Vaccine Phase 2 First Look

How to define eligibility for priority groups in Phase 2 of the state COVID-19 vaccination program was the subject of the regular weekly meeting of the Vaccine Sub-Committee at the RI Department of Health (DoH) on Friday, January 22. The goal is to have this clearly settled by the time Phase 2 is expected to begin in late March or early April.

RI COVID-19 vaccine Phase 1 progress
(Source: RI DoH)

The supply of vaccine, currently about 14,000 doses per week, is not expected to increase for the foreseeable future, Alysia Mihalakos of DoH told the sub-committee. Phase 1 began in December with the most high-risk groups, frontline health care providers and nursing home residents and staff in Phase 1.1, moved on to frontline professionals in critical infrastructure such as firefighters and law enforcement in Phase 1.3, and will conclude with all persons 75 years of age or older in Phase 1.5.

RI COVID-19 vaccine Phase 2 proposal
(Source: RI DoH)

The main challenge, according to meeting facilitator Mckenzie Morton, is to specify eligibility criteria that can be “operationalized,” meaning that the state can readily deploy resources in accordance to match and verify eligibility. As a result, the principal criterion proposed is age, which is known to correspond to risk of hospitalization and death, so that Phase 2 would begin with all persons age 65 or older. After that, all adults with medical conditions that put them at high risk would become immediately eligible, and other adults without such medical conditions become sequentially eligible by age strata 60-64, 50-59, 40-49, and finally 16-39.

COVID-19 hospitalization and death by age
(Source: US CDC)

No vaccine is yet approved by the US Food and Drug Administration (FDA) for persons younger than 16 because clinical trials are still in progress, so there is as yet no data on safety and efficacy. As of last week, a national trial had recruited 800 of a needed 3,000 volunteer test subjects ages 12 to 17.

Social Vulnerability Index (SVI) by census tract, more vulnerable is darker, centered on Central Falls
(Source: US CDC)

Although age can be checked with commonly available identity documents, geography is also known to correlate with greater risk of infection, and the proposal is to prioritize in part using the Social Vulnerability Index (SVI) published by the US Centers for Disease Control and Prevention (CDC) that measures “potential negative effects on communities caused by external stresses on human health” with census tract granularity. Exactly how “geography” would be defined for vaccination was not discussed, leaving open such questions as, for example, how a teacher who works in Central Falls and lives in Exeter would be classified.

US CDC risk factors for hospitalization
(Source: RI DoH)

Although the CDC lists medical conditions known to be associated with increased risk of hospitalization and death from COVID-19, several sub-committee members pointed out problems with the CDC list. Relatively rare conditions, such as amyotrophic lateral sclerosis (ALS), which is commonly called Lou Gehrig’s disease, and Ehlers–Danlos syndrome, probably did not make the list only because of their rarity. It was observed that other conditions on the CDC list may be secondary in risk, such as Down syndrome that is often correlated with heart disease that is also on the CDC list. It was also suggested that substance abuse disorders can result in severe alcohol disease such as cirrhosis, which would put a patient at high risk, but this is not on the CDC list although a history of smoking is on the list. Mental health disorders can result in patients being unable to access reliable physical health care, putting them at higher risk from COVID-19 and also presenting difficulties in making sure they receive a required second dose of vaccine after the first.

RI COVID-19 risk factors for hospitalization
(Source: RI DoH)

Some conditions listed as high-risk by the CDC are so common that they provide little help in prioritizing vaccination, such as high blood pressure, high cholesterol, and obesity that each affect over 30% of the entire population of RI. Nor are such conditions grossly disproportionately reflected in hospital admissions: obesity is present in 25% of hospital admissions for COVID-19 in RI, less than its 30% prevalence. As a result, the proposal focuses on four specific conditions of known prevalence that account for a disproportionate number of hospital admissions in RI at least triple their prevalence: renal disease (22% of admissions, 2%/20,000 prevalence), cardiac disease (30% of admissions, 4%/34,000 prevalence), lung disease (19% of admissions, 7%/59,000 prevalence), and diabetes (30% of admissions, 10%/89,000 prevalence). The proposal also includes those who are immuno-compromised, either because of another medical condition such as HIV positivity or because they are on suppressive drugs as would be the case for organ transplant recipients, accounting for 9% of admissions but of unknown prevalence. (Some patients have more than one condition.)

While there was some concern about people claiming to have high-risk conditions due to anxiety to be vaccinated, DoH Director Nicole Alexander-Scott said that her preference was to follow a “self-attestation” model, essentially putting people on the honor system, especially because the eventual goal is to vaccinate everybody. If there are too many barriers requiring proof of eligibility, the concern is not only would this discourage people in legitimate medical need, but would likely disproportionately discourage the most vulnerable who may not even have a primary care practitioner (PCP).

