As the state responds to its first positive tests for coronavirus, officials say risk of transmission remains low but are urging Rhode Islanders to remain vigilant.
“I understand why many Rhode Islanders may be concerned or even frightened … My primary message to the people of Rhode Island this morning is that the risk here in Rhode Island at this point is low, and we have been preparing for this for weeks. We did not wake up today and just get started in our preparations,” Gov. Gina Raimondo told members of the media during a Sunday morning press conference at the Rhode Island Department of Health’s headquarters.
“We fully anticipated standing before you at some point to make the announcement that we are making today,” added Dr. Nicole Alexander-Scott, the state’s health director. “We are not seeing widespread community transmission in Rhode Island, and that means the general level of risk for Rhode Islanders is still low.”
On Monday, Mayor Allan Fung said the city of Cranston has been in active contact with state officials regarding the situation.
“Communication has been good all the way around so far,” he said.
Fung said his administration has provided guidance to department heads in accordance with what has been recommended by state and federal health officials. He said his overall message to both municipal employees and residents is simple.
“The one message that I want to get out – don’t panic,” he said. “Just take the same precautions that everyone should … Those simple precautions can go a long way.”
Cases tied to Europe trip
The local cases of coronavirus – known formally as COVID-19 – have been tied to a February trip to Europe organized by Saint Raphael Academy, a Catholic School in Pawtucket.
All three of the potential local cases were part of a 38-person group that visited France, Spain and Italy – which has experienced a significant outbreak of the virus – before returning to Rhode Island last weekend.
The first positive case, a man in his 40s, was announced Sunday morning. Officials say he remains hospitalized.
Later Sunday, officials announced that a teenage girl had also tested positive for the virus. The third potential case, a woman in her 30s, was undergoing testing. The results of that test were expected Tuesday but had not been released publicly at press time.
Both the teenage girl and the woman in her 30s were described as being at home with mild symptoms.
The woman has been identified as a staff member at Achievement First Academy in Providence. Health officials on Monday said Achievement First’s Providence and Cranston locations would both be closed through Tuesday. Saint Raphael Academy, meanwhile, will remain closed for the rest of this week.
“All three people went on the same trip to Italy,” Alexander-Scott said in a statement issued Sunday night. “This is precisely why we are being so aggressive in identifying contacts, ensuring monitoring, and testing people who are symptomatic.”
Testing and containment
The positive tests are at this point considered “presumptive positives,” meaning they have yet to be officially confirmed through the Centers for Disease Control and Prevention.
Alexander-Scott said the Department of Health’s State Health Laboratories has the capacity in place to conduct testing for COVID-19 locally but is taking a judicious approach to the use of the kits. She also said the CDC confirmation of any “presumptive positive” is part of a protocol that is being followed nationwide.
Health officials say all of the participants in the trip to Europe have been instructed to remain home from work or school for a period of 14 days and self-monitor for symptoms.
During a phone briefing with reporters Monday, Alexander-Scott said: “Outreach to the people who were in direct contact with any of these three individuals is extensively ongoing at this time. These direct contacts, who we will get in communication with, will be asked to self-monitor for symptoms at home for 14 days with public health supervision.”
In a press release, officials said the state’s Health Department is “coordinating with other state agencies and community organizations to support anyone doing self-quarantining to ensure that people who are remaining at home have the support services they need.”
“This includes support with everyday needs, such as prescriptions and groceries,” the release reads. “The organizations that have offered support include agencies throughout the Executive Office of Health and Human Services (EOHHS), the Rhode Island Food Bank, the American Red Cross, and other members of Rhode Island’s Voluntary Organizations Active in Disasters (VOAD).”
Risk still seen as low in RI
Alexander-Scott said the man involved in the first diagnosed case had not yet returned to work and has had “very limited travel in Rhode Island after returning from Europe.”
She also stressed that based on the current guidance from the CDC, the risk of transmission is considered low. As all of the cases to this point appear tied to travel, the state is not experiencing what is called “widespread community transmission” – in other words, cases that cannot be tied to a specific chain of transmission.
Additionally, Alexander-Scott said at this point the primary concern in terms of transmission centers on coming into contact with someone who has become symptomatic. She said the risk is considered “very low for someone who is a contact of a contact” – meaning someone who came into contact with someone who had themselves been in contact with a potential COVID-19 carrier.
“You need to be exposed to someone who actually has symptoms” to be at risk for transmission, she said.
In a follow-up message to the media Sunday, Department of Health Joseph Wendelken wrote: “The science continues to evolve and what we know about this virus is subject to change. However, the latest guidance from CDC is that risk of asymptomatic transmission is very low. (The main way the virus spreads is through respiratory droplets expelled by someone who is coughing.) If someone is not exhibiting any symptoms there is no need to change your daily routine.”
According to the CDC, symptoms of COVID-19 may appear between two and 14 days after initial exposure. Symptoms include fever, cough and shortness of breath.
Global and national spread
According to the World Health Organization’s March 2 update, nearly 90,000 cases of COVID-19 have been confirmed across 64 countries. The vast majority of cases – more than 80,000 – are in China, where the outbreak originated.
