PROVIDENCE – When an earthquake struck Rhode Island and Southeastern Massachusetts on Sunday morning, shaking our region, it was “a humble rumble from Mother Earth,” reminding us that we co-inhabit the planet [with gratitude to Al Giordano, who first coined the phrase in the summer of 1979].

The earthquake was an aftershock, really, from the momentous events of Saturday morning, when the 2020 Presidential election results in Pennsylvania were declared, showing that former Vice President Joe Biden and his running mate, Sen. Kamala Harris, were now the President-elect and Vice President-elect of the U.S.

As fate would have it, former Mayor Rudy Guiliani was holding a news conference not at the Four Seasons Hotel in Philadelphia, but at the Four Seasons Total Landscaping Center, located next to an adult bookstore and a crematorium, when the news broke that Biden had been declared the winner in Pennsylvania, surging past the 270 electoral votes needed.

“What network?” Guiliani had asked. “All of them,” a reporter replied. Even Borat could not have dreamed up a better comic punk job.

More than 1,000 Americans dying daily
The Presidential election may be “over,” a petulant President Trump may never concede, but the public health crisis in Rhode Island and the nation remains very, very real, with promises that it will get much worse before President-elect Joe Biden takes office on Jan. 20, 2021, to become the 46th President of the United States.

On Tuesday, the U.S. Supreme Court will hear oral arguments on a case brought by several Republican governors and supported by the Trump administration’s Justice Department to declare the Affordable Care Act, also known as Obamacare, null and void, a decision that would result in tens of millions of U.S. citizens losing their health insurance coverage and the potential for health insurers to deny coverage to 10.2 million Americans that have contracted the coronavirus in the last eight months because it would be a pre-existing condition.

The situation is dreadful and getting worse, as cases keep multiplying exponentially, according to Dr. Ashish Jha, the dean of the School of Public Health at Brown University.

In a long thread posted on Twitter on Sunday morning, Nov. 8, Jha laid out the challenges facing the nation and Rhode Island during the next 72 days until Jan. 20, 2021.

• “Today, about 1,000 Americans are dying daily. ” [In total, there have been some 243,419 deaths in the U.S. since the pandemic took hold in March.]

• “We are identifying 100K-120K cases/day,” in what Jha labeled “the acceleration phase.”

• “The % of tests coming back positive has risen a lot.” Translated, “We are missing many more infections than we were 2 months ago.”

• “And, 1,000 deaths a day? Represents infections from a month ago.”

• “Would not be surprising to get to 2,000+ deaths a day in December.”

Jha offered a prescription of five things that the nation can do: not accept that the Trump team will do nothing. “We pay them,” he wrote. “We need to find ways to get them to do more.”

Further, Jha urged that “Congress should get [more money] to states for testing, schools, etc.”

Jha argued that states need to ramp up testing. In the meantime, Jha wrote: “Everyone just needs to wear a mask. Come on people. To save tens of thousands of lives? No brainer.”

We are no longer a plantation
The voters have spoken in Rhode Island: the state will no longer have the phrase “plantations” attached to its official name. But how will that translate into effective action by Gov. Gina Raimondo and by the R.I. General Assembly in terms of ramping up testing and investing in the public health infrastructure to combat the community spread of the coronavirus?

One of the first things the Governor could consider doing is changing the optics around her weekly news conferences, away from the stage at the Veterans Memorial Auditorium in Providence and traveling to some of the hardest hit communities in Rhode Island, such as Central Falls and Olneyville.

Why not hold her next presser at the Blackstone Valley Community Health Center’s Neighborhood Health Station at 1000 Broad St. in downtown Central Falls, where the spread of the coronavirus is not contained?

There are lines forming down the block outside Jenks Park Pediatrics, with patients waiting to be tested, according to Dr. Beata Nelken, a pediatrician. On Wednesday, Nelken reported that her practice had administered 125 tests, of which 20 percent were positive, adding that the families calling were “100 percent desperate” -- calling and driving from all over the state in search of testing. [See link below to the ConvergenceRI story, “A pediatrician takes on COVID in Central Falls.”]

Testing, Nelken said, had been delayed everywhere by the 3-4 days required to book an appointment. Word of mouth, she said, is the major source of families seeking to be tested for the coronavirus at her practice.

Nelken said that she has had to substitute her testing from the Abbott ID NOW devices to the Abbott BINAX NOW devices, due to the federal supply running out each week. Nelken receives two days' supply of ID NOW testing materials each week, the rest in BINAX NOW -- a much less sensitive test. Nelken said she has tried to purchase supplies directly from Abbott, but new customers added since the start of COVID-19 are not able to purchase supplies at this time.

As for the winter ahead, Nelken said she has purchased Cepheld Genexpert Xpress 4-plex testing modules that will arrive this month: a  PCR test that checks for the four diseases of Flu-A, Flu-B, RSV, and COVID-19 at once with a single nasal swab, with results in one hour.

Nelken said that she has  been working 10-13 hour days to try and keep up with the demand from the community for access to testing and care for the coronavirus.

Note to WPRI’s Kim Kalunian, an excellent TV reporter, about a question to ask Gov. Raimondo during her next in-person interview with the Governor: Instead of featuring administrators, why not feature doctors and nurses on the front lines caring for patients as the coronavirus pandemic deepens, recognizing their courage and leadership?

Honoring public health heroes
On Thursday, Nov. 12, beginning at 3 p.m., the Rhode Island Public Health Association will hold its annual meeting virtually, with Dr. Jha serving as the keynote speaker following the presentation of five awards.

The recipients include:

• Dr. Megan Ranney, MD, MPH, emergency room physician, who is being honored with the Bertram Yaffe Award for her work as a founder of #GetUsPPE, and as outspoken advocate of gun safety and against gun violence.

• Dr. Jeffrey Dodge, DDS, from Carelink RI, who is being honored with the Distinguished Service Award for his “tireless work in dental education and providing dental care for underserved populations in Rhode Island.

• Owen Manahan, URI Health Studies Student, for his outstanding initiative and creativity for RIPHA.

• Marti Rosenberg, MA, director of Policy, Planning and Research at the R.I. Executive Office of Health and Human Services, who is being honored with the John Fogarty Award for her strong and effective advocacy of population health.

• Dr. Andrew Saal, MD, MPH, and his colleagues, Chelsea DePaula and Daniel McGuire, at the Providence Community Health Centers, will be honored with a Meritorious Service Award for their outstanding response during the early COVID-19 outbreak. [See link below to ConvergenceRI story, “Connecting primary care to emergency care in a pandemic.”]

[Editor’s Note: Dr. Saal and his colleagues are featured in a separate article in this week’s issue of ConvergenceRI.]

Free Wi-Fi to go live in Olneyville
The connections between investments in public health and in public policy and the recognition of the critical importance of such infrastructure investments often seems to be the part of the story that gets left out.

ONE Neighborhood Builders recently announced that it is starting to install free Community Wi-Fi in Olneyville, as a community-based solution to help combat the spread of the coronavirus pandemic in one of the city’s hardest hit neighborhoods. “Children and families need and deserve reliable, high-speed Wi-FI and we are so excited to make it happen with the help of all our donors and sponsors,” wrote Jennifer Hawkins, director of ONE Neighborhood Builders, a community development corporation. [See link below to ConvergenceRI story, "Healing the digital divide."]

Another question for WPRI’s Kim Kalunian to ask Gov. Raimondo: Will the Governor support scaling up similar investments in neighborhoods across Rhode Island as part of her revised state budget?