The Rhode Island Department of Health (RIDOH) is filing a new emergency regulation, effective upon filing with the Rhode Island Secretary of State, entitled "Long-Term Care Facility COVID-19 Procedures" (216-RICR-40-10-27), that requires long-term care facilities, specifically nursing facilities and assisted living residences, to deny entrance to any visitors, including essential caregivers, who do not provide proof of vaccination against COVID-19. For those who are not vaccinated against COVID-19, proof of a negative polymerase chain reaction (PCR) COVID-19 test completed within the previous 72 hours or proof of a negative test result from a point-of-care rapid antigen test (e.g., Binax NOW) completed within the previous 48 hours must be provided to long-term care facility staff prior to entry.

Additionally, a visitor must keep a mask on throughout the duration of a visit with a resident.

RIDOH anticipates that these mandatory requirements will be time-limited. Rhode Island is experiencing a sharp increase in COVID-19 cases. The uptick in cases may be driven by the speed at which the new Omicron variant is spreading. Omicron arrived in the United States around Thanksgiving and during the week of December 12 - December 18, 2021, Omicron accounted for 73 percent of all new infections, according to the Centers for Disease Control and Prevention.
Rhode Island is in a period of high COVID-19 transmission. As of December 23, 2021, there were 728.5 new cases per 100,000 persons in the last seven days in Rhode Island, with a test positivity rate of 6.1 percent. Of approximately 1.1 million residents, 794,940 (72%) are fully vaccinated against COVID-19.

According to a report from the United Kingdom (UK), which may be predictive for the United States, Omicron cases were multiplying at a pace of 35 percent per day. "There are legitimate concerns about the trajectory of the newest variant, Omicron, and public health experts are paying close attention to the exponentially mounting cases, particularly in the United Kingdom, which in the past has functioned a canary in the Covid-19 coal mine for the U.S."

The relationship between case fatality rates and the Omicron variant is still emerging: "With Omicron, however, we not only don't see the rise in death rates that were associated with the first waves, but we actually see a continuing decline in death rates, despite a radical increase in cases. Whether or not this breakdown of the relationship between Omicron cases and deaths will play out in other countries, like the U.S., is hard to say," according to STAT NEWS reporter Duane Schulthess.

It is important to point out that earlier in the pandemic (2020), Kaiser Family Foundation reported that Rhode Island was one of two states that had the highest percentage (78%) of long-term care deaths as a share of total state deaths. COVID-19's impact on the vulnerable long-term care population has been dramatic and disproportionate to the general population. RIDOH's goal is to mitigate COVID's effects on this population by requiring long-term care facilities to screen visitors for proof of COVID-19 vaccination and to have visitors mask up while in the facility.

The COVID-19 pandemic continues to have a profoundly disruptive effect on the lives of Rhode Island's nursing home and assisted living residents and their families, particularly as the second year of the pandemic draws to a close.
These emergency regulations are intended to protect nursing home and assisted living residents' lives; maintain safety in Rhode Island long-term care facilities; and avoid imminent peril during this challenging time by requiring proof of vaccination against COVID-19 and mask-wearing throughout the duration of a visit with a long-term care resident.

216-RICR-40-10-27

The Statement of Reasons for Finding of Imminent Peril

On March 9, 2020, Governor Gina Raimondo declared a state of emergency for the State of Rhode Island “due to the dangers to health and life posed by COVID-19.” Seventeen months later, on August 19, 2021, Governor Daniel McKee declared a further state of emergency “due to the dangers to health and life posed by the [COVID-19] Delta Variant and other emerging [COVID-19] variants.” As of October 7, 2021, the COVID-19 pandemic has significantly impacted the State’s health care system, gravely exacerbating a pre-existing shortage of health care workers, including nursing assistants. The lack of nursing assistants jeopardizes the ability of the State’s health care system to provide critical care. This emergency regulation is meant to avoid the imminent peril posed by the lack of nursing assistants by taking advantage of the CMS blanket waiver of certain nurse aide training and certification requirements to provide for emergency temporary nursing assistant licensure.

216-RICR-40-05-22

The Statement of Reasons for Finding of Imminent Peril

On March 9, 2020, Governor Gina Raimondo declared a state of emergency for the State of Rhode Island “due to the dangers to health and life posed by COVID-19.” Seventeen months later, on August 19, 2021, Governor Daniel McKee declared a further state of emergency “due to the dangers to health and life posed by the [COVID-19] Delta Variant and other emerging [COVID-19] variants.” As of October 15, 2021, the COVID-19 pandemic has significantly impacted the State’s health care system, gravely exacerbating a pre-existing shortage of health care workers, including emergency medical services personnel. The lack of emergency medical services personnel jeopardizes the ability of the State’s health care system to provide critical care. This emergency regulation is meant to avoid the imminent peril posed by the lack of staff for private ambulances for basic life support transportation, which has severely impacted the ability of hospitals to discharge patients in a in a timely manner, thus not allowing patients to be admitted to the hospital from the emergency department.

