Her State’s in a COVID Death Spiral. Biden Just Hired Her.

President-elect Joe Biden confirmed on Friday that he would nominate Rhode Island Gov. Gina Raimondo for Commerce Secretary. “She’s one of the most effective, forward-thinking governors in the United States of America,” Biden said in a speech unveiling the pick.

Raimondo had reportedly impressed Biden during the vetting process for vice president, and she was previously floated to run the departments of Treasury and Health and Human Services.

But the Rhode Island governor would move to Washington at a time when her state is facing among the highest COVID-19 infection and death rates in the country, raising questions about how she might manage the massive and sprawling agency. If confirmed, Raimondo’s responsibilities will range from negotiating trade deals to overseeing the census and the National Oceanic and Atmospheric Administration.

While some public health officials blame Rhode Island’s exceptional coronavirus rates on demographic factors, like population density and poverty, others say the governor made key missteps, delaying restrictions to prioritize economic activity that left the state with untraceable and uncontrollable community spread.

“We allowed the explosion of disease in November and December,” Dr. Michael Fine, Rhode Island’s former director of the Department of Health and chief health strategist for the city of Central Falls, told The Daily Beast.

Worried About Virus Mutations? There’s a Solution.

Early in the crisis, Rhode Island seemed to be staving off the worst of the pandemic. Raimondo received positive national attention for quickly obtaining tests and keeping infection rates low. She also won headlines for promising to aggressively enforce a quarantine on New Yorkers visiting her state.

Raimondo and her health secretary were holding daily press conferences to announce restrictions and new executive orders. In Rhode island, unlike many states, there are no county or local boards of health. Raimondo filled that void.

In an interview with POLITICO Magazine last summer, Raimondo said that she relied heavily on public-private partnerships, with companies like CVS (which is headquartered in Rhode Island) to provide tests, and Salesforce to conduct effective contact tracing. “I cold-called CEOs of diagnostic companies. I engaged the Chinese consulate. I called every CEO in the medical device world that I knew,” she told the outlet.

That type of coordination with the business world, especially at the state and local level, is reportedly what Biden—like most presidents—was seeking out in his appointment for Commerce.

But critics in Rhode Island are skeptical that the governor has effectively managed that coordination, especially when it comes to the pandemic.

“Those partnerships were better than nothing, but we begged in those early months for resources, and those resources didn’t come,” Fine told The Daily Beast. “So I think a fair amount of time and attention was being paid to those partnerships, and to testing, and to employment of consultants, but I thought money would have been spent better in our communities, directly with our municipal governments.”

The state has spent $4.18 million paying two consulting firms for services related to the pandemic: Boston Consulting Group and Alvarez & Marsal Public Sector Services, according to the state’s transparency portal. A Wall Street Journal investigation of the practice nationally found that states retaining consulting firms for COVID-19 management assistance “have seen only modest benefits, if any at all, for the extra cost.”

Josh Block, spokesperson for Raimondo, told The Daily Beast the governor’s approach had been vindicated.

“As a result of the public-private partnerships initiated by Governor Raimondo, Rhode Island became an early leader in our response to COVID-19,” he said, adding, “We have partnered extensively with municipalities—and particularly high-density communities—to be able to meet people where they are in our testing and vaccination systems, setting up walk-in and drive-through testing sites at local schools and community centers.”

Likewise, Andrew Bates, a spokesperson for the Biden transition, told The Daily Beast, "Governor Raimondo is an innovative and effective leader who inherited the worst unemployment rate in the nation and brought her state back through successful workforce training and small business programs. The first woman to hold her office, she has made Rhode Island the nation’s leader in COVID-19 testing per capita. The President-elect looks forward to working with her to build our economy back better from the damage wrought by the pandemic.”

Raimondo’s pandemic record, however, is an increasingly fraught one.

On Dec. 7, local media reported that Centers for Disease Control and Prevention (CDC) data had Rhode Island leading the nation in coronavirus cases per capita. Raimondo has consistently pointed to the state’s high testing rate and high density, as well as a lack of rule-following, as explanations for the disturbing numbers.

Experts say that’s only part of the story.

