PROVIDENCE, R.I. (WPRI) – Rhode Island remains among a dwindling group of states with zero reported deaths caused by COVID-19, a notable fact given its relatively high rate of positive cases.

State leaders, who say they fully expect a death at some point, attribute the trend so far to swift measures taken earlier in the month to protect citizens most at risk, including asking older Rhode Islanders to avoid gatherings, and banning visits to nursing homes.

Hospitals, likewise, quickly implemented strict restrictions on who could come into health care facilities, as nationwide and global deaths appear to be highest among older people and those with underlying health conditions.

“We have been fortunate to date,” R.I. Health Department spokesperson Joseph Wendelken said in an email. “We have been very aggressive in putting restrictions in place in higher-risk settings.”

A Target 12 analysis of cases, deaths and population across all 50 states and Washington, D.C., however, shows Rhode Island could also be benefiting from its size.

As of Thursday, Rhode Island was one of nine states that had reported zero COVID-19 deaths. Three of them – Alaska, North Dakota and Wyoming – have fewer people than Rhode Island. Two others – Montana and Maine – have similar sized populations.

Gov. Gina Raimondo is also looking to take advantage of the state’s limited land borders, ordering R.I. State Police to stop incoming cars with New York license plates to instruct them to self-quarantine for 14 days if Rhode Island is their final destination. Her goal is to keep the high volume of COVID-19 cases recorded in the New York metro area away from Rhode Islanders.

“Nearly half of the coronavirus cases are in the New York City metro area,” Raimondo said Thursday.

But population size isn’t always a factor.

At least nine people have died so far because of COVID-19 in Vermont, which only has about 625,000 people compared to the roughly 1 million in Rhode Island. Other parts of the country with at least one reported death and smaller populations than Rhode Island included Delaware, South Dakota and Washington D.C.

Geographically, Rhode Island has done fairly well to not follow trends seen in neighboring states. As of Thursday, every other state in New England except Maine has seen a COVID-19 death, including 21 in Connecticut, 25 in Massachusetts, nine in Vermont and one in New Hampshire.

Arguably most surprising is the lack of deaths in Rhode Island despite its relatively high rate of confirmed cases compared to other states. Rhode Island on Thursday ranked 15th nationwide with about 15 cases reported for every 100,000 residents, the Target 12 analysis found.

New York had the most per capita, with 191 cases per 100,000, and West Virginia had the fewest with about three cases per 100,000.

“We don’t want to become New York,” Raimondo said this week.

Limited access to testing has made it difficult for state leaders to effectively track the illness in Rhode Island and across the country. It’s also raised questions about whether the official count of COVID-19-related deaths is skewed in part because people might be dying of the disease who are never diagnosed.

Wendelken said Rhode Island would count a COVID-19 death – or COVID-19-associated death – even if someone with the disease dies of something else like pneumonia as the body fights to stave off both illnesses.

“That’s the same thing we do with the flu,” he said. “It’s usually the flu plus some other health conditions (often in elderly people) that is the cause of death.”

Wendelken said testing is also being done at the R.I. Office of the State Medical Examiner based on what type of symptoms people were showing before they die. As of Thursday, the medical examiner had administered about five tests, he added.

For the living, public health officials have had to pick and choose who gets the test based on narrow guidelines, including travel history, symptoms and contact with other positive cases. Raimondo on Thursday said the state is positioning itself to have the materials necessary to test about 1,000 people per day by next week, which could help loosen the restrictions.

It would also help public health officials more accurately pinpoint where the disease is affecting people, giving them the information necessary to quarantine more people and prevent the illness from spreading further. And stemming the spread could ultimately keep the death rate low in Rhode Island.

“We want to stay one step ahead of it,” Raimondo said.

Eli Sherman (esherman@wpri.com) is a Target 12 investigative reporter for WPRI 12. Follow him on Twitter and on Facebook.

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