RI COVID-19 vaccine Phase 2 principles
(Source: RI DoH)

Consistent with the frequently emphasized goal of equity, several members of the sub-committee raised the concern that COVID-19 has radically disparate effects by race and ethnicity, citing as an example a study that showed infected Black patients in their 50s have a risk of death comparable to those in their 70s among the general population. Rather than take race into account explicitly, the proposal intends the combination of geography and medical conditions to subsume race, as these factors are believed to be significant likely causes of racial disparity in health outcomes.

The proposal avoids distinguishing by occupation in Phase 2, which would be operationally difficult as well as requiring selections among, for example, teachers and grocery store workers, effectively putting different occupations in competition with each other for vaccine. Alexander-Scott said that more than half of teachers would qualify based upon age and medical condition alone, even before taking geography into account, reducing the need to prioritize teachers specifically. Jonathan Brice, a school superintendent representing educational interests, said that he would prioritize teachers who work with students unable practice mask wearing and physical distancing, either because they are very young, in his example kindergarten through second grade, or because they have special needs. It is possible that the federal government may make additional vaccine supply available and earmark it for specific groups such as teachers, Mihalakos said, but at this point there is nothing definite.

One of the main advantages to the proposed structure for Phase 2 is that it would allow communicating to the public approximately when any given adult could expect to be vaccinated, based upon the known supply of doses, one of the most frequently asked questions to DoH, Mihalakos said. If the supply increased, as is expected from additional vaccines being authorized by the FDA and greater production of vaccines already approved, it would be simple to recalculate the improved time estimate.

RI COVID-19 vaccine Phases 1 to 3 overview
(Source: RI DoH)

The final Phase 3 would cover children younger than 16 and all others not previously vaccinated.

Bills That Address the Pandemic Passed Out of Committee: Health and Human Services holds first 2021 meeting

Josh Miller, Health and Human Services committee chair

The Rhode Island Senate Committee on Health and Human Services passed three bills out of committee on Thursday night in its first meeting of the year. The bills would extend coverage of telemedicine and provide coverage for it under RI Medicaid and enshrine certain ACA consumer protections and varying health insurance premium rates based on gender.

“Our priority will have bills that are important to address the COVID-19 pandemic,” said Sen. Josh Miller (District 28 – Cranston), committee chair. He continued, “Future meetings will therefore address issues such as nursing home visitation, overdose prevention and access to healthcare in the hardest hit communities.”

While most of the bills passed unanimously, many among the public testifying last night were concerned over language in the Sub A of Senate Bill 4. The bill would extend coverage of telemedicine under Rhode Island Medicaid. Some industry groups from different outpatient specialties were concerned that their own field was left out, as only primary care and behavioral health are specified in the bill. Sen. Miller noted that the reason is that the provider networks for insurers were historically inadequate (pre-COVID) for primary care and behavioral healthcare, and that the reimbursement rates were much lower for the providers than other specialties.

“Already we have the data, both anecdotal and scientifically, on how access to behavioral health and primary care was improved based on telemedicine during the pandemic.” said Miller. He said not having that parity language for the two fields would be a big step back, especially if reimbursement rates for telemedicine were lower than for in person. The bill was introduced by Miller, and cosponsored by Sens. Gayle Goldin (District 3 – Providence), Bridget Valverde (District 35 – EG, NK, SK, and Narragansett), and Maryelln Goodwin (District 1 – Providence).

Senate Bill 5 protects consumer protections as they exist under the Affordable Care Act, laying out a list of essential services that all health insurance must cover if they wish to sell health insurance in Rhode Island. The bill was (again) introduced by Miller himself, with Sens. Ryan Pearson (District 19 -,Cumberland/Lincoln) Valerie Lawson (District 14 – East Providence), Meghan Kallman (District 15 – North Providence/Pawtucket) and Frank Lombardo (District 25 –  Johnston) cosponsoring. The list of essential services includes but is not limited to hospitalization, emergency services, prescription drugs, maternity and newborn care, lab services, preventative services, and more. The law is written so if the ACA was to be overturned and no longer be the law of the land, health insurance companies would still be bound by these standards in the Ocean State.

Cori Chandler of the American Cancer Society Cancer Action Network presented concerns in telephonic testimony that the current bill is missing elements they consider critical. She emphasized the importance of prohibition on life and annual limits. Prior to the ACA, insurance companies could limit the number of visits to services that would be covered under insurance plans, or just impose a $2,000 limit on coverage every year. 

Senate Bill 3 would prohibit insurance companies from charging different rates for premiums based on gender. The bill has been introduced in the past by Sen. Susan Sosnowski (District 37 – New Shoreham, South Kingstown), and as many testifers noted was a source of gender discrimination. Other cosponsors on the bill include Michael McCaffrey (District 29 – Warwick), Goodwin, Hanna Gallo (District 27 – Cranston/West Warwick), and Walter Felag (District 10 – Bristol, Tiverton, Warren). Laurie-Marie Pisciotta executive director of the RI Mental Health Association noted that males were more at risk for schizophrenia, develop it earlier and live with it longer than their female counterparts but the insurance premium rates remain the same.