“High testing is never a reason to excuse poor performance,” said Lawrence Gostin, a professor of law at Georgetown and director of the WHO Collaborating Center on Public Health Law & Human Rights. “Testing should have the opposite impact, which is to help the state detect cases quickly and then to initiate tracing and isolation.”

Still, experts acknowledged that Rhode Island does have unique vulnerabilities that have made the pandemic especially brutal there.

Dr. Megan Ranney, an emergency physician and associate professor of Emergency Medicine at the Alpert Medical School of Brown University, told The Daily Beast that demographic factors probably played an important role.

High population density “makes it tougher to distance,” Ranney said. And “we have a lot of multigenerational households.” She added that Rhode Island was a state where many people spend their entire lives, and multi-generational family gatherings are hard to prevent.

“The governor has tried really hard to balance the need to take care of our population economically with the need to take care of the health of the population,” Ranney said. “We have a very strong restaurant and tourism economy, and the lack of federal support has made it difficult for her to lock things down further.”

But when cases began to rise this fall, critics say, the governor did too little too late, allowing the virus to get out of control. And her own behavior also left her vulnerable to charges of coronavirus hypocrisy that have dinged Democrats across the country.

By October, Rhode Island began to see a renewed surge. On Oct. 30, Raimondo restricted the household gathering limit to 10 people, and said the state would be cracking down on “unstructured social settings.” However, she left—and continues to leave—institutions like bars and restaurants open for indoor dining, albeit at reduced capacity.

In mid-November, a local news investigation found that even though the governor had restricted household gathering limits, “a snippet of contact-tracing data obtained by Target 12 shows health officials actually have limited insight into where transmission of the virus is taking place.” The story pointed out that Michigan—which was seeing similar surges—had closed bars, restaurants, and gyms, while Raimondo had ordered these institutions to close earlier at night.

Days later, IBM, working with Salesforce—which the state had contracted for contact tracing services—provided news outlets with a report showing that about 40 percent of cases were being spread within households or families. In other words, the majority of cases still came from outside the home. The state health department, for its part, said it was nearly impossible to know where transmission was happening, echoing the titanic struggle to contact-trace nationwide.

This State Is Getting the Vaccine—and a Surge of New Cases

On Nov. 19, Raimondo announced that the state would heighten restrictions to stop a COVID-19 surge, but that it wouldn’t start until Nov. 30—after Thanksgiving. “The pause was delayed two weeks to allow Thanksgiving to happen, and it ended four days before Christmas to allow shopping to happen,” said Fine, the former state health official.

The choices were made, “very likely at the cost of disease spread,” he added.

Gostin agreed that the delayed “pause” might have been a problem.

“It would be poor decision-making to announce a lockdown in the future and wait until after Thanksgiving,” he told The Daily Beast. “First, lockdowns need to be immediate, not long-delayed. It will only encourage risk behaviors in advance of the lockdown. Second, Thanksgiving is the most dangerous time, so risk mitigation measures should occur before, not after the holiday.”

That might only have been obvious in hindsight, argued Maciej Boni, a professor of biology at Penn State and informal adviser to the Rhode Island Department of Health. Boni said that Raimondo was “one of only a handful of governors who have taken this seriously, and put together scientific teams who gave them good advice and balanced those with political considerations.”

Still, Fine argued the hospitalization data Raimondo—like many governors nationwide—was using as a metric didn’t have much to do with controlling disease spread. “The focus on hospital capacity probably cost lives, because balanced against hospital capacity was the economy, and keeping bars and restaurants open, when in many other places they would have been closed,” he told The Daily Beast.

Critics note that restaurants in the state were allowed to remain open at reduced capacity, even during the “pause.” And Raimondo came under fire for her attendance at a wine and paint event in December—which she insisted was in keeping with her policy restrictions, but did produce a photograph of her without a mask.

Nearly 2,000 Rhode Islanders have now died of COVID-19, and nearly 100,000 positive test results have come back in the state of about one million people since March.

Any governor tapped to take a national post will have home-state scolds to contend with. And a pandemic is not the sort of health crisis that produces many success stories, as Gov. Andrew Cuomo has learned the hard way in New York. But Raimondo’s critics are baffled by her elevation even as the state continues to battle back a uniquely ferocious outbreak.

As Gostin put it, “The state's consistently high COVID levels show that the governor's performance was not exemplary.”

Read more at The Daily Beast.

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