress, anxiety, or have other mental health concerns. Adults can contact BH Link, 24×7, at 401-414-LINK(5465) and for under 18 at 855-KID(543)-LINK(5465).

The RI Foundation worked with local insurance companies to establish a $5 million Behavioral Health Fund for non-profit organizations working to address behavioral health needs during the coronavirus pandemic. Applications from non-profits will be accepted beginning Apr 6.