HHS is the first committee to meet since the start of the term and the first to meet in a digital format. Only Miller and staff were present in the committee room. Other senators on the committee, including new appointees Sam Bell (District 5 – Providence), Alana DiMario (District 36, – Narragansett and North Kingstown) and Jeanine Calkin (District 30 – Warwick), attended using televisual software and broadcast on Capitol TV. Members of the public who wished to testify could either submit written testimony (of which there were 70 letters), or call into the meeting, giving the usual staid senate committee meeting a talk radio show vibe.

While the bills easily sailed out of committee, the work is far from done. Sen. Miller acknowledged the state Senate was now meeting once a week, down from its usual three times a week in the Great COVID Before Time. He acknowledged the testimony and concerns from the public, and proposed sending the bills out of committee onto the floor, and working out amendments as a committee to be presented when the bills are presented. Currently, according to Miller, the earliest the bills could be passed by a floor vote is a week from Tuesday.

“I would give us like a 91 on both technical and conduct,” said Miller, rating how the new format of the meeting went under the circumstances. “Calls were much better than I imagined they might. “

Stay Positive and Test Negative: LG Dan McKee takes questions from the press

Lt. Gov. Dan McKee

Lieutenant Governor and soon-to-be-Governor Dan McKee held his first official press event today, the first one since he became a governor-in-waiting where he was the star of the show. The setting was unusual for a group accustomed to “big” city politics in Providence, a Chelo’s over by the airport in Warwick, chosen for its small business emphasis as well as its Rhode Island connection. The owners of Chelo’s are reported to have gone to high school with McKee’s father.

“My message to Rhode Island is this,” said McKee. “We’re gonna work through this together and come out of this [COVID-19 crisis] better than we came in.” The lieutenant governor is about five days into his transition, and he stressed to the press today it was his fifth one as an executive officer. McKee, as previously reported, will be keeping the current COVID-19 response team in place for the state, but wants to work with towns and local groups more, bringing a grassroots response to the pandemic he thought had been lacking.

McKee said his door was always open to the media, and didn’t see that policy changing. Local media felt the sting yesterday, when Governor Raimondo declined to answer questions of any kind at her weekly COVID-19 presser. McKee offered no criticism of his predecessor and re-oriented questions repeatedly around the state’s COVID response he’s about to take over. 

“The goal for the year is to stay positive and test negative,” said McKee.

There are no foreseen changes to cabinet according to the lieutenant governor. Each cabinet member, including the RIDE commissioner, will have a conversation with McKee and they will come to a decision together whether they are staying on. On choosing his successor as lieutenant governor, McKee repeated his intention to form a committee to help appoint a new LG, and not get into “side bar conversations” with the General Assembly about the process. McKee offered no specifics of who he favored, but invited more people to put their names in. When asked about the utility of the office and the big stink Bob Healey made in 2014 about the uselessness of the office, McKee said he had long wanted to realign the office to make it more useful. He also noted many did not think the office was useless, and cited the number of people putting their names forward for consideration.

McKee made a commitment today to legalize marijauana. Rhode Island has long lagged behind its neighbor states and others over legalizing what is widely viewed as a popular and harmless drug. The lieutenant governor said he favors a private, entrepreneur-run system as opposed to the state-run dispensary system favored by Raimondo.

Local school districts can expect a lot more support from the future governor. McKee made no bones about forcing school districts to follow state guidance or else. “We need to let local districts decide and support them,” he said about distance learning. While he admitted he could not criticize a mayor after being one for 14 years, he did emphasize the need for state input in education under COVID. The lieutenant governor also said he would not seek to  expand charter schools, something he’s heavily supported in the past. He wants to support the current system as much as possible, stressing the need for districts and charters.

McKee declined to get into specifics over the budget deficit, saying it was impossible to say one way or the other without “pinning down the numbers.” He stated that the original projected budget deficit of $900 million was off by hundreds of millions of dollars. The lieutenant governor was confident in his ability to handle the deficit, citing improving the bond rating of Cumberland during his time as mayor. He also expressed confidence in President-elect Joe Biden, who has pledged to get aid to cities and towns through Congress this year. 

His budget proposal for the upcoming fiscal year will be submitted to the General Assembly as soon as March 10, and it remains to be seen how different it will be from Raimondo’s.

Ready for Reform: The progressives challenging State House leadership — an interview with Senator Sam Bell

Senator Sam Bell

“Rhode Islanders are now standing up, running for office and fighting for the values that we’ve always had.” This is what State Senator Sam Bell believes underlies the wave of progressive wins for General
Assembly seats we saw this year in Rhode Island – a wave that has threatened the power of Senate Leadership, what Bell calls “the right-wing machine.”

