How the Smallest State Engineered a Big Covid Comeback

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How the Smallest State Engineered a Big Covid Comeback

So how did Rhode Island do it? The short answer is Raimondo copied the playbook of nations like South Korea and New Zealand that have fared much better than the United States in battling the virus—intensive testing, tracing and isolation plus wear-your-damn-mask policy and messaging—while adding innovative twists through uniquely American public-private partnerships. It doesn’t hurt that Rhode Island is home to drugstore giant CVS, which is also the state’s largest employer; in part through help from the company, more than 25 percent of Rhode Islanders have been tested, many of them barbers, grocery clerks and other public-facing workers with no symptoms. She persuaded Salesforce to develop a state-of-the-art contact tracing app for Rhode Island for free, while working with Infosys on a location tracking feature and SurveyMonkey on symptom monitoring. Brown University has provided dorms for health care workers who want to remain isolated from their families. Raimondo was also one of the first governors to shut down schools and businesses, ban large businesses and require masks.

Basically, it’s worked. Deaths have plunged from more than 20 per day to fewer than five, infections from more than 400 per day to fewer than 50, and there’s plenty of room in the state’s intensive care units. Raimondo, a centrist Democrat who has received a bit of buzz as a possible running mate for Joe Biden, has a legitimate story to tell about leadership in a crisis.

When Raimondo spoke with POLITICO Magazine’s Miami-based senior writer Michael Grunwald about her approach to the emergency, however, she talked just as much about lack of leadership, specifically Trump’s hands-off happy-talk approach. Raimondo isn’t known as a political grandstander or a hard-edged partisan; her signature issue before COVID was an unsexy and unpopular pension reform, and she spoke warmly about her cooperation with like-minded Republican governors like Charlie Baker of Massachusetts and Larry Hogan of Maryland. She’s really angry at Trump, though. And if Rhode Island’s trajectory illustrates the power of state leadership driven by data, science and common sense, its death toll illustrates the limits of what states can achieve without help from the federal government.

Raimondo spoke to POLITICO shortly after she announced a mandatory two-week quarantine for visitors from high-risk states. This conversation has been lightly edited for clarity.

MICHAEL GRUNWALD: I had hoped to do this interview in person, but you won’t let me come up from Florida.

GINA RAIMONDO: You can come, but we’ll lock you up in a room.

MG: Florida’s positive test rate is over 15 percent, and Rhode Island’s is under 2 percent. Why have you done so much better than us?

GR: It’s not magic. It’s just good execution. We got on it right away, and just took it very seriously from the get-go.

MG: You definitely bent the curve. But before we talk about all the cool stuff you did, you also had a thousand deaths.

GR: Almost a thousand, and we’re still losing people every single day. I’m still doing press conferences about this, and it hurts to have to say, we’ve lost more Rhode Islanders today. The majority are folks who were in nursing homes and assisted living, with underlying health conditions. But it’s really tough.

MG: Is there anything you regret, anything that in retrospect you wish you had done earlier?

GR: You know, I ask myself that all that time. We were very quick to shut down visitation to nursing homes, and that was a life saver. But if I had to do it over, if I knew then what I knew now, I would’ve shut down restaurants and retail even sooner. And in the very beginning, the first few days, we did have some Covid-positive folks discharged from hospitals to nursing homes, and of course we don’t do that anymore. Now we cohort all the Covid patients into the same nursing home.

MG: When did you realize that this would be such a defining moment?

GR: Our first few cases, I’ll be honest, it wasn’t immediately apparent to me that this would be the absolute defining moment. I remember the first few press conferences in the first week of March, saying we still don’t have widespread community transmission, it’s still OK to go out for dinner. I went out for dinner on a Monday night [March 9] but by Wednesday or Thursday, it became very clear to me that I needed to shut it all down. On March 13, I made the decision to close school. That was big. That was my “oh, crap” moment. You don’t do something that disruptive lightly. Then I closed the restaurants. We got religion fast.

MG: There have been a lot of good results in foreign countries—in South Korea, in Taiwan, in New Zealand. They did massive testing, tracing, isolation. Did you essentially adopt that model?

GR: Absolutely. You know, this entire crisis would have played out so differently with leadership and a national plan from the federal government. If the Trump administration in January had started to stockpile PPE [personal protective equipment], get serious about testing, put together a plan, we would have far fewer deaths, far fewer people out of work, far fewer sick people. Those first couple weeks of March, when we still weren’t certain how bad it would be, we were getting zero direction or guidance from the federal government. That’s when I took it on myself to dive in deeply. To figure out what’s going on in South Korea, in Singapore, in Europe, in China—like, immediately. I had this moment of clarity very early on, at 2 a.m. while I was working in my house alone: There’s no way you can outrun this thing. You have to stay a step ahead. That’s when we said we need aggressive testing, very aggressive contact tracing and social distancing. We came to that realization earlier than some other places, because it seemed like the only way to keep a lid on the virus. Otherwise, we could see it would outrun us and we’d never be able to catch up.

MG: Every time you said something like that, people said, “Oh, it’s a hoax, you’re destroying my freedoms.” What’s it like being a leader in a time like this?

