R.I. faces uncertain COVID-19 prognosis for fall

PROVIDENCE — While Rhode Island thus far overall has managed the coronavirus pandemic better than many other places, factors beyond the state’s complete control foretell an uncertain future here, with the U.S. now in a dangerous new period that has resulted in record numbers of deaths and cases in Florida, Texas, Arizona, California and other states.

That is the consensus of three Rhode Island scientists with national reputations who spoke with The Journal last week.

All three gave generally good marks to Rhode Island government for management of the crisis to date — but each expressed concern regarding the rest of the summer and the fall, when schools will reopen in one fashion or another and cooler weather moves people back indoors.

“Some of our hard-won gains may be endangered simply because the rest of the country was not prepared,” said frontline practitioner Dr. Megan Ranney, an emergency physician at Lifespan’s Rhode Island and Miriam hospitals. Now more than ever, she said, Rhode Islanders must wear masks, social-distance, avoid large gatherings and follow other protection measures.

Mark Lurie, associate professor of epidemiology at Brown University School of Public Health, agreed with Ranney’s admonition. As for the future, Lurie said “it all very much depends on how we behave, on how our leaders behave, and on how we as citizens behave. It's become clear across the country that if you open too quickly and you don't mandate the wearing of masks, you're going to have a major resurgence.”

Dr. Leonard Mermel, medical director, epidemiology & infection control, Rhode Island Hospital, also stressed the importance of following the rules. Acknowledging that neither he nor anyone can predict the future of a pandemic with precision, he said his many years studying diseases and their transmission had led him to a sobering conclusion:

“Historically, we know with just about every flu pandemic in relatively modern history — in the last 150 years or so — there's been a second wave, and the timing of those have been somewhat unpredictable [because] they occurred at different times of the year.”

Other key takeaways from The Journal’s conversations with the three scientists, which can be viewed on video and listened to in their entirety at providencejournal.com:

Despite the state’s overall commendable performance since COVID-19 struck with force beginning in March, new warning signs have emerged.

Regarding testing in Rhode Island, “we have a 3% positivity rate, which is very encouraging,” Lurie said. “The discouraging side is that the number of tests that are being conducted are not sufficient.” About 75% of what he described as the ideal “target number” are being conducted, the Brown epidemiologist said.

The tests that are being completed, said Ranney, who is also a professor at the Warren Alpert Medical School of Brown University and director of the Center for Digital Health, portend possible trouble ahead.

“It's summer, and Rhode Islanders are traveling and people are traveling from other states to Rhode Island,” said Ranney. “And as we travel, we potentially can bring the virus back with us. … We're starting to see little bumps in the numbers of positive tests per day, and we risk reimporting and spreading the virus in our own community.”

Add the state’s relative stability in mid-July onto the timeless appeal of Rhode Island’s beaches, parks and hospitality industry, and a toxic mix potentially is created.

In considering where to vacation, Mermel said, out-of-towners may find the Ocean State and its regional neighbors particularly attractive this summer. They may think, he said, Where's a safe place for us to take vacation? Well, let's go to New England. They don't have any cases. “And so that is a potential problem with people coming from these hot spots to Rhode Island,” Mermel said.

Even with unambiguous, science-based guidance, risk assessment will vary person by person, with young people more likely to break the rules, a point Gov. Gina Raimondo made last Wednesday in reducing parking-lot capacity at two state beaches and ordering other measures, including crackdowns on bars that violate safety mandates.

Mermel noted the difference in reasoning and decision-making abilities — rooted in certain parts of the brain — between younger people and those who are older and have more fully developed brains and longer life experience.

“We know the development of ‘executive function’ in the brain [proceeds] at different rates,” he said. “Younger people … think they're to live forever and [ignoring rules] is not a risk. But they may be forgetting that when they go home and see their moms and dads and grandparents, they could infect them, and that could cause a bad outcome.” Asymptomatic people can unknowingly harbor the virus and transmit it to others.

In ordinary times, fall and winter bring on “regular” flu season and increased incidence of other viral diseases, which typically results in deaths and hospitalizations. The presence of COVID-19 will challenge the health-care response this year.

“If things get worse in the fall, this is all going to be complicated by flu and respiratory syncytial virus, metapneumovirus, the common cold virus,” Mermel said. “There's a lot of viruses that will start being transmitted more in the fall, and that's going to cause a lot of confusion. ‘What do we do? Is it COVID? Is it the flu?’ ”

— There will be no quick end to life as we now experience it. Despite what some politicians have said, an effective, safe, inexpensive vaccine available to all is not on the immediate horizon.

Historically, “the best that medical science has done in terms of developing a vaccine is a four-year time period,” said Lurie. “We're trying to compress that down into less than one year, which is a big ask, for obvious reasons. Even if we develop that vaccine successfully in one year, there are still going to be lots of questions about scaling up production, about who gets the vaccine, whether there's enough doses for everybody.” Also, whether people will be willing to be vaccinated. Surveys have shown many are not.

Lurie added: “It's certainly going to be multiple months, if not years, until we have an effective vaccine. The plus side is it's fair to say that we're in an unprecedented effort to develop vaccines. I say plural, because there are multiple vaccines, dozens of potential vaccines, that are currently in various stages of being tested in human populations. So that's very positive that we haven't put all of our eggs in one basket.”

— gwmiller@providencejournal.com

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On Twitter: @gwaynemiller