Bell, who represents State Senate District 5 (a core district of Providence, made of neighborhoods west of downtown), stood strong in support of Senator Gayle Goldin’s challenge of Senate President Ruggerio, and Senator-elect Jeanine Calkin’s challenge of Senate Majority Leader McCaffrey. His reason was simple: “We are going to have to build a leadership in the State Senate that supports the core values of the Democratic Party. And most importantly, cares about the people of our state – which the current leadership does not.”

Alex Kithes (Motif): You first ran in 2018. What inspired you to run?

Sam Bell: I was angry with how poorly run our state was, and really frustrated with watching people suffering because of the policy decisions made at the State House – egregious, right-wing policy decisions that had
huge impacts on the daily lives of the people of our state.

I ran on a message of fighting for people who are struggling, and being a real Democrat, and the people of my district were good enough to elect me. It’s been an incredible honor to serve as their senator.

AK: Coming now to 2020, you had a pretty heated reelection race where you were being challenged by Councilwoman Jo-Ann Ryan, which you won by a pretty big margin. What was the margin? And tell me why you believe your constituents sent you back to the State House.

SB: I got 72.5% of the vote or so. The election was portrayed by a lot of people in the media as a serious race and a strong challenge, and they [Jo-Ann Ryan’s campaign] certainly spent more money than I did and put a lot of energy into unseating me.

The message I heard over and over again was: The people don’t want brutal budget cuts. The people want a state government that invests in helping the people of our state, that invests in helping people who are struggling because of illness, invests in healthcare, invests in housing, invests in social programs and poverty reduction, in jobs, and keeping our restaurants afloat. That’s what people want their government to do, and they really reject the policies of slash and burn that we saw cause so much damage to our state when we cut everything in the last big crisis, the Great Recession, and Rhode Island spun into a massive economic crisis.

People remember that, and how painful it was, like when they laid off every single teacher in the City of Providence. I think a really huge turning point for a lot of people in my community was the round of consolidations in the Providence schools this year. It was the first big round of budget cuts that hurt the community. Mount Pleasant High was especially hard-hit, and it was really clear for my neighbors that they care a lot about having someone that would go up and fight against these policies.

AK: This year saw a lot of progressive General Assembly wins around the state. What factors do you think were responsible for that? Do you see it as a sign of a changing political climate in Rhode Island?

SB: Rhode Island is a blue state, but we’ve had people whose policies are basically the policies of the national Republican Party running as Democrats, and governing and winning because real Democrats
don’t actually challenge them or run against them. And when real Democrats run – and run strong campaigns – you typically find that Democrats want Democrats.

What happened in 2020 was that we saw a huge, very-well-organized effort to run really strong, inspiring candidates. The RI Political Co-op made an incredible difference in recruiting a really strong slate of inspiring candidates, and a lot of them won by massive margins. Groups like Sunrise, ReclaimRI, and [PVD] DSA really put in the work to make these wins happen.

AK: I want to focus for a second on the topic of healthcare and health insurance, which is on everyone’s minds due to the COVID-19 pandemic, and you are a strong advocate for healthcare justice. Where do you see that the General Assembly has failed in their approach to healthcare legislation, both prior to and in light of COVID-19?

SB: We’ve had years of truly embarrassing failures when it comes to healthcare, which is perhaps the government’s most sacred responsibility. We have slashed Medicaid year after year. This final budget, that came out just a few weeks ago – which came after a wave of progressive primary wins, a strong challenge to the leadership and an unprecedented activist movement standing up to fight for a just budget – was the first budget in years, certainly since Gina Raimondo was elected, that didn’t cut Medicaid.

Our Medicaid system has been slashed year after year – especially in 2015 – and that’s left us with a healthcare system that has been crippled. And it’s not just Memorial Hospital and nursing homes shutting down around the state. It’s that what’s left of our healthcare system has often been bought out
by for-profit, out-of-state corporations that don’t care about quality of care, that prioritize their profits, that don’t support their workers. Most of our nursing homes and several of our hospitals don’t even have unions in place! And so we’ve created this system that isn’t just underfunded, but where the
management has a very corporate mentality and isn’t focused on delivery of care. Of course they didn’t stock extra PPE! Of course they weren’t focused on the possibility of a pandemic!

And when this pandemic rolled through, the healthcare system – especially in the nursing homes, where the Medicaid cuts have been the harshest – it has been absolutely brutal.

And then, we get to the rest of our healthcare policies. It’s not just that we cut Medicaid. But we messed with the payments model in a way that really penalized delivery of care, and we created a very strong incentive to not delay elective surgeries. Through messing around with payment models, we
have put in place a real lack of strong insurance coverage protection.

