EXPLAINER: Why the smallest state has a big virus challenge

PROVIDENCE, R.I. (AP) — For a few days in December, Rhode Island was one of the worst places on the planet when it came to new cases of COVID-19 per capita.

Hospitals hit capacity as the rate of new cases topped the nation, nearly double the rate in neighboring Connecticut. The state's record for daily COVID-19 deaths, set in April, was broken. Faced with a worsening crisis, Gov. Gina Raimondo reluctantly re-imposed tougher restrictions on businesses.

“I am surprised that we have done so poorly," Dr. Keith Corl, an emergency physician and faculty member at Brown University's Warren Alpert Medical School, said last week. “We are all exhausted, and now we’re talking about staffing more ICU units."

The nation's smallest state by area has reported 1,855 pandemic deaths so far, far fewer than many states but giving Rhode Island the nation's sixth highest COVID-19 death rate. Like other Northeastern states, Rhode Island was hit hard early in the pandemic. Cases fell in the summer, but climbed through the fall.

“The state has done as good of a job as they could. We've got to be optimistic now that we've got the vaccine on the way," said Rhode Islander Donald Ritter as he ran errands in Providence on Monday. “But it's been quite a ride.”

___

A DENSE — AND OLD — POPULATION

Experts who have studied the state's bout with COVID-19 say it offers lessons for other parts of the country confronting the same factors that drove its surge.

Among them: dense communities; high numbers of seniors in nursing homes; an economy reliant on tourism and low-wage workers who can't work from home; restrictions that sought to balance health against economic activity; and a refusal by some to heed guidance on masks and social distancing.

“There are lots of reasons," Raimondo...