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How 2 Hard-Hit New England Cities Slowed Coronavirus Infections06:03
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Central Falls Mayor James Diossa, left, and Dr. Michael Fine stand in front of the Rhode Island College walk-up testing site in Central Falls. (Jesse Costa/WBUR)
Central Falls Mayor James Diossa, left, and Dr. Michael Fine stand in front of the Rhode Island College walk-up testing site in Central Falls. (Jesse Costa/WBUR)

Chelsea City Manager Tom Ambrosino scanned the chart he uses to track the daily coronavirus case updates for this small, densely populated community. The chart peaked on April 13, when160 residents received positive test results. In the past week, the city recorded between zero and four new cases a day.

Ambrosino liked what he saw.

“At this point I’d say it’s a very positive trend,” he said.

Chelsea has the highest coronavirus infection rate in Massachusetts and among the highest in the country. While the city has seen a marked drop in new, daily positive cases, the rolling average is still about four times higher than the state as a whole.

On Friday, the Baker administration launched an expanded testing program in Chelsea and seven other hard hit communities to try and stop the spread. Ambrosino said he welcomes the assistance. But he’s also pleased with the progress Chelsea residents have made toward controlling the coronavirus.

That progress may hold lessons for other communities with large numbers of immigrants who live in crowded apartments and commute using public transportation to jobs they can’t do from home — in hospitals, nursing homes or other essential services. Those factors haven’t changed in Chelsea. What has changed, said Ambrosino, is the behavior of residents.

"Most people in Chelsea were alarmed by the high contagion rates,” he said. “We put a lot of messaging out about the need to stay at home, stay isolated if you were sick, don’t go out if you were sick and wear a mask in public. For the most part, people listened.”

On a walk down one of Chelsea’s main streets, for example, Abrosino spotted just a couple of people who weren't wearing masks. And most people waiting in line at a food distribution site created to ease the stress of the pandemic were paying attention to markers spaced six feet apart.

The city hands out boxes with 10 prepared meals, as well as milk and bananas, Monday through Friday. Lourdes Alvarez, who runs Chelsea’s food distribution project, said she expects to distribute 600 boxes today. The city delivers meals to residents who are sick or are staying home because they may be infected.

A Chelsea resident receives a box of food supplies at a food pantry in Chelsea Square. (Jesse Costa/WBUR)
A Chelsea resident receives a box of food supplies at a food pantry in Chelsea Square. (Jesse Costa/WBUR)

Almost 9,000 households have also received so-called quarantine kits, via the MGH Chelsea HealthCare Center. The kits include masks, soap, hand sanitizer and public health guidance about thorough hand-washing, safe physical distancing and mask use.

Residents who needed a place to isolate while sick could check into a hotel where Chelsea, Revere and some neighboring communities booked rooms for use during the state’s initial COVID surge. Organizers expected to fill the 140 rooms within a week, but the hotel was never more than 60% occupied.

“We started to learn that people were afraid, that people didn’t want to leave their homes,” said Dr. Dean Xerras, medical director at the MGH Chelsea clinic and at the hotel. “People didn’t want to register and report that they were sick or have to give their names.”

Xerras worries, but can’t prove, that fear helps explain why, in March and April, so many COVID patients from Chelsea, East Boston and Revere didn’t arrive at Mass General until they needed intensive care. Xerras said health care leaders in Chelsea and similar communities stepped up messages to assure patients “we don’t care about immigration status, we don’t care about insurance status and there’s no reporting to immigration.”

A Chelsea resident is being directed by a healthcare worker before inserting a swab up her nose during free COVID-19 testing offered by the state in Chelsea Square. (Jesse Costa/WBUR)
A Chelsea resident is being directed by a healthcare worker before inserting a swab up her nose during free COVID-19 testing offered by the state in Chelsea Square. (Jesse Costa/WBUR)

In Central Falls, Rhode Island, elected and public health leaders faced similar challenges. Roughly 70% of the residents of this one square mile community are Latino. Mayor James Diossa said as many as a quarter of the city’s 20,000 residents may be undocumented. At its peak, 35% of coronavirus tests were positive, the highest figure in Rhode Island.

Diossa credited an incident command team that included representatives from across the city with helping to control the coronavirus in Central Falls.

“You have to have a grassroots operation where you outreach to every single person through every single means,” he said.

Diossa recorded public health alerts that played, on repeat, as police vehicles rolled down residential streets. The city created a triage hotline after realizing that the message, “call your doctor if you think you may have the coronavirus,” would not work in Central Falls.

“About 50% of the population does not have a primary care doctor,” said Dr. Michael Fine, the chief health strategist for Central Falls. “So I think the most important thing we did was quickly create an option for that half of the population.”

People who call the hotline are only asked for two pieces of information: a first name and a phone number. Fine said among those who provided additional information, the vast majority are living in poverty and only 28% are citizens.

“And that suggests to me that we broke through to many people who otherwise wouldn’t get access to any kind of care and would have stayed sick in their homes alone,” he said.

The hotline also connects patients who need to isolate with a support network of food, guidance and supplies. The city set up its own walk-in, rapid testing site. It has offered cash to some undocumented workers who didn’t qualify for federal assistance to help them stay out of work.

This week, the positive test rate in Central Falls is down to about 6%.

Health workers at the Rhode Island College walk-up testing site in Central Falls use a reacher tool to take the identification from a man requesting to be tested for COVID-19. (Jesse Costa/WBUR)
Health workers at the Rhode Island College walk-up testing site in Central Falls use a reacher tool to take the identification from a man requesting to be tested for COVID-19. (Jesse Costa/WBUR)

Following coronavirus safety rules for months on end is difficult. In Chelsea, Alvarez said people are doing their best. But worries over how they’ll survive are now competing with fears of getting sick.

“Everyone needs to work to pay their bills and their rent,” she said, ”so now there is more economical concern instead of health concerns.”

And some residents are letting down their guard. Michael De Jesus, a part-time student and warehouse worker, said he noticed the change in late May, around Mother’s Day.

“I’m guilty of it too,” he said. "We went to my grandmother’s house and had a little thing. We didn’t social distance. We didn’t wear masks. It was kind of relieving to just be more open and not care about safety and stuff.”

With its high infection rate, Ambrosino wonders how close Chelsea might be to herd immunity, if immunity holds for COVID-19.

“It’s an interesting theory that keeps cropping up in my mind,” he said. “It would be the best possible news because it would mean we might be spared from the harshest impacts of a second wave.”

A random sample of Chelsea residents in April found nearly a third had developed antibodies.

For now, Ambrosino said he watches the daily case reports closely, fingers-crossed, hoping that the mantras about good hygiene, masks, and physical distancing stay with people as the state reopens.

A young boy cries to his father after being tested for COVID-19 at the free testing being offered by the state in Chelsea Square. (Jesse Costa/WBUR)
A young boy cries to his father after being tested for COVID-19 at the free testing being offered by the state in Chelsea Square. (Jesse Costa/WBUR)

This segment aired on July 10, 2020.

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