GR: Look, there have been times where it’s been downright scary. In the thick of it, we were doubling our hospitalization rate every three days. We had an R of over 4! [The R value is the number of people the average infected person will infect; anything above 1 is extremely dangerous.] We’re a couple hours from New York City, where things were terrible. Meanwhile, I was looking at the models for my state, and I really wasn’t sure where I was going to get the ventilators and N95 masks and hospital beds. There were weeks of sleepless nights. I felt so responsible to minimize the loss of life. So the criticism never had any impact on me at all. I knew how bad this could get. Sure, for a while, I took a lot of heat. And I get that it stinks to have to do distance learning, to God forbid lose your job. But I was so certain that what we were doing was necessary. If you actually dig into the facts and the data and the science, you realize there’s only one solution, there’s only one way to do this right. By the way, those people who were critical have quieted down, because our results have been so good. We’ve tested 25 percent of our population, our positive rate is only 1.5 percent, our beaches are open, we’re going to open school in the fall, you can go out and get your haircut and go to dinner, our unemployment rate is declining. I don’t look so crazy anymore.

MG: It feels like politicians don’t necessarily get rewarded for making those kinds of tough decisions, for forcing people to do things they don’t want to do.

GR: Oh, I think we do. We’re in these jobs to get things done for people. The pundits and prognosticators and consultants might tell politicians to avoid the risk, but at the end of the day people want someone to deliver for them: jobs, public safety, public health, the truth. I think people respect public leaders who work hard and take on tough issues to try to make their lives better. I can tell you I’ve won every election, and my approval rating is extremely high.

MG: The president doesn’t seem to be taking the same approach.

GR: Look, very early on, President Trump made it crystal clear on phone calls with the governors, that we were on the front lines, it would be up to us to figure out how to get this done, the federal government would be taking a back-seat role. That was obviously an abdication of his duty.

MG: It’s odd that he was so open about that. It’s as if Pearl Harbor has been invaded and they’re asking Rhode Island to come up with a plan to fight the war.

GR: Yeah, good luck, Hawaii. My God, I can give you so many examples of deep dysfunction in the federal response.

MG: OK, let’s hear one.

GR: It was crazy, I spent hours and hours of my days and nights scouring the earth to find PPE for my state. I’d call FEMA and say, “Uh, can we tap into our national stockpile?” And I’d just constantly get the runaround. “Sure, we’ll have it to you on Tuesday.” Tuesday comes, I’d call back, “Oh, gosh, it’s not going to happen.” One time they promised me, “OK, it will be there today, a truck full of PPE.” I said: “Tell me the time, I’ll check on it myself.” They said 7 p.m. Great. At 7 p.m., no truck. I call and ask where is it, they say 9 p.m. Fine. Around 9 p.m., I get a text from FEMA: Governor, the truck arrived. Hallelujah! I called my director of health. “Great news, the truck is finally here!” She says governor, it’s an empty truck. They sent an empty truck. No PPE. I can tell you a dozen stories like that. So if you’re the governor, what do you do with that? You call every friend you know. I cold-called CEOs of diagnostic companies. I engaged the Chinese consulate. I called every CEO in the medical device world that I knew. My husband laughed at me, I’m on phone with China and Vietnam and Korea at 2 a.m. trying to cut deals.

MG: You come from a venture capital background, and you’ve done a lot of work with the private sector in this crisis. Can you talk about how that came about?

GR: Well, it was clear the federal government wasn’t going to help us. So I called Larry Merlo, the CEO of CVS, and I said I need help, we need to do testing. We set up an amazing public-private partnership; I was first governor to deploy the National Guard to do drive-through testing, and CVS really helped us ramp up. One Friday night I reached out to Marc Benioff at Salesforce, who I really didn’t know, and said hey, contact tracing is the key here, look at Singapore, and God bless him, they sent a whole team of people to Rhode Island, virtually, for free, and helped us build software for our contract tracers. Necessity is the mother of invention, and the bottom line was that we were on our own, and we had to get innovative. I’m comfortable with calling business leaders and asking them to pitch in, and I knew technology was going to be vital. By and large, people really stepped up to help.

MG: The feds didn’t take the lead on any of this?

GR: In an ideal world, this is what the president would do. He would have immediately gotten CEOs into the Oval Office early in the year, and used the Defense Production Act to mobilize all the best of what America has to offer—innovation, testing, PPE, medical products, we’d be in so much better shape today. But in the absence of that, we had to do it one state at a time.

We’re doing about as well as any state. I put together a plan, set up 10 work teams with a work flow that report to me on a daily basis, stood up a military-style operation with urgency and innovation in March. But if the feds had done something like that in February, we wouldn’t have all these deaths. We wouldn’t have double-digit unemployment. It’s very frustrating, because it didn’t have to be that way. The fact is, we have a showboat in the White House. The president spends a lot of time showboating. We need leaders to do your job, like Bill Belichick says. That’s what governors have been doing. Do the damn job. Take it seriously. People’s lives are at stake. Don’t worry about your politics.