In Massachusetts, there are much stronger protections to make sure that insurance companies actually have covered care, compared to Rhode Island. We’ve had a real lack of good enforcement to make sure
that health insurers actually do the right thing and pay for healthcare. And on top of all of this, we slashed taxes for the insurance industry – and people forget that.

We’re still living through the legacy of privatization of Medicaid. It really is a Republican policy that has been implemented in our state that has cost so much; and what it means is that, if you’re on Medicaid in Rhode Island, you’re not actually on Medicaid. You’re on a private insurance company (usually Neighborhood or United).

All of these policies add up to a really cruel healthcare regime in our state; and when it came to the pandemic, many states invested in public health. At the very beginning of the crisis, California invested a billion dollars in public health. Rhode Island, early-on, had really good COVID-19 safety protections. But when it came to delivering the money, we failed. It was in nursing homes especially, but the hospitals also went through this crisis in financial distress.

AK: You’ve been an outspoken critic of State House Leadership, and were a leader in that fight in the Senate in 2018. And this year, you made the decision to vote for Senator Goldin for Senate President, and Senator Calkin for Senate Majority Leader. Where do you see existing leadership has failed, and where would Senators Goldin and Calkin – or more generally, progressive leadership – do better?

SB: It’s a lot of things. It’s a lot of the core social issues. Dominick Ruggerio isn’t just endorsed by the NRA, he hasn’t just taken thousands of dollars from the NRA; he’s really done their bidding and advocated for an extreme, right-wing agenda on gun safety protections. He’s pro-life, of course, and fought really hard to try to stop the Reproductive Health Care Act. He voted against marriage equality! Especially for people in the LGBTQ+ community, it’s really tough to forgive that vote – and as far as I know, he’s never
apologized for it. In fact, the majority leader, his deputy, told me that he would never apologize for that vote.

But when it comes to the economic issues is when you see the real damage. Ruggerio and McCaffrey obviously both voted for the tax cuts for the rich. It’s now 14 years later, and it’s sometimes easy to forget just how radical a thing this was. It’s hard to find a red state that has cut taxes for the rich this
much. North Dakota – when they had all that oil revenue come in – they eliminated their income tax so technically they lowered their top rate more than Rhode Island did. But it’s extremely difficult to find an example, even in red states, of tax cuts for the rich that big – we cut the top rate by 3.91%!
And when we did that, we slashed everything to pay for it. This was implemented from 2006 to 2010, right in the peak of the economic crisis, and those cuts were devastating. In Providence, we saw our library system almost shut down, and wound up being half-privatized; they fired every teacher in the city, and they slashed so many crucial programs. And that devastation really flowed from those policies.

And the current leadership has now prioritized that same agenda.
When it came to the pandemic, I was truly shocked by the failure of leadership. I thought I’d be fighting them to make sure that they didn’t only help businesses; but also help workers, people struggling with their rent, people in poverty, people with COVID, invest in health care. I didn’t expect to have to fight to get them to even try and do anything – to appropriate any money to help. That wasn’t the fight I expected to have, and it shocked me that we just packed up and went home, and did nothing as so much suffering rolled out across our state.

A huge number of the senators who voted for Ruggerio privately told me they were really upset by this, and it really bothered them. So I hope that we can move forward; and ultimately, we are going to have to build a leadership in the State Senate that supports the core values of the Democratic Party and, most importantly, cares about the people of our state – which the current leadership does not.

One Day at a Time: Substance use spikes as the pandemic wears on

For those suffering from substance-use disorders, staying sober is a marathon. The last year was a perfect storm of external assaults on everyone to one degree or another. The traditional roadblocks to overcoming addiction — economic insecurity, inadequate healthcare, lack of emotional connection and the troubles of social isolation — all were exacerbated by COVID-19 and its accompanying shift from normalcy. 

Metrics across the board for addiction are running negatively, according to Herren Project executive director Kevin Mikolazyk. The combination of anxiety, depression, health issues and unemployment that marked the past year are making the road to recovery more of a challenge.

The Herren Project is a nonprofit, founded by former professional basketball player and Fall River native Chris Herren, whose public battle with addiction and subsequent recovery led to the organization’s formation. It offers a host of free resources geared toward the prevention of substance use disorder. 

The last time they crunched the numbers — from April to August 2020 — requests for their services had spiked 190%, with pleas for family aid being the most prominent. 

“It is still trending in that direction,” says Mikolazyk. “More people are struggling than ever before. A big part of recovery is togetherness and personal connection. When that was taken away, it threw a lot of people for a loop.”

Mikolazyk says he’s seen people with many years of sobriety fall back. A specific trend, which many in the recovery industry said is novel, was the sharp uptick in drinking and drug abuse among middle-aged and older women. In response to the restrictions that began last spring, the Herren Project started a nightly online meeting that at times had 80 people.

