Puerto Rico braces for COVID-19 peak with lowest per capita testing

By Julio Patron and Genevieve Leigh
13 April 2020

Puerto Rico’s governor, Wanda Vázquez, announced Saturday that the US territory will remain on lockdown until May 3 in an attempt to curb the outbreak of COVID-19 cases. The island has been under a mandatory quarantine and all non-essential businesses have been closed since March 16.

As of this writing there are 780 confirmed cases out of approximately 7,700 who have been tested. Puerto Rico has a population of 3.2 million. More than 1,300 test results are currently pending. The island has confirmed at least 42 deaths, including a pediatrician and a number of people in their early 40s with no prior health conditions.

There is no doubt that the actual number of cases on the island is much higher, as widespread testing is not yet available. A month into the crisis, Puerto Rico had the lowest per capita testing rate than any US state but Oklahoma.

A woman wears a face mask and gloves at the gas station in San Juan, Puerto Rico. (AP Photo/Carlos Giusti)

Starting from the initial case, it took 15 days for the territory to register 100 confirmed cases. However, it only took three days to register 100 more—a stark indication that the virus has already spread rapidly through the population.

Amid widespread frustration regarding the state of testing, the local government announced in early April that it had placed an order for 1 million tests. The following week, newly appointed Health Secretary Lorenzo González revealed that the government was canceling the $38 million order because the tests were not FDA-approved, sparking further outrage. Puerto Rico’s largest newspaper, El Nuevo Día, has also drawn attention to the fact that the company through which the government ordered the million tests—a small construction firm that has never before sold medical products—has close ties to the governor’s New Progressive Party (PNP).

Officials are trying to pursue a refund of their 50 percent deposit of $19 million, but the outcome remains unclear.

The local government’s overall handling of the pandemic has been criminal from the start. Local officials initially downplayed the threat of the pandemic and squandered valuable time to prepare. Incredibly, the island’s then-Health Secretary Rafael Rodríguez-Mercado issued statements shortly after the first case was confirmed in the mainland US, casting doubt on the likelihood of COVID-19 reaching Puerto Rico, a major tourist destination. Rodríguez-Mercado resigned from his post on the same day that the first case was announced in Puerto Rico. Only two weeks later, his replacement Concepción Quiñones de Longo also resigned under undisclosed circumstances.

The island is facing the impact of a global pandemic with its third health secretary in three weeks.

Highlighting the extreme crisis within the government, Governor Vázquez (who herself is the third governor in less than a year) also indicated that Puerto Rico’s state epidemiologist Carmen Deseda had resigned, but offered no further details on the circumstances.

Once the virus hit the island, the local government changed its attitude toward the pandemic quite dramatically. Governor Vasquez has since instituted some of the strictest measures imposed in the US so far. The National Guard has been screening passengers who arrive at Puerto Rico’s airports, detaining those with a high fever and other symptoms. The officers claim that passengers are using fever-reducing medication in order to get past the screening.

On Wednesday, Vasquez requested a ban on flights to the island from states which have been hardest hit by the coronavirus, such as New York, Florida, New Jersey, Pennsylvania, and others. If the request is accepted, flights to Puerto Rico would be resumed once there is a drop in cases in those states, said Joel Pizá, the interim executive director of Puerto Rico’s Ports Authority.

Only two days after the first case was reported on March 15, Governor Vázquez ordered a strict curfew on the entire island until April 12, which was extended this weekend until May 3. She also closed all non-essential businesses and restricted all travel except for groceries, to get medication, or to go to the bank. Violators are punished by either a $5,000 fine or a six-month jail term. Enforcement has reportedly been extremely stern. Hundreds of people have already been cited, according to the Associated Press.

Vázquez’s measures also stipulate that anyone entering a business is required to wear a face mask or other protective equipment around their mouth.

The most controversial aspect of the measures, however, is the shelter-in-place order. Only those family members who are part of a “family nucleus” are allowed to shelter in the same home, requiring anyone not deemed part of a family to be kicked out of the home.

This measure has prompted a backlash, and a lawsuit filed by the ACLU on Saturday, citing the curfew as unconstitutional. According to the lawsuit, “The order pretends that constitutional rights be handed over blindly to the government, and that is unacceptable.” The ACLU continues, “The government cannot interfere with who you interact with within your home or define your family nucleus.”

The lawsuit states that the ban is too vague and gives the police authority to arrest people with impunity. There are many people on the island who have elders to take care of, and in some cases have to give insulin shots, which requires them to travel daily.

The onset of the pandemic in Puerto Rico has exacerbated an already extreme social, economic and political crisis on the island. Omar Marrero, executive director of the island’s Fiscal Agency and Financial Advisory Authority, estimates that the costs associated with the coronavirus crisis and the economic fallout stand around $4 billion. That amount represents nearly half of the government’s overall budget. The island’s Treasury Department has estimated that it could lose up to $1.6 billion in revenue.

Puerto Rico’s Department of Labor has reported that it has processed more than 131,000 unemployment claims, sometimes receiving more than 10,000 claims a day. More than 45,000 business owners have sought a $1,500 one-time payment from the local government.

As for the island’s preparedness in terms of immediate health care, Puerto Rico is perhaps the most ill-prepared US territory. It has one of the worst health care systems in the US, on par with that of Mississippi. Many hospitals in Puerto Rico, for instance, have not been modernized since they were built in the 1940s, according to a 2017 study by the Urban Institute.

Cuts to health care and other vital infrastructure on the island have been carried out for decades under both the Democrats and Republicans, and their counterparts on the island. Just last December, Trump, with bipartisan approval, slashed Medicaid funding for the island from an initial $12 billion in funding over a four year period, to $5.7 billion over two years.

The dire situation has been greatly intensified since Hurricane Maria in 2017. Some 10,000 schools, bridges, roads and other infrastructure were destroyed by the hurricane.

The lack of any significant response to the devastation by the local and federal government has had, and continues to have, deadly consequences. The federal and local governments lied for months to the population about the real death toll which is estimated to be about 5,000 people.

Masses of people left the island in the aftermath of the hurricane, including many skilled workers such as health care workers and doctors which are badly needed to combat the pandemic.

While the tipping point for the mass emigration was the hurricane, many Puerto Ricans were compelled to leave due to the deteriorating social conditions which have been imposed by both the federal and local government for decades. Even before the hurricane struck, the number of doctors on the island dropped from 14,000 in 2006 to only 9,000 in 2016.

On top of the fallout from the hurricane, the coronavirus pandemic in Puerto Rico comes only two months since the island was rocked by a string of devastating earthquakes which destroyed and collapsed thousands of buildings, including homes, schools, and hospitals. Thousands on the island were forced to live in tent cities or in their cars. Many more were left without running water or electricity.

In Puerto Rico, the COVID-19 pandemic is a crisis unfolding amidst the backdrop of a series of other severe crises.