MG: It seems like in the Northeast, at least, it hasn’t been partisan.

GR: The collegiality among the governors, it’s nice, we’re all helping each other out. I talk to Governor [Charlie] Baker regularly. Governor [Larry] Hogan has done a very nice job representing us at the National Governors Association. A week ago, I spent 45 minutes on the phone with Doug Burgum, the Republican governor of North Dakota, he was picking my brain about what we’ve done to be so successful on testing. I don’t want to disparage any governors. We have a tough job right now. I’d simply say that in general, the public leaders who are more focused on substance and less focused on the politics are doing better right now.

MG: The politics has focused on we don’t want to wear masks, open the economy this second. And the president has been out front of that. Is that a problem?

GR: Of course it’s a problem. We know that mask wearing is effective. It’s cheap and easy. I understand that it’s inconvenient and a little strange. But we know it works, and it’s a heck of a lot cheaper than shutting down the whole economy. I’ve had protests at the statehouse, saying I’m taking away people’s freedoms. We’ve had lawsuits. It hasn’t been easy to deal with. I had to close our churches. That was a fun phone call, calling the bishop and telling him to suspend Mass in a very Catholic state. So absolutely, 100 percent, the president is making our jobs harder. You see these memes: Real men don’t wear masks. The president absolutely made that plain. Not wearing a mask is just selfish and mean. It means you don’t care about the people around you.

MG: This fall, I keep thinking there’s going to be a huge battle about reopening schools, because people are going nuts. You’ve said: Kids are going back to school.

GR: We need to get our kids back to school. They deserve an education. Their mental, physical and emotional development is suffering. But we also have to need them safe. The same is true for the economy. It’s a bit frustrating to hear this talked about like it’s all or nothing. We set a goal: Let’s get kids back to school on August 31. Practically, that’s going to be very difficult, so we’re working our tails off this summer, to try to figure out how to do it and keep the kids safe. It’s a lot of detail-oriented issues, a lot more testing and tracing, mask wearing for older kids, a lot of creativity around transportation, a lot more plexiglass. I just spent $50 million of our stimulus money to help cities and towns get ready for school. It’s going to cost money. But the bottom line is, we have to do it. We’ve asked every state to give us three plans: One for everyone going back to school, one hybrid plan with some distance learning, and one if God forbid we have a surge and we need to go primarily distance learning. But we want to open.

And if you’re looking for some upside in all this, I announced that we’re never going to have another snow day in Rhode Island. My kids grumbled, there was a collective groan among schoolchildren, but we’ve learned that we can do distance learning fairly effectively.

MG: When you think about the 2020 election, what are people looking for?

GR: Certainly if we had a President Biden, we’d be in a better position with the virus, because he would have had a plan, and he would have run a competent organization. My advice to all politicians, including myself, is just to worry about what people need, and the politics will take care of itself. You know, I just took over the Providence public schools. People said Gina, why are you doing that, it’s your second term, why take that on. But it’s a deeply inequitable system. The learning gap between Black and white kids is immoral. So let’s see if we can make it better. The average Rhode Islander is not sitting around their kitchen table trying to figure out if Gina is liberal or conservative. They want to know if they have a better job because Gina was governor. Are the roads paved? Is our economy opening because our infection rate is 1.5 percent?

MG: What’s it been like having the racial-justice protests explode during all this?

GR: Well, from the beginning, we’ve had a genuine equity lens across our Covid response. Very early on we had a Latino advisory group, an equity advisory group, and we’ve really been on it in high-density communities, immigrant communities. We were one of the first states to do walk-up testing—in Providence, Central Falls, Pawtucket—so if you didn’t have a car you could walk to a testing booth in the parking lot of an elementary school or the basement of a church.

MG: It seems like the main thing that set Rhode Island apart was mass testing and tracing.

GR: Precisely. Our big thing is being where people are. We do testing at Stop & Shop for people who don’t have symptoms. If you work in a close-contact business—a barber, a waiter, clergy—you can go to Stop & Shop get tested for free. If you’re sick, you can call your doctor, and you’ll get tested that day. Within a couple days, you’ll know if you’re positive, and within a couple hours, you’ll get a call from the health department. They’ll spend more than an hour on the phone with you, going through all everyone you’ve been in contact with. They’ll tell you to isolate. They’ll reach out to every one of your contacts: Hey, someone you’ve been in contact with tested positive, we need you to get tested. And then they do the same process for that person.

When the whole thing first started, I begged people to keep a contact tracing notebook. I still keep my own. At the end of every day, write down names of everyone you’re with. Now we’re more sophisticated: We’ve got a CRUSH COVID RI App. If you opt in, it tracks your location, so when you get that call from Department of Health, you can just tell them or give them access to location diary on your phone. And if you’re in isolation, we’ll stay in touch on daily basis. We’ll ping you on your app, how are you feeling, what’s your fever, do you need anything. You’ll get a phone call: What are your symptoms, do you need help getting groceries, what kind of support do you need?

MG: You’re a small state. You can get to everyone.

GR: You know, we’re dense, we’re vulnerable to what happens outside. But on the flip side, we take care of each other. We’re a community.

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