“You could have been doing good in your recovery and then suddenly you lose your job, and it becomes that much more difficult,” says Mikolazyk. “And I don’t think we’ve even seen the worst of it.”

Like the rest of the country, Rhode Island before COVID-19 was handling another kind of public health crisis. After years of relative success getting a handle on the opioid epidemic (Rhode Island saw a fatal overdose decline between 2016 and 2019), the well-publicized uptick in the early months of 2020 arrived, followed by the arrival of COVID-19, which is being credited by public health experts as the prime reason for last year now set to become the deadliest for overdoses on record.

Although finalized data from 2020 will not be available for some time (there is usually a backlog as cases are determined by the state’s medical examiner), Rhode Island is on pace to eclipse the earlier record of 336 fatal overdoses logged in 2016 by about 30%. The most recent data on the RIDOH website shows 332 deadly overdoses in 2020 (September through December’s numbers are incomplete). July was the deadliest month ever recorded.

The pandemic has stretched addiction recovery resources to their absolute limits.

“The longer you can keep someone in a therapeutic environment, the better their chances. The current system is not set up for that,” says Mikolazyk. “Even if you have great insurance, you may get 30 days [of residential treatment] and they’re going to place you in outpatient treatment, which basically puts you back in the old environment … it takes a long time to learn new behaviors and coping mechanisms.”

Early research shows overall alcohol consumption has increased by 50%. A spokesperson for Alcoholics Anonymous Rhode Island says the organization has been engaging in more public outreach since early last year. AA meetings have for a long time been ubiquitous in local church basements and social halls. “Now some people don’t know where to go,” he says.

The spokesperson, who opted to remain anonymous, said the groups have rolled with the punches, updating members as state guidance is amended.

“It’s changed a couple of times, the way everything else has. We follow the governor’s guidelines in our meetings,” he said. “Of course, we’ve had people who say, ‘We have a right to hold our meetings.’ And that’s a valid point. But on the other side of the coin, it’s a valid point to say that it may not be wise to be [meeting in person].”

Public information officer for the state’s Behavioral Health Division, Randal Edgar, said that 12-step meetings are now considered an essential service. 

“Many did initially close down, but under RIDOH guidance for faith-based organizations, they began holding in-person meetings again, following guidelines such as social distancing, wearing masks and staying home if sick,” he says. “Twelve-step programs are all about relationships, so not meeting in person makes it hard for people to stay connected. But providers have gone out of their way to make it work.”

A survey of local meetings shows that some have gone completely digital. Others have continued their on-site gatherings. 

One generational parallel he has noticed is younger people finding the online format more desirable than in-person meetings, especially when it comes to speaking up, which many find difficult early on. The elderly are also adapting, he said, and appreciative of the ease in which they can log in to a Zoom meeting from the comfort of their home. 

“As much as it’s been an adjustment for a lot of people, it has opened up a doorway for some who can’t get out to where they want to get to.”

There are few silver linings. But one positive development in recent months is the increased willingness to donate to the non-profit organizations that labor in the recovery trenches. This could be due to the consequences of addiction touching more families personally. The Herren Project relies on these monies along with foundational grants to continue its work. “Generosity has actually gone up during COVID,” says Mikolazyk. “And it’s not necessarily the wealthy who are giving more. It’s actually the lower and middle classes.”

If you or someone you know is struggling with substance use, here are some resources: or

Get in the Zone: An explainer of RI’s Health Equity Zone initiative

You may have heard of this forward-thinking RI Department of Health initiative that is beginning to serve as a national model for community-driven health. But what is a Health Equity Zone, and how does it work?

What Are Health Equity Zones? 

Ana Novais, deputy director of the Rhode Island Department of Health, defines Health Equity Zones this way: “Health Equity Zones are community-led collaboratives that are in a very specific geographic area making decisions about what health is, what health means to [community members], what’s important to them, and how they want to address those issues.”

Each geographically defined zone is headed up by a “backbone agency,” usually a non-profit that has the capacity to build an array of partnerships to help carry out the mission of the Health Equity Zone. In the Central Providence Health Equity Zone, ONE Neighborhood Builders is a community development corporation that acts as this convener. 

What Inspired this Approach? 

Jennifer Hawkins, executive director of ONE Neighborhood Builders

Jennifer Hawkins, executive director of ONE Neighborhood Builders, says that 80% of our health is determined by social, economic, environmental and behavioral factors, and just 20% comes from genetics and clinical care. This means that if the Rhode Island Department of Health focused simply on medicine, they would truly be missing the mark when it comes to the root causes of health disparity. 

Hawkins acknowledges that a development corporation cannot solve health issues alone: “You can’t build your way out of systemic inequity,” she remarks, and goes on to say that tackling the root causes of inequity requires a more holistic, comprehensive approach to health. 

