Innovation Ecosystem

Take two: RI’s continuing deadly experiment?

The conundrum of how best to reopen schools has exposed a widening gap between science, following the “facts,” and the arm-twisting art of political persuasion

Photo by Richard Asinof

Call it a public health landscape: The portrait of who we are as a community in Rhode Island is being revealed in the ongoing efforts to ramp up testing for the coronavirus.

By Richard Asinof
Posted 8/24/20
Access to transparent information around testing remains a critical component around plans to reopen schools in Rhode Island, where it seems the concerns of parents and teachers and students have a hard time being heard and acknowledged, given the Governor’s ability to control and manage the conversation.
What would happen if the state of Rhode Island contracted with the Broad Institute to manage testing results for the coronavirus, similar to what Brown and Bryant universities have done? How can the excellent work being done by student journalists find broader audiences? What would it take for the R.I. Department of Health to be invited by the R.I. Department of Education to conduct a health audit for all schools in Rhode Island, to determine problems related to air quality? How can the work of Health Equity Zones operating at the community level in Rhode Island be integrated with ongoing after-school educational programs? When will the Raimondo administration engage with groups such as RICARES to better understand what is involved with the recovery process from the trauma of the pandemic, particularly for health care workers on the front lines?
One resource underutilized in the coming plans to reopen public schools in Rhode Island is the role of the school nurse. What kind of facilities and resources will school nurses have to manage the ongoing demands of testing of students and teachers and staff in schools? How will students with symptoms of COVID-19 be managed within limited resources provided to school nurses? Have school nurses been fully integrated or consulted about plans to reopen schools?
The other “elephant” in the room is the fact that contract negotiations are ongoing with the Providence Teachers Union, with the current Superintendent Harrison Peters saying that teachers will be required to go “above and beyond” in their duties during this time of the coronavirus pandemic. The rationale for making that kind of statement, except to provoke division, seems lacking. In these perilous times, finding common ground should be the priority, not attempting to sow discord or to challenge the dedication of teachers in their jobs.

PROVIDENCE – In my junk email folder, one of the latest daily missives, courtesy of Constant Contact, arrived on Friday night, Aug. 21, at 9:31 p.m., from Gov. Gina Raimondo, with the headline, “A plan for every scenario.” It was written in a mother-knows-best, reassuring tone of voice, promising: “Every decision we make about reopening our schools will be guided by science and data.” To quote WPRO’s Steve Klamkin, “Really?”

The letter went on to claim: “We know that there will be positive cases in each district as the year goes on, just like we know there will be positive cases among adults. We can’t completely eliminate the virus, but we can stop it from spreading by planning thoroughly for every possibility.”

The confident tone of the letter could not have been scripted any better than if it had been ghost-written by a high-priced consultant, such as someone working for the state from the Boston Consulting Group or McKinsey, for a fee of hundreds of dollars an hour. [Perhaps it was.]

The problem, of course, is that having a plan for every scenario depends on whether the Governor and her team will commit to being transparent about what is actually happening in the schools, in real time, when it is happening. If past is prologue, the Governor’s spotty track record on sharing information in a transparent, timely fashion may not necessarily augur well for the state.

Translated, how will parents and teachers and the general public know when an outbreak of COVID-19 has occurred at a school?

One potential new credible source of information will be the national COVID Monitor website, which has been set up by Florida researcher Rebekah Jones.

In a recent interview, Dr. Ashish Jha, the incoming dean at the School of Public Health at Brown University, framed the issue around the importance of transparency. “If schools don’t notify, it actually can make disease control more difficult,” Jha told New York Times reporter Dan Levin in his story, “Covid in the Classroom? Shhh. Some Schools are Keeping It Quiet,” published on Saturday, Aug. 22.

“And it’s not like no one will know,” Jha continued. “Word will get out through a rumor mill. You don’t scare people by telling them what’s going on. You scare them by hiding information.”

Take, for instance, the recent study conducted by the Centers for Disease Control and Prevention, “Limited Secondary Transmission of SARS-CoV-2 in Child Care Programs – Rhode Island, June 1-July 31, 2020,” which has been heavily promoted in the news media as demonstrating that the spread of the virus had been contained in childcare facilities in Rhode Island through mitigation and testing strategies. However, none of the actual locations of the four childcare programs where secondary transmissions had occurred were identified in the study. As a result of the apparent lack of transparency, the general public and the news media have been kept in the dark.

