COVID Hits
By April 7, 2020, all 50 states had reported cases of COVID-19. Rhode Island had its first case in February, and a state of emergency had been declared by the Governor by March 9. The WHO declared COVID-19 a global pandemic on March 11. Rhode Island — the smallest state in the union, but the state with the second highest population density — was regularly ranked at the top of the list of states with high numbers of cases. The hardest hit areas of Rhode Island were found in the urban centers around Providence, Pawtucket and Central Falls where residents lived in multi-generational housing and many were unable to work from home. As communities scrounged for supplies, Rhode Island developed a strategy to identify and allocate resources to communities that had faced unequal risk, specifically those with highest infection rates, higher case fatality percentages, and increased risk for exposure and transmission due to systemic factors.
To address this inequity, the RI Dept. of Health (RIDOH) adopted a prioritization strategy based on community-level data on early outcomes and related structural factors that produced a higher risk for COVID-19 exposure, as well as higher numbers of cases, hospitalization and death rates compared to the state average, higher proportion of Black and Indigenous People of Color populations, higher population density, lower income and/or higher unemployment rates. Using these metrics, Pawtucket and Central Falls zip codes were designated as Tier 1 Priority Focus.
The process of identifying tiers invigorated community partners. It was clear that targeting the hardest hit communities and distributing resources based on the tiers would facilitate equitable, rather than equal, resource allocation and both community partners and local leaders got on board quickly. Early resources, like masks, PPE, and sanitizer began to flow to LISC as the backbone entity for the Pawtucket Central Falls Health Equity Zone, and LISC managed distribution to HEZ collaborative members, who worked together to get resources in the hands of the community.
Pawtucket and Central Falls were the highest risk communities. The two cities had the highest percentage of residents with chronic disease burden such as hypertension, diabetes and obesity. Residents are more ethnically diverse and speak a wide variety of languages including Cape Verdean Creole, Portugese, French, Spanish, Italian, Armenian, Chinese, Khmer, Korean, and others.
On March 5, 2021, The New York Times published: How Rhode Island Fell to the Coronovirus, detailing the life and death struggle of the Pawtucket and Central Falls community as it worked to weather the pandemic. At the time, Rhode Island had the dubious distinction of having more cases and deaths per 100,000 people than any other state, and the epicenter of that crisis was the twin-city communities of Pawtucket and Central Falls.