Rhode Island coronavirus cases are surging just as the Thanksgiving holiday approaches. The percent positive tests over the last seven days is 3% -- the highest in New England, according to data released Monday by Johns Hopkins University.  Rhode Island is performing twelve tests per 1,000 people, on average, per week, also the highest in New England. Massachusetts performed 10 tests per 1,000 people.  To try to understand what’s behind the numbers, health reporter Lynn Arditi spoke with Dr. Philip A. Chan, an epidemiologist and medical director at the Rhode Island Department of Health.

REPORTER: If you look at Rhode Island on the map published on the website Covidexitstrategy.org, it's a spot of deep red, surrounded by orange and above it green and yellow. Deep red signifies the most intense spread; meaning that Rhode Island is seeing “uncontrolled spread” of the virus that's worse than anywhere in New England, and on par with states such as Pennsylvania and Ohio. What is going on here?

CHAN: We are very concerned about what's going on in Rhode Island. First, a couple caveats.  Rhode Island really has one of the highest testing rates in the nation. So just by that fact alone, we are finding lots of cases and we believe probably more cases than anyone else, certainly throughout New England. So the more testing you do, the more cases that you're going to find. And all states measure their case counts a little bit differently. That being said, we are concerned and we do believe that cases are significantly increasing. And in the next week here we're going to be enacting some stronger measures to try to prevent spread. And we've been discussing those at the Rhode Island Department of Health and elsewhere.

REPORTER: What is driving this increased spread? We've heard some health officials talk about the “invisible spread,” referring to people who are asymptomatic. Last week the state’s health director, Dr. Nicole Alexander Scott, said that an analysis of tests conducted earlier this month showed that Rhode Island residents ages 19 to 24 comprise about 9% of the state's population but represent 21% of the new cases during that period. Is this what's driving this sudden turn that we're seeing now?

CHAN: What we have seen from the data that we collect, is that it's really smaller group gatherings. In general, people have done a fairly good job not attending larger gatherings, but it's the smaller gatherings among younger people in their 20s, 30s and 40s. It's backyard, you know, birthday parties, bachelor bachelorette parties, weddings.

REPORTER: Is there anything that explains why Rhode Island might be doing worse than Connecticut or Massachusetts just over the border? Is there anything different about our geography, population, testing or other response to the pandemic that might explain that?

CHAN: Rhode Island is one of the more densely populated states in the country. When you look at other states like Vermont, New Hampshire and Maine, there's a lot of rural areas in those states. And even compared to Massachusetts and Connecticut. I'd be curious if you looked at the comparison between Rhode Island and some of the more urban parts of Massachusetts and Connecticut, I'm guessing that we'd compare similarly. But I know that Massachusetts too, is also experiencing significant upticks in their cases. So it's what we're seeing across the U.S. and, unfortunately, here in Rhode Island.

REPORTER: You mentioned that Rhode Island is testing among the highest number of people in the country. So I'm wondering, are we able to pinpoint the source of the infections after we do that testing? How are we doing with contact tracing?

CHAN: So we have a great, robust team here at the Department of Health that is fully involved and engaged in contact tracing and contact isolation. I will admit at times it becomes a challenge due to the increasing number.

REPORTER: Does Rhode Island currently have enough contact tracers to track down the sources of these new infections?

CHAN: A month ago, two months ago, we definitely had enough. I think as cases increase, we have to be cognizant that does place an increasing burden on resources. I think the metric at the end of the day that matters is that people are being reached and engaged in a timely manner, that they're being notified when they're positive. Of course, as you may remember, our turnaround times for testing were terrible at one point. And those have now significantly improved with some in state capacity. So I think the fact that people can find out that they're positive in a timely manner, be notified. And certainly close contacts, as well, is a key piece. And you know, the other thing that's coming down the road, of course, are the increased capacity for rapid testing. And hopefully, that will facilitate a lot of this discussion in terms of allowing people to find out their COVID-19 status within, you know, 15, 20 minutes at most, so that people have access to testing all people in Rhode Island have access to testing.

REPORTER: As we head into winter, we see the coronavirus case numbers in the state climbing. If we continue at this rate, will Rhode Island have to consider pulling back on its economic reopening in some respects?

CHAN: I think all options are on the table. I think no one wants to close anything. And I totally get that and understand that. And we're working our best to prevent that. And that's why we're really pushing reductions in your social circle, masking at all times, outside of your household, physical distancing. I mean, the last thing we want to do is close anything down. And we all realize that and none of us want that. But if cases keep climbing, and especially if our healthcare system starts to become overwhelmed again, I think we're gonna have to look at some of these things and make some tough decisions.

REPORTER: What are your own plans for Thanksgiving this year?

CHAN: We're gonna make the tough decision just to celebrate Thanksgiving alone. And of course, it's not ideal. I mean, Thanksgiving is one of my favorite holidays, right? It's one of those holidays where the entire purpose is just to eat and there's no gifts, there's no pressure to buy things, etc. I guess unless you're the cook. But other than that, I mean, you know, Thanksgiving is one of my favorite holidays. And it's really been a time in the past, when, you know, personally I’ve gotten together with family. But this year, I mean, we just have to consider the people that we're getting around with the people that we're placing potentially at risk. And I think we all want to end this sooner rather than later. And I think it's going to require all of us to do our part to get there.

Testing data updated as Monday at 2:18 PM

Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org.