PROVIDENCE – A few weeks ago, when ConvergenceRI asked rhetorically, in a headline, “What does public health have to do with future prosperity in RI?” the focus of the reporting had been on the new Rhode Island Innovates 2.0 plan and its glaring omission of public health, health equity and the delivery of health care services as integral part of the future economic equation. [See link below to ConvergenceRI story.]

The story represented the kind of in-depth reporting and analysis that ConvergenceRI is valued for, even if much of the content slid far, far below the radar screen of most news media outlets in Rhode Island.

Indeed, plans to jump start the Blue Economy industry sector in the Ocean State, one of the key takeaways from the RI Innovates 2.0 study, is now being featured in a new podcast produced by CommerceRI, “Diving deep into the global ocean economy,” which was released on Feb. 25, in order to present “the big-picture happenings in the world’s burgeoning ocean economy.”

The Blue Economy sector, touted as one of the fastest-growing industry clusters, the news release for the podcast said, “is poised to double in size by 2030, generating more than $3 trillion in global economic impact and supporting more than 40 million jobs around the world.”

The import of that messaging, however, may get swept away by the tsunami from the credible threat of the novel coronavirus emerging as a global pandemic.

And, of course, the revelation on Sunday, March 1, that the first “presumptive” case of coronavirus has been diagnosed in Rhode Island. It is the first case in the U.S. linked to travel to Europe. It’s a small world, after all.

The infected person is associated with Saint Raphael Academy in Pawtucket, according to the school, which indicated the person with the presumptive case of novel coronavirus had been part of a recent trip to Italy with students and chaperones. Those on the trip are now in self-quarantine, according to the school, and will remain out of school until March 9. In addition, the school has announced that it will be closed for the remainder of the week. Further, health authorities said that they are attempting to trace potential contact with some 40 people who may have come into the contact with the infected individual.

As Dr. Annie De Groot, the CEO and CSO at EpiVax, which is hard at work at designing a smarter vaccine and therapeutic to address the coronavirus, tweeted out: “Here we are, Little Rhody. 1st COVID 19 case identified. Where from? Well, of course, Italy.”

[Editor's Note: The front lines of infection from coronavirus are rapidly expanding in Rhode Island. On Sunday night, the R.I. Department of Health issued a new press release, announcing that a second person, an adult in her 30s, had been confirmed as a presumptive case of coronavirus, while a third person, a teenager, has been tested. All were participants on the same trip to Europe on which the first person, a male in his 40s, had apparently contracted coronavirus.]

That was the week that was
Last week, U.S. financial markets were slammed, with the Dow falling nearly 4,000 points. When combined with the Nasdaq and the S&P 500, the markets saw $7.3 trillion in value go poof and vanish, the importance of linking public health to future prosperity became a fiscal reality hard to argue against. [Compare the $7.3 trillion figure “lost” in one week with the $3 trillion to be generated ocwe the next decade by the Blue Economy.]

As countries around the globe attempted to cope with the threat of pandemic [even the Louvre museum in Paris has been closed], the spread of the novel coronavirus has exposed a singular truism about the importance of connecting public health to future economic prosperity: our system of health is only as strong as the weakest links within it – the poor, the elderly, the uninsured and under-insured, the residents of nursing homes, and the nurses and front-line health workers who care for patients. The coronavirus does not discriminate.

“The United States is …vulnerable because of longstanding deficiencies in our health care system. We are the only major rich country without universal health insurance and paid sick leave, and we have fewer doctors per capita than peer countries,” wrote New York Times columnist Nicholas Kristof on Feb. 29.

Kristof reported how a Florida man, Osmel Martinez Azcue, who had recently returned from China and found himself becoming sick, went to a hospital for testing for the coronavirus. It turned out that it wasn’t the coronavirus, but Azcue was billed $3,270, as reported by the Miami Herald.

Here in Rhode Island, testing for the coronavirus is free, according to officials at the R.I. Department of Health. But that may not include hospital charges if the patient goes to a hospital emergency room, according to an infectious disease specialist in Rhode Island.

Hope for the best, plan for the worst
Whatever rosy scenarios the Trump administration would have you believe – that the administration is prepared and ready to “lean in” to address the crisis, that Vice President Pence is competent to direct a task force, that the coronavirus will be gone by spring, that its spread to the U.S. is not inevitable, that the news media is pushing a “hoax” to try and take down the President, that lower interest rates and new tax cuts will arrest the steep decline in the financial markets – all the scientific evidence is to the contrary.

