Rhode Island Pushes Aggressive Testing, a Move That Could Ease Reopening

Rhode Island gives the appearance of a state where the coronavirus is a fire raging, the average number of daily infections more than quadrupling since the start of this month.

The reality is more complicated and encouraging, as state health workers have tested more residents per capita in Rhode Island than in any other state, leading them to discover many infections that might have gone overlooked elsewhere.

Extensive testing is seen as an essential tool, experts say, as states contemplate restarting public life, and search for ways to keep a handle on the virus’s path and signs of new outbreaks in the days and weeks that follow. Five percent of Rhode Island’s residents have undergone a test, compared with about 1 percent of people in states like Texas and Georgia, where reopening efforts are taking shape.

“Rhode Island is shining a light into the dark in a way that very few other states are doing,” said Mark Lurie, a professor of epidemiology at Brown University in Providence. Rhode Island has been conducting an average of 283 tests per 100,000 residents a day, compared with 79 tests per 100,000 people in the United States overall.

To be sure, Rhode Island’s relatively small population — just over a million people — makes it easier to carry out testing on a high percentage of residents, but the state’s focus has grown intense.

“All I hear is testing, testing, testing,” said Dr. Ashish Jha, who is director of Harvard’s Global Health Institute and is helping Rhode Island’s government. “The bottom line is that there is no magic formula and the federal government is too often absent. But there are common lessons from states that have done a good job.”

On Monday, Gov. Gina Raimondo said that she intends in two weeks to begin the painstaking process of reopening Rhode Island’s economy, depending on how the situation looks in the coming days. “It’s not going to be a flick of the switch,” she said, cautioning that an uptick in hospitalizations could force her to delay. “It’s going to be slow, pinpointed, gradual.”

And all decisions going forward, Ms. Raimondo said, will rest on a foundation of testing and more testing, and tracing infections.

For the moment Rhode Island, the nation’s smallest state, walks an uncertain path. The mayors of its densely packed and polyglot cities speak of rising rates of infection. Last week, health officials announced that workers at a Taylor Farms New England, which packs salads and produce for supermarkets in North Kingstown, had tested positive for the virus. By Sunday, 133 cases had been reported in connection with the facility.

In its accomplishments and struggles, Rhode Island represents much that is confounding about confronting this virus. Like most of the governors in the Northeast, Ms. Raimondo was reluctant to issue a shelter-in-place order in mid-March, hoping that social distancing and the careful tracking of routes of infection might forestall a crushing shutdown of the economy.

She soon reversed herself, closing parks and tartly advising people crowding beaches and backyards to “knock it off.” On March 28, she ordered all but essential businesses and employees to shelter in place, saying: “This is going to get very real very fast for all of us.”

A week later, Gov. Raimondo and Nicole Alexander-Scott, her health commissioner, made a concerted effort to ramp up testing after Rhode Island had trailed some other New England states on that front. State officials across the nation have struggled to acquire and administer large numbers of tests, two steps considered essential in stopping the spread of the virus and reopening economies. Rhode Island officials said they were uncertain about what the testing regimen would cost, as they are pulling it together quickly from private-sector donations, including CVS Pharmacy, and federal stimulus dollars.

In recent weeks, Ms. Raimondo, who has a background as a data-driven venture capitalist, has regularly urged residents to keep a journal of all people they encounter each day, against the possibility that they might test positive and health workers will need to track down their contacts. Amid the crisis, Ms. Raimondo’s approval rating has risen to 80 percent, in one survey, from scraping by last fall with 36 percent.

“She’s a no-baloney technocrat,” said Ross Cheit, a professor in Brown University’s public policy program. “She’s not charming but she’s really smart, and that’s made her really popular now.”

Of late, state and local officials have turned their focus on testing to Pawtucket and Central Falls — dense, working-class cities nestled along the Seekonk River. These cities have multigenerational immigrant families, from Central America, Cape Verde and a dozen African nations, and many live tightly packed.

In Pawtucket, a city of 70,000 people, 570 residents have tested positive so far, second only to Providence, the state’s largest city.

“We have police going old-school, cruising around with their microphones going, telling them to distance, to wash hands and that free testing is available,” Pawtucket Mayor Donald R. Grebien said.

The two cities now have platoons of workers trying to contact all residents, and in their native languages. The object is to persuade those who are symptomatic to get tested. To this end, they have placed a testing site in the middle of each of these cities, an approach that is critical because nearly one-fifth of residents do not have cars. Testing is free with a referral, and anyone who needs a lift to the site can get one. Providence, too, started a new walk-up testing center last week.

Once a resident has tested positive, officials begin the painstaking task of trying to trace whom they came in contact with. “It’s been a herculean effort,” Gov. Raimondo said in a briefing. “It’s very labor intensive.”

Rhode Island is one of the few states to attempt such widespread testing and tracing. New York City until recently confined most of its testing to those who showed up at hospitals, the sickest of the sick. Perhaps as a result, Rhode Island’s test results show infections near evenly distributed by age, without a tilt toward the oldest and sickest that is seen in most cities.

Ahead for the state is figuring out how to merge its elaborate testing program with a plan to reopen.

Ms. Raimondo and other officials have taken pains to make clear that the first months back will not resemble anything like pre-virus life. Retail stores could open for pickup of pre-ordered items; restaurants with outdoor seating might soon be allowed to experiment. Each decision will entail a speculative, precarious calculus as the state tries to avoid new outbreaks. “We’re about to enter a whole new era of work,” she said.

To some extent, the many unionized city employees who have worked through the shutdown, in offices and on bridges and roads, have pioneered this new way of work life: They wear masks and gloves and have their temperature taken every day. Working hours are staggered, and meals are solitary affairs.

“We police it pretty tight,” said Michael Sabitoni, president of the Rhode Island Building & Construction Trades Council, which represents 16 unions. “This is not the old life.”

In the weeks ahead, other states may look to Rhode Island for signs of how extensive testing can affect reopenings and whether it helps slow new outbreaks. Systematic testing, Dr. Lurie said, should allow officials to monitor the virus’s path in the weeks ahead — to see who is sick, and to react quickly to close a factory, a school or an office building if a new outbreak emerges.