As noted in the study, “Case ascertainment among children is challenging, given the high rates of asymptomatic infection or mild infections,” with the acknowledgement that many “infections were likely undetected.”

Despite limited identified secondary transmission, the write-up of the study continued, “The impact on childcare programs was substantial, with 853 children and staff members quarantined, [which] highlights the importance of community mitigation efforts to safeguard child care programs.” Yes, wearing a mask in public is important. Yes, practicing social distancing is important. Yes, a regimen of testing is important.

But, translated, the spread of the virus never occurs in a vacuum; transmission directly reflects what is happening in the community where the daycare facilities are located.

Health disparities on display
One of the lessons driven home by the spread of the coronavirus in Rhode Island [and the nation] is the way that it has exposed the disparities around access to health care delivery services – in testing, in primary care, and in how essential workers – largely women and minorities – have been treated.

One of the four childcare programs, according to Joseph Wendelken at the R.I. the Department of Health, was the Progreso Latino childcare facility in Central Falls.

From an epidemiological perspective, the community where the childcare facility is located can provide important, critical context relative to the spread of the virus.

In Central Falls, for instance, the figures released last week by the R.I. Department of Health found that the level of community infection was 160 cases per 100,000 residents per week, the highest in the state of Rhode Island. Providence was second with 117 cases per 100,000 residents per week, while Narragansett [a beach community], at 84 per 100,000, was third, as reported by Boston Globe reporter Dan McGowan.

One of the metrics for reopening schools that Gov. Raimondo has promoted is that communities with rates of more than 100 cases per 100,000 residents per week would be required to stay in a distance learning mode past Sept. 14, the current opening day of school. Under the current metrics promoted by the Governor, neither Providence nor Central Falls would be permitted to open schools for in-person learning.

The other part of the story that the study did not include in its analysis was the way that the state responded when the outbreak of COVID-19 was first identified in adults working at Progreso Latino. [For the record, the outbreak had not been identified by state-operated testing sites in Pawtucket or Central Falls. Neither had it been identified as a result of testing conducted by the local community health center.]

However, that said, the response by the R.I. Department of Health was admirable and prompt: the agency hired Alert Ambulance Service to test children in the parking lot at Progreso Latino, some 50 children a day, for more than a week. [The testing appeared to have continued past the July 31 closing date of the CDC study.] The processing of tests was given highest priority by the agency, with results of the tests to be delivered in 48 hours.

The question remains: Is the Rhode Island Department of Education prepared to respond with similar alacrity and dedicated investment in the testing of asymptomatic children when the virus is detected in numerous school districts across the state, at the same time?

The access to COVID-19 testing by children remains a problematic part of any school’s reopening plans. [See link to ConvergenceRI story, “A pediatrician takes on COVID in Central Falls.”]

Further, the ability of private colleges and universities, such as Bryant University and Brown University, to invest in rapid testing in a partnership with the Broad Institute, with a 24-hour turnaround on results, has once again made “visible” the wealth gap when it comes to access to testing.

Return to college campuses
One of the next big challenges is what happens not just in the reopening of public schools but on college campuses, both here in Rhode Island and nationally, where college administrators have found themselves navigating difficult situations, attempting to chart a safe course through choppy waters caused by the pandemic in managing the return of students for the fall semester.

Consider the situation at the University of North Carolina at Chapel Hill, where four COVID-19 clusters and some 130 new cases were reported, after students were returned to campus for in-person learning at the behest University of North Carolina System Board of Governors, according to the Charlotte News & Observer.

Student journalists at The Daily Tar Heel responded with a provocative, courageous headline in an editorial, “UNC has a clusterfuck on its hands.” In response, university officials decided to move all classes online until further notice. Reporters at The Daily Tar Heel are now analyzing hundreds of emails sent by the university administrators in advance of the planned reopening. Stay tuned.

A similar experience occurred at the University of Notre Dame in South Bend, Ind., where the school suspended in-person learning for at least two weeks after it recorded more than 300 COVID-19 cases since reopening the campus. Once again, student journalists led the way in criticizing the university’s policies around reopening, publishing a front-page editorial with the headline: “Don’t make us write obituaries.”

At the University of Iowa, it was once again student journalists at The Daily Iowan who forced the school to apologize to students after a student tested positive for COVID-19, in which the student described her experience as: “I felt like a guinea pig.”

