Puerto Rico is having the ‘worst time’ during the COVID-19 pandemic
Throughout the pandemic, Dr Víctor Ramos, a paediatrician, had not seen more than two COVID-19 patients hospitalized at the same time at San Jorge Children & Women’s Hospital in San Juan, the Puerto Rican capital, where he works nights. When he left after one of his shifts a few days ago, the hospital’s pediatric patient count had grown to 10.
“We had never seen that,” he said.
Puerto Rico has experienced its worst coronavirus outbreak of the pandemic over the past five weeks, with explosive growth in cases exceeding records set in December. Only this week did the numbers stop rising, giving the territory its first respite since the surge began in mid-March.
“The government relaxed restrictions around January and February; it opened the economy completely,” said Mayor Luis Javier Hernández Ortiz of Villalba, a town in south-central Puerto Rico. “This gave the virus opportunities to spread that it didn’t have a year ago. Now the virus has the opportunity to spread in all places.”
Behind the rise, experts say, was a confluence of factors, including the arrival of variants that probably made the virus more contagious right when people weary of staying home and hopeful about vaccines began to let their guard down, returning to work in person and shopping and dining indoors. Tourists poured in for the spring break season. People gathered to celebrate Holy Week, a time when many are off work.
The results were staggering. In early April, the island went from averaging about 200 new cases a day to about 800, according to a New York Times database. In the week leading up to April 13, more than 7,100 cases were identified, a record. A two-week period this month saw cases grow by a remarkable 151%. At its peak, the positivity rate reached about 14%, according to the Puerto Rico Department of Health.
In response, scientists and physicians like Ramos, who is the president of the Puerto Rico College of Physicians and Surgeons, begged the public to follow masking and social distancing rules and urged elected officials to tighten pandemic restrictions. Hospitals still have bed capacity, Ramos said, but doctors and nurses are stretched thin. For years, Puerto Rico has lost many medical professionals to better-paying jobs in the states, leaving fewer of them to tend to the virus on the island.
Starting April 28, travellers who do not show proof of a negative COVID-19 test upon their arrival will be fined $300 unless they submit a test result within 48 hours. (The previous rules allowed travellers the option of isolating for 10 days if they could not provide a negative test result. Some have been arrested after breaking quarantine orders.)
Scenes of tourists behaving badly — flouting mask orders, crowding local hangouts and refusing to heed demands that they respect pandemic rules — have routinely made headlines. But contact tracing suggests many of the new infections have come not directly from tourists but from Puerto Ricans going to work, restaurants and shops in person, public health experts say.
This month, the administration of Gov. Pedro Pierluisi shut down in-person instruction at schools because of the virus surge. Officials pushed up the start of a nightly curfew to 10 p.m. from midnight — it is the only remaining blanket curfew in any state or territory — and reduced indoor capacity to 30% from 50% for restaurants and businesses. Some mayors have adopted additional restrictions, including closing beaches. Masks remain mandatory in public places across the island.
The latest outbreak can be managed with more gradual measures, Pierluisi said, citing the existence of virus treatments, a contact-tracing system in Puerto Rico’s municipalities and the availability of vaccines.
About 1.65 million people — about 31% of the population — have received at least one vaccine dose, according to a Times database, which relies on statistics from the federal Centers for Disease Control and Prevention. Dr Carlos Mellado López, the Puerto Rico health secretary, said in an interview that the Health Department estimated the number was higher: about 2.2 million people.
The testing rate had dropped sharply before doubling in recent weeks, Mellado said. The health department is working to send more tests directly to primary care physicians to test people in their offices, free of charge.
Outside of public testing sites, private labs in Puerto Rico still require a doctor’s order to conduct a gold-standard polymerase chain reaction test to detect the coronavirus, creating a barrier for socially vulnerable populations to find out if they are infected, said Melissa Marzán-Rodríguez, a public health researcher and assistant professor of public health at Ponce Health Sciences University.
“The situation has deteriorated so much over the past few weeks,” she said. “It might be the worst moment we’ve been through this past year.”
There is also resistance to mask-wearing, testing — “Some people think it’s going to hurt, up to their nose,” she said — and vaccinations.
“They don’t believe in vaccines, and the Johnson & Johnson situation has only made it worse,” Faustina said, referring to the pause of that vaccine to study whether it causes blood clots. “Or they say, ‘Why should I get vaccinated if I can still catch it or have strong side effects?” She tells them she got the shot herself and felt fine.
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