South Korea, Italy and Iran have also experienced significant outbreaks. In the United States, the number of confirmed cases approached 100 Monday following a sharp increase in new reports over the weekend.
There have been roughly 3,000 deaths associated with the virus in China and nearly 130 elsewhere across the globe, according to the WHO. As of Monday, six deaths have been confirmed in the United States, all in Washington State.
On Monday, global health officials indicated the spread of the virus appeared to be slowing in China as the number of cases in the West continued to grow. Increasing unease about the virus has shaken global markets, and on Tuesday the Federal Reserve reduced its benchmark interest rate in a surprise move aimed at boosting the economy amid the uncertainty.
Virus concerns have also spurred a rush on basic goods and medical items such as facemasks. That effect has been seen in Rhode Island, where shelves at some stores have been cleared of items like hand soap.
Fung on Monday said he was aware of no direct Cranston connection with the European trip that has been tied to the local COVID-19 cases, although both the Achievement First and Saint Raphael’s communities
The guidance his administration issued to department heads reads: “The same precautions and good health habits we are all familiar with when it comes to combating the flu and limiting our potential exposure are the same for this virus.”
“The message is basically be safe and don’t panic,” Daniel Parrillo, Fung’s director of administration, wrote in an email. “Take the same precautions you would for the flu and be proactive in keeping yourself symptom free.”
The message to department heads indicates the city has instructed building maintenance staff to follow specific protocols when cleaning various surfaces and high-traffic areas. Additionally, anyone with symptoms of the virus – or who has a family with symptoms – is urged not to come to work.
“Any extended use of sick time will be reviewed on a case by case basis and will not become a disciplinary issue unless there is evidence of abuse,” the document reads.
The mayor said his administration has also been in close contact with Cranston Public Schools, which on Monday issued its own communication to parents and members of the school community.
“We strongly suggest that you go about your daily routine as usual. We do not want children or adults to panic in this situation and we encourage good, common sense approaches to this virus, just as you would the flu,” the message reads.
According to the message, custodial staff in the district have been “disinfecting all high traffic surfaces” with “hospital grade disinfectant” for several weeks. The message indicates that has been common practice during flu season in recent years. Buses are being disinfected in the same manner.
Additionally, the district has set up hand sanitizing stations and ensured that “all bathrooms are fully equipped with alcohol-based hand soap and regular soap so students can was their hands throughout the day.”
“School nurses are in communication with RIDOH for the most current information and guidance at the school level,” the message adds.
Given the international origins of the virus – and the travel-related nature of the local cases – many Rhode Islanders may be reconsidering plans for trips overseas.
Janis Constantine, a travel agent at Global Excellence in Warwick, said none of her personal clients have canceled travel plans because of the virus but there has been a heightened level of concerns and questions. She said many airlines and cruise companies are allowing the rescheduling of trips to Asia as well as Italy without a fee.
Constantine said many travelers are considering insuring their trips. She said insurance would cover instances where the traveler became ill, however, she said, few policies would cover situations where people are fearful of contracting the virus and therefore want to cancel their trip.
“Most people are on a wait and see basis,” she said.
Constantine said most of her time at this point is spent trying to give her clients accurate information, “so they can make an informed decision.”
How to prepare
Raimondo and Alexander-Scott on Sunday both stressed that masks are not advised as a means of containing transmission in the general public, and asked residents not to take part in the rush on acquiring them to help ensure a shortage is not experienced in medical settings.
“Masks are not recommended for people in the general public who are healthy,” Alexander-Scott said.
In a press release, the health department elaborated: “The CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19. You should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected.”
Raimondo said the state has an “excellent plan in place” and has maintained “close collaboration” with municipal and school leaders. She said she has noted spoken directly with Vice President Mike Pence – who has been put in charge of the federal coronavirus response – but that her administration has been in contact with the White House.
“Here in Rhode Island, we are prepared for this … We are following the science, we are following best practices,” she said.
Information provided by the state mirrors CDC guidance on how Rhode Islanders may best protect themselves against COVID-19 transmission. In short, officials advise that the steps are like those that would typically be taken to avoid the flu and other viruses.
Specific guidelines include receiving a flu shot; washing hands frequently with warm water and soap, or, in lieu of that, an alcohol-based hand gel; coughing or sneezing into one’s elbow to avoid spreading viruses onto one’s hands; remaining home from work or school when experiencing symptoms of illness; avoiding touching one’s eyes, nose or mouth; and keeping surfaces such as bedside tables and children’s toys disinfected.
“Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious foods,” Department of Health guidelines state.
The guidelines additionally advise: “If you have recently traveled from an area with widespread or ongoing community spread of COVID-19 and you have symptoms of the disease (fever, cough, shortness of breath) reach out to your healthcare provider and call ahead before going to a healthcare facility. The healthcare provider or facility will work closely with RIDOH.”
Additional information is available in multiple languages by visiting health.ri.gov/covid or calling 222-8022.