The first steps taken under Vice President Pence, it seems, were to muzzle the scientists and the health care experts at the National Institutes for Health and the Centers for Disease Control and Prevention, a staple policy of authoritarian regimes. Not auspicious.

The reality is that the production of a vaccine or a therapeutic will take more than a year to reach consumers, perhaps in time for the next wave of the novel coronavirus to circle the globe again. How much will such a vaccine cost and how much will Big Pharma profit from it? Good questions.

The epidemiological process of tracing contacts becomes a critical component in understanding the spread of the viral disease. In Washington State, where the first U.S. resident died from coronavirus, health officials say they believe that the virus may have been spreading for weeks, with the possibility that up to 1,500 people may have been infected.

Media scrum
At a hastily called news conference Sunday afternoon, March 1, at the R.I. Department of Health, what was revealed was that a male in his 40s had tested positive for a “presumptive” case of the coronavirus, after traveling to Italy, Spain and France.

That diagnosis still has to be confirmed by the Centers for Disease Control and Prevention, according to current protocols. Both Gov. Gina Raimondo and Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, stressed the risk in Rhode Island for further transmission was low.

“We have been preparing for this for weeks,” the Governor said. The message she wanted to deliver to Rhode Islanders was: “Be careful, be vigilant, but don’t panic.” At this time, she continued, “The general level of risk is low,” saying there was no reason to be frightened, and urging the need to get that message out to our kids.

The messaging was repeated numerous times: If you feel sick, stay at home. Don’t go to school. Don’t go to work. Wash your hands with soap and warm water. Don’t shake hands. Be smart. Use common sense. Stay informed. Every one has a role to play. There was no need for the public to wear masks.

As a way of attempting to quell fears and reassure the public, the Governor talked about attending Mass that morning, but practicing good habits such as frequent hand washing.

Flow of information
The basement of the R.I. Department of Health has been transformed into a command center of operations, with all hands on deck, according to the Governor. The watchwords were “collaborative” and “coordinated” in terms of the state’s response.

When asked by ConvergenceRI about protocols in place at nursing homes and for front-line health care workers, Dr. Nicole Alexander-Scott assured the news media that communication about protocols was ongoing.

However, a person visiting a relative at a Rhode Island nursing home on Sunday afternoon, at the same time as when the news conference was going on, reported to ConvergenceRI that about half of the nurses working at the skilled nursing facility were wearing masks, which were available in a box at the front door.

The person said that the nursing home administrator had heard nothing from their corporate office about a potential change in protocols, such as doing a temperature check at the front door for all visitors and staff coming into the building.

In terms of the flow of information, United Way of Rhode Island has agreed to serve as a resource for the R.I. Department of Health, handling any overflow of calls on its 211 system, according to Cortney Nicolato, the president and CEO of the agency.

Expert advice
ConvergenceRI also reached out to a number of physicians in Rhode Island familiar with epidemiology and emergency response planning.

Dr. Michael Fine, the former director at the R.I. Department of Health, said: “About 60 percent of Chinese citizens have regular access to primary care. In the U.S., likely less than 43 percent have and use primary care clinicians and practices. Most people with coronavirus will have mild disease. Our challenge is going to be identifying and providing access to people with severe disease that need hospital level supportive care,” he said.

Dr. Peter Simon, a retired pediatrician and epidemiologist, said: “There is some information coming from China, but it is biased by one important fact that few have mentioned: the test they are doing in China is only based on hospitalized patients.”

Simon continued: “What is needed is a “point of care” test. That is, a rapid test for when you go to your doctor because you feel sick. She/he will conduct the test. The same applies to emergency rooms.”

Until there is a “point of care” test that is reliable and cheap, Simon argued, “We are unable to reassure anyone that the infection caused by this new virus will be well tolerated – and that this will be a low-severity illness among a large proportion of our community. This needs to happen even before there is a vaccine or drugs that might be effective in severe infections.”

Simon concluded: Developing the drugs and vaccine [to fight the coronavirus] will take time and resources. “But what we urgently need now is a new screening test for this virus that is cheap, reliable and available. This problem will be solved by scientists in a laboratory.”

Editor's Note: Unconfirmed reports as a result of Facebook posts have allegedly identified the person infected by the coronavirus as a vice principal of student life at St. Raphael Academy, whose wife is allegedly an elementary school teacher in the East Providence. Parents in East Providence were being informed, according to a a source.