The student had moved into a residence hall on Aug. 15 and then, after testing positive the next day for COVID-19, was moved in another room under quarantine, which the student said had dirt on the bed and on the ground, as well as an unclean sink and curtains. When the student asked the hall coordinators why the room was in such poor condition, she said they responded by telling that they had not anticipated anyone contracting COVID-19 within the first move-in day.

On campuses here in Rhode Island
At Bryant University, the school has invested more than $3 million to test students, faculty and staff as part of its plan to welcome students back to campus.

As described by the university, “The testing process is painless and extremely quick, requiring only that you insert a small Q-tip ¼-inch into each of your nostrils. Once you walk to the tent one of our testing staff will ask your name and date of birth to confirm your identity.”

The instructions continued: “We will provide you with a testing swab and specific step-by-step instruction on how to perform the test,” suggesting that students watch a short video of the testing process.

Further, the instructions said: “Beginning on Monday, Aug. 24, faculty and staff members will be asked to make an appointment online, at their convenience, using the MediCAT software.”

To facilitate the rapid response of test results, Bryant University has hired the Broad Institute in Cambridge, Mass., to conduct the laboratory analysis of the tests, with test results to be returned within 24 hours, according to a story in The Providence Journal.

Brown University has entered into a similar arrangement with the Broad Institute for testing of its students and faculty and staff, according to reporting by Olivia George in The Brown Daily Herald.

In terms of transparency, Roger Williams University has created an online data hub for its testing, called “RWU Covid-19 Campus Monitor,” a practice that other colleges and universities in Rhode Island might consider doing.

Calculating the results
How the increase in testing of college students returning to campus will be calculated as part of the ongoing testing metrics in Rhode Island remains an open question – or at least identified as a significant part of the data – does not appear to be transparent yet. One of the key metrics for Rhode Island, related to potential requests for quarantines in neighboring states such as Massachusetts, is the rate of positive infections across the state’s population.

In a message sent out on Friday, Aug. 21, Joseph Wendelken, the public information officer at the R.I. Department of Health [who has done an excellent job, in ConvergenceRI’s opinion, in responding to reporters’ request], said that in updating the daily CVODI-19 numbers, “We have 130 new positives, but I wanted to flag that we did a lot of testing. We did more than 7,200 tests, so our positivity rate for yesterday [Thursday, Aug. 20], [was] actually quite low – 1.8 percent.”

What would be helpful to know, moving forward, is how increased volume in testing for students returning to campus at both Brown and Bryant and Roger Williams universities, are reflected in the state’s testing numbers.

Giller vs. Raimondo
Last week, Providence parent Jeremy Giller continued to raise questions about the readiness of Providence schools to reopen, given what he claims is the lack of proper air ventilation in many of the city’s schools.

For the second week in a row, Giller has taken to Twitter to take on Gov. Raimondo and RIDE Commissioner Infante-Green, publishing an extensive thread, while voicing his frustrations around the difficulties of engaging with the Raimondo and her team around the issues of poor air quality in schools.

Giller tweeted on Aug. 19: “Gov. Raimondo, you are arguing against a straw man. No expert [that I have heard] is claiming that ventilation is *more* important than mask wearing. What they do say is that, *absent* proper ventilation, the universal wearing of cloth masks is insufficient protection against the risk of transmission from lingering aerosolized droplets. In other words: there is *no* “end-all be-all.” Rather, there is a need for multiple risk mitigation measures.”

Giller’s tweet thread continued: “Renowned expert Dr. Anthony Fauci said as much to you last Thursday [on Aug. 13, in a Facebook forum with the Governor]: “When I’m in the car now, I keep the window open, even though the person who’s driving the car and me both have masks on. I keep the mask on and keep the windows open.”

Giller then challenged the Governor: “I could go on, but tell me, @GovRaimondo: Which experts have *you* spoken with who take your position that mask wearing is “the end-all be-all” for students & teachers returning to PPSD’s decrepit school buildings, half built before 1944?”

The issues being raised by Giller around poor air ventilation in school buildings should be an important part of the conversation moving forward in making decisions about whether it is safe ot not to return to in-person learning. At the same time, the difficulty and frustrations voiced by Giller, in his attempt, as a parent, to engage with and be heard and acknowledged by the Governor and the Commissioner, speak to the larger problem that has become endemic with the pandemic: how much the Governor has been able to control the flow of information and the narrative around plans for school reopenings.

Equity, homelessness and the reoopening of schools

Rhode Island Kids Count, in a equity analysis of reopening plans by school districts in the state, found that "students experiencing honelessness or housing insecurity" were explicitly mentioned in 23 percent of district plans.

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