“Why do homeless people end up in the emergency room more often? It’s because they’re homeless,” Hawkins says. We can continue to treat them with expensive ambulance rides and emergency room visits, or we can get to the root of it and get them stable housing. 

How Does Funding Work? 

The Health Equity Zone initiative truly is a grassroots approach: The RI Department of Health provides infrastructure grants to backbone agencies to help offset the cost of collaboration and accomplishing their missions. This is a relatively new approach; Departments of Health across the United States historically have relied on much more controlled, top-down approaches to solving systemic health inequity, rather than trusting community organizations to decide for themselves what is more important to them. 

What Are Some Successes of the Program? 

After a series of community feedback sessions, ONE Neighborhood Builders identified economic opportunity as one of the biggest factors of health inequity. So with Department of Health support, they launched their Community Health Worker Registered Apprenticeship initiative. The program trains community members with 144 hours of classroom education and 2,000 hours of on-the-job training to become certified Community Health Workers; this achieves the program’s dual goal of economic empowerment and health disaster preparedness. Read more about ONE Neighborhood Builders’ other HEZ initiatives on their website

Hawkins pointed out, though, that every Health Equity Zone is unique, and other backbone agencies might focus on areas such as family health or food insecurity. It really is all up to the community. 

How Can I Get Involved? 

Hawkins says that we all can support the Health Equity Zone initiative by championing the idea that social determinants of health matter, and that we all have a part to play in advancing this important cause. 

To learn more about the program or explore a partnership, contact Ana Novais at Support a backbone agency near you, look at this list of Health Equity Zones, backbone agencies, and contacts in Rhode Island. 

Lunar Notes

January started off with a bang and things probably won’t settle down any time soon. Inauguration day on the 20th coincides with the First Quarter Moon. Quarter Moons are times of action. At this one, Mars and Uranus are exactly conjunct. We already felt the vibe of this duo on the 6th, and on the 20th it is stronger. Mercury goes retrograde on the 30th. Get all important paper work done before then.  

Aries: The focus shifts to your public persona, your standing in the community and your reputation. This is a great time to make connections and expand your network. Some surprises come your way that will affect your budgeting. A little self-healing is going on here as you begin to engage in those activities you truly enjoy. 

Taurus: Change, disruption and interruptions prevent any attempt to maintain a schedule. Your career and public image are at the top of your list these days. A long-term goal may be within your reach. This close, you may decide this is not what you want. An intuitive friend offers counseling and some spiritual guidance. 

Gemini: New ideas roll around in your head as you discover some folks who share the same values as you. Discussions with these people spark your intellectual curiosity and send you on a journey of discovery. Your ruler, Mercury, retrogrades at month end. This ushers in a good time to read and digest all that you have learned. 

Cancer: Partners, friendships and other relationships fall under the microscope during this period. Money, shared resources and values dominate discussions. Some crazy and argumentative friends shock you and cause you to react in a way that might not be productive. Try to be a healer in these volatile situations. 

Leo: Career, routine and relationships receive jolts and unexpected developments. Some folks are interested in power and control. Beware of obsessions and the obsessive. Events beyond your control shake up your world. They may create difficulties now, but further down the line the results will be beneficial.

Virgo: You’re serious about getting tidy and organized. For you that is really saying something as you are normally in that groove. But these days there is a heightened awareness about the proper order of things. Someone brings out your passionate side. Oh yes, earthy Virgo can be quite passionate. Be on the alert for the controlling one. 

Libra: Activities that you love and bring you joy dominate during this period. This is a time for you to get creative, with your life, your relationships and your “space.” Love and romance are in the air. Someone quirky and passionate is on the horizon. This is a good time to begin a creative project that requires discipline and inspiration. 

Scorpio: You begin this period like a hibernating bear, staying close to home and keeping a low profile. There is plenty to do on the home front.  Some of it is work, some is play. Lots of conversation going on. By month end you are ready to head out into the public and get noticed. Someone surprises you with their unexpected, quirky actions.

Sagittarius: While the world is hunkering down for the winter, you are on the go, busy, making calls, driving, talking and exchanging ideas. Your schedule is busy and you have trouble keeping up with it all. Someone on the work front gets aggressive, argumentative and seemingly unreasonable. Remain calm and chill.  

Capricorn: Venus in your sign during this period lightens things up a bit during the gloomy winter. Not enough to ease your concerns about money and your budget. Your usual practicality comes in handy as you figure out how to deal with any shortfalls. Capricorns are really creative and that creativity gets a boost during this period. Use it!

Aquarius: With Jupiter and Saturn, that rare conjunction, in your sign it is truly a new beginning, a new cycle for you. A new seed has been planted in your psyche and may take time to manifest. In the meantime, you concentrate on you. Who you are and what you want to do. Change on the home front reflects the changes within.  

