Yesterday, the Medical Task Force on COVID-19 recommended Governor Wanda Vázquez Garced a "road map" that includes not lifting all prevention measures until there is a vaccine or effective treatment against the virus available and proposes a gradual and limited reopening of the island's socioeconomic activity.
The document – which was shared with El Nuevo Día - reiterates a vaccine against COVID-19 does not seem likely to be available in less than 18 months, so social distancing will be the new reality in the near future.
Other issues, such as curfew, loss of human resources in hospitals, beaches, and religious activities, are not mentioned in the document.
The proposed flexibilization divides the process into reopening stages - a total of four - which will be implemented as long as certain epidemiological criteria are met and the government complies with a series of measures to address the pandemic that has caused more than 195,000 deaths worldwide.
The main factor, however, is the transmission rate, which will be calculated according to data on new infections gathered by the Health Department, confirmed Marcia Cruz Correa, a member of the task force and executive director of the Comprehensive Cancer Center. When modeling the scenarios, they projected total infections - not just those confirmed with tests - using the number of people who have died from the virus.
Puerto Rico is currently one of the jurisdictions that had the least testing for coronavirus per capita. Cruz Correa estimates this will change due to the recent flexibilization of medical guidelines so that tests can be administered to people who do not strictly comply with COVID-19 symptoms.
According to Cruz Correa, during the first weeks, the transmission rate was reached nearly 37 percent. She noted that, due to the lockdown and the curfew, this rate dropped to between 6 and 8 percent. To avoid exceeding hospital capacity, this percentage cannot exceed 12 percent, she added.
The recommendation basically seeks to establish a system to gradually ease commercial restrictions and to reactivate social distancing measures ordered by the governor if contagion increases and the infection rate exceeds 12 percent.
"The important thing is the number of cases. It can't be over 12 percent," Cruz Correa said, assuring that the government has the capacity to perform 1,500 COVID-19 tests daily.
This scheme will allow reactivating commercial activity without risking the rates of contagion, hospitalizations, and deaths getting out of control.
The latest version of the document did not recommend specific dates for the first reopening measures of Puerto Rico's socio-economic activities, although earlier versions contemplated reopening plans starting in May and ending by fall, with schools being the last in the list.
However, reopening some businesses would not be recommended until a vaccine is available. For example, movie theaters and theaters, the document says, could represent favorable conditions for the spread of the virus in a group of people, so reopening them is not recommended at this time and the same recommendation applies to concerts, festivals, and mass activities until there is a vaccine, treatment, or sufficient group immunity, according to the document.
Cruz Correa explained that churches were not included in the recommendations because they focused on economic sectors. She said, however, that from an epidemiological point of view, this activity is similar to theaters.
Earlier versions included recommendations on beaches, but in the end, they were not included. As for the curfew, Cruz Correa said that it is up to the governor to make a decision.
The first sectors to reopen
The proposal recommends encouraging online work in any activity it is possible. As for reopening, the first sectors to have more flexibility will be construction, mining, information technology, agriculture, and manufacturing. Each of these sectors must comply with social distancing measures, which include the availability of hygienic and protective equipment and changes in work areas to avoid crowding.
This first phase, according to Cruz Correa, could begin in May, since they believe that they already have all the surveillance systems in place. The main criteria at the federal level to begin the reopening phase - 14 consecutive days with reductions in new cases - has already been met in Puerto Rico, she said.
Real estate, wholesale trade, finance, insurance, recreation, art, entertainment, and government nonessential services sectors would come in a second phase.
Weeks later, it would be the turn of retail trade and shopping malls. This group would also include hotels, inns, restaurants, transportation, storage, commercial or technical services, as detailed in the document. The latest to reopen would be schools.
In fact, the task force argues that it is "very likely" that parents will have to return to work before students return to school, so "employers and business owners should have to consider that employees with school-aged children will benefit from continuing their work remotely whenever possible.
They also stress that people over 65, those who have had transplants, on dialysis, or with a history of cancer or immune deficiency syndromes should be especially protected in these processes.
The reopening plan responds to contagion risks and fatality analysis by sector, prepared by Heriberto Marín, a professor at the Graduate School of Public Health. The higher the indicator, the greater the risk involved. The information computing area, for example, shows a 3.5 risk under this index, which is very low. For manufacturing, the relative index is 6.8; for wholesale trade, it is 16.2, and for retail trade, it is 61.7. Schools have a higher indicator than health-related workshops, according to the report.
The document states that all activities must daily evaluate that no employee comes to work with symptoms by interviewing and taking their temperature. Customers will be also evaluated. If they have symptoms, the person will be told to self-isolate and be tested with his or her family doctor, as indicated in the protocol.
"It is essential that each employer, administrator, and supervisor evaluates the roles of their employees, interaction between employees and their customers to develop and implement all the necessary measures to protect their customers and employees based on risk, type of contact, and modifiable behavior," it adds.
Cruz Correa said that while implementing these reopening phases, the Health Department would have to strengthen processes and develop a series of initiatives to better understand the behavior of the epidemic in Puerto Rico and manage the response to the emergency in the long or medium term.
Among the tasks entrusted to the Department of Health, the agency has to complete the system to identify infections, contact tracing, provide the necessary human resources to handle outbreaks. The agency must also strengthen hospital capacity; study the prevalence of the disease, and the beginning of clinical trials to mitigate mortality rates, such as the use of plasma of recovered patients to treat those who are still fighting the virus, antivirals, and antibiotics, among others. Some of these milestones have already been reached.
Outdoor activities and mental health
On the other hand, the report states that outdoor activities such as walking, jogging, cycling, and sports with little physical contact have a low risk of contagion. They recommend opening protected natural areas, avoiding crowding, and maintaining social distancing recommendations.
"This will help and greatly benefit community relax and mental health," says the government medical task force.
The team, however, estimated that according to the calls and the decrease in suicide rates reported in recent months, "there does not seem to be signs of an increase in psychiatric emergencies in Puerto Rico during the lockdown. There are many variables of adaptation to the stressors of the pandemic and the lockdown for which we still don't have accurate data, but they should be evaluated."
The incidence of violence, anxiety, depression, use of alcohol or addictive substances, and also the use of mental health services are among the variables to be evaluated.
Commercial or recreational activities in places such as hotels, inns, and restaurants, for example, must improve hygiene measures and reduce their capacity to ensure physical distance once they are authorized to reopen. In the case of hotels, they recommend keeping common areas such as gyms, swimming pools, activity rooms, among others, closed.
Similarly, municipalities should establish health brigades to disinfect common areas.
El Nuevo Día learned that the governor's economic advisory group submitted its own recommendations during the week. Last week, a group of entrepreneurs began a public campaign to promote the reopening of Puerto Rico's economy, paralyzed by mitigation measures to prevent the spread of the virus.
SARS-CoV-2 is highly contagious and lethal, especially to the elderly.