Lorenzo González and David Capó. (David Villafañe)

The symptoms began in late March when Puerto Rico and the world feared the spread of COVID-19. As the signs worsened, Aracelis Reillo, a special education assistant in Quebradillas, knew she couldn't wait any longer.

"There was a day when I had a lot of nausea and dizziness," the 36-year-old said of the moment she decided to get tested for the virus that has the whole world in a panic. The result of the test came on April 2 and brought the worst news: she had COVID-19.

"I completely lost my senses of taste and smell," said Aracelis, who lives with her husband, 38, and their three children, a 16-year-old and twins of three.

Epidemiology staff from the Department of Health followed her case and kept in touch, even after she overcame the virus and tested negative on April 24.

However, they never called the people Aracelis had contact with. "Outside of my close ones, husband and children, they didn't call anyone," she said. "Those I had contact with, I called them, I had the responsibility to warn them, and those people got tested," she said.

There many stories like this one on the island and they illustrate what is, along with the shortage of diagnostic tests, the government's biggest issue in the fight against COVID-19: the lack of a solid contact-tracing model, which is the most successful universal strategy to prevent the spread of this virus.

Next Friday, May 8, marks two months since the first suspected cases were identified on the island and the government has not been able to implement this strategy, which consists of identifying people who had contact with those infected, to test them and isolate to avoid infecting others.

"The idea is that the more people you can contact, the higher the number of people who will self-isolate, thus preventing the virus from continuing to spread in the communities," said epidemiologist Melissa Marzán, from the Ponce School of Medicine. Health professionals have also warned that this information is essential to know if there are outbreaks of infection in specific areas.

Health Secretary Lorenzo González confirmed yesterday that what the agency calls "contact tracing" is, in fact, communicating with people in the family of those infected, without contacting people with whom the positives have had casual contact.

González also revealed that although the agency reported 1,924 positive cases until yesterday, only the contacts of those who tested positive to the molecular test have been traced, which total 1,005. "We are using the CDC's (Centers for Disease Control and Prevention) definition of what a positive case is," González said.

Limited tracing

The Health Department indicated that it has contacted all of the 1,005 molecular test positives. Of that total, 675 reported "at least one contact." Of the remaining cases, according to the Health Department, those affected did not provide the information. In other words, no contact tracing has been made in some 330 cases, or 32 percent.

About the 675 positive cases that have been traced, the Health Department says it has followed up on 2,223 contacts, which is an average of 3.3 per case. Of that total, they have not yet been able to make contact with 35 people.

Dr. Jessica Irizarry, a member of the team conducting the tracing, explained that they only identify close contacts, as defined by the CDC. "We classify close contact as family contacts, someone who lives in the house with that positive case, a person who has had intimate contact with a positive case, or a person who has been within six feet of a case of COVID-19 for an extended period, who has not had personal protective equipment," she said.

The agency does not trace what it considers "casual contact" with positive cases, although they may infect.

Irizarry said two out of three contacts had already been tested by molecular (PCR) or serological testing at the time of the initial call, and about 10 percent of them tested positive for the virus.

In its Strategic Preparedness and Response Plan for the New Coronavirus published in March, the Health Department recognized the importance of contact tracing. The plan states that this allows for early identification of infected individuals, reducing the risk of exposure to surrounding people, and argues that this process should occur "as soon as possible."

That plan was never implemented.

The government wasted at least two opportunities to launch a contact-tracing operation, for reasons that are not entirely clear.

On 1 April, Dr. Juan Carlos Reyes, an epidemiologist of the Medical Task Force on COVID-19, explained to El Nuevo Día a contact tracing model which, he said back then, was ready to be implemented as soon as the Health Department authorized it.

"We are going to have a person who will be calling these people daily, the positive cases and contacts, to see the evolution of the disease in each case and if a person gets sick, direct them to a health service," said enthusiastically Reyes, on that occasion.

The model was never implemented. Dr. Reyes did not want to answer questions from El Nuevo Día about it. "Dr. Reyes will not further comment on the subject, beyond what has already been explained, because this project is no longer in his hands. It went to the Health Department," said Vivian Vázquez, spokeswoman for the University of Puerto Rico (UPR) Medical Sciences Campus, where Dr. Reyes works.

The model designed by the Task Force was based on the work of student volunteers who would do the fieldwork of tracking down the contacts of the positive cases. But more than a month after the March 24 announcement requesting volunteers was published, the students' work has not begun.

Volunteers are left waiting

El Nuevo Día learned that it was not until April 20 that the Health Department sent an email to some 250 volunteers who said they were available. Israel Méndez, a fourth-year medical student, was one of those who volunteered on March 24. It has been more than a month since the Health Department contacted him.

"I'm very interested in contributing to this initiative," he said.

State epidemiologist David Capó justified the delay by saying the government needed to have the technological capacity to link the volunteers' phones to the official Health hotline and to incorporate a system to protect patient information.

On April 8 and 9, on the other hand, the Public Health Trust, part of the Science, Technology and Research Trust, made available to the government, free of charge, a contact-tracing platform already developed for dengue cases, which, with slight modifications, could be used for COVID-19.

The offer was made on April 8 to National Guard Colonel Jorge Galofín, who, according to a source, reacted to the proposal with great enthusiasm. But the next day, Health personnel rejected the offer, confirmed the director of the Public Health Trust, Dr. José Rodríguez Orengo. "They indicated that they already had their own platform, so we did not insist," said Rodríguez Orengo.

Secretary González said he will contact the Trust to see "how they can be integrated into current efforts. The College of Medical Surgeons also offered the Health Department its call center to help with the tracing.

There is also no record of any follow-up of passengers arriving at the Luis Muñoz Marín airport. Although the National Guard sends daily reports to the Health Department with contact information, travel history, and places where passengers stay, the government has not implemented the tracing plan.

El Nuevo Día contacted Health epidemiologist Myriam Ramos, who is in charge of airport operations, but indicated that she was not authorized to give statements.

While this is happening, countless people who, having been infected with COVID-19 or in contact with people infected, have not been contacted by the Health Department.

That is the case of young Alejandro Sacarello, whose family has not been contacted by anyone in the government even though his 88- and 93-year-old grandparents died of coronavirus, his grandma passed away on March 30 and his grandad on April 22.

"I asked my mother to be really sure, I said, 'Hey, has the Health Department called our family, any family contacts? Because we're a big family, and during this whole process, different people helped with my grandmother and the hospital, and she said no, the Health Department never called," the young man said.

Nor has Edgardo Rosario, a 58-year-old federal employee and his wife, 68, both diagnosed with COVID-19 on April 2, been contacted. Rosario and his wife stayed in his apartment in Fajardo, isolated from the rest of the family. "To date, no one has called us to ask who our contacts were," Rosario says.

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