216-RICR-20-10-2

The Statement of Reasons for Finding of Imminent Peril

COVID-19, the new disease caused by novel coronavirus SARS-CoV-2, has been deemed a global pandemic. It continues to spread and threatens to overwhelm the state's ability to respond. Since late summer 2021, Rhode Island has had a high transmission rate of COVID-19; as of December 20, 2021,Rhode Island has been averaging 727 cases per 100,000 persons in the past seven days. New weekly hospitalizations have nearly tripled between mid-November 2021 and mid-December 2021. Aggressive and sustained efforts are necessary to slow the spread of COVID-19 to lessen the strain on our health care system. Protective measures must be followed and implemented for individuals and establishments to continue operations so that the public is protected. By promoting compliance of COVID-19 Executive Orders through regulations that provide explanations and guidance, the public's health, safety and welfare can be assured.

216-RICR-10-05-6

Since October 1, 2021, an Emergency Regulation (216-RICR-20-15-8) has been in place mandating that all health care workers and providers be vaccinated against the novel coronavirus SARS-CoV-2, also known as COVID-19 (the “Emergency Regulation”). Two highly contagious strains of the virus, the Delta and Omicron variants, spread through Rhode Island between October1, 2021 and March 9, 2022, with transmission rates ranging from a low of 94 cases per 100,000 people in the prior seven days, on March 8, 2022, to a high of more than 3,400 cases per 100,000 people in the seven days prior to January 9, 2022. Among the purposes of 216-RICR-20-15-8 has been to limit transmission of COVID-19 and protect public health.

The Emergency Regulation will expire on March 12, 2022 and the COVID-19 transmission rate is at its lowest point since 216-RICR-20-15-8 went into effect, allowing restrictions to now be eased. The Rhode Island Department of Health (“RIDOH”) is currently in the process of promulgating permanent rules to ensure that suitable protections regarding health care workers and COVID-19 will continue to be enforceable for the health, safety, and welfare of Rhode Islanders, but those rules will not be finalized when the Emergency Regulation expires. While COVID-19 transmission rates and number of persons hospitalized with COVID-19 is decreasing, a need remains to protect vulnerable patients from the spread of respiratory droplets containing COVID-19 by ensuring that mitigation measures continue to be in place in locations where COVID-19 represents an especially high risk to public health, such as facilities in which health care workers are treating the most vulnerable patients, especially in a congregate setting.

There is significant evidence that masking is effective in reducing transmission of SARS-CoV-2, including variants. See e.g., cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#anchor_1619457210222 (last updated Dec. 6, 2021); cdc.gov/mmwr/volumes/70/wr/mm7010e3.htm (published March 12, 2021); cdc.gov/mmwr/volumes/70/wr/mm7036a3.htm (published September 10, 2021); cdc.gov/mmwr/volumes/70/wr/mm7007e1.htm (published February 19, 2021); cdc.gov/mmwr/volumes/70/wr/mm7035e2.htm (published September 3, 2021).

Research also supports that mask-wearing has no significant adverse health effects for wearers. cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#anchor_1619457210222 (last updated Dec. 6, 2021). The reason masks are effective in limiting the spread of SARS-CoV-2 is because the disease is transmitted predominately by inhalation of respiratory droplets generated when people exhale in any manner (i.e., through coughing, talking, or breathing). Masks are primarily intended to reduce the emission of virus-laden droplets from someone who is infected with SARS-CoV-2. This includes people who may be asymptomatic or pre-symptomatic and may be unaware of their infectiousness to others—more than 50% of transmissions are estimated to result from asymptomatic or pre-symptomatic transfers. Masks also help reduce inhalation of these droplets by the mask wearer. Please see here for the source and a summary of the available data, which are extensive, from the CDC:
cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html. Additionally, there is significant evidence that vaccination is effective in reducing transmission of SARS-CoV-2, including variants. See https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm; https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Contraindications.

The risk of inadvertent transmission by COVID-19 positive health care workers, who are often asymptomatic or pre-symptomatic, will be ongoing. Health care workers interact with individuals who are immunocompromised and individuals with co-morbidities, who remain at risk for adverse health outcomes from COVID-19. A lapse in regulation during the pendency of permanent rules for COVID-19 protections would allow health care workers to interact with patients without any COVID-19 mitigation measures and place these vulnerable populations, and the public health at large, in imminent peril. Under these circumstances, it is imperative to public health that the Department immediately promulgate emergency regulations to ‘bridge the gap’ between the expiration of the Emergency Regulation and the finalization of pertinent permanent rules.

216-RICR-20-15-9