On November 19^th we listened with interest to the governor’s weekly Covid-19 briefing as she announced her plans for a statewide “pause” in response to Rhode Island’s surging case numbers. The plans, which included a reduction in the number of people allowed to dine indoors, were intentionally delayed 11 days and instituted on December 1^st. Governor Raimondo explained that she had consulted a representative from the hospitality industry and learned about the problem of “food spoilage.” Without enough lead time, an unacceptable amount of meat and produce might perish. 

In the weeks since this announcement the number of Covid-19 cases and hospitalizations in the state have skyrocketed. Rhode Island has more cases per capita than any other state, with an average of 14 Rhode Islanders dying of Covid-19 per day. This amounts to suffering a Station nightclub fire each week. Statewide Covid-19 hospitalizations have topped their springtime peaks and continue to rise. 

While much was unknown in the early spring, the science of Covid-19 transmission is now more clear. We know now that you’re 19 times more likely to catch Covid-19 while indoors compared to being outdoors. A landmark paper published in Nature this November used cellphone data from 98 million Americans. It showed the vast majority of infections outside the household setting occur in restaurants, houses of worship, gyms and hotels. In an attempt to bend the curve, during the “pause” indoor dining and in person gathering at houses of worship in Rhode Island are reduced to 33 and 25 percent respectively of their pre-Covid levels. The gyms are temporarily closed. 

If the goal is to reduce infections and save lives, this is a half measure that is failing in spectacular fashion. 

Partially reducing the number of indoor restaurant goers and worshipers while keeping these high risk public spaces open only moderately decreases transmission rates. Too many Rhode Islanders continue to get infected. As emergency medicine and intensive care unit physicians we see the evidence of this first hand as patients fill the hospitals. Once again nurses, doctors, respiratory therapists, pharmacists, techs, and other health care workers are being called upon to try to limit the destruction Covid-19 inflicts upon patients. 

SARS-CoV-2, the virus that causes Covid-19, ravages the patients’ lungs, kidneys, brain and the body’s blood clotting system. The effects are devastating. While we each have personally cared for and lost too many elderly patients to Covid-19, we have also had patients in their 30s and 40s die under our care. We have experienced the heartbreak of telling teenagers that their parents are gone. We have called daughters and sons to let them know they won’t be able to say goodbye to their parents in person. For the patients who manage to survive, their hospitalizations can be long, painful, frightening and lonely.

Nurses, doctors and other health care workers are exhausted. Some of our colleagues have contracted COVID-19 and following recovery continue to suffer long-term symptoms. Our medical system cannot afford to sideline any more health care workers to illness or burnout. If we do, expanding our capacity to treat Covid-19 patients in field hospitals will become a moot point. We won’t have a workforce to treat them.

We still have the opportunity to shape our collective future. 

New York City and Pennsylvania which have fewer cases per capita than Rhode Island (52 and 78 vs. 115 per 100,000) have ordered indoor dining closed. Internal documents from The White House Coronavirus Task Force have urged the states to realize that the “same mitigation policies that stemmed the tide of the [spring and] summer surge… must happen now.” We would be served well to follow these states’ examples and heed federal advise.

A vaccine is on the way and frontline health care workers are scheduled to receive vaccinations this week. However, this will not provide instantaneous relief. Governor Raimondo can act now to push down transmission rates and save many lives in the interim.

We understand the need to protect small businesses and preserve livelihoods. We have witnessed firsthand the desperation of our patients who have been left jobless, uninsured, impoverished and hungry by this pandemic. The health of the Rhode Island economy rests ultimately on the health of its people. The catastrophic failure in federal leadership and the shortfall in financial assistance has pushed the responsibility to lead onto the states. Governor Raimondo’s announcements of additional assistance for the furloughed, the unemployed, and small business owners are heartening and urgently needed. 

As recently as November, the state still had yet to spend $900 million of the $1.2 billion allocated by the Coronavirus Aid, Relief and Economic Security (CARES) Act. This money should be spent, transparently and quickly before the January 1^st deadline, to pay restaurant workers and other high-risk non-essential businesses to send their workers home.

This has been an incredibly painful and isolating time. Doctors take no pleasure in telling people to stay away from places of work, worship, and leisure. We too desperately miss our families and friends, and we look forward to going out to our favorite restaurants and returning to our houses of worship. Thankfully, we now have a way out; a highly effective vaccine that can lead us out of this dark night. But we have to survive until the dawn, and we are not doing nearly enough right now. While personal responsibility has its place in this crucial moment we need our leaders to act with courage and conviction. Surely the point of all this collective sacrifice is to ensure that our family members, friends, and neighbors do not perish. We can worry about the rotten vegetables later.