EXPLAINER: Why the smallest state has a big virus challenge

For a few days in December, Rhode Island was one of the worst places on the planet when it came to new cases of COVID-19 per capita.

Hospitals hit capacity as the rate of new cases topped the nation, nearly double the rate in neighboring Connecticut. The state's record for daily COVID-19 deaths, set in April, was broken. Faced with a worsening crisis, Gov. Gina Raimondo reluctantly re-imposed tougher restrictions on businesses.

"I am surprised that we have done so poorly," Dr. Keith Corl, an emergency physician and faculty member at Brown University's Warren Alpert Medical School, said last week. "We are all exhausted, and now we're talking about staffing more ICU units."

The nation's smallest state by area has reported 1,855 pandemic deaths so far, far fewer than many states but giving Rhode Island the University of Rhode Island, Johnson & Wales University and Providence College.

Like other states, Rhode Island limited indoor dining and customer capacity at many businesses in the spring and temporarily shuttered bar areas, gyms and theaters. Tougher rules were reinstituted for the first three weeks of December after case numbers began to tick upward.

While physicians like Fine and Corl argue the restrictions haven't gone far enough, many business owners have expressed concerns about long-term economic damage to the state's hospitality and tourism industries.

Bob Leonard is the co-owner of the Coast Guard House, a seaside restaurant in Narragansett popular with tourists. He said his business worked hard to comply with the restrictions and doesn't think restaurants are responsible for the recent rise in cases.

"From what I've seen, it's people being at home and letting their guards down," he said.

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SPOTTY DISTANCING & WEARING OF MASKS

Residents who ignore guidance on masks and social distancing also deserve some blame, Raimondo has said.

The Democratic governor also points to the state's vigorous testing program as an explanation for the recent surge. Rhode Island has performed more than 2 million tests, more per resident than any other state, according to Johns Hopkins University data. More testing means more asymptomatic cases will be identified—cases which might go unnoticed in other states.

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But testing doesn't fully account for December's increases in deaths and hospitalizations too, said Dr. Ashish Jha, a physician and dean of Brown's School of Public Health. Jha said he believes population density and poverty are bigger factors.

"Pandemics are complex. They are not simple, straightforward things," Jha said. "But we are learning a lot."