Pisces: Your daily life, routine and immediate surroundings continue to have disruption, interruption and unexpected monkey wrenches upsetting everything. While this is going on outside, a lot is going on inside. Some serious self examination occurs that will set you on a new course in the months to come. Listen to your heart. 

Briefly Explained

In the past 12 months, Rhode Island added an additional $20 million dollars to its unclaimed funds, and a chunk of that might have your name on it! Read “Briefly Explained: Lost Money” at to learn how you can get reunited with your wayward wealth.

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Project PVD Love

Frog & Toad, the gift shop stuffed with perfect little somethings, has become a beacon of hope during the pandemic — a place always willing to collaborate, fundraise and bring smiles to the homebound with their madcap personal deliveries. So it made sense when a Providence-based parent/teacher organization president called them to discuss a mask donation project.

Providence Public School children often can’t afford to purchase masks, and some weren’t given the one mask each child was promised by the state. “This was a real need that I was shocked to find in the schools,” said Asher Schofield, co-owner of Frog & Toad.

Schofield was immediately on board with the project and asked employee Michael Ezzell to come up with the signature Project PVD Love mask design. The plan was to donate one mask to PVD schools for every mask purchased. “We are super grateful that our base responded,” Schofield said. “We can make a product, but if no one sees value in it, we can’t execute that giving component.”

Frog & Toad customers saw plenty of value in the masks and the project behind them — three different Providence public schools have already received 100 masks each.

Recognizing that the pandemic has stopped entertainment groups from visiting schools, Frog & Toad teamed up with Big Nazo Labs to deliver the masks. “They provide a scientist and robot to inspect the masks for the children and make sure they’re up to all health and safety standards,” says Schofield. “It gets the kids outside and laughing, and they’re delighted by these crazy creatures.”

Schofield appreciates the relationships he’s formed as a result of the project. “It’s been really great to have this connection with these amazing teachers, administrators and support staff and to show them some level of support for what they’re doing. A lot hinges on the health and wellness of our schools, and the fact that they’ve been able to deliver a safe and healthy area for kids to be is amazing.”

To purchase a Project PVD Love mask, go to

Raimondo Addresses the Press for the First Time in Weeks: A summary of the governor’s January 13 press conference

The circus was in town today at The Vets, as Governor Raimondo declined to answer questions from the press in her first public appearance since it was announced she was President-elect Joe Biden’s pick to lead the Department of Commerce. State officials steered away from political questions in an attempt to orient the press conference around COVID-19 response. The governor left shortly after concluding her announcements, much to the consternation of the press.

Raimondo began her remarks today by saying what an honor it was to serve as Rhode Island’s governor and be asked by President-elect Biden to lead a cabinet department. With inauguration a week away, it’s unclear when exactly Raimondo will step down. Her offices are reported to be coordinating with Lieutenant Governor Dan McKee. McKee speculated in a later press huddle with reporters that he would take the reins as a new governor officially sometime in mid-February. His office has scheduled a press conference tomorrow at Chelo’s on Post Rd in Warwick. The only confirmed detail of transition is McKee’s pledge to keep the current COVID response team in place after Raimondo leaves.

“I say that because I want Rhode Islanders to know there will be no disruption in our COVID-19 response,” said the governor. 

Raimondo is leaving Rhode Island in the midst of a stark resurgence of COVID-19. Today, there are 823 new cases of COVID-19 with a percent positive testing rate of 5%. The cumulative number of cases is now 102,485 since March. Weekly new cases per 100,000 continue to rise, while other trends, like weekly percent positive and new hospital admissions, trend downward. There are 402 people currently hospitalized; 49 people are currently in the ICU with 35 on ventilators. 

McKee gave his first remarks to the press today as presumptive governor, crediting Raimondo with her accomplishments during her tenure. “The governor has done a great job as governor of Rhode Island,” he said. McKee went on to say it was a point of personal pride for all Rhode Islanders that a sitting governor from the Ocean State was nominated for a cabinet position. He stated his office has been communicating with Raimondo’s for some years, moreso during the pandemic. There have been news reports from the past few weeks that McKee has not met with the governor personally since 2019.

Dr. Nicole Alexander-Scott gave a briefing on vaccination progress by DoH. With very little room for wastage, this week the following areas are getting vaccinated: nursing homes, outpatient providers like respiratory clinics and urgent care workers. Also getting tested are some folks in Central Falls, school nurses, EMS workers and others. Next week many of the same groups will continue to be vaccinated, with additional groups like doctors and dentists offices, behavioral health providers, group homes and residents older than 75. 

While the room at the start of the presser was fully packed with local honchos and members of the national press hoping to get some kind of vocalization out of Raimondo vaulting onto the national stage, most press quietly exited by the end when it was just COVID news. Raimondo reportedly dodged and declined to answer questions from the press both inside and outside The Vets in Providence. It remains to be seen whether she will communicate with the press again like she did prior to the commerce secretary news.