Rhode Island this week reported the highest rate of new COVID-19 cases in the country, according to The New York Times. Driven by the rise of the more contagious Omicron subvariant, known as BA.2, the average daily increase in new COVID-19 cases in Rhode Island during the last two weeks has more than doubled, although hospitalizations remain far below the winter surge. Earlier this week, Philadelphia became the first major U.S. city to reimpose an indoor mask mandate after reporting a sharp rise in COVID-19 cases. Health Reporter Lynn Arditi talked with Rhode Island’s interim health director, Dr. James McDonald, about the state of the pandemic here.
(The following is an edited transcript of the conversation.)
Lynn Arditi: Dr. McDonald, in Rhode Island we've lifted the indoor mask mandates and now we're starting to see cases creep up again. So what indicators do you look at to determine whether to advise that Rhode Island consider reinstituting a mask mandate?
Dr. James McDonald: Yeah, so we're going to be in the world of recommendation, not mandate, and I just want to get that out in the open. So in other words, I really think we just have to use the word recommendation, because, you know, we're not going to be in that space, we're going to be requiring things. So we'll issue recommendations and guidance. I'm really looking at the hospitalization numbers. So I look at things very closely like, how many people are being admitted to the hospital every week? How many people are in the hospital every week for COVID-related reasons? And those numbers are actually pretty good right now.
Arditi: The last I checked, we were close to 200 new cases per 100,000 population, which is higher than it was last February, late February. And we know that that could be an underestimate because many people test at home now. So for looking at the spread of disease, are you concerned that we are spreading a lot of this disease around now and even if people are not hospitalized, they may get very sick, may even have long COVID? Or COVID-like symptoms that can compromise their health. Is there any threshold that you have any rule of thumb that you've created in the department to look at? What are we willing to tolerate in terms of new cases before recommending that people wear masks indoors, supermarkets and food stores etc.
McDonald: Right. And so what we're following is the Centers for Disease Control COVID-19 community levels and indicators. So we're following the same guidance that the CDC is putting out, and we're going to try to follow that as close [sic] as we can. At this point, there's really every reason for us to do that. You know, so as we move into medium, which might happen this week, you know, we don't know, you know, that's a time where, you know, if you're someone who's immunocompromised, or someone who has underlying health conditions, you might talk to your doctor, like should I be wearing a mask all the time, or maybe just choose to do that on your own.
Arditi: So there's a difference, obviously, between making recommendations as a doctor or even a public health person for individuals to do themselves. If you're following the CDC guidelines, what does the CDC guidance tell you about at what level case rates are to be a concern where there might be some public health advisories for all people regarding wearing masks, or even public health requirements that all people wear masks in certain situations?
McDonald: So when you get over two hundred cases per 100,000 per week, you know what the CDC says, hey, get your vaccine, make sure you're boosted. The other thing is CDC says, if you're at high risk, you know you have underlying health conditions, you should talk to your doctor about wearing a mask. That's what the CDC says. It makes sense to me. When you get above, into that high transmission level. In other words, we not only have over 200 cases per 100,000 per week but we see substantial impact on our hospitals, that's when we have more admissions, you know, and more beds that are occupied for people with COVID, then you might see the health department come along and say what the CDC says, you know we recommend that you wear a mask when you're outside, you know, if you have underlying health conditions, and you're at higher risk.
Arditi: So the goal of the restrictions is really to prevent hospitals from being incapacitated or strained considerably to the point where they may not be able to care for all their patients. Correct me if I'm wrong, it's not to prevent people from getting COVID. Period.
McDonald: Yeah, I mean, I think at this point in the pandemic, that's where we are as a country. In other words, what we're really trying to do is not overwhelm our healthcare system. That's the philosophy of the United States, it's very different [from] China, which [has] a zero-COVID policy. This is not the policy the United States has ever taken.
Arditi: The goal that the governor set was pretty ambitious, he wanted to get the majority of people boosted. And he made that very clear months ago, and we have fallen very far short of it. Now we're not unique in that respect, we’re higher than other states, but 40% were not even half of the way there. Why is it that we haven't gotten more people boosted?
McDonald: Yeah, you know, it's interesting, Lynn, it's a national problem, because we're one of the highest boosted states in the country. But we're only at 40%, which is kind of intriguing to me. People have, quite frankly, gotten the first two vaccines, and we've done really well in Rhode Island in that phase, they just haven't gotten around to that third dose. And it's, it's a variety of reasons. Sometimes people just quite frankly, [haven't] gotten to it yet. For the people, they just, you know, they feel like I don't know, I just don't want to get it, you know. But that really gets to one of those things where I think it also gets a larger issue, people are just kind of tired of talking about the pandemic. You know, you've lived with the darn thing for two years. And at some point, I'm just like, I don't want to deal with it anymore. And regrettably, though that's not how the virus looks at us, like in other words we might be kind of tired dealing with the pandemic, but the virus isn't tired of dealing with us. Because the virus will infect us whenever it can. You know, if you haven't gotten that booster, you really need to do that, because that really offers you a great deal of protection. And by the way, we get boosters for every other vaccine, like you know, we're not worried about measles, mumps and rubella vaccine booster or tetanus boosters. Everybody gets those. It's just getting our country around to thinking about this one, like I got to make it more normal for me.
Arditi: So really, we've left a lot of the decisions about this public health beyond what we do to protect our hospitals and our healthcare system, we really left it up to individuals to decide how to act. Given that that is the baseline of how this country has responded, what did you think when you heard about the mandate in Philadelphia, to reimpose indoor masking?
McDonald: Yeah, I mean, Philadelphia is a different area. I mean, their vaccine rates aren't really quite what ours are. You know, but quite frankly, when I look at our situation, we're just not in that space. We're not talking about mandates. And I don't anticipate that happening here. 15:55 You know, one of things that Rhode Island has going for it and other states do not as we're a highly vaccinated state against COVID.
Arditi: Is there any situation in which currently you would wear a mask now?
McDonald: I wear a mask whenever I go [into] health care settings. And then if I go anywhere that's crowded, I wear a mask. Well, if I go into a crowded store, when I'm shopping, a lot of people around me, I wear masks there.
Arditi: Do you think going forward, are we out of the woods with COVID?
McDonald: I'm choosing to look at it like every other disease out there. In other words, it's treatable. It's preventable. It's controllable. And at this point, we've given you all the tools you need to succeed. So I don't see restrictions forthcoming and I expect a decent spring and a lovely summer. You know, it's the fall that you start to just wonder what's going to happen, right. In other words, in the fall, we'll have to wait and see what happens. One, you know, immunity might fade while the people who had Omicron back in January. I hope those people have gotten boosted by then. That you know, and I don't know if there'll be another vaccine booster in the fall. And if that comes, that'll be protection we’ll enjoy locally and nationally as well. We'll have to wait and see what that looks like.
Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org. Follow her on Twitter @LynnArditi
